SUNDAY, FEBRUARY 20 , 2022. THE WASHINGTON POST EZ BD B3propped open two doors for ventilation.
l Odds of contracting the coronavirus from
a close conversation with an infected
person: about 1 in 10. This is a particularly
hard piece of data to find, especially in the
omicron era. My estimate draws on a
study of the risk of one person in a
household infecting another member.
l So, my chances of getting covid from
attending this party: about 1 in 50
l Odds of needing to be hospitalized if I got
covid, given my age and vaccination sta-
tus: about 1 in 200
l Odds that I’d die if I got covid: about 1 in
1,400
l Odds that I’d get long covid in some form
if I developed covid-19: about 1 in 20
l Finally, odds of infecting my elderly mom
if I visited her while infected: about 1 in 3.
Again, I drew on research on transmission
within households.
To estimate probabilities for those other
bad outcomes, beyond the 1-in-50 chance of
getting infected, I multiplied fractions:
l Chance I’d be hospitalized for covid-19: 1
in 10,000
l Risk of dying of covid-19: 1 in 70,000
l Odds of developing long covid: 1 in 1,000
l Danger of infecting my mom: 1 in 150
In the practice of medicine, our lifeblood is
calculating and applying benefits and risks.
Those were the risks. The benefits were enjoy-
ing a party with close friends, many of whom Icould be outside or in. That sounded great: I’d
mask to pick up my food and drink inside, then
make a beeline to the backyard.
Good plan, until nature intervened. Just as I
pulled up to my friend’s house, it began to
pour. I had three choices: leave the party; eat
and drink outside — drenched, alone and
pitiful; or ditch the mask and enjoy the party
indoors.
Here was my quick calculation of the risks
I’d be taking if I chose to join my friends inside.
(Most of these odds are based on rigorous
studies or official data, but some involved
educated guesswork and extrapolation. But
even if I was off by a significant amount in
some estimates, it wouldn’t matter much for
the crux of the decision.)
l Odds that someone at the party was
infected: about 1 in 50. This was a ba-
ck-of-the-envelope calculation that began
with Florida’s test-positivity rate, 17 per-
cent, which I adjusted downward because
the guests were mostly asymptomatic
vaccinated professionals from blue states
who had undergone rapid tests that day.
l Based on the previous estimate, odds in a
group of 40 people that at least one guest
has covid: about 50-50.
l Assuming face-to-face chats with 15 peo-
ple at the party, odds that I’d have a close
exposure to an infected person: about 1 in- I didn’t worry about those on the other
side of the room, particularly since I
Pedestrians make
make their way
along the Fremont
Street Experience
in downtown Las
Vegas on Feb. 12.
Gov. Steve Sisolak
(D) announced Feb.
10 that Nevada’s
mask mandate was
lifted.hadn’t seen for years. Before walking in, I
asked myself how I’d feel if any of these bad
things happened. The answer was “terrible,” of
course, but, given the low odds, I wouldn’t feel
that I’d made the wrong decision. And so I
entered, removing my mask after the first few
minutes.
I tell you this whole soggy dog story not
because it’s unusual, but because it’s not: It’s
the kind of scenario that tens of millions of
people have been grappling with since March- The difference is that now, as the rules
are stripped away, the decisions become en-
tirely personal.
It’s understandable why, faced with this
much math and angst, many folks have decid-
ed that going maskless everywhere is less
stressful and safe enough. I wouldn’t argue
with fully vaccinated people who choose to
discard their masks in indoor settings. Odds
are they’ll do fine. As for me, I loved the party,
kept the virus at bay — though one attendee
got covid a few days later, possibly from the
gathering — and felt good about my decision.
The next day I went back to wearing masks
indoors and avoiding indoor dining — a deci-
sion I feel equally good about, and one that I’ll
rethink if and when cases fall some more.
Twitter: @bob_wachter
Robert M. Wachter is a professor and chair of the
department of medicine at the University of
California at San Francisco.Such actions by the United States send a
bitter signal to 38 million Afghans. The
majority of Afghans, especially in rural areas,
didn’t know about the 9/11 attacks and why
the United States invaded and bombed them
for 20 years, but they do feel the hunger of 23
million of their fellow citizens and the pain of
3.2 million malnourished children younger
than 5, of which 1 million could starve to death
by the end of the winter.
“We must pull the economy of Afghanistan
back from the brink,” António Guterres, the
United Nations Secretary General, told the
Security Council last month. “This means
finding ways to free-up frozen currency re-
serves and re-engage Afghanistan’s Central
Bank. International funding must be allowed
to pay the salaries of public-sector workers.”
In seizing the central bank funds, Biden
issued a statement that his plan was “de-
signed to provide a path for the funds to reach
the people of Afghanistan, while keeping
them out of the hands of the Taliban and
malicious actors.” But this concern can be
addressed in various ways; members of the
Supreme Council of the central bank have
suggested having monitored and conditional
access to reserves. The transactions can be
verified electronically and through one of the
international auditing firms currently operat-
ing in Afghanistan.
The way forward is to simply allow the
Afghan economy to breathe by lifting sanc-
tions and gradually returning the central
bank reserves that belong to the people of
Afghanistan. This will prevent the collapse of
the banking sector. Commercial activity will
resume.
The United States should also allow devel-
opment partners like the World Bank and
Asian Development Bank to complete unfin-
ished infrastructure projects. Implementing
them is critical to helping rural communities
flourish and earn their livelihoods instead of
waiting in their mud homes or tents to get a
weekly sack of flour and beans from humani-
tarian organizations.
The resumption of irrigation, energy and
transport projects will more likely bring an
end to the crisis without the need for more
humanitarian assistance. Lifting sanctions on
commercial activity and completing unfin-
ished development projects will be sufficient
for the economy to recover. This would be in
line with American values. It would do justice
to the $2 trillion in American taxpayers’
money spent on the war in Afghanistan.ing was also suspended. The United States
ordered partner agencies, including the
World Bank, International Monetary Fund
and the Asian Development Bank to halt the
flow of aid to Afghanistan. Out of fear of
retribution by the United States or to main-
tain the alliance, European countries also
blocked their support.
Medical supplies have stopped flowing to
health-care facilities, and doctors and nurses
at hospitals aren’t getting paid. Caesarean
sections are being done by cellphone flash-
light. A hospital had to deliver the babies of
five mothers with just one pair of gloves.
Many pregnant mothers and newborns, per-
haps thousands, have lost their lives because
of this deliberate obstruction of aid to health
facilities.
The World Bank blocked five months’
salary of 10,000 Afghans who worked on
Afghanistan Reconstruction Trust Fund proj-
ects. My colleagues told me heartbreaking
stories of hunger and hardship that these
employees’ families had endured. The World
Bank also suspended the construction of 600
schools, including girls’ schools in rural Af-
ghanistan that were nearly completed, and
9,000 projects of the Afghanistan Citizens’
Charter Program — primarily in irrigation,
renewable energy and transportation. Some
124,000 Afghan women in 13,000 communi-
ties led and monitored these projects; they are
now abandoned.republic’s government fell, the Taliban took
over, and the United States withdrew from
Afghanistan.
The U.S. government suspended this and
all infrastructure projects funded by the
USAID, the World Bank and the Asian Devel-
opment Bank on Aug. 15. These projects
provided a livelihood to hundreds of thou-
sands of Afghans. Most of these projects had a
progress rate of more than 80 percent, col-
leagues in the Ministry of Finance told me.
Billions of dollars were spent to reach this
stage and then stopped overnight.
As a parting shot to the new Taliban-led
government, which the United States consid-
ers illegitimate, the U.S. government imposed
punishing sanctions that throttled the econo-
my. The impact has gone beyond the wide-
spread starvation that has left 97 percent of
the population unsure where their next meal
will come from. Seven billion dollars of the
bank’s funds were frozen, leading to instant
consequences for everyday Afghans. For in-
stance, when my father wants to withdraw
cash, he has to register his name four days in
advance and stand in a queue for hours —
once, more than six hours. When it’s his turn,
he is permitted to withdraw the equivalent of
$400. That sum won’t cover regular house-
hold expenses like rent, groceries, utility bills
and medicine.
International aid that accounted for 75
percent of the previous government’s spend-P
resident Biden’s recent decision to seize
the frozen reserves of the central bank of
Afghanistan came as a shock to starving
Afghans battling a harsh winter coupled with
a crippled economy. It has led to severe
withdrawal limits at private banks, further
squeezing the pocketbooks of average people.
Imagine dissolving the U.S. Federal Reserve,
blocking the savings of all Americans and
implementing a weekly withdrawal limit of
less than $400.
Biden’s intention to divide the money
between survivors of the 9/11 attacks and,
nonspecifically, humanitarian aid to “benefit”
the Afghan people, is as confounding as it is
cruel. A year ago, the United States was trying
hard to preserve and strengthen institutions
in Afghanistan like the central bank. Now, the
Biden administration is knocking the legs out
from under the country’s banking sector,
thwarting the economy and leaving Afghans
like me unable to access our savings.
Since the disastrous pullout of U.S. troops
in August, much of the criticism of American
actions has centered on their leaving Afghans
to the mercy of the Taliban. But as this
decision demonstrates, the legacy of U.S.
abandonment goes much deeper. After the
withdrawal, international aid that the coun-
try came to depend on dried up under U.S.
pressure. School, road and utility projects
started during the occupation were abruptly
halted, leaving thousands unemployed.
The pattern of costly and damaging starts
and stops is nothing new. I remember vividly
in 2011 meeting U.S. government officials at
USAID offices in Kabul made of cramped
cubicles inside tight cargo containers. At the
time, I was leading the implementation of
large power projects at the national power
utility of Afghanistan. USAID was promoting
the idea of providing electricity to southern
Afghanistan from Central Asian countries via
imported electricity passing through the
rough terrain of more than 500 miles.
We, the Afghan technical team, pushed for
indigenous generation via renewable energy
sources. But the Americans wanted a quicker
fix in the misguided hope that by extending
power line pylons, people would refrain from
supporting the Taliban.
The $861 million project became bogged
down in paperwork, delays, cancellations, and
numerous corruption and embezzlement
scandals. Extravagant salaries and benefits
were provided to American consulting firms
to supervise the project. Still, the project
moved forward, promising to bring electricity
to the people of five provinces in Southern
Afghanistan. The project was finally on the
verge of completion in August — when theAmericans nurtured Afghanistan’s economy. Now they’re gutting it.Twitter: @MohsinAminnMohsin Amin is a Fulbright scholar and an Afghan
policy analyst and researcher.Biden’s
decision to
seize central
bank assets fits
a pattern of U.S.
abandonment,
says Mohsin
AminHUSSEIN MALLA/ASSOCIATED PRESSAfghan workers in
Kabul prepare food
supplies during a
humanitarian aid
campaign for poor
families on Feb. 16.I
n the past few weeks, the tide of govern-
ment coronavirus mandates has clearly
turned. Pretty soon, nobody will be forced
to wear a mask in most indoor spaces. But that
only shifts the decision onto the individual, so
the question remains: Should you wear one?
If you’re wondering how to calculate risk in
the post-mandate world, you may find it useful
to see how I — a moderately cautious (and, I
hope, relatively nondogmatic) academic phy-
sician who has written and spoken extensively
about covid — concluded that jettisoning the
mask last week at a friend’s 65th birthday
party was safe or, at least, safe enough. You
may not have as many statistics at the ready as
I did, but many Americans may soon be doing
some version of calculations like these several
times a day.
Before I tell you about this one decision,
here’s some context: I live in San Francisco — a
blue city in a blue state, and one that’s been
aggressive when it comes to coronavirus pre-
cautions. I’m 64 — old enough to be at
moderately high risk from the coronavirus.
I’ve had three Pfizer shots and, to my knowl-
edge, have never had covid.
Having made it this far without getting
covid-19, I think it would be a dumb time for
me to catch the virus. Case rates are falling fast
enough that the risk will soon be sufficiently
low for me to let down my guard. When?
There’s no bright line separating safe from
unsafe, but case rates of approximately 10 per
100,000 people per day and test positivity
rates of less than 1 or 2 percent would make it
quite unlikely that a person in line with me in
the supermarket or sitting near me at a
restaurant has covid. (No state has case rates
quite that low, but Maryland is closest, at 11
cases per 100,000; its test-positivity rate is 2.3
percent.) When rates reach that level, I’ll begin
eating indoors and will remove my mask in
low-risk indoor settings. But I’ll still mask up
in very crowded indoor spaces.
Why do I still fear a case of covid? First, after
three shots, my chances of severe illness are
low, but they’re not zero. Second, I worry about
long covid — study results vary, but a reason-
able interpretation is that about 5 percent of
people who become infected after vaccination
can expect symptoms that last longer than a
month. And a recent study found a disconcert-
ing rise in cardiovascular diagnoses, including
heart attacks and strokes, in people previously
infected with the coronavirus. Finally, while I
don’t have much contact with young children,
I do with immunosuppressed people and the
elderly, and I don’t want to infect someone if I
can avoid it.
When I was invited to my friend’s birthday
party near Miami, though, I had little hesita-
tion about saying yes: Many of my college pals
would be there, and I’d get to stay with my
recently widowed 86-year-old mother, who
lives nearby. The host asked his guests to be
vaccinated and boosted and to take a rapid test
immediately beforehand. My assumption was
that most did, raising the level of safety.
Case rates in Florida and in the hometowns
of the guests were well above my maskless
threshold (they averaged 30-80 cases per
100,000 residents per day), so I was not ready
to eat and drink indoors there. Thankfully, the
plan was that eating, drinking and socializingHow I calculated my covid risk at a maskless indoor partyBRIDGET BENNETT FOR THE WASHINGTON POSTPhysician
Robert M.
Wachter on the
decisions we’ll
be making as
public health
restrictions are
lifted