The COVID-19 pandemic presented us with a live demonstration of science at work, much to the surprise of many who are not regular followers of its history. It gave a ringside view of the current state of the art, yet it created confusion among people whenever they missed consistency in the messaging, theories, or guidelines. The guidance on protective barriers—using masks, safe distancing, and hand washing—was one of them.
Swiss Cheese Model of Safety
The Swiss cheese model provides a picture of how the layered approach of risk management works against hazards. Let us use the model to check the underlying math behind general health advice on COVID-19 protection. I describe it through a simplified probability model.
The probability of someone getting infected by Covid 19 is a joint probability of several independent events. They are the probabilities:
- an infected person who can transmit the virus in the vicinity (I)
- to get inside a certain distance (D)
- to pass through a mask (M)
- to pass through the protection due to vaccination (V)
- to get the infection after washing hands (H)
- to infect the person once the virus is inside the body (S)
Infected person in the vicinity (I): is equal to the prevalence of the disease (assuming homogeneous mixing of people). Let’s make a simple estimate. These days, the UK reports about 50,000 cases per day in a population of 62 million. It is equivalent to an incident rate of 0.000806. Assume that an infected person can transmit the virus for ten days, and half of them manage to isolate themselves without passing the virus to others. The prevalence (proportion of people who can transmit the disease at a given moment) is 5 x 0.000806 = 0.0004032. Multiply by a factor of 2 to include the asymptomatic and the symptomatic but untested folks too into the mix. Prevalence becomes = 0.0008064 (8 in 1000).
To get inside a certain distance (D): If the person managed to stay outside the 2 m radius from an infected person, there could be zero probability of getting infected, but it is not practically possible to follow every time. Therefore, we assume she managed to stay away 50% of the time, which means a probability of 0.5 to get infected.
To pass through a mask (M): General purpose masks never offer 100% protection against viruses. So, assume 0.5 or 50% protection.
To pass through the protection from vaccination (V): The published data suggest that vaccination could prevent up to 80% of symptomatic infections. That means the chance of getting infected is 0.2 for the vaccinated.
The last two items – hand washing (H) and susceptibility to getting infected (S) – are assumed to play no role in protecting COVID-19. Infection via touching surfaces plays a minor role in transmission, and the latest variants (e.g. Delta) are so virulent that almost all get it once it is inside the body.
Scenario 1: Fully Protected Getting Infected Outdoor
Assume a person makes one visit outside in a day. The probability of getting the infection is = I x D x M x V x H x S = 0.008 x 0.5 x 0.5 x 0.2 x 1 x 1 = 0.0004 or the chance of not getting is 0.9996.
The person makes one visit for 30 days (or two visits for 15 days!). Her probability of getting infected on one of those days is = 1 – the probability she survived for 30 days. To estimate the survival probability, you need to use the binomial theorem. Which is 30C30 x 0.999630 x 0.0040 = 0.988. The chance of a fully protected person getting infected in a month outdoors is 1 – 0.988 or 12 in 1000!
Scenario 2: Fully Protected Person Indoor
The distance rule doesn’t work anymore, as the suspected droplets (or aerosols or whatever) are available everywhere. The probability of getting the infection is = I x D x M x V = 0.008 x 1 x 0.5 x 0.2 = 0.0008. This means the chance of not getting is 0.9992. 30-day chance is 1 – 0.976 = 0.024 or 24 in thousand.
Scenario3: Indoor Unprotected but Vaccinated
I x I x D x M x V = 0.008 x 1 x 1 x 0.2 = 0.0016. The chance of getting infected in a month = 1 – 0.95 or 5 in hundred.
Scenario4: Indoor Unprotected
I x D x M x V = 0.008 x 1 x 1 x 1 = 0.008. The chance of getting infected in a month = 1 – 0.78 or about 2 in 10 chance.
A bunch of simplifications were made in these calculations. One of them is the complete independence of items, which may not always hold. Some of these can be associated – a person who cares to make a safe distance may be more likely to wear a mask and get vaccinated. Inverse associations are also possible – a vaccinated person may start getting into crowds more often and stop following other safety practices.
Second is the simplification of one outing and one encounter with an ill person. In reality, you may come across more than one infected. In the case of indoor, the suspended droplets containing the virus act as encounters with multiple individuals.
The case of health workers is different as the chances of encountering an infected person in a clinic or a medical facility differ from that in the general public. If one in ten people who come to a COVID clinic is infected, the chances of the health worker getting infected in a month are 95% if she wears an ordinary mask and comes across 100 patients daily. If she uses a better face cover that offers ten times more protection, the chance becomes about 25% in a month, or one in 4 gets infected even after getting vaccinated.
Bottomline
Despite all these barriers, people will still get infected. Small portions of large numbers are still sizeable numbers but do not get distracted by them. Use every single protection that is available to you. Those include vaccination, mask use, maintaining distance, and reducing non-essential outdoor trips. They all help to reduce the overall rate of infection.
