Racing Towards Normal…What are They Thinking?

Globally, a number of jurisdictions are throwing off Covid-19 protections as quickly as they can. In Canada, several provinces are moving forward in haste to remove vaccine mandates, capacity limits and masks, for example. Ontario is one of the slower ones, although the Chief Medical Officer’s recent announcement suggests Ontario is joining the lemmings. While some people are welcoming these opportunities to pretend that spring 2020 never happened, others are concerned about just what the ramifications might be. Count me in as one of the latter: ready to make some changes, but recognizing we need to be ready for surprises.

Furthermore, medical experts and politicians need to make these decisions based on the reality of Covid-19, not on the demands of those demanding “freedom” without understanding what that means. Sadly, those upending the rule of law appear to be having an impact on the latter.

In September 2020, I started to write a post on the “rhythm” of Covid-19, its ups and downs: “As we have seen, covid-19 has a foreseeable rhythm: initial identification, small increase followed by significant increases in cases and deaths, lockdowns and other measures, a serious decline in cases, opening up, a renewed surge and reluctant responses.”

And even then, I noted another trend: “There appears to be another cadence, too, however: the decline in the sense of community that turns slowly into atomism, except in this case it has not returned to community. The pandemic has become a victim of those who disassociate from society, joining like-minded antagonists of science and caring.” This is even more true today.

Much has changed since September 2020. We have effective vaccinations, with a high number of Canadians doubly vaccinated (about 83% over five years old), but fewer who have also had a booster shot (about 52% over 18). While for a while the vaccinations were effective in preventing infection, that is no longer the case; they remain effective, however, in minimizing the need for hospital care, including ICU, and death. Vaccines are the most significant development since the pandemic started.

We can no longer track the number of cases because there is little official testing. We can track the number of people in hospital (again including in ICU) and the number who have died. For most parts of Canada, these last two numbers are decreasing (commentators talk about declining cases — but by what measure?). But even these stats are being complicated: who goes to hospital because they have covid? who is found to have covid when tested when they go to hospital for another reason? who becomes infected in hospital?

Increasingly, people are becoming fed up and frustrated with covid restrictions — we might rather call them protections — especially since the message has been “everyone will get Omicron”. Governments are purporting to respond to the data when they begin to drop protections or announce they’ll be doing so soon. But it’s hard to avoid that they’re responding to restlessness in the population and to the illegal blockades in Ottawa and Windsor, Ontario and Coutts, Alberta.

They are racing towards the finish as if they can decide when Covid is finished, not only the protections against it,.

But as epidemiologists, other healthcare experts and people like me say, ” you may be done with Covid, but Covid isn’t done with you”. Yet it is also true that “we can’t keep going on like this”. So what’s the answer? I lack the expertise to give THE answer — no one seems to to be able to do that, in fact, but certainly some can get a lot closer than I can — but there are some things I’d like to see.

Two bottom lines (they’re very close together!) for me are that mask requirements continue for inside places, such as grocery stores, theatres and similar places, and people isolate after contracting Covid-19. Jason Kenney has removed mask requirements for school students (but not for staff and bus drivers) and has also eliminated the authority of school boards to impose mask requirements. School board administrators considered this might be too hasty. He’s also announced he’ll deny municipal authorities the right to impose mask requirements, a turnaround from previously (when he apparently thought municipalities had a better handle on local conditions). An echo of Governor Ron De Santis of Florida?

Saskatchewan will end masking at the end of February, along with self-isolating when infected with Covid-19. Other provinces have developed short timelines for removing or relaxing restrictions.

The goal is to act as if Covid-19 is not a threat, although certainly we’ll hear “it’s still with us” even while these protections are being removed. And there’s no question that at some point, various requirements must be abandoned. I’m not ready to trust those premiers whose readiness to eliminate requirements last summer (with the clarion call that Alberta “is open for business”), after which they saw large increases in cases. In Saskatchewan, that meant sending patients to Ontario, taking advantage of Ontario’s more cautious approach.

There are no easy answers and all through the pandemic, we’ve seen different provinces take different approaches. And one can be critical of different efforts to bring a cudgel to bear on Covid — no single approach has worked and the closing/reopenings are frustrating and economically harmful to businesses relying on regular customers, such as restaurants. It’s especially easy to be critical in retrospect, but I shudder to think what would have happened during the beginning, until we had vaccines, with Alpha and Delta if we hadn’t been restricted in our movements, including distancing, or been required to isolate. Vaccines were crucial against Delta, but are more limited against Omicron and presumably the new subvariant emerging from Omicron, which is even more transmissible than Omicron (although we don’t seem to have heard too much more about that).

We are where we are now, though. What we know is that people who are vaccinated — even with the booster — can both become infected and can transmit the virus. We also know that unvaccinated people are more likely to end up in hospital or the ICU or to die than those who are vaccinated. This doesn’t mean vaccinated people can’t also suffer more serious consequences depending on their personal conditions. We also know that being infected doesn’t result in immunity, since people are becoming infection more than once (“reinfected”).

And, significantly, it is not unusual that people who get mild Covid may end up with long-Covid. I recall early on that medical professionals questioned the occasional claim of having being infected twice or having long-term effects, but now there seems no doubt that both are not only possible but frequent. People infected with Alpha or Delta, who have been relying on so-called “natural immunity” rather than becoming vaccinated, are apparently particularly vulnerable to being infected with Omicron because their natural immunity has waned.

Finally, it seems the newest variant (although it doesn’t yet have a Greek name, which may be significant in terms of its prevalence) is more transmissible than Omicron, which is more transmissible than Delta (it has replaced Delta, of course). In short, it’s easier to catch it. This is especially true now we’re returning to “normal” (if “normal” included a variant of Covid-19, which has been described as as transmissible as measles, which requires 94% of the population to be immune to eliminate it).

Even I (characterized by a friend as the most cautious person they know — I think they meant as far as Covid-19 is concerned) recognize eventually we will resume life more or less as normal, getting regularly vaccinated for Covid-19 as we do for the flu (or I hope most of us will). Possibly, from time to time, it will be necessary to take particular protective actions because a new more virulent strain emerges. We have dealt with this kind of thing before. Not least, when there is a particularly bad strain of the flu, congregate living places where older people reside effectively lock-down, with meals in the residents’ rooms and no visitors.

The issue is, what do we do in the meantime?

Three general principles can guide us:

  • minimize the chance of infection and severe consequences of infection, while also minimizing restrictions;
  • not doing things that can be seen to risk unnecessary infection; and
  • not handing over decision-making to lawless hostage-takers.

Continuing Protections/Minimizing Disruption and Frustration

One important protection is wearing masks inside, yet there is an eagerness of authorities to remove mask mandates. Of course, we are free to wear a mask if we want to, but masks are most effective when everyone in a group (or two people together) are wearing them. Wearing a mask is an easy thing to do and does not have high cost implications (as closing businesses do, or even capacity limits). It is somewhat uncomfortable, however, and without a mandate, I expect we’ll soon see many people ditching their masks.

Minimizing the risk of infections appears to require at the very least discouraging large crowds, if controlling capacity is no longer seen as feasible. Reluctantly, I wonder whether we should continue with capacity limits in restaurants where people remove masks and sit for some time.

I do, however, think it’s probably time to eliminate the vaccine passports. They worked when vaccinated people were highly unlikely to get infected or to transmit the virus, while unvaccinated were more likely to do both. The passports allowed businesses, such as restaurants and museums to open while at the same time allowing people who were vaccinated to enjoy greater societal interaction. A reassessment of traveller policies is also in order.

At this point, it is almost inevitable that new or continued protections will frustrate people. Those opposed will be loud and aggressive. Protections need to be as minimal as possible to still be effective. Politicians need to acknowledge frustration, respond to the concerns of those who want to do the right thing, and develop signposts for when protections will change, subject to unforeseen developments (such as an entirely new and dangerous variant). The signposts are not dates, but measures reflective of the most accurate state of Covid-19.

Not Taking Steps Likely to Lead to Infections

I hope Fraser Valley hospitals change their plan to place people with Covid who are asymptomatic or mildly symptomatic and people without Covid (who are vaccinated) in the same room (even distanced). There are exceptions, such as a high-risk condition of the patient without Covid. The biggest irony is that the patient with Covid would only be placed in a room with a non-infected patient who is fully-vaccinated. It appears, if I understand it correctly, that the hospitals will protect unvaccinated patients. I hope no other health authority follows suit.

But it is also important politicans not take premature steps in order to increase their popularity. We have seen elsewhere how “getting back to normal” results in paying a price.

Everyday we hear of “famous” people who have contracted Covid-19, usually mild cases to be sure, but why is this? No doubt because of the high transmissibility of Omicron, but also because people are living life as they did before the pandemic: mixing with people without masks. Perhaps they and those around them have been tested and perhaps not. Prince Charles is a perfect example: he is, by all accounts, doubly-vaccinated with a booster and has already had the virus and thus some immunity; yet he has become reinfected after being out and about with many people and with no one wearing a mask, as photos show. On my Twitter account, I see a number of people I follow announce they have Covid — just mild symptoms, mind you. One thing we do not know is how many people will have long-Covid. Of course, we also see people famous for their anti-vaccination diatribes dying of Covid.

These announcements, at least about “mild” symptoms, are part and parcel of the normalizing of Covid: “everyone” is getting it and “anyone” can get it: it’s not a big deal. But everyone doesn’t get mild Covid and even mild Covid can apparently have long-term effects.

Responding to Lawless Hostage-Takers

What is most disturbing now is how certain politicians are plainly pandering to the illegal demonstrators in Ottawa and Coutts in particular. Pierre Poilievre has declared himself “proud of the truckers”. Scott Moe, Premier of Saskatchewan, saying he has heard those who will be at Saskatchewan border crossings, has announced the province will remove all Covid-19 protections by the end of February. He and Jason Kenny have adopted the language of the “Freedom Convoy”, referring to the end of restrictions on people’s freedom. Jason Kenny tweeted, “Alberta will not continue to damage people’s lives and violate their rights and freedoms indefinitely. We’ve just got to learn to move forward.” Of course, people have had negative experiences because of the need to take restrictions: loss of business and other income, sometimes closing businesses, mental stress, children out of school and so on. But the adoption of this language is a clear statement of catering to those who have evidenced little undertanding of why these protections have existed and who are part of a larger attack on our institutions.

Many, many people in Canada have followed restrictions because they care about their own health and the health of others. Is there room for criticism? Yes. Might some protections be reconsidered? Yes. I hope, though, that the answers to these questions aren’t found in shameful toadying to those with the loudest voices and the most ill-conceived selfish tactics premised on harming others.

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