What does “learning to live with Covid” really look like?

Jordan Living with COVID is a tricky phrase. I mean, technically, humanity has been living with this virus for two years now. The only problem is that lots of folks keep dying. But as this most recent wave declines, as vaccination numbers sit around 90%, and hospital pressure starts to recede, will living with COVID circulating in our communities become not only necessary, but popular. If you had posed the question, is it time to end restrictions and just live with COVID? A few months ago, and most played company, you’d have been rebuked. But polls now show support for the ending of restrictions is rising relatively fast, almost across the country. And right now you can hear everyone from protesters to your own neighbors, and even the country’s top health officials using that tricky phrase,

News clips We have to learn to live with this virus, we need to learn to live with the virus, as we discuss living with COVID 19 as an endemic disease time for us to learn to live with CO virus has changed and has become part of what we will be living with for years to come.

Jordan So when we say living with COVID, what does that phrase actually mean on the ground? Who gets to live with COVID? And who still has to die from it? What level of restrictions make sense in a world where almost everyone has some level of immunity? And can we please decide on some actual metrics that we can rely on? Instead of getting the rug yanked out from us. Every time things don’t go according to our latest plan.

I’m Jordan Heath-Rawlings. This is The Big Story. Timothy Caulfield is the Canada Research Chair and Health Law and Policy at the University of Alberta. Hey, Timothy,

Timothy Caulfield Hey.

Jordan Let’s start maybe from a health policy perspective, when you hear people say that we have to learn to live with COVID. What does that mean to you?

Timothy Caulfield Well, you know, I think it means different things to different people. And of course, that that’s the real challenge, both from a policy perspective. And from a public public health perspective. Increasingly, I think for a significant sector of, of society, it means no restrictions, it means absolutely no public health measures at all, it means a return to normal in quotation marks. And unfortunately, that is probably inaccurate, you know, that kind of picture of our future where it says if COVID doesn’t exist at all, that that vision I think is probably inaccurate, I think for another sector of the population, there is probably a more accurate kind of assessment of, of what the future is going to look like. And of course, that that is going to be a world where we have ongoing surveillance, where COVID is a background risk, you know, it’s hovering in the background. And it’s something that is going to require ongoing vigilance.

Jordan Before we get into exactly how we might set up public health to do that vigilance and to keep it in the background. Let’s explore for a second the no restrictions back to normal desire. What would that actually do? And do we have any evidence of places in the world that have tried this already, and here I’m talking about like not even mask mandates? This is just nothing. Let’s try going back to normal see what happens?

Timothy Caulfield Well, yeah, I think it is important to recognize because there is so much noise right now about getting back to normal and COVID fatigue. And I think that COVID Fatigue is absolutely real. And every survey that you look at it, whether it’s large or small, you know, kind of finds that that outcome, right, you know, that the people are understandably sick of. I’m sick of it, right? We’re all sick of this, but it is mixed, it is mixed, you know, this desire to remove all restrictions. So ekos research had a study that came out not that long ago that really found Canada was split, where most Canadians still wanted some restrictions. Most Canadians, by the way, still support mandates support vaccines, obviously. But we’re seeing that desire for policies decline and understandable because this always is a risk and risk-benefit analysis right. And as this threat subsides, we should be adjusting. We should be adjusting our policy. So I think that that’s one thing that that I think is often forgotten is that we focus on those are protesting hard right? When the reality of public perception is, is much more complex.

The second thing I think that’s often forgotten, and this is this drives me nuts, if I may, is how I like to say the deniers are trying to own the narrative of the end of the pandemic. So what do I mean by that? Look, vaccines worked unbelievably well, are they you know, the these vaccines are a scientific miracle, they’ve saved hundreds of 1000s of lives, right? The mask mandates made a difference. The other, you know, physical distancing approaches, these, these public health measures made a difference. And that’s one of the reasons we’re where we are right now. Right. So I don’t think we should let the people that are frustrated and angry, you know, have this ending have put it that way. It’s like someone who’s against winter coats, you know, against the big coat, you know, that the big coat conspiracy, celebrating the end of winter and saying we want the spring is here. Right. You know, it’s.

Jordan I was talking about that with someone last week that there are absolutely going to be actors on both sides of this thing that try to play off the protests kind of coinciding with the downslope of this latest wave and the obvious easing of restrictions that was going to happen anyway, to create a narrative that these protests worked, we got rid of the restrictions.

Timothy Caulfield It’s it’s already happening, right? It’s already happening. I’ve been out in the public and heard people yell, the truckers, one that is, you know, a bizarre spin on, you know, the complexity of the pandemic, and all the incredible work that scientists and public health experts and clinicians and you know, you name it did to get us to where we are today. And it’s just it’s simply, it’s simply not true.

Jordan Let’s talk about what would actually happen as in what do we know would happen if we dropped all restrictions? Now wish I won’t say tomorrow, but you know, it’s pretty clear that we’re on the downslope of this wave. And as it continues to recede, as you point out, everyone is exhausted, and it’s going to be spring, the weather’s gonna be better. This does seem like if there’s ever gonna be a time, this is it. What do we know about what happens next? If we do that?

Timothy Caulfield You’re gonna hate my answer.

Jordan I’m expecting it at this point. But I got to ask the question.

Timothy Caulfield I bet you know, what I’m gonna say, you know, I don’t think we do know. And I know, that’s incredibly, incredibly frustrating. And, you know, I try to follow the science very, very closely. And I’m very fortunate, I’m part of a wonderful research and policy community here in Canada. And I think it’s fair to say we actually don’t know, I will say, and this is another sort of frustrating narrative that we’re hearing, that somehow there’s this belief that, you know, a false dichotomy has been created, right, that there are those who want a total lockdown, right, and those who want total freedom, right. On the contrary, virtually everyone, almost everyone result resides in the middle, right? always striving for balance, and I everyone that I work with, wants to move to a situation where there are less less restrictions. Right. So that, you know, that’s, that’s the reality.

I’m disappointed with some of the policy moves that have been made. Although, listen, I favor moving away from restrictions. Absolutely. I do. But I don’t think we know what it would look like if we just, you know, snapped our fingers. And all the restrictions went away today. We you know, the variants are obviously, a large unknown. The degree to which people have immunity from both disease-induced and vaccine-induced immunity, you know, how, what’s that going to look like going forward? I think we’re still getting data on that. So there are still and when people are frustrated, there’s still a lot of scientific uncertainty. There’s still a lot of variables that make it difficult to predict exactly what it would look like if we just removed everything. But listen, we’re gonna find out because those jurisdictions are doing that. Look, I’m hopeful. I’m hopeful we’re going to be okay. Because there is a high degree of population immunity, whether you’re talking about vaccine-induced immunity, or whether you’re talking about disease-induced immunity, that hopefully is going to shepherd us in in the right direction.

Jordan What would be a version of learning to live with COVID that could hopefully, keep it to background, keep it under control, but also provide I keep hesitating to use the term normalcy because I don’t know what that looks like anymore, but could also provide something close to a life like most of us are used to.

Timothy Caulfield Its funny,I always I always hesitate to say normal to and then I find myself using it anyway. Because I think that that for all of us, right, whether you work in this area, whether that’s that’s kind of the vision that you have in your mind, it’s hard to because of all of the variables I said above, it’s hard to predict exactly right, what this is going, it’s going to look like, but I think we can, there are elements that most people agree on. Right. So number one, robust surveillance, right, let’s get it get a sense of how this disease is progressing. You know, are we seeing the beginning of surges? So robust? Surveillance? And I don’t just mean, nationally, regionally or internationally, right, we need this is something that we have to cooperate as a globe to do to do well, Mm hmm. Secondly, we have to continue with logical vaccination policy, I think it’s almost certain that we’re going to have yearly vaccines, you know, like we do with the flu.

And I know that the anti-vaxxers are going to try to make this into a big deal. And what’s wrong, you know, that they try to cast that as if because we’re going to have more of them. It’s inherently evil. That’s not the case at all. Right. You know, we have we have flu vaccines, etc. So I think that boosters aren’t going vaccines are going to be like likely. So surveillance, we’re going to have boosters. I think that when we see surges emerge, we’re going to have to roll out intelligent public health measures that balanced the the risk against restrictions. So I think we’re going to see the implementation of you know, masks and possible isolation if it in in a more structured way, if if surges start to happen. I think so those are the kinds of elements I think we’re going to see. See going forward. And yes, if we see a significant surge and a dangerous variant, we’re going to see the return of more fulsome. I’ll put it that way public public health measures. I think that that’s probably what, what our future looks like. But there’s so many variables, right, that some might nudge are in a better direction, and some might nudge in a more pessimistic direction.

Jordan I’m glad you mentioned masks, because I wanted to ask about that specifically. Because on the one hand, it seems like such a small and easy and effective thing for us all to do. And I totally agree that it is and they’ve been super necessary for two years. On the other hand, when we all hesitate to use the words, normalcy and normal. I think a large part of that is because masks are so visible on the frontlines of this and a reminder that things are not as they were and may never be. And so I wonder if masks themselves just have an outsize place in this discussion about what a new normal looks like. And what do you think we should be doing about that? Because it’s a very politically loaded issue. But at the same time, I’m totally in favor of masks. And I don’t want my four-year-old to wear hers in kindergarten if she doesn’t have to.

Timothy Caulfield Yeah, I think it’s an excellent. It’s an excellent point. And, and it’s an opportunity, opportunity to talk about what we’ve learned regarding what works and what doesn’t work. There has been a lot of research right on, on what kind of lockdown measures worked, when or masks necessary. And the data is messy, and we’re going to learn, right, you know, do we really need to close more borders? Is that really an effective way to slow spread? You know, what kinds of mask policies really make a difference? Like, for example, we know being outside really does matter, right? It really seems to make a big, big difference. So I think we’re going to learn we’re gonna look at the data going forward, we’re gonna have a better sense of what measures work well. And that’s good news, right? Because then if we do see these surges, we can have more a more targeted, more science-informed strategy in place hopefully hears me being optimistic. Right. So with masks, I think I think we need to do that too. I totally agree with you, they become almost symbolic, almost like a an ideological flag, right? You if you’re wearing them in certain situations, I hope that we develop more, more science-informed guidance about when we should be masking, and when it’s valuable.

It’s hard to study well, and I think that that’s one of the reasons that masks have caused so much controversy. It’s really one of those areas. And a very good example of when a body of evidence matters, because, again, so many variables to create these very controlled studies to pinpoint the actual effect of masking but we have laboratory studies. Now we have real world studies, we have observational studies, we have comparative studies, right? That tell us that masks really do make a difference. So I think what’s going to happen, you know, going forward, there are going to be certain situations where it is normal to wear masks, maybe it’s going to be traveling, maybe it’s going to be when you go into hospitals, and maybe it’s going to be when you feel like you have symptoms so you’re wearing masks to protect others, right. So I think I hope that that’s what the mask policy is going to be Like going forward. And the other thing I think we need to recognize is, for some people, it’s not that much of a Flashpoint, you know, I have a lot of, you know, young adults in my life. And you know, they’re going to school and are in high school and they view it as kind of normal, they don’t really view it as such a big deal. I know there are other young adults and teenagers and kids where it is a big deal. So, again, a plurality of views around the mask issue.

Jordan When folks like me, and you talk about living with it, and I think when the conversation in the general public talks about, you know, how we get on with our lives, despite there being COVID, circulating, what, to the more vulnerable and immunocompromised people among us here, when we say that, and how can we have this necessary discussion about moving on with our lives in the face of a virus that’s not going away? Without leaving them out? And making them feel like, you know, they’re going to be stuck in lockdown for the rest of their lives?

Timothy Caulfield Yeah, you know, I think this is a intriguing question. And it reminds me of the beginning of the pandemic, because remember, at the beginning, we also had this conversation, right, you know, the reason you need to get vaccinated or the or the reason you need to lock down, the reason you need to wear masks at the very beginning, right, is to protect the vulnerable. And I almost feel like that was lost a little bit in the polarized discourse that we’ve had over the past, say, six, seven months really has become very, very ideological. Right, you don’t, you don’t hear it as much. But I think going forward, that is going to be from the from the public health perspective. More of the focus, right, you know, that these are the individuals were elderly people with immuno-compromised with, you know, other kinds of risk factors, where we’re really going to be to be focused on. So I think that we need to bring that back to the front, right, and recognize that, you know, vulnerable populations really matter.

Jordan One of the things that I hear in the discussion around vulnerable or elderly people, but also kind of just in the discussions in general is that people who want the majority or all of the restrictions gone, have kind of settled into the place of well, you know, if you want to stay home, or if you want to wear a mask, or if you want to get vaccinated, then by all means, go ahead, but I need to have my life back. And my question for you as somebody who deals in how to craft policy for an entire population is, is there any policy that could make that kind of approach work in which everybody chooses their own level of risk?

Timothy Caulfield I think it’s important to highlight and this is one of the reasons is challenging. Answering this question from a policy perspective is really challenging. There’s a fairly large and consistent body of evidence that tells us that those are the who are the hardcore deniers, you know, those who don’t want any restrictions don’t think they’re necessary. Also embrace misinformation. Right. And it’s a very strong correlation. I’ve, you know, anecdotally, you know, people will tell me, they’ll, they’ll say, I’m really just about Rights. I, that’s what I’m concerned about, but then they’ll immediately provide me with a list of reasons why they’re against public health measures that are based on misinformation, the role that misinformation has played in informing the perspective of those that are strongly against a lockdown now I want to be really careful here,I’m not saying that everyone who wants the restrictions to be removed, who believe in misinformation, they’re completely rational reasons for that. And why that’s important is because it’s hard to craft policy, when the people that are against that policy have embraced misinformation or a different narrative or reject the science, right. So I think that it’s going to be very difficult to satisfy a sector of society. And I think it’s important to recognize it’s not that large, right, unfortunately, allowed sector but it’s not that large, because, because their position is so ideological, it’s just so much a part of who they are as individuals, their personal identity is probably tied up in these perspectives, that makes crafting policy that’s going to satisfy everyone very, very difficult

Jordan In terms of that policy, when we eventually arrive, and it seems like a lot of provinces are getting quite close to the point where there are very few restrictions left except maybe some mask mandates. When we get to that place, how can we devise a policy that helps us avoid what I think is really killing everybody? And I said don’t say that lately, but the yo yoing you know, The feeling like life is coming back, and then it’s gone again. And you don’t know how long it’ll be and the schools are open, and they’re shut and you’re not sure, like more than the actual restrictions that have been in place, I think it’s the, the yo yo nature of it, and having, you know, life sort of yanked away from you, as soon as you get it back that is that is driving people crazy. So is there a way to craft policy that would give us indications of what happens when that we can rely on?

Timothy Caulfield Yeah, because there’s so much scientific uncertainty and all these other variables out there, it will be a challenge, but but I think there are, you know, factors that we we can embrace that will help us. So number one, let’s have as much as possible, the science-informed strategies that we will utilize, and then an indication of when we’re going to deploy them. And look, I know, this isn’t going to be exact, but you know, things like hospital numbers, ICU, surges, things like that we can use to tell the public look, we’re getting worried. Right? And, and, and then also explain the kinds of policy the kinds of tools that will be used, so people know, what is potentially coming. I think that those are, you know, strategies that can be utilized. And the other thing I think, is, I do think science literacy is so so important. You know, I still hear people complain about public health authorities changing their mind and using that as some kind of condemnation and saying, that’s why we can’t trust them. They should change their mind when the science changes. If they didn’t change their mind, that would be a problem. Right? So I think, you know, explaining the process more. And we and I think that a lot of public health officials were great at this early in the pandemic, I think that that is going to be another really, really important element. When I’m feeling pessimistic, I worry that every people have gotten so good at weaponizing, the scientific uncertainty of weaponizing, the frustration at weaponizing, misinformation that these battles are, the polarization is going to continue. And these battles are going to continue in a way that won’t allow us to resolve them with with sensible policy.

Jordan That leads to my last question, which is given the fact that the situation is going to change, and there’s all the uncertainty that you mentioned, what is the best path forward once we kind of identify those guidelines that are going to shape our policy to get people to buy into it, even if it involves a level of restriction that might not be what they’re comfortable with. And I, what I’ve noticed, and yeah, the protesters and the truckers if we want to call them that are kind of a hardcore minority, perhaps. But the longer this does go on, I have seen more and more of my totally liberal, totally progressive friend circle, get really frustrated with these restrictions. And I guess one of the reasons I wanted to talk to you is to try to figure out if there’s a way to get buy in for the fact that these may come back, because I don’t think a lot of people are talking about that right now we’re talking about as we always do the end of this wave and what comes next. And what keeps me up at night is I can picture a time when another wave starts, and ordinary Canadians are just sick of it and don’t buy in to public health measures.

Timothy Caulfield That’s one of my exact fears. I think you really captured that that? Well, there is so much frustration right now, there’s so much polarization, that, you know, God forbid, we have another severes surge, perhaps because of a variant in the relatively near future, it’s going to be really hard to get a significant majority of the population to buy-in. Because it has been so polarized. And again, when I’m pessimistic, I really do fear that that sector of the society has that has so politicized the discourse is going to win the day. And they don’t have to win it by a lot, right? They just have to be, you know, helped to create information chaos, in order to really throw sand in the gears, right to make it more difficult to implement sensible, sensible policy. I get so frustrated. I’m going to repeat this again, when they make it sound like all these measures didn’t work. They weren’t necessary. It’s just not true. Like it’s just simply not true. And we have a huge body of evidence that tells us it wasn’t true. These measures were necessary and they were effective. And the vaccine saved hundreds of 1000s of lives like that is not an insignificant thing. And I worry that this political politicization is going to cause us not to recognize that so that is a very pessimistic response. Very good question. Let’s talk glass half full. I do think you know, we’ve learned a lot over the past two years. We really have about what strategies work, what strategies don’t work, and what kind of science communication matters. So I’m hopeful that we can use that evidence to inform how we deal with the next search. And unfortunately, it is probably coming.

Jordan What a lovely note to end it on. But I’m glad that we could have a frank conversation about it because I think it’s going to be important in a few months.

Timothy Caulfield I agree. Thanks very much for this opportunity.

Jordan Timothy Caulfield, Canada Research Chair and Health Law and Policy at the University of Alberta. That was The Big Story, you know, by now that you can find us at thebigstorypodcast.ca .You can talk to us on Twitter @TheBigStoryFPN and you can email click here!. Look for this podcast in your favorite podcast player and your second favorite and your third favorite podcast player. As always, leave us a rating leave us a review. Tell us why you like us. Tell your friends why you like us and subscribe to us on their phones. Thanks for listening. I’m Jordan Heath-Rawlings. We’ll talk tomorrow.

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