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The end is near — again: How to decide what’s safe for you as COVID restrictions lift


‘People just want to go back to normal, the 2019 normal, but the world of 2019 no longer exists’

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As provinces start scrubbing public health restrictions, people are being advised to do mostly as they see fit. Will people throw caution to the wind, or tread gingerly?

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More than two years in, and the pandemic has left many feeling emotionally raw, says Western University’s Marnie Wedlake. COVID forced people to sit with uncertainty and their own mortality, “two biggies that poke at our emotional defenses.” So has a sense of decision fatigue, the exhaustion of constantly assessing risks and trade-offs. One survey taken before Omicron’s surge found that a third of American adults sometimes felt so stressed about the pandemic they had difficulty making basic decisions, like what to wear or what to eat.

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“Most people are feeling tired and battle weary — ‘Are we making good judgements?’ I’d like to think that for the most part, people will be able to tune in and say, ‘This is going to be good for me, or this isn’t,’” says Wedlake, an assistant professor in Western’s faculty of health sciences.

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Others just feel so done with it all. “They just don’t want to do this anymore — ‘I don’t care what happens to me, I want my life back,’” which Wedlake, a registered psychotherapist, sees as an interesting space of impulse, that sense of, damn the torpedoes, and away they go, “and you kind of hope it goes well, and if it doesn’t go well people say, ‘Wow, what was I thinking?’”

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I don’t care what happens to me, I want my life back

Vaccine passports, capacity limits, masking in schools and other COVID measures are rapidly being wound up. The messaging now from provincial leaders is for people to use their own judgements. “What does that mean? It means that each person will have to evaluate their own risks,” Quebec Premier Francois Legault said recently. “‘I’m with how many people? How many have three doses? How many are over 60?’”

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Canada is past the peak of the Omicron-driven wave, and while an apparently more contagious sibling known as BA.2 is spreading in Canada, reinfection with the new subtype appears rare, Danish researchers reported this week in a pre-print study that hasn’t been peer-reviewed. The majority of those infected with Omicron twice in Denmark, where BA.2 is gaining the upper hand, were young and unvaccinated, and most experienced mild symptoms, Reuters reports.

Even scientists deeply uneasy with the new “over and done, let’s learn to live with it” narrative say many authoritarian measures no longer make scientific sense and that the fully vaccinated, especially those with third doses, are well protected against serious outcomes.

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No two-year pandemic can erase the hunger for attachment hard-wired into humans, says Dr. Roger McIntyre, a professor of psychiatry and pharmacology at the University of Toronto. While he suspects the walk out of restrictions will be slow and steady for many, at least for a while, “I do think it’s going to whipsaw, and people are going to go right back to where things were.” He believes that, not because of any political position or ideology, “but because of my faith in human genetics, evolution and the appetite for pleasure and connectedness that is millions of years into the making.”

What information do people need to make informed decisions?

Many experts now believe that SARS-CoV-2 is spread largely by inhaling fine, microscopic aerosol particles that can stay airborne and travel short or longer distances, and less so by large respiratory droplets, globules of mucus and saliva that, once coughed or sneezed out, fall quickly to the ground. “It’s an airborne disease — I think that’s clear,” Adalsteinn Brown, co-chair of Ontario’s science advisory table said in December.

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“We know that we’re breathing it in, we’re inhaling it — that’s how it’s transmitted,” says atmospheric scientist José-Luis Jimenéz, of the University of Colorado Boulder. The World Health Organization, after long insisting COVID is not airborne, acknowledged in December that SARS-CoV-2 can hang suspended in the air or travel further than “conversational distance,” though the world body still maintained the virus spreads mainly between people in close contact with each other.  The strongest resistance to “it’s airborne” has come from Canadian scientists, says Jimenéz, one of several prominent voices that have pushed against the “droplet dogma.”

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With the lifting of restrictions, “people just want to go back to normal, the 2019 normal, but the world of 2019 no longer exists,” Jimenéz says. “We have a new world where there is a pathogen that is pretty nasty.” Scientists continue to find more ways long COVID batters the human body, and new research shows even a mild infection boosts the risk of heart failure, stroke and other cardiovascular “manifestations” for one year after infection. SARS-CoV-2 isn’t going anywhere soon and will continue mutating. Immunity from infections or vaccines wanes with time to some degree. “If we just go back to what we were doing before, we are going to have a persistent level of disease that is going to damage some individuals.”

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What should people consider when making their own personal risk assessments? The number of cases in the community controls the chance you will encounter someone who is infected. The second consideration is individual risk factors, such as age, “or you’re immunosuppressed, or you are the only parent to four kids — for whatever reason you want to be more cautious, you can be more cautious,” Jimenéz says.

The more vaccinated and boosted, the more people can relax a little more. “If you choose not to get vaccinated then I think, principally, you should be more careful.”

He and colleagues have studied super spreader events, outbreaks involving big tour buses, call centres, slaughterhouses and choir outbreaks, and modelled the relative risks of getting infected in various indoor settings.

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“How many people are there? How long are they going to stay? What are they doing in terms of vocalization or exercise Are they wearing masks? What is the volume of the room and ventilation rate? Those are the things that matter.”

Generally, the more time spent, the more people talking or especially shouting or yelling, the fewer well-fitting masks, the heavier the exercise in an under-ventilated gym — the more variables at play the higher the risk of transmission. There have been numerous outbreaks involving choirs, with very high attack rates, but Jiminéz knows of no outbreaks in libraries or movie theatres, where people are mostly quiet and sedentary. The volume of space, and ventilation and filtration also go together. “Imagine you are in one of these huge churches and someone is exhaling some smoke. The air is trapped by the building, but the building is huge. So, there is a huge amount of dilution.”

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Close proximity, standing, say, one to two metres from someone speaking, is important, but shared room air is major, he says.

There are ways to adapt. Bars could lower the music when case levels are high, so that people aren’t forced to shout over the music, which puts much more virus in the air. Carbon dioxide meters could be made mandatory, and publicly visible, in restaurants and all indoor spaces where people share the air. Yes, we should wash our hands, Jimenéz says, “but mostly because of other diseases.” Outdoors is at least 20 times safer than indoors. “Masking still makes sense in many scenarios — it will make less sense when numbers drop further,” infectious diseases specialist Dr. Andrew Morris recently wrote in one of his COVID emails.

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Ultimately living with COVID means there will be people who get infected

“There are all these permutations and combinations (when assessing risks). It’s not simply, yes or no,” said Dr. Samir Sinha, director of geriatrics at Toronto’s Mount Sinai Hospital.

He worries that people will throw caution to the wind. Experts are predicting a bump in cases, hospitalizations, and deaths as mask mandates and other restrictions are rolled back, and 90 per cent of deaths across all waves have been among older adults. SARS-CoV-2 is still also very good at finding people who are not protected, “and sending them to the hospital, ICU or morgue,” Sinha says.

“Ultimately living with COVID means there will be people who get infected, they will most likely be marginalized and vulnerable citizens, in particular older people. If the majority feel that is okay, because it won’t affect them too negatively, well, then, so be it. And I think that’s a tragedy,” he says.

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It doesn’t make sense to hermetically seal seniors off from the rest of society, which is why Sinha is part of a group with Ryerson University’s National Institute of Ageing that developed a COVID risk visit tool that helps people understand the nuances and what makes people less or more vulnerable, safer, or less safe.

People should prepare for any outcome. There have been enthusiastic relaxing of restrictions before, then, “out we go and, bing, bang, boom, something happens, out of left field comes another variant,” Wedlake of Western says. “One doesn’t need to have a degree in psychology to say that is actually leaving people somewhat mistrustful that the end is near, as we’re now being told again,” McIntrye adds. “We’ve been to this rodeo before.”

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There are going to be slip-ups, as people re-adjust to being in the company of others more often, Wedlake says. We haven’t practiced our social skills as much as we normally would. “We can be much more relaxed about our social graces at home.” It also takes emotional and physical energy to be sociable. “It’s a great thing — we’re social creatures. But it also requires us to spend energy to do that, and it’s going to be more tiring for some people to be out there.”

Not everyone will move at the same pace. “The eager beavers who can’t wait to get out there and are feeling almost no fear at all, if any, they’re one group,” Wedlake says.

“Then we’ve got the folks that are absolutely terrified, and everybody else in between.”

National Post

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