Living with Covid: What does it mean?

Over the last year or so I've heard a lot of people talk about "living with Covid." I will confess that I was not entirely certain what they meant because they themselves were often not clear. In the case of Republicans in the United States (or, at least the Trumpist wing of the Republican Party), living with Covid seemed to mean doing nothing in terms of public health while an unusually large number of people died who -- and this is the sad truth -- did not actually need to die. 

I've met a number of people in my neck of the woods who basically meant the same thing. When they talked about living with Covid, they tended to mean that public health measures should be as limited as possible and restrictions should be as limited as possible. For me, this is a particularly poor way of thinking about what it means to live with Covid. After all, if we flipped the question around and asked about what it might mean to, say, live with Polio or the Plague or Ebola on similar terms, most people would view that as a really bad public health policy. After all, we do have to live with Polio, the Plague, and Ebola, but no one counsels doing nothing about them. We have to live with crime, but does that mean that we will take no actions to limit or control or punish criminals? 

On the other hand, the extreme response on the other end -- lock us down -- is likely unproductive for a range of reasons. These include: no government is going to do it. It is not a viable long-term strategy for the kind of interconnected world in which we live (for example, it assumes a security of supply chains and I am not certain I would make that assumption). I have not seen the data on mental health and I am worry that these two words have become some sort of catch all discourse mobilized in any situation to justify just about any particular policy recommendations someone is making but it is an important consideration. Indeed, I'd argue that it is so important that we should be making specific provisions for it, rather than assuming that "going back to normal" will resolve mental health problems in and of itself. 

So, what does -- or, should -- "living with Covid" mean? I think it should mean several things. Most importantly: I think it should mean that we will need to redefine "normal" and to understand the stresses, strains, and opportunities that it provides. What might this look like? For purposes of discussion, I think it could involve a number of things. A non-exhaustive list might look something like this: 

• Maintaining stricter limits on the number of people who can be in a store or restaurant or gym, etc. 
• Maintaining contact information for patrons 
• Keeping sanitizer at entrance ways and requiring its use upon entry
• Maintain directionality in grocery stores and potentially other venues like restaurants and pubs, where this is possible.  Planning for directionality can be added to considerations in new construction (much in the saw that access requirements were in the past). 
• Vaccination education is a long story, I know, but it should be maintained and there may be a need to restrict access to some venues to the vaccinated. I personally believe that vaccination can also become a requirement for immigration and travel to Canada. I recognize that there are problems with this that will need to be addressed. For instance, not everyone has the same access to vaccines. In the shorter term this will need to be taken into account, but we can maintain the longer run objective as an aspirational ideal. 
• It might also be useful to restrict hours. In my town, for instance, hours for the liquor store and for shopping were more limited at the height of pandemic concerns last year. 
• I personally like senior hours for grocery shopping. One of the stores in my town, for instance, opened early a couple of mornings each week to provide space for seniors to shop (they should shop at other times, but two hours each week were reserved for seniors alone). 
• Masking in public areas may need to be maintained. 
• Public provision of N95 masks (or, whatever the kind of mask that is needed).
• Public provision of rapid tests.
• Ensuring a robust public health care system that can both respond to flare ups and conduct its regular work. 
• Providing a globally equitable access to vaccinations and public health measures. 

I'll venture more slowly into a consideration of education because, the truth of the matter is that I don't know a great deal about public education and how it operates. I'm reticent to start suggesting things to teacher and parents who have a much higher level of first hand knowledge than I. However, I do think there are consideration for higher education that can help and I'll address those in a future post. 

My list above is not exhaustive and there is, of course, room for discussion but you can see what I am trying to suggest. The current discourse is to impose restrictions in response to public health problems when those problems reach a certain level. They are often imposed "with regret" and with the proviso that this will be for as short a time as possible. I find this approach reactive. What we need to do is to think about a pro-active response.  We may not be able to eliminate Covid (I might debate that but let's assume it for now), but that doesn't mean that we can't take steps to provide for as high a level of safety and security as possible. 

There are a couple of questions that my proposals need to answer. I have mentioned in the past that the burden of proof rests on those making proposals. I often hear, for instance, people say "we have to do something." This could be true but what we need to figure out is whether the specific course of action is both useful and viable. The key questions that need to be addressed are:

1. Will these kinds of permanent changes create more harm than good? Are they not undo restrictions that can be accepted in emergency situations but which, under other conditions, become an unwarranted and perhaps unconstitutional intrusion on individual rights (among other things)? 
2. Will these changes actually do any good? 

Let me take the second question first and leave off the first for another day. The short answer is that no one knows the future. We can't provide guarantees on just about anything, but we can make reasonable projections. For instance, ensuring that seniors have a dedicated grocery shopping time does not mean that seniors will not catch Covid (or, something else). But, it can lower the chances and it can proactively address mental health issues with regard to seniors, many of whom are deeply concerned about -- indeed terrified of -- Covid. It seems to me that the great merit of (to use just this one example) of special seniors shopping times is that they can address both the health concerns (providing better protection for a vulnerable population) and mental health concerns (alleviating some measure of fear with regard to being out in public). It is a proactive statement that shows "hey, we are thinking about this issue." And, it quite literally harms no one.  The most I can figure is that there might be a small staffing cost increase for some groceries stores. Moreover, in larger centres, different stores could take turns so that whatever minor costs there might be can be spread around. 

This is just an example. I use it to show how living with Covid should not mean going back to 2019. But, instead, developing a proactive strategy that looks at how we can actually live with Covid. This involves changes to how we do things as as society but we need not resist those changes. They can help address mental health issues and can provide services that ensure a higher level of protection for vulnerable populations. 

Now, I recognize that that one was easy. Other provisions I have suggested will likely be greeted with a higher level of skepticism. There are costs to providing M95 masks and rapid tests. Some may have concerns about limiting capacity in spas and gyms and classrooms. In my next post I will try to address those or at least lay out a way of thinking about these issues.