Pandexit, please: The need for a Covid end date

The rolling Covid mandates and restrictions sidestep the most important question: what is the end-game?

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When “three weeks to flatten the curve" sent us scurrying indoors, many of us took heart in having an end date. We would watch Netflix or read for three weeks, after which time the policymakers would take a step back, regroup, and shift to more sustainable mitigation strategies. Which is exactly what didn't happen.

As the weeks rolled into months, the doors kept opening, shutting, opening, and shutting again. 'Cases' down? Ease up on restrictions. 'Cases' up again? Slam the door, fast.

We somehow got used to this curious facsimile of living, this hallway of swinging doors stretching out to a vanishing point. We stopped questioning the hallway's existence. We trudged along, giving up on finding the door that would lead us out.

A year and a half into it, with shots in billions of arms, we're still uncertain about what we will be permitted to do tomorrow, next month, and next year.

Until when?

Timelines give a shape and order to things. They help people cope. It's why children in the back seat of a car want to know "how many more miles". And as any parent knows, "eat three more broccoli spears" gets better results than "eat as much as you can".

It's no different with Covid. Had the policymakers given us clear endpoints, we could have powered through their demands with less confusion and frustration. We would have fewer people resisting what they perceive, not without reason, to be government overreach.

Here's what powers-that-be might have told us:

"The new capacity limits apply for the next two weeks. After that, barring unforeseen trends, we plan to replace the mandated limits with recommendations...

“We are all working toward the same thing: reopening. Every month we will review the data and let our constituents know which measures we are lifting and why... The vaccine passport is a temporary policy. We will revisit it at the start of next year, with the intention of lifting it at the earliest reasonable time...”

Instead, they simply told us to wait "until it is safe". They consistently leaned away from normalcy, rather than into it. They handed down rules that often seemed arbitrary, without satisfactory rationales or timelines. I call that bad policymaking.

The World Health Organisation (WHO) would have agreed with me, at least before this pandemic started. In its 2019 guidance document about pandemic influenza, the WHO recommended enlisting the public as "partners in prevention", rather than simply recipients of information. They also made a case against quarantining exposed individuals, arguing that the balance of benefits and harms didn’t justify this measure. The same goes for the US Centers for Disease Control and Prevention (CDC). Even for most severe flu pandemics – those with case fatality ratios greater than two per cent – the CDC recommended only voluntary quarantine of affected people and their family members. Social distancing in schools? For no longer than twelve weeks. It's exactly this kind of timestamp that's been missing from Covid policies.

The virus decides

I am not the only one who has puzzled over the lack of an end-game. As early as July 2020, a paper in The Journal of Infectious Diseases identified an urgent need for an exit strategy: "It is critical to plan for the reactivation of society, restarting work and production, opening up travel and education," the authors wrote. More than a year later, schools are still being shut down and travel is still a mess.

Well, everything is a mess. As US statistician Nate Silver recently Tweeted: "There's no strategy, there's no endgame, there's no philosophy, there's no internal consistency, there's no cost-benefit analysis, there's no metrics to define success, there's no consensus on what we want to accomplish."

Some people have argued that we can't create an exit plan because we can't fully control the pandemic arc. It's the virus, not us humans, that decides when this all ends. Newspaper headlines have run with this theme, implanting the notion that it's out of our hands. Some examples among hundreds:

"Covid spike forces reversal of face-to-face classes" ...

"Covid surge in Martinique compels Air Belgium to postpone flights" …

"Sydney's worsening Delta surge forces state to extend lockdown" ...

Um, no. The virus doesn't decide.

Politicians decide. People decide. There is no law of physics dictating that X cases merit a new mask mandate or that Y cases in a school warrant a closure. There are many evidence-based approaches, aside from mandates and closures, to handle the ebb and flow in cases. The WHO's 2019 pandemic playbook did an excellent job of describing these approaches, with a remarkable sensitivity to minimising disruptions. Policymakers would do well to revisit this document.

Covid-agnostic timelines

Above all, decision-makers need to uncouple the exit ramp from Covid stats. "When 'cases' go down to X" doesn't cut it. "When the positivity rate dips below Y" doesn’t cut it, either. We need a date. The UK had the right idea with its 'Freedom Day' on July 19th (if only it had properly followed through with it!). So did Denmark when it set September 10th as the date to lift all Covid restrictions. It remains to be seen how these jurisdictions react when 'cases' rise again in the winter – which they inevitably will, because this virus ain't going anywhere. It may retreat for a time, but when a new weather system or mutation blows in, it will sneak up on us again.

We need political leaders to put a clock on 'Plan A' and move on to a more holistic 'Plan B' – an "endemic equilibrium", if you will. Plan B could be many things: a replacement of mandates with recommendations, a focus on supporting the vulnerable, or a move toward managing Covid as we do other contagious diseases.

What Plan B cannot be is more of the same – unless we want the remainder of our lives to roll by on a conveyor belt of restrictions. Now that vaccination has brought the risks down to more manageable levels, we can transfer some responsibility from the government to the individual, reverting to the social contract that existed before Covid. There is nothing preventing the more cautious among us to continue to wear masks and keep a distance from other people, but to ask everyone to live this way for the foreseeable future simply is not reasonable.

The social end

As historians have observed, pandemics have both a medical end and a social end. The medical end is often diffuse, with waves getting smaller and outbreaks more sporadic, while the social end happens when people have had enough. Dr Catherine Troisi, an Infectious Disease Epidemiologist at the University of Texas, expects that Covid will end when "people are no longer afraid, or no longer care, about the virus and return to their normal lives". In other words, the social end arrives when the desire to rejoin life exceeds the fear.

We're not there yet. Too many people still don't feel safe. One can hardly blame them, given the fear that has bathed our planet for the past eighteen months. But the arduous climb from fear to equanimity belongs to them, not to any public health department or schoolboard. As Toronto Sun columnist Anthony Furey shrewdly observes "The struggle they now face is one within themselves and no government policy can solve this for them."

For a year and a half, governments have kept a narrow focus on responding to each new outbreak, each new surge. This reactive mode no longer serves the public good. Going forward, the most helpful thing governments can do is to encourage an 'endemic equilibrium' in which Covid becomes just one of the many background risks we face in life. Or maybe we should leave governments out of it and let the social end of the pandemic play itself out. We're not there yet, but we will be. Human nature will see to it.