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Sunday, February 25, 2024

Politicians Say It’s Time to Live With Covid. Are You Ready?

Since January 27, England has dropped pretty much all its measures against Covid-19. Any person can saunter into any shop without a mask; work-from-home guidance has been scrapped; and all needs for a vaccine passport have been squashed. England will be the “most open country in Europe,” proclaimed health and social care secretary Sajid Javid.

And other European countries are following suit. Ireland has dropped almost all its restrictions, bar mask requirements. Denmark is also eliminating all measures beginning February 1, except for testing on arrival from abroad. Other Nordic countries have signaled they will also do the same in the coming weeks. The Spanish government is urging European countries to consider the possibility that Covid-19 can now be treated as an endemic disease—a permanent fixture in our lives.  

Despite towering case numbers for Omicron, these parts of the world are beginning to declare—arguably prematurely—that the worst of the pandemic is behind them. It’s time to get on with it, to learn to live with Covid, they say. The World Health Organization has warned that new variants are likely to emerge and that the pandemic is nowhere near over. But a wise decision or not, it’s happening. 

Now what? Stuck at home for the past two years, our social skills have decayed, we’ve outgrown our jeans, and we've developed an unrelenting suspicion for every cough and sneeze. But now, suddenly, we’ve been set free, urged to dive back into a Wild West revision of the new normal. How will we cope? And what wounds will we be carrying? 

George Bonanno, a clinical psychologist at Columbia University, reckons most people will welcome the return to normal (or some semblance of the previous normality). “I think people are really ready to move out from under the shadow of this thing,” he says. In his book, The End of Trauma, he makes the case that humans are more resilient than we give ourselves credit for. While some have dubbed the pandemic a “collective mass trauma event,” Bonanno chafes at this term. A traumatic event is defined as one that is unexpected and violent or life-threatening. “When people start talking about collective trauma, they get into the illusion of some sort of medical diagnostic thing, and that's just wrong.” The abundant overuse of the word “trauma” in casual references means the word is losing some of its clinical weight, not least in the case of the pandemic, he thinks. 

But for some, it has certainly been traumatic. Health care workers, who have borne the brunt of caring for patients and seeing them suffer and die, and have worked unrelentingly long hours in difficult conditions for the past two years, are reporting record levels of post-traumatic stress disorder, a mental health condition triggered by a traumatic experience, with symptoms including flashbacks, difficulty sleeping, anxiety, and nightmares. According to modeling from the Royal College of Psychiatrists in the United Kingdom, 40 percent of intensive care staff have symptoms of PTSD, as well as 35 percent of Covid patients who have been ventilated. 

To gauge the coming mental fallout from the pandemic, other epidemics may serve as models. One study conducted in Hong Kong looked at chronic PTSD rates among survivors of SARS, two and a half years after the 2003 epidemic. Almost half had PTSD at some point after the outbreak, and over a quarter were still suffering with it after 30 months. Another study found that PTSD was the most common long-term psychiatric condition among survivors.

While it might not be traumatic for all, the Covid pandemic has been what is called a chronic stressor, meaning a nearly constant source of stress and anxiety. On-and-off lockdowns, millions of deaths, fragmented childhoods, devastating losses, health anxieties—all have taken their toll. It’s normal—and reasonable—that a return to normal will spark anxiety for some, says Bonanno. Many have grown accustomed to a hermit lifestyle, or have even found comfort in it. Some may even want to stay locked inside for longer, for fear of being infected, a reaction that has been dubbed “cave syndrome.” And there is evidence that the constant hum of distress has translated into longer-lasting conditions for many. According to data from the UK's Office for National Statistics, rates of depression doubled in the UK in early 2021. Reports of anxiety and depression symptoms also rose dramatically in the US

After all, it’s hard to ignore that Covid is still very much here. Life is inherently risky. Common activities—such as crossing the street or driving a car—all carry risk. But the stakes are higher now for many everyday activities. Before the pandemic, the biggest risk of a trip to the pub was the next day’s hangover. Now, it’s catching a virus. “What I think is hard now is that people kind of want to say, ‘Well, when is it safe? When is it going to come back to the point of being safe?’” says Julie Downs, a social psychologist who researches risk perception at Carnegie Mellon University. But 100 percent safety against Covid might never arrive. 

And crucially, we haven’t all weathered the same storm. Certain communities have been forced to shoulder the worst effects of the pandemic: people of color and those in poorer areas have suffered the most. And for many, a forced return to normalcy means returning with a disabling, life-shrinking condition: It’s estimated that 1.3 million people in the UK are living with long Covid, a term used to describe a case of Covid that stretches on for weeks or months, with symptoms such as brain fog, fatigue, and shortness of breath. 

For some, there is no return to normal. For Nick York, the loosening of restrictions for others means tighter restrictions in his own life. York, who is in his late fifties and lives in the Midlands in England, has been living with chronic lymphocytic leukaemia, a cancer of the immune system, for over a decade. His condition means his body doesn’t mount a response to vaccines; it struggles to defend itself against any pathogen. For York and other immunocompromised people, a government’s declaration that society will “live with Covid” means it will be living without them. The dropping of masking requirements means he is largely confined to his home. He can’t go into shops. He can’t travel. He has spent the past two Christmases alone. He struggles to see his own daughter. “It's essentially removed a swathe of society,” he says of the easing of restrictions. 

York describes himself as pretty resilient, but he says he feels forgotten—by his own local community and by the government. “The feeling of isolation, the mental health side of that, it's hard to manage,” he says.

One of the consequences of the government lifting restrictions is that the onus to take health precautions will fall from the collective to the individual. “As we move to thinking about Covid as an endemic risk instead of a pandemic, it comes along with this shift from a public health approach of ‘What can we all do to help reduce the systemic impact of this event?’ to this being one of all the risks that we're trying to reduce for ourselves,” says Downs. “And it's going to take a while for people to reorient and make their own decisions.”

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