Post-Pandemic Anxiety
As of March 2022, it will be exactly 2 years since the province of Manitoba, Canada reported its first case of COVID on March 12, 2020. Over 2 years the province has coordinated with professional health experts to provide the most accurate, up-to-date and scientifically relevant public health guidance to the population.
Unlike our neighbors across the southern border, Canadians have been more welcoming to the idea of vaccinations, lockdowns and mask mandates. While I doubt Canadians are any more or less scientifically competent that their American counterparts, Canadians do have higher trust in institutions. In a survey of 1,305 participants in American carried out in May 2021, only 52% and 37% of Americans had trust in the CDC and the NIH, respectively. The numbers for Canadians were slightly higher, where a similar sized study in Canada in January 2021 noted 63% of participants trust Canada’s Chief Medical Officer of Health on matters related to COVID-19.
The concept of confidence in institutions is important because at every stage of the pandemic, provincial governments have made careful deliberations on the safety of the public and the economic costs to Canadians and small businesses. The public is more likely to have confidence in public health restrictions when you know public health is using the best information available to them at the time to make these tradeoffs between public health and personal freedoms. When you know they have your best interests in mind, sacrificing Christmas with family is a price worth paying to protect your fellow Canadians.
There has always been this understanding that life would return back to normal some day, but nobody knew when that would be, what it would look like, or how people would readjust to an endemic COVID-19. What wasn’t discussed until now is something that I call Post-Pandemic Anxiety, or the discomfort that comes with transferring social responsibility to personal responsibility.
Personal and Social Agency
This leads me to the more fundamental issue, which is the idea of Personal Agency. As an individual you have a lot of freedom when it comes to the level of harm you choose to do to yourself when it comes to health matters. For the most part we understand that instituting seat-belt laws do more good than harm, and as a society we have agreed that would be a good thing — especially for young people who are incapable of making a decision for themselves on the benefits.
In other matters, like the amount of sugar we consume on a regular basis, we take the level of risk that we find most appropriate — and we live with that decision and the cost of our actions. In most things we have the freedom to drink what we like, eat what we eat, and largely decide our own fate by the decisions we make. That is all part of Personal Agency which is the idea that we can make decisions for ourselves and balance the risk and reward for what we do.
During the COVID pandemic, public health becomes the focus because an individual health focus is not appropriate when the actions of individuals affect the health outcomes of others. Since viral transmission is exponential with respect to community spread, the actions of a few have consequences for the fate of the whole. At this stage lockdowns and other public health restrictions become appropriate to reduce the degree of spread in the population.
Personally, I never felt a sense of fear or anxiety about what level of exposure I should take because I simply followed the public guidance at the time. My personal level of risk was wholly a product of what the public health guidance suggested was appropriate for my age group. And when it came to others I interacted with, it was assumed that they made their own decision on what interactions they felt were most appropriate at the time.
All of this discussion of following public health guidance means I am suspending my own Personal Agency with that of Social Agency. After all, when the fate of others is not independent of our own actions, then it makes sense that coordination among the population makes sense — and the best way to do so in a Pandemic is to follow public health guidance.
Social Agency in Decline
Following widespread transmission of Omicron, the emergence of oral antiviral treatments, and a reduction on the load on the healthcare system, public health experts have made the decision to begin lifting public health restrictions as of February 2022 in Canada.
From a Public health perspective, they consider all of the aforementioned improved health prospects, as well as the current susceptibility of the population to re-infection or adverse health outcomes. After a certain level of protection in the population, those that have received their booster and perhaps a community transmission of the virus are as protected as they can be against the current variant — all other things being equal.
Based on this holistic view of the situation, the costs of public health restrictions exceed that of protecting a small subset of the population that would still be negatively impacted from COVID-19. Therefore, the province is now giving Personal Agency back to the people in making their own decisions when it comes to their exposure to potential infection.
For some this idea is not welcoming. In a recent article titled: “2 years in, what once was a collective fight will soon be an individual struggle” we can see what Post Pandemic Anxiety looks like. The article says the following:
[the loosening of restrictions] phenomenon “shifts the burden to the very groups experiencing mass deaths to protect themselves, while absolving leaders from creating the conditions that would make those groups safe,” University of Pennsylvania sociologist Courtney Boen told The Atlantic magazine earlier this month.
The article also makes mention of “shift[ing] the burden of the pandemic risk to Manitobans who are more susceptible to contracting COVID-19”. The arguments are well taken, but don’t account for the fact that public health has to consider the costs of restrictions in their accounting of re-implementing restrictions. Approaching the situation as 1-dimensional discounts all the difficult decisions that are involved in balancing public health risks with the freedoms of individuals and businesses.
It also doesn’t help that using terms such as “mass deaths” as a form of fear-mongering isn’t reflective of what the true dangers are to most Canadians. Would provincial governments, with the insight and oversight of Health Canada, be indifferent to “mass deaths” of the population? Of course not, and saying otherwise is irresponsible.
Changing the Perspective of the Population
The reality on the ground is much different than people make it out to be in rhetoric. It also represents a basic misunderstanding of what the role of public health is during a post-pandemic COVID-19. The goal is not to eradicate SARS-CoV-2 as a virus, nor to ensure that infections should be driven to zero in the province.
An endemic virus means our baseline for hospitalization and ICU capacity has changed. While some people are still talking about pre-COVID capacity as if that is relevant, an endemic virus means there will be an increase to the baseline load on the healthcare system indefinitely, and that what we consider “normal” has changed.
At the onset, the goal of public health was to minimize the spread of the virus and mass vaccinate the population. If healthcare systems were under duress, then the healthcare system would be unable to provide 100% care to those in need. So tapering the community spread of the virus bought time for vaccination and the completion of clinical trials for life-saving COVID-19 therapies.
So while people are continual being infected at increased rates, the outcomes of those infected has significantly improved. These types of outcomes are conveniently absent from the conversation when we hear about heightened concerns over widespread infection and the indifference of Premiers.
That is because people are still concerned with metrics such as daily infections because that is what they see in front of them — friends and family getting sick and missing work due to COVID. But the reality is on the front lines it is much different. And that is why public health is concerned with monitoring hospitalization and ICU capacity.
So we would all be better served by trusting our public health officials, and keeping in mind that they have our best interests in mind — even when we don’t know what those interests might be.
