Jen Gerson: We can't contain Omicron
It's time for fear-based messaging to end.
"Dear Colleagues," wrote Craig R. Smith, the chair of the department of surgery at the New York-Presbyterian Hospital/Columbia University Medical Center. "This has been a very active day, during which the hard data has become alarming."
This was in the opening days of the pandemic, way back in early 2020, when the threat of the emerging virus was just becoming clear and our information about it was limited. Remember, back then, health-care workers faced a lack of tests and increasing patients in need of a limited number of ventilators. Projections suggested that hospitals would well exceed their ICU capacities. Personal protective equipment was in short supply and crucial N95 masks were scarce.
"Nothing would give me greater pleasure than to apologize profusely in a few weeks for having overestimated the threat. That would mean we never exceeded our capacity, and that mortalities and morbidities rarely seen in non-pandemic circumstances were avoided. The next month or two is a horror to imagine if we're underestimating the threat. So what can we do? Load the sled, check the traces, feed Balto, and mush on. Our cargo must reach Nome. Remember that our families, friends, and neighbours are scared, idle, out of work, and feel impotent. Anyone working in health care still enjoys the rapture of action. It's a privilege! We mush on."
Craig's words ring so clear and so powerfully to me even years afterward. Yes, the situation is bad, but we must rise to the moment; we must rise to the best of ourselves and seek to be worthy of the crises we have been prepared to handle. We must mush on.
I kept on waiting for a voice like this to emerge in Canada; someone both unifying and galvanizing. Someone who could transcend the COVID denialists, and the COVID hysterics, and instead offer some useful words that could inspire us in a dark moment. In other words, a leader.
But, frankly, I've been disappointed, not just in our elected leaders, but in all of us. There has been very little of this. Instead of creating a culture that has become better adapted to manage the shifting risks of this pandemic, we've doubled and then tripled down on messages of fear and panic. No Keep Calm and Carry On in these quarters. No, now we live in a dystopian future of endless waves of variants, forever pandemics and death trap hospitals on the verge of collapse. We support punishing the unvaccinated with health-care premiums, even if those premiums put the cherished tenets of universal health care at risk. We smugly grin at the "idiot" kids stranded in Cancun after partying mask-less on a plane. “What better way to teach them a lesson," after all. Tens of thousands of us signed up to rat out our neighbours for violating COVID restrictions.
This has not served us well.
We've faced two years of this pandemic and we're all tired and exhausted and I realized only late last week that many people are struggling to come to terms with the fact that the Omicron variant is a fundamentally different beast. Not only is it less dangerous at an individual level, it's also wildly more contagious, and thus more difficult to manage at a population level. Practices we've used to manage a disease with 1 per cent mortality and an R of 1 make no sense at all when we're dealing with a variant with a much lower mortality rate and an R of 4 — and at a time when we are widely vaccinated and even have access to therapeutics (assuming Canada ever gets around to approving them).
We are just starting to come to terms with this emotionally: We cannot contain Omicron. Virtually everyone is going to get exposed to the virus. It will put a strain on our hospital system, and may cause shortages and staffing problems in the next few weeks.
Our governments are beginning to be more candid about this fact.
From the New York Times this week: "It's hard to process what's actually happening right now, which is, most people are going to get COVID," according to Janet Woodcock, the acting commissioner of the Food and Drug Administration. The U.S. is recording more than 700,000 cases per day. Containment was a lost cause the moment this virus escaped into the wild months ago.
In Manitoba: "It is highly likely everyone will be exposed to the virus in the coming weeks," said Dr. Jazz Atwal, the deputy chief provincial public health officer.
Bonnie Henry, the provincial health officer in B.C., was making this point way back in December. “Everybody’s going to be exposed.”
For the immunocompromised and the elderly, those who face more risk even with a weaker disease, these facts are undoubtedly particularly horrifying. Is pointing out what is obviously true and inevitable a cruel or unfeeling thing to do? Put another way, it's not an act of empathy to mislead people into believing we can contain a virus when we cannot. That's delusion — and it doesn't lead to sane or practical mitigation measures, but rather to politically driven pandemic overreaction that will make no difference at best, or do significant harm at worst. I'm looking, here, at school closures, and vaccination requirements on cross-border truckers that risk putting food supply in jeopardy.
The fact that Canadian hospital systems appear to be particularly vulnerable puts a kink in any of my optimism, granted. And the reality of Omicron should encourage us to take reasonable, common sense precautions; get vaccinated, isolate if you're sick, wear the best mask you can find, improve ventilation where possible, and all the other things we know help.
Otherwise, I'm not sure that there's much else to be done.
Yet in public, there seems to be a near-moral obligation to ignore these realities in favour of creating more concern — to underplay the relative mildness of the illness, for example — in order to squeeze a few more weeks of compliance from an increasingly uncooperative and distrustful population.
What I find telling is that the same questions of ethics in communication rarely seem to be applied in the opposite direction; we don't question the harm that we are causing by the creation of a state of chronic fear. What kind of trauma and mental-health issues do we risk creating by barraging people with worst-case scenario messaging for years? Psychosomatic illness is a real thing. Social contagion is a documented phenomena. (This is why newspapers traditionally do not report on suicide.)
This week, I've taken flak for expressing the expectation that Omicron will be our last major wave, and that after this, we truly will move into an endemic phase of COVID. I think this is plausible not only for practical, but also sociological reasons. However, even if you don't share my optimism, if you believe, rather, that variant after variant will wash over us indefinitely like the waves of a violent and boundless sea, and that we're facing a forever pandemic, I have to ask: is this sustainable? Is scaring the hell out of everybody and shutting everything down every six months something that we can do indefinitely? Is how we handled previous waves identical to the way we should handle subsequent ones?
The answer is no. The answer is obviously no.
Empathy is always to be cherished, but I don't think it moral or empathetic to validate pointless and counter-productive anxiety. I want you to accept the risk, to manage your personal affairs in a common sense way, and then to live your life bravely in the face of crisis.
What other choice do we have, but to mush on?
On a secondary but related note, I wanted to add an observation to Laura Mitchell's Thursday column here at The Line. She called upon institutions to stop wasting a resource that has been painfully underutilized during this pandemic — volunteers. I agree with her, and I believe that this failure to think outside of the box has been one of our most crucial mistakes during this pandemic.
One of the most fundamental distinctions between liberal and authoritarian societies lies in the power of civil institutions and society. Authoritarian governments have to dictate citizen action from the top down, while liberal ones must create common consent from the bottom up. And you can't do the latter unless you engage independent and freewheeling civic institutions; media, churches, clubs, volunteer organizations, even knitting circles.
We should have been enlisting and training volunteers to help from the outset of this pandemic. There is no reason we couldn't have engaged thousands, if not millions of Canadians in everything from sewing masks to baking meals and volunteering child care for essential workers, to managing triage and administrative tasks. This may have eased at least a small portion of the burden on front line workers. But it would have served an even more important function than this: in a liberal democracy, you need to facilitate buy-in to radical policies and restrictions in the long haul. You get buy-in not through scolding and snitch lines — the tactics of the authoritarian — but rather through persuasion, calls to action, and acts of collective sacrifice.
Even if all of those volunteers were engaged in nothing more than busy work, the fact of that work would help forge a society that came out of this pandemic feeling proud of itself, more resilient, and more community-minded than it was at the outset.
Instead, we've been told to sit down, listen to our betters, stay home, see no one, watch Netflix, and to remain obedient to our governments. Not only has this been isolating, but it's left many of us feeling unmoored and useless, damaging our fundamental sense of ourselves and our roles in our communities. I fear this has contributed to a breakdown in social cohesion, a loss of trust in government and civil institutions and media, and an increase in polarization, which we've seen manifest itself in the astonishing rise of the PPC and an increasingly aggressive anti-vaccine movement.
In other words, we've responded to this pandemic with more of an authoritarian mindset than a liberal one. Yet we lack the capacity to act as an authoritarian regime, to actually enforce the requirements and restrictions being dictated for our own safety. So our governments vacillate, trapped between cracking down and easing off, demanding compliance yet being unable to coerce it. This gives everyone the justified sense that our leaders are flailing and incompetent. We're left with the worst of all systems: we lack the will to crack down and the cohesion to come together.
We'll emerge from this pandemic not a more resilient, more unified nation, but instead one that is increasingly embittered and distrustful of our neighbours and our institutions.
It's not quite too late to rectify this. If the leadership is willing.
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Early on in the pandemic, there were volunteers self-organizing to do things. There were thousands of people sewing masks and scrub caps and donating them to hospitals, LTC homes, and other places of need. (I was involved with several Facebook groups doing exactly this.)
You may also recall that a number of distillers reorganized themselves to make hand sanitizer available during times of shortage.
But as a society, we didn't want to mobilize more of this, which is a damn shame.
During the contract tracing, when it was still happening, I wondered why hundreds of people with interviewing and analyst skills were not invited to contribute. For example, anyone with a journalism background, anyone from the marketing research industry... but there was never a call put out for that. So the whole thing fell apart.
We need a strong civil society (many kinds of organizations) to sustain a strong democracy. our leaderships do not seem to value these groups any longer, except as places to support campaigning.
Now that we are short of HCP in hospitals, we could have ordinary folk giving vaccines under the supervision of one well-trained HCP. Because it takes very little time to learn how to give an injection. I have been told this is all because of liability/insurance or similar blah, blah. I'm not buying it -- we protected LTC from lawsuits, we could have done the same in other areas. If that was even the issue.
In fact, it is worse than you think, because the volunteers that used to work in hospitals have not been welcome since the beginning. (At least this is the case with Sunnybrook, so I am assuming it is widespread.) So HCP are going to be forced to take on mundane tasks formerly done by volunteers.
Maybe citizens need to start organizing ourselves. How do we do this? Because politicians are not going to do it, that is very clear.
Once again you have hit the nail on the head, Jen. Just don't make any predictions, okay?