Learning to live with COVID-19

Covid-19 and our future:

The changes we will learn to live with

When the first vaccines were announced as a success, the world breathed a collective sigh of relief. ‘There will be an end to this’, was the promise. Yet, the reality is, we are destined to live with Covid-19 for a long time yet. It’s not going anywhere, and it certainly won’t vanish overnight.

How will we adapt to a deadly virus that won’t go away?

By Richard Forsyth

There have been pandemics throughout human history, yet Covid-19 in today’s world still feels like uncharted territory with so many shifting variables. In just a year and a half so much in our lives has changed. We have learned to live with wearing face masks in all indoor public venues, we have learned to live without going out to visit people and places, and we have learned to test ourselves regularly for the virus. Many of us have also learned to live without jobs, loved ones and the health we once took for granted.

Now the vaccination programmes are rolling out, how can we foresee the future of our daily lives evolve? People are still getting infected, despite vaccinations. Some are weary of constrictions to freedoms to a point they no longer care, whilst others have developed a terror of going beyond their house, and for mixing with others in any way. Beyond these different reactions to cope, there are some things that will become routine and impact us all, some familiar and some not. Covid-19 is widely expected to stay with us, rather than be eradicated, so what do the days, weeks, months and years look like moving forward? What will we notice about changing life in the era of Covid-19?

A passport for rights

One change we need to get used to is using so called ‘vaccination passports’. The EU has made the Covid-19 passport documentation a sufficient proof of vaccination for no restrictions to entry to an EU country. The idea is that those who are double vaccinated will be able to travel between countries without a requirement to quarantine.

Beyond a ‘green light’ for travelling, there is the controversial question of passports being used for allowing unrestricted access to venues such as museums, bars, gyms, nightclubs, stadiums, shops and even schools and higher education institutions. Whilst seeming a very practical way to show vaccination status, there is the glaring ethical question mark over the passport scheme. This could lead to a society split in two groups, one group that is stripped of basic rights, denied entry to most establishments. Whilst a vaccination is essentially a choice, there will be a margin of people who cannot take vaccines for medical reasons, beliefs, moralities or fear. The moment such as a passport becomes a way to enter any crowded venue, or rather to enjoy rights of movement, is a moment that human rights of a proportion of the population are taken away. It could lead to ostracisation, stigma, persecution and could prove a grim, lonely outlook for those without the correct ‘pass’.

France has already witnessed a rage fuelled backlash for introducing its health pass (pass sanitaire) and making vaccination compulsory for health workers. In July, 100,000 people protested and vaccination centres were vandalised in response to the measures.

In April, just prior to the health pass introduction, President Macron himself said, “The health pass will never be a right of access that discriminates among the French. It cannot be made compulsory for access to everyday places,” and yet the pressures from the rapidly spreading Delta variant led to a very sudden and dramatic U turn.

From 21 July, the health pass was made compulsory to access leisure and cultural venues with over 50 people, like museums and cinemas. And from August, the health pass was supposed to be essential if you wished to shop or sit down for a drink or food at a restaurant, even with an outdoor area. Since the protests, the French government has made some concessions, like lowering fines for noncompliance and changing the rules for shops, but it is a reality, that these types of passes are being rolled out across Europe, and the world. They are to be a major part of the fight to reopen the streets and the economies of beleaguered countries.

Another significant problem is that there could be a particularly hard hit, for poorer areas. In the US it was picked up by the Kaiser Health Foundation that vaccination rates of racial minorities and people in less affluent areas were behind the general population in take-up. This was for a variety of reasons from locations, transport issues, lack of technology etc but what’s apparent is the new ‘passports’ could drive a deeper wedge between the ‘have’ and ‘have nots’ and punish already pressured communities and individuals unfairly. Marginalising groups on health status is also a contentious issue. How this develops will attract close attention from human rights groups and politicians all over the world but it looks like vaccination passports might be here to stay, as an imperfect, quick fix to an incredibly difficult problem.

Will testing fall apart?

In the absence of a Covid-19 passport another safety check is of course, being tested. A negative PCR test 72 hours before travel or proof of recovery from infection, also allows for restrictions to be lifted. This could also apply to any access to crowded venues.

Since 2020 a culture of testing has become part of our daily lives. School children, any worker in a public place and those with symptoms have lateral flow tests regularly. Testing may become the onus of the individual moving forward, who will need to potentially pay for those tests, which have thus far been free in countries with free healthcare. This kind of testing is creating something of an industry, and with costs for a PCR being equivalent to a week’s shopping for some, they may be prohibitive for regular use.

This could lead to less testing, indeed with vaccination passports, testing will almost certainly diminish compared to the regularity we have seen prior to the summer. Whilst PCR tests are often required for certainty with individuals when travelling for example, for someone who just feels ill one day, they may not bother. As society becomes more open, and tests being less freely available, we will at some point stop testing rigorously and with that we lose the data on infection rates just when they may start to rise. It will be an uncertain moment, because testing regimes have been something that has been the guiding force for national policies on handling the crisis so far, as well as isolating the infected in quarantine. Could it lead to overwhelming national healthcare systems, if we ease off testing regimes too soon? In short, we may risk losing perspective of any growing new waves with less testing, as was the case for many countries in the first waves of the pandemic.

The challenge of herd immunity

It is possible that Covid-19 will be with us for several years, or several generations or permanently, however, it will at some point become a substantially reduced threat to life and health it is theorised. Those who encounter it and beat it, those who are vaccinated, are part of a defensive chain of events, that will provide stronger immunity for populations. Herd immunity was initially proposed as a solution by the UK Prime Minister, Boris Johnson, in the early days of the pandemic to suggest natural herd immunity would occur if the virus was left to infect society. This of course was seen as a big mistake when the projected deaths were forecast.

Vaccines can help create herd immunity but achieving this is not the same for every disease. The more infectious the disease, the more of the population needs to be immune, to stop it spreading. For example, for measles it was estimated that 94% of the population needs to be immune to stop the chain of transmission. Covid-19 as we know, is highly transmissible so it follows a very high proportion of society needs to be immune for this to occur effectively. The vaccine rollouts are crucial to speeding up the process

The Covid-19 pandemic has reshaped infrastructures, affected culture, and changed our expectations.

which would otherwise take a long, long time and lead to a catastrophic amount of deaths. The vaccine rollout does not mean those vaccinated cannot catch the virus as it is clear that reinfection can and does occur in some who are double vaccinated. A positive indicator, however, came from the UK in the advanced stages of their vaccination programme on 19 July when Patrick Vallance, the UK’s science chief confirmed 60% of hospitilisations are people who have not been vaccinated. The whole UK’s gambit on opening up was on the evidence they had significantly weakened the link between contracting the virus and hospitalisations and death. At the time of writing, in the UK, all the numbers are rising: infections, hospitalisations and deaths. Whilst there are obviously less people in hospital care and less deaths, what will be the acceptable thresholds before taking action or a lockdown, remains unclear. As Covid-19 variants mean we can still become ill despite vaccination, herd immunity is not really possible. the best we can hope for at present is small percentages, lessened illness and death rates more in line with flu.

Healthcare shockwaves

Many healthcare systems are now dealing with a backlog of years of treatments that were on hold because of the virus. In 2020 across Europe, there was a significant increase in excess deaths in March and April and whilst Covid-19 played its part up to 50 percent in some regions were recorded as non-Covid-19 related. Cancellations and avoiding operations and treatments could be part of this, and as Europe continues to face a backlog of treatments the problem remains significant.

For many countries, the daily healthcare support and infrastructure has been damaged, with long waiting lists for postponed treatments, leaving many with worsening conditions and exhausted healthcare workers now facing more uphill battles with what should be ‘business as normal’.

Every country is handling the Covid-19 pandemic in slightly or wildly different ways and that is also affecting outcomes, sometimes in unforeseen ways. New Zealand was praised for its quick response and long lockdowns which proved effective in quashing the spread of the disease, but we are only now seeing other issues emerge such as ‘immunity debt’ where children who would normally develop immunities to illnesses by mixing with other children, are becoming very poorly when they reintegrate in society. It seems when our patterns are out of balance, all kinds of issues can emerge that we did not expect.

Something we can expect moving forward, is the strain on our healthcare systems to continue to take a toll. To compound the work related pressures, workforces in healthcare have also been severely short staffed when Covid-19 infections rise as sickness or precautionary isolation means many key workers cannot be in their places of work. As a society we may have to learn to live with a reduced capacity for addressing healthcare needs and for some, hospitals induce fear, and are being seen as ‘no go’ areas.

Tests and isolation

Contact tracing has been widely adopted, to know who has been in close proximity with confirmed Covid-19 cases. This ‘test, trace and isolate’ policy was seen as a fail-safe but there are challenges that have emerged. For example, the tracking is done by mobile phone – in the UK this was an app that pinged you an ‘isolate for 10 days’ instruction if you were within two metres of someone with confirmed Covid-19. In the week up to 7 July there was what the media termed a ‘ping-demic’, where over half a million people were pinged by the NHS Covid-19 tracking app. The isolation advisories also caused a shortage in lorry drivers which left some shelves in supermarkets without stock. This was immediately followed by a wave of the population, one in four a poll revealed, uninstalling the app, as it meant they would be missing work, could not interact with family or had their plans completely disrupted. This mass-deletion of the software has been likened by those who were involved in the app as ‘killing the canary in the coalmine’. Indeed, the app was only an advisory, not legal binding unlike a direct instruction by the NHS to isolate but it shows that people are less willing to be tracked and traced when it interferes with their lives and jobs if they have an ‘out’. There is something equally Orwellian if they are at some point in the near future, made to install the app by law.

The public willingness to adhere to isolation plays a huge part in what happens next, for populations who are reeling from a year and a half of not being near people and seeing loved ones. The battle in this pandemic is not just with the virus but also with the hearts

and minds of all the citizens. It’s possible that track and trace may become too problematic and unpopular to continue effectively. However, whether it’s a health passport or tracking software, it’s clear our own mobile phones are seen as a key monitoring device for citizens moving forward.

Jabs and masks as standard?

Pfizer and BioNTech have stated their vaccine will remain effective for at least half a year after the second dose, and so a third jab would be advised after this time period has elapsed. Pfizer CEO Albert Bouria also revealed it would ‘likely’ to be necessary to take an annual vaccination. That would mean repeating an exercise across Europe that has, as we have seen, required a huge effort and enormous resources from organisers and a steadfast commitment from the public. With such new vaccines, there will need to be research and collecting more data for definitive answers on longevity of effectiveness, but we should be prepared for potentially a culture of jabs on-going against Covid-19, at least in the near future.

With mask wearing in the future, the jury is out. When the UK announced ‘Freedom Day’ on the 19 July, the legal requirement for masks was largely abandoned. However, there was a mixed response from the public and businesses to this. With a rise in infections businesses did not want to be forced to close their doors or infect staff, so many have asked people to continue wearing masks. Indeed, despite signs at some supermarkets saying clearly it was no longer a requirement legally, many customers chose to continue to wear masks. It may be a long while till people feel completely safe, especially when the infection is far from finished and disrupting lives across countries. Masks maybe part of a daily precaution, a habit and a way to prevent spreading infection, for many people for a long time yet.

Rise in remote working

Finally, something that is already happening for many of us is a changing nature of our work and home lives. In 2020 people were instructed, where possible, to work from home by their governments, creating essentially a global testbed for gauging productivity of home workers as opposed to office-based workers. It accelerated a trend for remote working. In the same year, a record number of high profile companies announced moves toward more permanent flexible and hybrid ways of working. For industries that can adopt remote working, with online collaboration tools, work and home lives for many employees will merge as one.

McKinsey and Company analysed the potential of remote working across more than 2,000 tasks used in 800 occupations in eight focus countries. Taking those tasks into account that can be done with remote work with no loss of productivity, they revealed that about 20 to 25 percent of the workforces in advanced economies could work from home between three and five days a week, representing four to five times more remote work than before the pandemic. Companies and workers could also move out of large cities.

For companies and workers there are savings, and less movement means less carbon footprint. To illustrate personal savings possible, let’s look at the UK for example, where 26% of British workers plan to continue to work from home permanently or occasionally after lockdown. On average, it’s been estimated each of these workers will save £44.78 a week by cutting out things like commuting and buying lunch out. Essentially it was also found from two different surveys, that around two-thirds of employees say they’re more productive when working from home. The right to working from home is being woven in government policies too, like the German ‘Right to Work from home’ bill, which means 80% of the workplaces in Germany now have a flexible work policy.

The Covid-19 pandemic has reshaped infrastructures, affected culture, and changed our expectations. The future of living with Covid-19 may well depend on each of us, how much social mixing we choose to do, how we take precautions, if we take the likelihood of meeting someone infected seriously. Covid-19 has disrupted schools, businesses, lifestyles and family and friends and it has led us to make changes around the way we choose to live. We are all desperate to see the back of this disease but as we forge ahead, with a hope resting on vaccinations, there are inevitably going to be some adjustments to make. The truth is, we will be in the process of adapting for a long while yet.