What it means to live with COVID

On Monday, children across Nova Scotia are set to return to their schools after this week’s March Break.

While some restrictions will remain in place for the health care system, students will be re-entering classrooms on the same day that the province enters Phase 3 of its reopening plan.

Public health and school public health restrictions are ending, as are physical distancing and mask requirements.

On Thursday, the IWK Health Centre published an open letter written by the NS Pediatric Pandemic Advisory Group. Its members —physicians working in pediatrics at the IWK and other parts of the province —”strongly recommend” mask wearing in schools until at least mid-April.

“Schools, like hospitals, provide an essential service. We need our students and educational staff to be healthy and able to attend so that all can benefit,” the letter states, in part.

The authors also note the importance of ensuring students aren’t bullied for wearing-or not wearing-masks.

“Discuss this with your children. Be kind to one another, and tough on the virus,” they wrote.

Pediatricians aren’t the only ones encouraging the ongoing wearing of masks. In a Twitter message on Wednesday, the union representing Halifax Transit workers also asked people to continue using them.

“Although restrictions are lifting Monday, #CovidIsNotOver. Realizing we transport 1000’s of people a day, we hope you will still wear a mask during your short trips with us #safetyforever #Halifax #hfxtraffic #Haligonia,” read the tweet from ATU Local 508.

During a press conference on Wednesday, the World Health Organization’s (WHO) director-general Dr. Tedros Adhanom Ghebreyesus addressed the rise in reported COVID-19 cases globally (especially in parts of Asia) following several weeks of decline.

“These increases are occurring despite reductions in testing in some countries, which means the cases we are seeing are just the tip of the iceberg,” he said.

“And we know that when cases increase, so do deaths.”

While many are embracing the next phase on Monday, others — particularly those who are deemed more at-risk should they contract COVID-19 — are anxious.

On Thursday, the Halifax Examiner spoke with Dr. Scott Halperin, a professor of pediatrics and microbiology and immunology at Dalhousie University and infectious disease at the IWK Health Centre. Halperin is also director of the Canadian Center for Vaccinology and a member of Canada’s COVID-19 Immunity Task Force (CITF).

We asked Halperin about what it means to live with COVID, dropping mask requirements, how to best protect those who are at risk, and what we might be looking at as numbers surge again globally.

Here is our conversation, edited for brevity and clarity.

Halifax Examiner (HE): The WHO yesterday addressed the global rise in cases. They called it the tip of the iceberg and warned nations to be vigilant. In your opinion, how concerned do we need to be? Could another wave be on the horizon?

Dr. Scott Halperin (SH): Absolutely it could be. I think we’ll certainly see a bump in cases. Whether it rises to the number that we start calling it another wave really depends. I think we’re in a better position to manage it in terms of population immunity. Therefore the likelihood that it’s going to bring us to the edge of our ability to manage things in ICUs and hospitals, I think that’s quite low. But then I wouldn’t underestimate it.

For me, the public health goal of not overwhelming the hospitals was very important and at the time was critical. But I don’t think that’s the only goal. To me, the only goal is to try to have no one dying of this disease and as few people hospitalized and in ICU as possible.

If we have another wave, a bump of cases, there will be people who die and there will be people who get hospitalized and go into ICUs. Whether that overwhelms the system or not from a systems standpoint, that’s important because then you won’t have people dying of other things because they can’t get hospital beds. But there will still be people dying of COVID. To me, the goal is to minimize that.

We do need to be vigilant and I think we’re missing the subtlety and the nuance of the public health messaging, at least in Nova Scotia. Nova Scotia’s saying that they’re going to be decreasing public health obligatory measures. They’re not saying that people should stop doing those types of measures. They’re saying that the responsibility is being placed on the individual rather than being enforced by public health. But it’s not changing the message that this virus is still out there, it’s still circulating, it can still cause severe illness, hospitalization, and death.

HE: Are you hearing from many people distressed by the number of deaths that we’ve had in the last couple of weeks as a result of this pandemic?

SH: Absolutely. I think the change from daily to weekly reporting does two things. It takes it off the front burner. But then once you see the numbers, you say, ‘Oh my God, there were 2,500 cases last week, there were X number of deaths.’ Because when you take all seven of those days and add them together, one or two deaths a day turns out to be 14, 15 deaths. That’s still too many.

HE: From your perspective, how important is masking in schools?

SH: Masking is important overall. It helps slow spread. We know the Omicron variant is more transmissible. We know the new Omicron subvariant is even more transmissible, and masks do provide some benefit. We’ve certainly seen higher rates of spread in schools where the kids are a little less likely to follow masking.

Masks have been demonstrated to be an easy, risk-free intervention. As the mask mandates come away, that doesn’t mean masks shouldn’t be used. I’d still like people to use masks when and where they are gathering in larger groups of people that they don’t know. So in grocery stores, shopping malls. It still has a benefit even if public health says you no longer have to keep it on.

HE: Are you personally going to continue masking? It sounds like yes.

SH: Absolutely. I will mask in those areas where there are large gatherings and where I don’t know people. And, of course, we’re not lifting the extra mask requirements in the hospitals at this time, and that’s where I spend a lot of my time.

I’d rather it not be that the hospital is the safest place for me to be. Usually, as an infectious disease specialist, the hospital should be a more risky place for me. I think it’s counterintuitive that I can go to the hospital and see infected patients and feel safer than when I go to the grocery store.

HE: What message do you have for frontline workers who might be distressed about the removal of mask requirements next week?

SH: A good point to bring out is that we should think of others in this too because we can choose to wear a mask or not. But the mandates were very nice for people who are frontline workers, in places like grocery stores and malls, and all who had to be there.

Wearing a mask protects them. We should be thinking of them too as we decide whether or not to wear masks because the variant is still circulating, the virus is there, and those people have to be at work. Having a bunch of people walking around without a mask is not very encouraging to them because they’re putting themselves at risk every day.

HE: Some people who continue to have concerns are sometimes accused of living in fear. Are you personally concerned?

SH: The pandemic’s not over and we’ve got a virus that continues to mutate, so I think we have to be very diligent in our monitoring of the situation. That’s why I think we need to continue doing what research is necessary to try to improve vaccines so that we can really get on top of this virus and the way it’s affecting the world.

I don’t think it’s paranoia. I think it’s careful and reasonable monitoring of the situation. We need to understand that vaccines still haven’t penetrated all parts of the world, so this virus can continue to mutate and then be reintroduced into Canada with possibly a more virulent strain. One has to continue to live and function, but to me being careful does not equate with paranoia. I think we need to be very careful about letting down our guard too much at this point.

HE: Can you talk about the low vaccine uptake in children five to 11? I know here in Nova Scotia it’s better than the national average. But what’s your messaging to parents?

SH: We should somewhat congratulate ourselves on being here in Atlantic Canada the highest in terms of pediatric vaccination. And that’s a good thing. When you look across the world, we’re doing probably amongst the best. That’s really good and that’s really important. Our parents are immunizing their kids to protect their kids, but a nice side benefit of that is protecting the people the kids come into contact with.

But we shouldn’t pat ourselves on the back too much because public health is telling us that while most of those kids are now eligible for their second dose, the fall-off for parents completing those second doses is being detected. So while parents are getting those second doses, it’s behind schedule for what we’d expect for when those first doses were, that two-month interval. Parents are becoming complacent and saying, ‘Well, maybe I won’t get the second dose.’ And we do know that the second dose is very important for any protection against the Omicron variant.

We want to congratulate parents for getting that first dose, but we want to encourage them to get the second dose. The vaccine is very well tolerated by kids. Even the minor adverse events that adults had, like the very sore arms, the feeling like they have a flu-like illness, just being under the weather for a day? While those can happen in kids, they’re happening at a much lower frequency. It’s tolerated so much better and they’re getting good protection.

HE: What about parents who are concerned about the possible side effects of the vaccine given that children seem thus far to have fewer effects from COVID-19 infections?

SH: I’d be very much encouraging parents to finish out those doses and not underestimate this because there are cases where kids are getting those other effects from COVID. Some of them are getting more severe disease, some of them are getting the multisystem inflammatory syndrome, MIS-C. While that’s rare or uncommon, it’s not completely absent so there is something severe to protect against in children as well.

When parents say, ‘We don’t know much about the vaccines.’ Vaccines for kids were studied in as many kids as for any other new vaccine that’s been introduced in Canada. It’s not like they were rushed in kids. They came to kids even slower because the regulators were more careful.

HE: What do you think we should we be doing at this point of the pandemic?

SH: When people talked about ‘OK, we’ve got to get used to now living with COVID,’ that doesn’t mean going back quite yet to being completely open with no precautions. Living with it means to incorporate some of these things that we’ve learned. Good hand hygiene, masks when in areas where it would be more risky, following the vaccine recommendations, and getting immunized. And for adults that means getting that third dose and for kids getting that second dose.

All those things should be now incorporated as part of our norm. That’s what living with COVID means. It doesn’t mean saying, ‘OK, well, we’re just going to accept the fact that some people are going to get infected and die.’ To me, that’s dying with COVID. That’s not living with COVID.

HE: Some people in my circle who are immunocompromised are certainly feeling somewhat abandoned and scared.

SH: That’s where we need to take the public discussion and public discourse, talking about what that means to live with COVID. To get that nuanced public health message out that it’s taking individual responsibility, but it’s not individual responsibility for yourself. It’s individual responsibility for others, too.

We still have a social contract here in living together, and that just means it doesn’t all have to be mandated by government. But the rest of us should say, ‘You know, I’m going to do what I need to do to protect myself, my family, and others.’ And then not drop out that ‘others.’

HE: What can people do to best protect themselves and their loved ones?

SH: My preference would have been to do this (removal of mask requirements) a little bit later when people are spending more time outside. But people can still do that on their own, saying, ‘OK. I’m going to keep my mask on because I’m still spending a lot of time indoors and I’ll get to take my mask off more in another couple of months when things warm up and I’m spending more time outside.’ So taking that responsibility on their own to say the government doesn’t have to make all the rules, I can make some of these rules for myself.

HE: Do you personally have any concerns about long-COVID?

SH: Yeah. You can certainly decrease the likelihood of getting long-COVID if you decrease the likelihood of getting COVID in the first place. What we don’t know yet is whether the likelihood of getting long-COVID is more likely if you get severe COVID. We will have a better idea of that.

But in the meantime, I’d rather not learn by having a lot of people who got mild disease because they let down their guard find out later that the risk is equally as high as in people who were hospitalized. I think anything we can do to prevent and slow down the transmission is good. As we keep immunizing to get the population immunity up, hopefully we’ll have modified vaccines that will then protect against even mild disease as time goes on.

HE: Is there anything I neglected to ask that you think would be important to articulate?

SH: I do think the nuanced message that we need to get out is very important. We’re not ready for end-of-pandemic parties, but we’ve certainly seen some where then large numbers of people get infected. We’re still not there. I think people still need to take precautions and just make it part of their normal activities to continue to be careful.

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