How countries are learning to Live with COVID

Almost all coronavirus restrictions have been lifted in England. Vaccinated people can travel to Germany without being quarantined. Outdoor mask laws have largely been repealed in Italy. Singapore’s shopping malls remain open.

Eighteen months after the coronavirus first appeared, governments in Asia, Europe, and the Americas are encouraging people to resume their daily routines and adjust to a new normal in which subways, offices, restaurants, and airports are once again crowded. The mantra is becoming increasingly consistent: we must learn to live with the virus.

Scientists warn, however, that pandemic exit strategies may be premature. Because of the emergence of more transmissible variants, even wealthy nations with ample vaccines, such as the United States, remain vulnerable. We closed our international border in Australia because we realised, we couldn’t keep the virus out.

Rather than abandoning their plans, officials are beginning to recognise that rolling lockdowns and restrictions are a necessary part of the recovery process. People are being encouraged to change their pandemic mindset and focus on avoiding severe illness and death rather than infections, which are more difficult to avoid. Countries with zero-carbon ambitions are reconsidering their plans.

For months, residents of Singapore scrutinised the specifics of each new Covid case. When infection rates reached double digits for the first time, there was a palpable sense of dread. With borders closed, there was also a sense of defeat, because even the most stringent precautions were insufficient to prevent infection.

“Our people are battle-weary,” a group of Singapore ministers wrote in an opinion essay in the Straits Times newspaper in June. “All are asking: When and how will the pandemic end?”

Singapore officials announced plans to gradually ease restrictions and chart a course out of the pandemic. Instead of infections, the plans called for tracking the number of people who become critically ill, how many require intensive care, and how many require intubation.

These measures are already being tested.

Outbreaks did spread to several karaoke lounges and a large fishery port, and on 22 July Singapore announced tightening measures, including a ban on all dine-in services which was just lifted on Friday 6 August. The Ministry of Health announced in a press release that fully vaccinated individuals will be able to dine-in at Food and Beverage (F&B) outlets from Tuesday, 10 August.

In addition, the current restrictions on group sizes for social gatherings have been also raised from two to five for fully vaccinated individuals from 10 August.

Gan Kim Yong, the trade minister, said the country was still on the right track, comparing the latest restrictions to “roadblocks” on the way to the final goal.

Singapore has fully vaccinated 70 per cent of its population and has cited Israel as a model. Israel has shifted its focus to severe illness, a strategy dubbed “soft suppression” by officials. It is also experiencing a sharp increase in cases, which has risen from single digits a month ago to hundreds of new cases per day. The country recently reinstated the requirement to wear an indoor mask.

“It’s important, but it’s quite annoying,” said Danny Levy, 56, an Israeli civil servant who was waiting to see a movie at a cinema complex in Jerusalem last week. Mr. Levy said that he would wear his mask inside the theatre, but that he found it frustrating those restrictions were being reimposed while new virus variants were entering the country because of weak testing and supervision of incoming travellers.

Michael Baker, an epidemiologist at the University of Otago in New Zealand, said that countries taking shortcuts on their way to reopening were putting unvaccinated people at risk and gambling with lives.

“At this point in time, I actually find it quite surprising that governments would necessarily decide they know enough about how this virus will behave in populations to choose, ‘Yes, we are going to live with it,’” said Mr. Baker, who helped devise New Zealand’s Covid elimination strategy.

Longer-term restrictions appear to have been accepted by New Zealanders. In a recent government-commissioned survey of over 1,800 people, 90 per cent of respondents said they did not expect life to return to normal after being vaccinated, owing in part to unanswered questions about the virus.

Scientists are still learning about “long Covid,” or the long-term symptoms that hundreds of thousands of previously infected patients are experiencing. Covid-19, they say, should not be treated like the flu because it is far more dangerous. They are also unsure about how long vaccines provide immunity and how well they protect against variants.

Much of the developing world is also still facing rising infections, giving the virus a greater opportunity to rapidly replicate, which then increases the risks of more mutations and spread.

Only 1 per cent of people in low-income countries have received a vaccine dose, according to the Our World in Data project.

In the United States, where state and local governments make the majority of decisions, conditions vary greatly from place to place. States with high vaccination rates, such as California and New York, require unvaccinated people to wear masks indoors, whereas others, such as Alabama and Idaho, have low vaccination rates but no mask mandates. Some schools and universities intend to require on-campus students to be vaccinated, but several states have prohibited such requirements for public institutions.

Several state legislators in Australia suggested this month that the country had reached a “fork in the road” and needed to choose between continued restrictions and learning to live with infections. They predicted that Australia would have to abandon its Covid-zero strategy, as has much of the rest of the world.

Gladys Berejiklian slammed the proposal right away. “When our vaccination rates are so low, no state, nation, or country on the planet can live with the Delta variant,” she said. Only about 11% of Australians over the age of 16 are fully immunised against Covid-19.

Prime Minister Scott Morrison has also distanced himself from calls for a change in the country’s Covid protocols.

Countries in places where vaccine shots have been widely available for months, such as Europe, have bet big on their immunisation programmes as a way out of the pandemic and the key to keeping hospitalizations and deaths low.

Germans who have been fully immunised within the last six months are allowed to dine in restaurants without presenting proof of a negative rapid test. They are free to meet in private and travel without being subjected to a 14-day quarantine.

Masks are only required when entering stores or crowded areas in Italy, but many people continue to wear them, even if only as a chin guard. “My daughters chastise me, saying I’ve been vaccinated and don’t need to wear a mask, but I’ve grown accustomed to it,” Marina Castro, who lives in Rome, said.

England has taken the most drastic approach, vaccinating nearly all of its most vulnerable residents. Despite the rise in Delta-variant infections, particularly among young people, the country lifted nearly all Covid-19 restrictions on Monday.

Pubs, restaurants, and nightclubs flung their doors open wide on “Freedom Day,” as the tabloids dubbed it. Gathering restrictions and mask requirements have also been lifted. People were seen eating outside and sunbathing cheek to jowl.

In the absence of most rules, the government is urging people to use “personal responsibility” to keep themselves safe. Britain’s health secretary, Sajid Javid, who tested positive for the coronavirus last week, stated last month that the country needed to “learn to live” with the virus. Despite the fact that polls show that the English public prefers a more gradual approach to reopening.