What does 'living with Covid' actually mean?
Last year, Covid hit and made 2020 an exceptionally unpopular year. At that time, I feel like we heard a lot about “returning to normal”. Maybe this would happen later in 2020, maybe it was for 2021, but it was going to be sometime in the not-too-distant future. In the meantime, Australia was (largely) CovidFree and we were told the world envied our freedoms.
Fast forward to mid-2021, there were major outbreaks in Sydney and Melbourne, over half the population of Australia were in lockdown, and the message had changed to “living with Covid”. Other countries were managing it (which perhaps gave them a break from envying us), so why couldn’t we? Vaccination targets were established for re-opening, the vaccination program was sped up, and both NSW and Victoria are now officially “living with Covid”.
The politicians have been out in full force for months selling it. But what exactly is being sold?
For months, this has been presented as a major reason for getting vaccinated.
We would be able to end lockdowns. See family members. Be able to do the things we love again:
No matter what case numbers were doing, the commitment to the people of Victoria and Australia was that when we reached certain vaccination targets we would be granted extra freedoms. We would get back to normal, and be able to live with Covid.
This kind of language is certainly motivating, but I think it’s also dangerous. Different people have very different ideas about what is “normal” and which things they really want to be able to do again, and if the reality doesn’t live up to the hype a lot of people could end up disappointed.
Two different visions
In broad brush strokes, I think there have been two main visions presented:
Treating it like flu: I think this is the hope many of us had at the start of the year, when vaccine efficacy numbers came out higher than expected. If Covid vaccination reduced the risk of serious complications and death enough, maybe Covid would be no worse than flu. If so, why would we continue to treat it more seriously than we ever treated flu?
In this world, perhaps there would be no more worrying over daily case numbers. No more need for masks, and no more stigmatisation of anyone unfortunate enough to cough. Freedom to have large gatherings, major sporting events, concerts, and indoor dining.
Border controls could be relaxed. That would allow people to reunite with their family overseas or have family visit them. Australians could go on international holidays, while tourists and international students and workers could come here.
Retaining significant control measures: In this model, vaccination allows us to lift some restrictions and do some things we weren’t able to do under lockdown, but significant control measures will remain. It won’t even be close to “a return to normal”, and could include many things we didn’t expect and don’t like.
In this world, we’ll still be tracking Covid cases and obsessing over the numbers. People catching Covid will be placed in isolation. Close contacts may also be placed in isolation, and if we have higher Covid case numbers there may be a lot more close contacts affected.
Masks could still be required. There could still be density limits and restrictions on crowd sizes. Areas considered hotspots could be locked down. People may have to prove their vaccination status.
Covid tests and quarantine would still required for international travel (and in fact they might be required for inter-state travel as well).
The one extreme prioritises a “return to normal” while losing all ability to control Covid spread. The other extreme contains some normality, but keeps a lot of the things we didn’t like about the previous version and adds the need to prove vaccination status. And the reality is somewhere in the middle.
I don’t think this is an intentional bait and switch, but sometimes it feels like it. These are very different visions, and I’m not sure how clearly that has been articulated.
What was I hoping for?
Back in February I wrote about what I hoped a “return to normal” would look like:
I think the long-term hope is an actual return to “normal”. Being able to move on from the uncertainty and the many changes we’ve had to make to our lives, from the major to the small but annoying.
To me, it’s things like not having to frequently don masks. Not having to check-in when visiting anywhere. Not feeling an instinctive need to keep a distance when encountering others. Not having to worry about what might change next week or next month.
But it’s also being more easily able to have mass gatherings of people: Festivals, sporting contests, concerts, plays. Some of these things have been permitted, but often with lower capacity and a lot more red tape and hygiene theatre. Understandably, that means that many event organisers just don’t even bother trying.
What I wanted is much closer to the “treating it like flu” model, and I think I even used those words sometimes. Some of them are things that we have got with our current “living with Covid” strategy. More than I’d have expected a couple of months ago, to be honest (though there are still caveats, which I’ll get to later).
I very much hope that we have had our last Covid-19 lockdown, and that once we ease restrictions they will be able to stay eased. Mass gatherings are also being permitted, and I gather we’ve got rid of just about all density requirements (though I think in places like the theatre world many have gone “We’ll wait till next year to restart”).
Victoria has been fairly conservative relaxing restrictions throughout the pandemic, so I expected indoor masks and at-home quarantine for international travel to be around for the long term. Instead, originally we planned to largely remove those for the fully vaccinated when we reached 90%, though more of the mask rules remained than expected, and some international quarantine has come back with Omicron fears.
However, for other parts of what I wrote the red tape has actually got worse than it was in February, and it’s expected to stay for the long-term. Checking in, for example, was expanded in May to include workplaces, most retail and takeaway food (not just dine in). And now many of those places require proof of vaccination, and we’ve been told this requirement is likely to remain for the long term.
Two levels of politics
Throughout the pandemic, the goals of the federal government and the goals of the individual state governments have been in conflict. The states have been more responsible for health (which has meant bringing in significant restrictions), while the federal government has been more responsible for the economy (including financial support for those in the affected states). This is a simplification, of course: I think the federal government are aware that controlling Covid has also given people more freedom to spend (fuelling an economic recovery), while NSW in particular focused more on the economic implications of lockdowns and the need to “live with Covid” than other states did.
This has led members of the federal government to push for restrictions to be relaxed faster, for inter-state borders to be re-opened, and for us to learn to “live with Covid”. Typically, this has required emphasising the positives and downplaying the negatives, which I think has made the situation feel more like a bait and switch.
And I think this is also where the “treating it like flu” language has come from. It’s certainly common - I heard a co-worker saying it today, and I know I’ve said it myself. But from a political level I would say it’s come most specifically from Prime Minister Scott Morrison. And this concerns me.
For example, take these words from Scott Morrison on 9 April, in a press conference after AstraZeneca was recommended for over-50s only:
If we are in a position to have vaccinated 1A and 1B then that has implications for being in a position where we can begin starting to treat Covid-19 like the flu. That’s where national cabinet wants to be.
We want to get Australia to a position where we can treat Covid-19 in the same way as we treat many other viruses.
It doesn’t mean the virus can’t be present, it just means that the virus is not going to lead to the disastrous outcomes we have are seeing overseas.
The flu, every year, sadly has impacts on Australians including fatalities sadly, but that being the case we haven’t engaged in mass lockdowns of our country because of the flu.
I was shocked when I re-discovered that quote - I had always believed the goal was to vaccinate a large percentage of the population before we opened the door to Covid. In fact, I thought we should be able to credibly say that we had at least offered it to everyone. This wasn’t just about the death rate - enough people were seriously affected with long Covid, heart and lung damage, hospitalisation, etc. that we should be cautious responding to it.
I agreed (and agree) that we needed to be able to live with Covid sometime. But at the same time, knowing that the federal government have consistently pushed for re-opening for political reasons at a time when it was almost certainly too early, it’s hard to then trust their next target. It makes the push to re-open feel more political than evidence based. Scott Morrison wanted lockdowns to be over, and ideally to get the credit for ending them and giving us a new way forward.
That’s led to me being torn over the last few months. When Morrison has said “We can’t stay closed forever, we need to open up sometime”, I go “I completely agree, and I’ve been saying that for a very long time”. When he’s said “If not at 80%, then when?” I’ve kind of agreed - at some point you do need to draw a line. But is 80% the right place to draw it?
When the Doherty report was first released, it felt like its main goal was to give cover for what the federal government wanted to do anyway. This Tweet made a lot of sense to me:
In every press conference, replace the words “Doherty modelling” with “federal election campaign” and it all makes much more sense.— Alex Giurtalis (@AlexGiurt) August 26, 2021
Politically, it’s ended up a blunt instrument, with the 70% and 80% targets presented as set in stone, but without as much consideration of the various mitigation measures that were in the Doherty Report. As I wrote in my last post, I really didn’t understand why Victoria was being pressured to follow NSW’s easing of restrictions when our situation was clearly different.
Morrison used the flu image again back in July when describing the four phase Australian plan. For the third phase (after widespread vaccination), he said:
So, when it is like the flu, we should treat it like the flu, and that means no lockdowns.
But this is getting to the heart of what living with Covid really means. Yes, treating it like flu would mean no more lockdowns. But it would also mean most of the other things I described as a “return to normal”, some of which seem certain not to happen for a long time. It seems Morrison has acknowledged this (as “common sense”), while also trying to down-play the consequences.
In late September, I was struck by this in a Weekend Sunrise interview with Morrison:
It means, it’s not carte blanche. Of course, there are sensible, common sense things we’ll still need to do to live with the virus, just like people are here. There’s not no controls. Of course, there is common sense things that we will do, there’ll be the QR code log ins and all that sort of stuff, wearing masks perhaps occasionally in particular settings. But, you know, comes a time when you just got to move on and get on with it.
I think this is important because he’s tacitly acknowledging what I think some of the biggest potential concerns with “living with Covid”. He mentions two different things here: masks and QR codes. However, they are very different things.
I’ll be honest: I don’t like masks. I’d prefer them to be required in fewer places. However, they do act to reduce Covid transmission, so requiring them might make some amount of “common sense” (and not just “occasionally in particular settings”, either).
Checking in is different. As my brother is fond of saying, QR codes have no anti-viral properties. Checking in has a purpose, and that purpose is requiring people to get tested and possibly putting them in quarantine.
It may be a simple, one minute job to check in when going somewhere, but it’s far more disruptive if as a consequence you later have to be tested or go into isolation (which has to happen sometime - otherwise “common sense” would say we shouldn’t require check-ins).
Going back to the “treating it like flu” model, we don’t track people’s movements and require them to get tested or isolate them because they’ve come into contact with someone who has flu. This may be necessary for Covid, but I don’t think it’s “common sense”. It’s a choice we make as a society - a choice that has both costs and benefits, and a choice that it seems will form part of our “living with Covid” strategy.
I highlight this because I think Morrison’s trying to have it both ways - acknowledging the measures taken by the states that mean living with Covid is not “treating it like flu”, but still trying to pretend the implications are minor.
High vaccination rates have reduced the risk of our being collectively restricted at a moment’s notice. As a society, we hope never again to have the hastily called press conference saying “We are going into lockdown tonight”. However, we probably have increased the risk of being individually restricted at a moment’s notice.
For the vaccinated majority, catching Covid is much less likely to come with serious health consequences (though it still can - which is why we continue to try and control it). However, with higher case numbers in the community it’s more likely to disrupt the lives of individuals. This to me has been one of the biggest question marks since we started “living with Covid” in earnest: Will it affect our planning? And will it make us more cautious?
I knew about this in theory when we were still in lockdown. However, since then I’ve heard much more about it in practice - work site exposures, co-workers with school kids in isolation, people with casual exposures needing to get tested. It hasn’t yet affected me personally - but maybe it’s only a matter of time.
Being more socially active will probably increase the risk of catching Covid - but it also increases the chance of being placed in isolation and possibly having to cancel other arrangements as a result.
We have been reducing the impact of this - firstly by reducing quarantine requirements for vaccinated close contacts to 7 days, then just requiring isolation until receiving a negative test. I think our Health Minister called it correctly when he talked about the benefit of “safely removing rules that could sweep hundreds of thousands of people into long quarantine at any one time”. The impact will certainly be lower than it was with 14 days of quarantine. But it will still be there.
What does this mean? It means kids who are supposed to be learning in person at re-opened schools will actually be at home isolating without proper support from their teachers. It means not being able to go to the event tonight you’ve been looking forward to for months. It means people on holiday hundreds of kilometres from home needing to figure out where and how to get tested and where and how to isolate waiting for test results. It means feeling guilt that other people have had their lives disrupted because you caught Covid.
And hopefully we’re not talking hundreds of thousands of people here, but this is part of what “living with Covid” means. It might be necessary, but it doesn’t sound “normal”, and we haven’t done it with flu.
I’ve wondered whether this will mean people going “I really want to do X, so in the week before I’ll reduce activities Y and Z to make sure I don’t miss it”. For myself, at least so far, I’ve pretty much done anything permitted that I wanted to do. But there have certainly been plans I’ve made where I’ve gone “I want to do both X and Y, so I will - but Y is more important to me, so I’d be really annoyed if an exposure from X prevented me doing Y”.
I suspect if I do get caught out once I’m more likely to be cautious, but I don’t really know. And, realistically, the disruption to my discretionary activities could come from something less discretionary - for example, going to a grocery store or going to the workplace.
What about the low Covid states?
So far, I’ve been talking about the likes of NSW and Victoria, where the decision to “live with Covid” was relatively straightforward. We had significant outbreaks, and vaccination was the way out of them. Whether we liked “living with Covid” or not, it was going to be better than what we had in August or September.
The situation for other states is much more complicated. Yes, they’ve had the potential of a snap lockdown being triggered the instant a case gets in. But they haven’t had long lockdowns, and for most of the last eighteen months they’ve been CovidFree and as a result had a lot of freedoms. So I imagine people in those states have found it quite weird to hear our Prime Minister talking about vaccination being the way to “get our lives back”.
“Living with Covid” is likely to allow a few things that those states don’t currently have, in particular inter-state and international travel. But it could also mean fewer freedoms if there is a serious outbreak. And it could mean hospital systems under greater strain - which I gather is already an issue for CovidFree WA.
There’s also a political and social element to this: Isolationist stances have been politically popular. In Western Australia in particular the incumbent party were re-elected by a landslide. Their success stories have been based on taking Covid seriously, and “living with Covid” changes that.
Those states will need to change to encouraging people to be more accepting of a certain level of Covid cases. For states that are CovidFree, this is making the choice to import Covid into the state - a disease which has previously been feared and demonised. I imagine there are some without connections to other states or countries who will want the borders to stay closed forever.
Our Prime Minister has been at great pains to stress all states should thrown open their borders the instant they reach 80% vaccinated and “honour the arrangement you’ve made with the Australian people”. However, it’s not clear to me that this is true. Throughout the pandemic, each state has been free to go off and do their own thing, and I see no reason why that should change now.
Listening to the likes of Scott Morrison and former NSW Premier Gladys Berejiklian over the past few months, you would think that the good states were the ones with major outbreaks, not the ones without them. You would think the real problem was with the lockdown free states that had kept Covid out and had the breathing space to re-open borders cautiously. This makes sense from a political point of view, but no sense in the real world.
I do think that at some point, the low Covid states will need to open their borders and become part of one Australia. South Australia have opened their borders to vaccinated travellers from Victoria and NSW, and other states have roadmaps to doing that. But there’s nothing magic about the 80%. If, say, taking an extra month or two to re-open borders allows a state to increase its vaccination rate and that leads to a better over-all outcome for the state, that seems completely reasonable to me.
There are of course costs to delay. In particular, with Christmas under a month away, some in those states will have inter-state and even international family that they want to be able to visit or have visit them. But there’s no reason for those states to rush it so Scott Morrison can win political points.
Even when the borders are re-opened, Covid controls are likely to make border crossings more complicated. The low Covid states are likely to include testing or maybe even self-isolation as an entry requirement. This is just another way in which “living with Covid” is not a return to normal. And to me right now it means that NSW looks like a more appealing destination than, say, South Australia, just because it will be less hassle getting there.
What about the variants?
In the last week, the focus has shifted to responding to the Omicron variant, WHO’s latest “variant of concern”. And I’ve noticed that responses have followed the same predictable political polarisation.
The people who were stressing the importance of us “living with Covid” are now saying “Yes, that includes living with new variants as they emerge”. And the people who were concerned about letting Covid in now see Omicron’s emergence as proof that we relaxed restrictions too quickly.
It’s true that we knew variants would come, and that some of them could be serious. But to me it was different actually having it happen and watching the reaction.
Here in Australia, it meant bringing back some restrictions on travel: 72 hours of quarantine for all international travellers, 14 days for those who’d been in certain African nations, and travel bans for those nations. Certain classes of visa holders that were originally to be permitted to come to Australia tomorrow will be delayed for at least two weeks.
This, it seems, is also part of “living with Covid” - sudden, unexpected changes, that it may not be clear for a while whether they are wise decisions or knee-jerk reactions.
The pandemic isn’t over. We know it’s not over. But perhaps we don’t need quite so many reminders that life isn’t “normal” just yet.
I wonder what effect this will have on people’s confidence. Will people be less likely to travel overseas or to visit Australia? Or will most of the people travelling have reasons important to them and go ahead with it anyway and just hope things will work out?
People in Victoria and NSW have had to contend with major Covid outbreaks, and thus have realised that we need to learn to live with Covid. We’re sick of lockdowns, and we’ve hoped and planned for increasing vaccination rates to lead us in one direction - increasing freedoms. For political reasons, the federal government have also tried to push this, whether or not the time was right.
However, Covid doesn’t make this easy even with high vaccination rates, and it continues to throw up curve balls. That means continuing restrictions, and it also means continuing uncertainty. We may not have lockdowns, but individuals can be required to isolate at a moment’s notice, and the rules for travel can change very quickly. I’d prefer it not to be that way, but all I can do is deal with the situation as it is.