How Nations Are Learning to 'Let It Go' and Live With COVID

·7 min read
Members of the National Guard prepare vaccine doses outside of a gas station in LaPlace, La., June 17, 2021. (Emily Kask/The New York Times)
Members of the National Guard prepare vaccine doses outside of a gas station in LaPlace, La., June 17, 2021. (Emily Kask/The New York Times)

SINGAPORE — England has removed nearly all coronavirus restrictions. Germany is allowing vaccinated people to travel without quarantines. Outdoor mask mandates are mostly gone in Italy. Shopping malls remain open in Singapore.

Eighteen months after the coronavirus first emerged, governments in Asia, Europe and the Americas are encouraging people to return to their daily rhythms and transition to a new normal in which subways, offices, restaurants and airports are once again full. Increasingly, the mantra is the same: We have to learn to live with the virus.

Yet scientists warn that the pandemic exit strategies may be premature. The emergence of more transmissible variants means that even wealthy nations with abundant vaccines, including the United States, remain vulnerable. Places like Australia, which shut down its border, are learning that they cannot keep the virus out.

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So rather than abandon their road maps, officials are beginning to accept that rolling lockdowns and restrictions are a necessary part of recovery. People are being encouraged to shift their pandemic perspective and focus on avoiding severe illness and death instead of infections, which are harder to avoid. And countries with zero-COVID ambitions are rethinking those policies.

“You need to tell people: We’re going to get a lot of cases,” said Dale Fisher, a professor of medicine at the National University of Singapore who heads the National Infection Prevention and Control Committee of Singapore’s Health Ministry. “And that’s part of the plan — we have to let it go.”

For months, many residents in Singapore, the small Southeast Asian city-state, pored over the details of each new COVID case. There was a palpable sense of dread when infections reached double digits for the first time. And with borders closed, there was also a feeling of defeat, since even the most diligent measures were not enough 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?”

Officials in Singapore announced plans to gradually ease restrictions and chart a path to the other side of the pandemic. The plans included switching to monitoring the number of people who fall very ill, how many require intensive care and how many need to be intubated, instead of infections.

Those measures are already being put to the test.

Outbreaks have spread through several karaoke lounges and a large fishery port, and on Tuesday Singapore announced a tightening of measures, including banning all dine-in service. The trade minister, Gan Kim Yong, said the country was still on the right track, comparing the latest restrictions to “roadblocks” toward the final goal.

Singapore has fully vaccinated 49% of its population and has cited Israel, which is further ahead at 58%, as a model. Israel has pivoted to focusing on severe illness, a tactic that officials have called “soft suppression.” It is also facing its own sharp rise in cases, up from single digits a month ago to hundreds of new cases a day. The country recently reimposed an indoor mask mandate.

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

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 Baker, who helped devise New Zealand’s COVID elimination strategy.

New Zealanders seem to have accepted the possibility of longer-term restrictions. In a recent government-commissioned survey of more than 1,800 people, 90% of respondents said they did not expect life to return to normal after they were vaccinated, partly because of the lingering questions about the virus.

Scientists still do not fully understand “long COVID” — the long-term symptoms that hundreds of thousands of previously infected patients are still grappling with. They say that COVID-19 should not be treated like the flu, because it is far more dangerous. They are also uncertain about the duration of immunity provided by vaccines and how well they protect against the 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% of people in low-income countries have received a vaccine dose, according to the Our World in Data project.

In the United States, where the state and local governments do much of the decision-making, conditions vary widely from place to place. States like California and New York have high vaccination rates but require unvaccinated people to wear masks indoors, while others, like Alabama and Idaho, have low vaccination rates but no mask mandates. Some schools and universities plan to require on-campus students to be vaccinated, but several states have prohibited public institutions from imposing such restrictions.

In Australia, several state lawmakers suggested this month that the country had reached “a fork in the road” at which it needed to decide between persistent restrictions and learning to live with infections. They said that Australia might need to follow much of the world and give up on its COVID-zero approach.

Gladys Berejiklian, the leader of the Australian state of New South Wales, immediately knocked the proposal down. “No state or nation or any country on the planet can live with the delta variant when our vaccination rates are so low,” she said. Only about 11% of Australians over age 16 are fully vaccinated against COVID-19.

Prime Minister Scott Morrison also backed away from calls for a shift in the country’s COVID protocols. After announcing a four-phase plan for returning to regular life on July 2, he has insisted that the strength of the delta variant requires an indefinite postponement.

In places where vaccine shots have been widely available for months, such as Europe, countries have bet big on their inoculation programs as a ticket out of the pandemic and the key to keeping hospitalizations and deaths low.

Germans who have been fully immunized in the past six months can dine indoors in restaurants without showing proof of a negative rapid test. They are allowed to meet up in private without any limits and to travel without a 14-day quarantine.

In Italy, masks are required only when entering stores or crowded spaces, but many people continue to wear them, even if only as a chin guard. “My daughters chide me — they say I’ve been vaccinated and don’t need to wear a mask, but I got used to it,” said Marina Castro, who lives in Rome.

England, which has vaccinated nearly all of its most vulnerable residents, has taken the most drastic approach. On Monday, the country eliminated virtually all COVID-19 restrictions despite the rise of delta-variant infections, particularly among young people.

On “Freedom Day,” as the tabloids called it, pubs, restaurants and nightclubs flung their doors wide open. Curbs on gatherings and mask requirements were also lifted. People were seen dining al fresco and sunbathing, cheek to jowl.

In the absence of most rules, the government is urging people to use “personal responsibility” to maintain safety. Sajid Javid, Britain’s health secretary — who tested positive for the coronavirus last week — said last month that the country needed to “learn to live” with the virus. That is despite polls suggesting that the English public prefers a more gradual approach to reopening.

Officials in Singapore, which reported a year-high 182 locally transmitted infections Tuesday, say the number of cases is likely to rise in the coming days. The outbreak appears to have delayed but not scuttled plans for a phased reopening.

“You give people a sense of progression,” Ong Ye Kung, Singapore’s health minister, said this month, “rather than waiting for that big day when everything opens and then you go crazy.”

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