When will we return to normal?
How do we live with COVID?
CLINICAL MATTERS
As deaths from COVID-19 continue to drop globally as a result of increasing vaccination coverage, the question of when things will get back to a semblance of normalcy is foremost on everyone’s minds. Having gotten used to the routine of masking, physical distancing, and avoidance of risky situations, people are understandably uneasy about starting to do things which have been anathema for the last two years. Here are some changes we can expect should cases remain low and we are able to open up safely in the next few months.
Testing
Countries such as Sweden have completely stopped routine testing for COVID-19. This is understandable because with their high vaccination rate and dropping death rate, the costs of routine testing are no longer justifiable. Moreover, there is hardly any change in the management for vaccinated people who are not part of the vulnerable population. Just like with the flu, all that is needed is rest and supportive care. No antiviral treatment is indicated unless one is unvaccinated or is part of the high-risk population. Denmark has likewise declared that COVID-19 is no longer a disease of significant societal impact and has rolled back most pandemic restrictions, including mask mandates and vaccine passes.
Some countries are already removing testing requirements for fully vaccinated international travelers. Canada has shifted from a molecular test such as PCR, to more affordable tests like antigen-based assays. Other countries like the United Kingdom have completely done away with predeparture COVID-19 testing.
Testing in the Philippines has already begun to shift, prioritizing the vulnerable population for RT-PCR testing. Isolation of symptomatic patients at home is now allowed and testing for low-risk patients can be deferred or done with antigen kits. Sentinel sites for surveillance testing to give an accurate estimate of ongoing transmission are already being set up. Routine testing of all suspected COVID-19 cases is no longer necessary since the recent Omicron wave showed that high vaccination rates protected most people from severe disease. Predeparture testing for entry into the country will likely remain for now since some countries are still having high rates of transmission. It is possible, however, that antigen tests may be considered for entry if cases globally remain low. If the low numbers are sustained, removing testing altogether may eventually be considered.
Masks
Nothing is more associated with the COVID-19 pandemic than masks. While early WHO advice only required masking for symptomatic individuals, evolving evidence subsequently showed that asymptomatic transmission did occur, leading to widespread mask mandates. Masks continue to protect against infection, especially in high-risk situations. Early attempts to do away with masks in countries with high vaccination rates resulted in subsequent case spikes. Masking remains an important public health tool not just for COVID-19 but also for seasonal respiratory viruses such as influenza, which have gone down in incidence due to widespread masking.
In the Philippines, it is unlikely that mask mandates will go away any time soon. Vaccination rates are just above 50 percent of the population, and vaccination of children is still underway. While the healthcare system capacity is currently adequate, spikes in cases can still significantly burden hospitals especially in areas where the number of beds is low. As more and more areas hit 70 percent vaccination coverage of their eligible populations, easing some aspects of masking can be considered. This can include requiring masking only indoors, or in crowded spaces and only for unvaccinated individuals.
Vaccinated individuals may eventually see relaxing of mask mandates especially in low-risk situations if cases remain low. The relaxing of mask mandates in the Netherlands, Sweden and the United States is risky especially since their case rates remain much higher than our local numbers. However, different countries have different priorities and healthcare capacities. In the Philippines, the safety nets to prevent the healthcare system from being overwhelmed are not as strong as those in more developed nations. Masks remain one of the best tools to protect our healthcare system and these should stay until there is more confidence that the pandemic is indeed over.
Schools
The disruption of education has been one of the biggest pieces of collateral damage in this pandemic. Aside from the inferior nature of online classes versus physical classes, the lack of social interaction and physical isolation have caused much harm to children. While initial plans were to allow both vaccinated and unvaccinated children to return to school, the emergence of more transmissible variants like Omicron and Delta have led authorities to rethink this strategy.
Alert level 2 already allows the resumption of face-to-face classes. More schools will reopen physical classes under Alert Level 1. Vaccination will be a major safety net when resuming actual classroom learning since it is very difficult to control interactions in these settings. Masks and public health standards will remain during the transition period, but there should be more schools opening as we relax restrictions. Resumption of physical classes will represent a major relief for both children who have not seen their friends in more than two years, and for parents who are understandably anxious of the negative impact the pandemic has had on their kids.
Travel and Tourism
The tourism sector has endured one of the steepest declines in history. Airlines, hotels, and communities dependent on tourism have been hit hard. There is a lot of pent-up demand for travel. As governments drop quarantine and testing requirements and more people are vaccinated, travel and tourism are poised for a comeback. International travel for business and leisure is starting to recover, and more and more countries are easing restrictions as a result of widespread vaccination of their populations.
As travel becomes more predictable with less disruptions, more people will be venturing out and we will see a revival of our most popular tourism destinations. Accommodating only fully vaccinated travelers for now will significantly reduce the risk of outbreaks and the introduction of new variants since vaccination reduces both the risk of transmission and the risk of mutation. Many airlines are already requiring that passengers are fully-vaccinated, and there is little patience for the significant added risk and liability of carrying willfully unvaccinated customers.
While things are looking hopeful that the acute phase of the pandemic will end within the year, the World Health Organization continues to warn against complacency. A pandemic exit is predicated on achieving a high level of vaccination globally, which will keep deaths low and attenuate the emergence of new variants. Everyone is looking forward to societal reopening. The hardship and suffering of the past two years have been unprecedented, but hopefully the lessons learned will help us plan for future pandemics so that we can keep the damage to a minimum.