What does "living with COVID-19" really mean?

Nova Scotia has began a new phase of the pandemic with most Public Health measures easing across the province. (Note: masks are still required in schools and in most health-care settings.) This marks a big shift in how we deal with COVID-19, so it’s understandable to feel unsettled or unsure about what’s coming. For more than two years, we’ve followed advice from our Public Health and medical experts about wearing masks, keeping distance from others and getting vaccinated and boosted to help protect our loved ones and our communities. The pandemic isn’t over, but it’s time to move away from collective province-wide measures to managing your own risk and taking steps to protect the vulnerable people around you.

To help make sense of what this means and what the next few months will look like, we connected with Nova Scotia’s Chief Medical Officer of Health, Dr. Robert Strang, for his advice.

Many Nova Scotians have died from COVID-19 in the past few weeks and the virus is still widespread in our communities. Why is now the time to relax public health measures?
Due to time lags between infection and the onset and progression of severe illness, COVID-19 deaths represent the level of community activity of the SARS-CoV-2 virus from about a month prior to those deaths being reported.

We can now start to begin to loosen Public Health restrictions and mandates as there has been continued and substantial decline in the levels of community virus activity, as well as a more recent but now clear trend in decreasing new hospital admissions.

What things did you consider when making these decisions?
There are a few key indicators that we continue to watch to inform our COVID-19 response and the use of Public Health restrictions and mandates: the weekly trend of lab-confirmed cases; the number of outbreaks in congregate living situations – long-term care, corrections, shelters – and the status of these outbreaks; the weekly trend in new admissions to hospital due to or with COVID-19, along with weekly trend of new hospital-acquired cases; the trend of health-care workers off work due to being either a COVID-19 case or contact; and COVID-19 vaccine coverage (both primary series and booster for adults).

Why is this a gradual reopening? Can’t we just rip off the Band-Aid?
Our reopening plan is about balancing risks – risks of stalling or even reversing the decline of community virus activity versus the known health, social and economic harms of prolonged restrictions. The balancing of risks also needs to acknowledge the ongoing and significant pressures that the acute care and long-term care sectors remain under even as new COVID-19 admissions decline. The overall capacity pressures will take a substantial time to resolve.

My perspective is that moving too fast carries too much risk of increasing virus transmission and creating more pressure on our health-care system, which had limited surge capacity pre-pandemic. Slow and steady has worked well for the past two years and is my recommended approach once again.

What advice do you have for immunocompromised people who are still at high risk of serious illness? What about parents of kids under the age of 5, who can’t be vaccinated yet?
It is very important to help all Nova Scotians understand that COVID-19 is now moving in two very different ways in our communities. For most, vaccines now mean that COVID-19 is a mild to moderate disease that will not place us in hospital or put us at risk of dying. But for older Nova Scotians, especially those in group living settings like long-term care, for people with underlying medical conditions such as being immunocompromised, there is still a significant risk of severe disease, and this is especially true if these populations are not vaccinated.

As we lift restrictions, the choices and actions each of us make become even more important. People at higher risk of severe disease will need to continue to be careful about taking the necessary steps to minimize their risk of exposure (this is no different than what such individuals have had to be aware of before the pandemic) and all other Nova Scotians need to also continue to adhere to strong personal protective measures which we have used throughout the pandemic to help protect others who are at higher risk.

We have seen guidelines for how we access and use rapid tests change over the past few months. What role will testing play in our reopening plans?
Our testing strategy will continue to meet the needs of where we are at in our response to COVID-19. During the current transition period, we will continue to test those who have COVID-19–like symptoms, as this is important for both clinical and surveillance purposes. Longer term, there will still be a need for focused testing as part of overall respiratory virus surveillance, as well as when identification of a specific virus is clinically warranted.

What happens if a COVID-19 variant appears that’s worse than Omicron? How soon would Public Health measures be put back into place?
There is international, national and local surveillance on COVID-19 variants and overall COVID-19 activity that we continue to monitor, along with our laboratory colleagues. If a new variant of concern arises, we are well positioned to respond appropriately in a timely manner based on our experience from the past two years.

Are you confident that Nova Scotians would heed the advice from Public Health?
Throughout the past two years the large majority of Nova Scotians have followed the advice of Public Health to protect their health and that of their families and community. I believe that this will continue as we transition from a pandemic to an endemic response.

Why is getting vaccinated (and boosted) still important at this stage of the pandemic?
It is important to get as many adults as possible who are eligible for a COVID-19 vaccine booster to receive one due to the reduced effectiveness of current vaccines against infection with the Omicron variant. Two doses have limited protection against being infected by the Omicron variant, although protection against severe disease is maintained. We know that protection does wane over time. Receiving a booster helps restore and sustain protection to both infection and against severe disease.

Do you worry that removing proof of vaccination requirements won’t inspire people who still haven’t gotten vaccinated to get their shots?
I think that Nova Scotians who will choose to receive COVID-19 vaccine have already done so. The less than 7% of Nova Scotians who are eligible to receive COVID-19 vaccine but have not done so are either unable or unwilling to get vaccinated regardless of the presence of proof of vaccine requirements. We are hoping with the availability of new vaccines using more traditional technology, such as Novavax, some unvaccinated Nova Scotians will receive this vaccine.

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