Photo of three masks on a table to protect against COVID-19.
Three masks on a table to protect against COVID-19. Credit: Mika Baumeister / Unsplash Credit: Mika Baumeister / Unsplash

Despite being overtaken by the war in Ukraine, there is still a steady stream of news regarding COVID-19 here in Canada and around the world. Broadly, Omicron is losing steam. Infection rates, at least as reflected in hospitalizations and ICU admissions, are decreasing. 

Governments across the country are reacting by reducing and/or eliminating health care cautions and restrictions. Much to the delight of participants and supporters of the Canadian so-called Freedom Convoy, COVID-19 passports are no longer required in most of the country. Wherever we stand on health-care restrictions, we are all tired of limitations on our personal movements and social interactions. 

After two years of COVID-19, people in Canada can now enter restaurants, bars, gyms, theatres, and the like without proof of vaccination. Most of these locations can now operate at full capacity. Life is opening up again.

Mask-wearing regulations are the exception. The provinces and territories have taken different stances on this public health measure. In some jurisdictions, masking is still required in schools, hospitals, congregate living centres and select indoor public spaces. In others, masks are said to be a personal preference. Except where they aren’t, which is usually in spaces with poor air circulation, such as elevators.

It is all very confusing. This is why public health representatives, politicians and infectious disease specialists now advise the shift to personal responsibility. 

We are entering the era of antinomic thinking, or the ability to consider two different and opposing concepts at the same time. F. Scott Fitzgerald is credited with having said, “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”

Are we up to this challenge? Can we handle cognitive dissonance on a grand scale? There are two major concepts we have to consider. One is that COVID-19 is likely here to stay. 

Medical News Today explains the differences in COVID-19’s trajectory. In an article written by Caitlin Geng on February 25, 2022, it stated

Pandemic, endemic, and epidemic are all terms that describe how far a disease or pathogen has spread within a geographical region or population. 

An endemic disease is one that is always present throughout a region or group of people and remains fairly consistent. An example of this is coccidioidomycosis, or valley fever, which is endemic to the Southwestern United States and northern Mexico.

An epidemic occurs when a disease unexpectedly increases among a large population or region. An example is ebola, which spread rapidly throughout West Africa in 2014–2016. 

A pandemic spreads across multiple countries or continents, affecting large numbers of people. An example of this is COVID-19, which results from a coronavirus called SARS-CoV-2 that first appeared in one region before spreading around the world.”

If COVID-19 is now in the endemic stage, what does this mean? Is this virus more significant than the annual flu? The Canadian government reports, “In Canada, an average of 12,200 hospitalizations and 3,500 deaths related to the flu occur each year.” In contrast, Institute for Health Metrics and Evaluation reports almost 38,000 deaths from COVID in the 12-month period beginning January 2021 in Canada, despite a significant drop from the initial COVID-19 period.

A second and contrary concept we have to accept is that we can now dial down concern about COVID-19. This applies to people who have abided by all the COVID restrictions. The same is true for people who remain unvaccinated. As a reader commented to me, “I am not vaccinated and continue to respect all sanitary restrictions.”

How is this possible? People in Canada may be beyond the point of arguing with the unvaccinated, but this does not mean that vaccines are not important. Vaccines and boosters remain the single best protection against COVID-19. They protect not just the individual but the broader community.

Now, we are asked to let our guards down and to return to a world where we are not divided by our vaccine status. We are asked to make personal choices.

Full disclosure: the writer is an information junkie and believes in evidence-based decision-making, particularly in matters related to health care. But there are increasing cracks in the definition of evidence. The field of physics is a classic example of theories that have been proven incorrect. The internet is rife with lists of examples, including that the earth is flat and/or hollow. 

Statisticians are also questioning the validity of using a concept called standard deviation to determine whether a new treatment should be approved or not. The argument is: “Statistical significance is a statement about the likelihood of findings being due to chance. Classical significance testing… can only provide a dichotomous result – statistically significant, or not.” Some statisticians now suggest that either/or should be replaced with both/and. The context is as important as the number calculated.

Medicine is at a turning point. Numbers alone do not suffice for decisions on major health care initiatives. Recall that at the beginning of the pandemic, we were advised not to wear masks. We were similarly told that the virus would settle on surfaces, making cleaning very important. As the pandemic evolved, we learned differently.

Now we have to learn differently again, accepting that things change — and then they change again. Dealing with COVID-19 is not a black and white issue; there are many shades of grey. Accepting cognitive dissonance is the current new normal. Whether it is the final new normal is subject to debate. 

One thing we do know, however, is that “learning to live in the messy gray is now required.

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Evelyn Lazare

Evelyn H Lazare is a healthcare planner, strategist and executive. Lazare has led nation-wide healthcare organizations in Canada and has consulted to an array of healthcare and related clients in both...