For almost eight weeks Canadians have been sheltering against an invisible threat, a virus so dangerous we had to stay inside.
The virus hasn’t changed, but the message has.
It’s a pandemic paradox: The nasty pathogen that drove us inside is still spreading — but now we’re told it’s time to go out and face the risk.
“We’ve had a message for weeks that this is really dangerous, and now the governments are switching gears,” said Richard Gold, a law professor at McGill University in Montreal.
There are still no approved treatments for COVID-19, and a vaccine is months or years away.
But across Canada governments are beginning to ease social restrictions even though many people are still worried about catching the disease.
This should not come as a complete surprise. That’s because the social distancing policies were aimed at protecting hospitals, not individuals. The goal was to keep everyone from getting sick all at once — a population-wide policy intended to slow the spread.
And it worked.
“The first priority was that we didn’t flood the hospitals,” said Katherine Lippel, a civil law professor at the University of Ottawa. “That was a collective response for a collective need.”
But individual Canadians could be forgiven if they’re not keen on going back out there and becoming infected.
For weeks they’ve been bombarded with alarming headlines describing COVID-19 horrors including mysterious symptoms, sudden death in apparently healthy people and mass graves.
Experts still predict that most people who become infected will survive and many won’t even realize they’re sick.
But stories of people who recovered safely don’t tend to make headlines.
“Nobody’s writing a story about ‘I got COVID, didn’t know it and ran a marathon,’ but those stories are out there as well,” said Dr. Michael Gardam, chief of staff at the Humber River Hospital in Toronto.
Still, the stark statistics of hospitalizations and deaths reveal a genuine risk that can’t be dismissed.
“I think all of us have a certain degree of anxiety or fear,” said Dr. Sanjeev Sockalingam, a professor of psychiatry at the University of Toronto. “We’re seeing large amounts of people having these concerns and sharing in these worries.”
That’s why labour lawyers are suddenly in demand to answer questions about whether facing the risk of COVID-19 qualifies as unsafe work.
“There are definitely some elevated risks for people returning to work,” said Alison Thompson, a University of Toronto associate professor who studies public health ethics. “Certainly employers have an obligation to make sure their workplaces are safe.”
But in the end, most people will not be able to refuse to return to their jobs.
“You have to work if you’re called back to work,” labour lawyer Howard Levitt told the CBC’s Heather Hiscox on Wednesday, but he said employees have the right to insist on safety measures including protective equipment and disinfected workplaces. And no one should be forced to work with someone who is showing COVID-19 symptoms.
“The employer has to be rigorous about this,” he said. But at the same time employees “can’t let their amorphous fear of leaving their house prevent them from coming to work if it is a safe workplace.”
The return to the new COVID-19 “normal” will force some to make risk calculations they’ve never before considered, including the disturbing realization that by returning to work they could be putting vulnerable family members in harm’s way.
There’s also the unpleasant possibility of being forced to reveal personal medical information to an employer in order to be granted a chance to work from home.
“There are a whole bunch of people who have health conditions who would suddenly have to go public,” said Gold, who believes there is the potential for a form of labour anarchy, where people simply opt out until they know more about the risks and their rights.
“I think if people are not confident that the system works, yes, I’m imagining some type of anarchy,” he said. “People can say it’s not safe for me to go [to work], and each one of these claims will have to be adjudicated on an individual basis. It will be a monstrous affair.”
The new politics of ‘deconfinement’
Life with COVID-19 is creating a tangled mess of ethical and moral issues.
After just a few months, the basic rules of human interaction and civil society are being rewritten on the run from a virus.
There are unprecedented questions about whether collective obligations override personal preferences. For example, should everyone be required to wear masks to protect bus drivers and fellow transit riders? Can you be prevented from entering a store if your temperature is too high?
It’s all happening so fast that it’s not clear who should be protected. How do you decide if you’re at a higher risk? Obesity, high blood pressure, asthma, age — the list of potential risk factors is only just emerging.
“I do not really want individuals to be making those risk calculations, because even understanding that if you’re 70 and you’re healthy, your risk is actually quite different than someone who is 60 and has underlying diabetes and heart disease,” said Sandro Galea, dean of the Boston University School of Public Health.
“I think that’s the role of government to come up with the guidance that essentially arrives at a consensus acceptable risk within society.”
A group of Canadian public health experts have written an open letter published in Le Devoir on Wednesday, calling on governments to protect people from the risk of job loss if they decide their personal risk from COVID-19 is too great.
“The main goal of the letter is to try to persuade governments to adopt policies that will save lives, in the context of deconfinement,” said Janet Cleveland, a researcher on migrant rights and health at McGill University, and one of the letter’s authors.
“As things stand, if these individuals wish to stay at home because they (rightly) fear that a return to work may put their lives at risk, they are likely to be fired.”
Simulated herd immunity
One option is to err on the side of maximum flexibility, said Gold. He suggests extending social distancing as long as possible, and that includes the workplace.
“If we tell people it’s actually good not to go to work and we’re going to accommodate you, it decreases the risk on everybody else because you’re taking out a good chunk of the population. And therefore the circulation of the virus is much lower.”
Gold sees it as a form of simulated herd immunity.
“If you get half the population staying at home, you’ve just cut down the population who can get infected in half.”
And if people are encouraged to stay home, it reduces the stigma on those who are opting out, he said.
It would also allow those who do go back to work to spread out and practice physical distancing while they continue to follow other strategies shown to prevent the spread of COVID-19, like hand-washing and avoiding touching their face.
“You could adopt risk-averse life strategies that would make it less likely that you’re going to get infected,” said Gardam. “Now that we’ve had two months’ experience with this, you could definitely do things that would dramatically decrease your risk.”
“But there is no such thing as eliminating the risk.”