As we’re moving past lockdowns, this is a question I hear a lot these days. Of course, there are some people who believe that there should never be any restrictions imposed on their behaviour for any reason and others who believe that we should never stop wearing masks and social distancing until COVID is in the same category as Smallpox — extinct.

For the rest of the population (and these groups as well), we need to negotiate a new social norm as we move out of the very critical waves, variants, and consequences of the COVID pandemic.

Whether people use this language or not, it boils down to “risk calculus.” So often in our culture, we are taught to see risk as “binary” — something is risky or it isn’t — there is no gray.

Risk isn’t Black and White

Risk management typically calculates risk using 2 variables: the probability that a risk will happen, and the impact of the risk should it happen. If the probability is 100%, it isn’t a risk; it’s a certainty. There isn’t a risk that we will die someday; it will happen. But for everything else: how? when? where? that’s only a probability.

For example, what is the risk of dying in an earthquake? Depending on where you live and work, this answer will be different. Where I live, buildings have no earthquake design features built into them. There are no torsioning cables in the highrises, no earthquake drills, no hardened shelters. If a serious earthquake was to occur, there would be a huge loss of life and infrastructure and I may indeed die. Fortunately for me, an earthquake with a magnitude greater than 6.0 (the threshold generally accepted to cause building damage) has never happened in Alberta. And that’s why we don’t build hardened buildings here and I will almost invariably die of another cause.

On the west coast of North America, big earthquakes do occur. That’s why building codes in these areas require earthquake mitigation in all new and most existing buildings. Does this mean that living on the west coast is riskier than Alberta? Not necessarily. Remember that risk is a product of probability and impact. Although the west coast is more likely to suffer a large earthquake, building codes reduce the impact of an earthquake should it occur. A higher probability with a lower impact might mean less risk than a low probability with a very high impact. It gets complicated.

Risk Responses

Risk management tells us that there are only 4 ways we can respond to risk:

1. Mitigate the risk (meaning taking steps to reduce the probability that the risk will occur or the impact of the risk when it does occur).
2. Avoid the risk (take steps to prevent the risk from ever occuring).
3. Accept the risk (if the cost or impact of the risk is small, or the cost to mitigate, avoid, or transfer the risk is very large, accepting it might be the only option).
4. Transfer the risk (insurance is a good example of transference — have someone else pay for repairs or loss should a risk materialize).

COVID as a Risk

A Brief History of the COVID Pandemic

We’ve been through a lot these past couple of years including multiple waves and variants of COVID. Each wave and variant can be calculated as having a different risk profile.

• The initial COVID outbreak was very virulent and deadly. In some countries, 10% of patients died from the illness. We didn’t know much about it. Some of our initial conclusions were faulty (it actually wasn’t easily spread by touching surfaces; it was mostly by aerosol transmission) and we had few treatments and no vaccine.
• The alpha variant which appeared in summer/fall 2020 was even more infectious and deadly than the original strain.
• Although vaccinations (at least in developed countries) began in earnest in early 2021, the vaccine wasn’t completely effective against Delta which appeared in mid 2021. Delta was also twice as infectious as Alpha, with double the hospitalization and mortality rate for those who were not vaccinated. But even though vaccination was not always effective at avoiding Delta, it did mitigate probability (contagion) and impact (hospitalization and death).
• Omicron (discovered late in 2021) has a higher probability of reinfection but tends to have very mild impact on those who are vaccinated and boosted.
• Omicron 2, the current dominant variant in North America, is more infectious than Omicron but also has mild impacts for those who are vaccinated, boosted, or previously infected.

Will there be other variants yet to come? Possibly, but we don’t know for sure until they emerge. Hopefully, the world’s leading imunologists have an eye out for them if they do come along. But even without future variants, what will our world look like going forward?

One of our regular seasonal flu variants today, H1N1, is the decendant of the original 1918 Influenza virus. Influenza is called “endemic” because we are likely to never be able to get rid of it. Some years have a bad flu season and others aren’t so bad. There is a vaccine that usually helps people who take it every year. COVID might turn out to be an endemic much like Influenza.

Managing the Risk of COVID

Here’s how we can manage the risk of COVID going forward:

1. Risk mitigation: Vaccines are a disease mitigation measure. No vaccine is 100% effective for everyone and there are always some people in a population who aren’t or can’t be vaccinated. But vaccines reduce both the probability and the impact of the risk.
2. Risk avoidance: Masks, quarantine, social distancing, travel restriction all help avoid the risk provided they are followed in large enough numbers. If we don’t breathe each other’s air, the chance of catching COVID from each other becomes very small.
3. Risk acceptance: This is likely going to be a bigger part of our response going forward. Even if infection rates remain high, the impact of the illness on the general population is waning. Many people have some immunity and we’re likely to accept an increase in infection rates as long as death rates remain low.
4. Risk transference: There is no way to transfer the risk of a pandemic, but government financial support during the acute phases of the pandemic did help transfer the impact of the risk avoidance measures when businesses needed to close and commerce was restricted. Risk transference is expensive and part of the reason we have a high inflation rate right now. Governments have no choice but to reduce or cust risk transference measures.

Societal Risk vs Individual Risk

At the level of a country or province, the risk calculation of a pandemic generally leads to a choice of risk avoidance vs risk acceptance. Unless a much more virulent variant of COVID emerges, and one against which current vaccine cocktails are not effective, it’s likely that governments will choose to continue removing pandemic restrictions. The costs to the economy of avoiding COVID now exceeds the cost of accepting it:

• ICU beds are no longer filling up;
• Morgues are not being overrun;
• Nursing homes have a stable vacancy rate again.

There could be a case made for mandatory sickness leave for employees, but in Canada this is generally a provincial responsibility and depends on the ideology of the provincial government in power. In my mind, paid sick leave should be a right of every worker. The cost and social equity in making sure that people can recover from illnesses without infecting their colleagues and still being able to pay their bills is unarguable.

But personal risk assessments don’t always match society’s. Some people are immuno-compromised, or live with people who are.  They may conclude that avoidance is the better choice. Some people have no paid sick-leave; for them, the chance of catching (or recatching) COVID remains an expensive risk with possibly a week or two of no income. For others, their innate anxiety isn’t an easy one to overcome. They will continue to wear masks, stay 2m away from others, and eschew in-person and inside gatherings long after many of us have returned to pre-pandemic socializing.

How to Respond to the Risk-Adverse

Two values held by UniteAsOne are:

1. Evidence-based (and logically derived) decision making; and
2. The innate, intrinsic value of every human being.

At a more personal level, some mitigations provide risk-adverse people with emotional comfort. Unless the cost is too high in terms of time or money, why not indulge them? Some people are hanging together by a thread these days. It’s an issue of compassion, so when I see someone in a store wearing a mask, I try to give them 2m of distance. I sanitize my hands when people ask me. I wear a mask when visiting someone who would be more comfortable if I do.

But I think we also have a responsibility to help people get over their anxiety. For those we know well, perhaps we can gently encourage them to use their Employee Assistance Program (EAP) or other programs to get professional help. Perhaps we can have a discussion about risk calculations just I have tried to do in this article.

We all want to get on with our lives, but we should also feel a commitment to reach out and gently pull others along with theirs as well.