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LIVING WITH COVID, a 🧵 Since covid isn’t going away (thanks to a series of poor choices over the last 2 years), it’s time to brainstorm what a real exit strategy might look like because “living with covid means accepting more deaths” doesn’t work for me. We can do better.
I think it’s important to recognize that no matter what camp someone finds themselves in, we actually all have the same goal which is to move forward with as few restrictions/measures as possible. We want to exit the “emergency phase” and stop moving from one crisis to the next.
Restrictions only become necessary when we lose all control and hospitals can’t handle the avalanche of patients. They’re the endpoint of catastrophic policy failure. And this idea that we can just ignore covid and move on has “catastrophic policy failure” written all over it.
We need to do the opposite of ignore it. We need to restructure society around this unfortunate turn of events so that we can keep circulation low and prevent surges that sink our healthcare system, leading to either restrictions or mass death — often both.
Ways to be smarter about this and restructure around an airborne pathogen starts with *clean air*. Cholera went away with clean water. We need to make the air in all our buildings as clean and safe as possible. Everywhere — schools, restaurants, work, apartment buildings etc
We need robust ventilation standards, use of UVGI, visible CO2 monitors (where above a certain threshold you would have to evacuate because the air is deemed unsafe). Call in the engineers! Yes it’s a huge project, yes it’s expensive but we can’t keep doing this yo-yo thing.
We need to have an effective plan for when transmission is growing to nip it in the bud *immediately*. No more “we’re watching the situation closely.” When a new variant shows up and cases start to grow, we need a plan ready to implement immediately, before it gets away from us.
This can include things like a rapid pivot to a blanket mask mandate, better than our current ones — continuous use of K/N95s in all indoor spaces. Honestly mask mandates might be necessary in certain high risk places like public transportation forever. We need to adapt.
Another quick switch break measure could be widespread rapid testing. Not “in a month we’ll be able to provide most people with 5 per family per month if you line up early”. It has to be extensive and *fast* — 7 per person per week ready to be mailed out/ distributed immediately.
Testing is a very effective NPI. When everyone has covid (like now), having so many people isolate at once seems disruptive. But when cases are low and just starting to grow, it wouldn’t be disruptive at all. It would actually curb transmission and prevent widespread disruption.
When things are going in the wrong direction there could be a threshold above which the ultra high risk stuff automatically gets modified. For example, 20,000 people at a hockey game? Ok fine with ventilation standards and K/N95 mandate BUT no food or alcohol, masks stay on.
“No beer at a hockey game? 😐” Listen at least you can still go right? And 2-6 weeks of lost food sales is nothing compared to losing ticket sales (and also food sales!) for weeks on end.
Same with bars and clubs, when we go to “covid protocol”, they would have to close the dance floor and have people stay seated in groups instead of mass mingling for a period of time. Yes revenue would decrease temporarily but it’s better than being shut down for months.
2019 isn’t coming back. So we need to make our peace with that and be pragmatic. We can’t have it all, all the time anymore. But we can still have a lot — without giving up safety and healthcare.
How do we know when to pull the trigger on our “covid protocol” ? We could use wastewater testing programs. We’d need to determine a threshold or rate of growth above which covid-protocol is *automatically* triggered. It can’t be a politician just deciding how he feels that day.
Another covid-era restructuring we seriously need to start thinking about is the school year. We don’t have to have 2 weeks off at Christmas, 1 in March and 10+ weeks in the summer. Christmas is a superspreader catastrophe in these covid times. How do we deal with that?
Maybe we need to design a detox period pre-holidays, something like from Dec 1 to 12 or whatever, it’s mandatory to work from home, we do a blanket K/N95 mandate, automatic switch to virtual learning for grades 5+, gathering/capacity limits and home testing every day.
The idea would be to maximally reduce community viral load so that when people gather and celebrate from mid December to early January, we don’t pay for the happy memories with mass illness and the collapse of healthcare every year.
We could also add on 3 extra weeks of holiday break in January so the school breaks would be 6 weeks off for the holiday period and decrease to 7-8 weeks in the summer to get us through the December/January danger period intact.
Anyway, these are just some of my thoughts on ways we can live with covid without sacrificing healthcare. Surrendering to the virus and letting it all just burn down is not in anyone’s best interest. And I’m just not a fan of giving up and “accepting more death.”
I’m sure a lot of bright people out here have lots of great ideas on how to move forward safely — please share your own thoughts! — but it needs to start with a paradigm shift.
Covid isn’t going away and trying to act like it’s just a cold or the flu when it isn’t will just lead to more restrictions and preventable tragedies. We can’t keep doing this.

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Dr. Lisa Iannattone

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