There will come a time when enough people are immunized against COVID-19 that government will be able to eliminate the vast majority of its public health restrictions.
The question becomes: at what point should that occur, and does government have an obligation to inform the public in advance on where the goal posts are?
The threshold to achieve herd immunity from COVID-19 has been pegged at somewhere between 70 and 80 per cent. But is it reasonable to keep most restrictions in place before reaching that threshold, even after the vast majority of high-risk people (primarily those over age 70) are vaccinated?
Maintaining restrictions longer than needed could result in a net harm to society. The benefits of economic lockdowns (reducing the transmission of SARS-CoV-2) could be outweighed by the costs (bankruptcies, job losses, psychological anguish).
Finding the right balance, as governments have tried to do throughout the pandemic, will not be easy during the vaccine rollout. It is a conversation that needs to happen now.
There are many people under the age of 70 who are at high risk of a severe outcome from COVID-19, such as those with underlying health conditions. It could be argued all those who fall into that category should be immunized before the economy is allowed to fully reopen.
The problem is those conditions exist on a broad spectrum and are not easily categorized.
The U.S. Centers for Disease Control and Prevention lists a dozen categories where people are at high risk of a severe outcome from COVID-19, including those suffering from cancer, chronic kidney disease, heart conditions and Type 2 diabetes. Pregnancy, smoking and obesity are also on the list.
The CDC has a second list of those who "might be at an increased risk." They include people with asthma, cystic fibrosis, high blood pressure, liver disease and Type 1 diabetes.
Should government wait until all the above are vaccinated before reopening the vast majority of the economy?
Probably not. The logistics alone would be a nightmare.
Once people over age 70 have received their first dose (and the required two weeks has passed to build up immunity), government would be hard-pressed to justify keeping most restrictions in place.
Some will likely be phased out over time, even after most are vaccinated. Mask wearing in indoor public places, for example, will probably be around for awhile. Not only does it offer substantial protection, it has few downsides.
It will be some time before large arena and stadium crowds are allowed. But as far as physical interaction goes, most of it should return to normal after the highest-risk population gets its first vaccine dose.
The whole point of using the blunt instrument of lockdowns and restrictions is to mitigate severe outcomes, including death, and to protect hospital capacity. Once the majority of those 70 and up are vaccinated (assuming case counts and hospitalizations remain under control), those risks fall dramatically.
No one can eliminate all risk; that’s not what public health officials do. Their job is to mitigate risk and impose restrictions, if necessary, proportionate to the level of harm.
Government doesn’t shut down the economy during flu season to prevent the 3,000-4,000 influenza deaths that occur most years in Canada. That would be a disproportionate response.
This is an issue government needs to deal with sooner rather than later.
A basic framework of how the economy will reopen once a certain vaccine threshold is reached should be shared with the public as soon as possible. Businesses and not-for-profits need it for planning purposes; it’s critical to help prevent further destruction of the economy.
With greater certainty around Canada’s vaccine rollout, this level of planning can now be done based on reliable data and epidemiological evidence.
These decisions should be made in advance, at least in broad strokes. They should not be made on the fly.
Tom has been covering Manitoba politics since the early 1990s and joined the Winnipeg Free Press news team in 2019.