Why we need to rethink COVID-19 risk as the weather warms up

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It's been almost a year of "Stay home. Do nothing. Save lives." And people are tired.

Pandemic fatigue has turned to pandemic restlessness as the weather shows signs of improving and vaccines gradually roll out across the country.

Hope is on the horizon, but if last spring is any predictor of what lies ahead we can expect to see Canadians flocking outdoors in search of safe ways to gather as temperatures rise.

And with good reason.

After a surge of cases after the holidays, Canada has seen a significant decline in COVID-19 levels across the country following lockdowns in hard-hit regions even with frigid temperatures driving people indoors and more contagious variants spreading.

As more people get vaccinated, cases (hopefully) continueto decline and society slowly reopens, it may be time to shift our messaging away fromstrict one-size-fits-all public health guidelines.

Allow small risks to counter fatigue

Experts say officials need to start to shift their messaging and set out realistic parameters for socializing safely over the next few months or risk losing the room or worse, pushing people to more dangerous behaviour.

Dr. Zain Chagla, an infectious diseases physician at St. Joseph's Healthcare in Hamilton, Ont., says guidelines need to shift in Canada toeducatepeople on how to see their friends and family safely.

"Now that transmission is down, we need to start making some discussions on the trade offs," he said.

"Can you really realistically think that people can wait it out at home without any interactions outside of their household for another three months? Or can you at least start prioritizing and building in low risk stuff, so that you give people the sense of normalcy?"

Chagla says recent negative reactions to outdoor activities like tobogganing and skating rinks mirror concerns at the start of the pandemic, when outdoor gatherings in places like parks were seen as dangerous even with no evidence of transmission occurring.

In Ontario, reservations for provincial parks have surged in anticipation of warmer months ahead, nearly doubling in the first few weeks of this year. Cottage rentals are also in high demand, with bookings at levels never seen before.

There's no doubt people will want to congregate more as the weather improves, and experts say we should transition from an abstinence approach to one of harm reduction.

"If you gave people that opportunity to do things appropriately outside, how many cases would you then save from indoor activity?" said Chagla.

"If you allow them to take that small risk, you're preventing the people that are going to fatigue and say, 'Well, I'm just going to have my family over, we've been fine, we've been isolating for weeks, I deserve this,' and then have COVID transmission that way."

Outside is better than inside

Finding practical ways to alleviate pandemic fatigue and allow for some level of safe interaction in the coming weeks and months will be essential to keeping Canada on a downward trajectory with COVID-19 levels.

"People are tired of the sacrifices they've made, and for their mental health and physical health want to see other people and want to socialize," said Linsey Marr, an expert on the airborne transmission of viruses at Virginia Tech.

"Doing it outdoors is very low risk if you avoid face-to-face conversation with people, maintain your distance and avoid crowds."

Marr says going for a walk side-by-side, taking an exercise class or even having a beer with friends are all relatively safe outdoors when more than two-metres of space is maintained.

New research from the U.S. Centers for Disease Control and Prevention shows the risk of indoor activities when proper precautions aren't taken.

In Hawaii, 21 cases were linked to a fitness instructor during a class where physical distancing measures were in place, butmasks weren't worn and airflow wasn't prioritized.

A similar situation occurred in Chicago, where 55 people were infected with COVID-19 after attending indoor exercise classes despite physical distancing and some mask use.

The missing element in both of those outbreaks was ventilation.

"We should be opening up park spaces, we should be encouraging outdoor activities where people can gather and gather safely and converse and talk and just be with people," said Erin Bromage, a biology professor and immunologist at the University of Massachusetts Dartmouth who studies infectious diseases.

"Recognizing that there is a small risk associated with it but it's better than the alternative."

'Get creative' with public health messaging

Timothy Caulfield, a Canada Research Chair in health law and policy at the University of Alberta in Edmonton, said public health officials are walking a "tightrope" in communicating public health guidelines in the coming months.

"We have to figure out ways that we can allow people to live their lives, while still making sure that we're reducing the risk," he said."And I think we need to engage people as part of the solution."

A recent research article published in SAGE surveyed several hundred Italian and French citizens under strict lockdown and found there was significantly less adherence to public health guidelines when people's concern about COVID-19 was waning, along with their trust in officials.

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The World Health Organization released guidelines for fighting pandemic fatigue, focused on understanding people, allowing them to live their lives while reducing risk, engaging with them to find a solution and acknowledging the impact of the pandemic on their lives.

Caulfield says officials need to evolve their messaging with emerging scientific research and avoid being tuned out by the public by setting realistic guidelines for safely interacting.

"We need to recognize that we're really getting to a point where there's going to be profound complacency," he said.

"There is profound fatigue, and not just fatigue about the lockdown. I think there's fatigue about the messaging people are sick of hearing about this stuff. So I think we need to get creative."

Variants make noncompliance higher risk

Bromage said he's concerned transmission could soon skyrocket due to increased interactions with warm weather amid the spread of variants.

"We're heading into March very soon, and March is when the pandemic really took off last year," he said. "I'm holding my breath, just sort of hoping that it's not a repeat of 2020 given the changing mobility that comes with the weather."

COVID-19 levels have risen by about five per cent globally in the past week, after significant declines since the beginning of the year, with recent upticks in parts of Canada and the U.S. concerning officials.

"What comes next is really uncertain. Do we roll back up again? Do we just stay at this level?" said Bromage. "Nobody really knows."

Chagla says we need to give people more low risk activities to do together in the near future, or risk people hiding their interactions with each other behind closed doors.

"A Zoom call versus seeing a very close friend with a mask in the park is slightly higher risk," he said. "But I think using it to allay fatigue is probably a whole lot better than the implications of just keeping people at home."

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Caulfield says officials need to re-evaluate public health messaging and explain clearly to people what's safe and what isn't.

"I do want to see recommendations on what they can do outside now and how they can enjoy the weather," he said. "Let's put a positive spin on this, letting them know that there are steps that can be taken."

With the emergence of variants, Chagla says the risk of people letting their guard down now is incredibly high.

"You've got to get people on your side for the next few months," said Chagla. "And realistically offering things to them, rather than taking things away, is going to be the way to do it."

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