Abstinence-only messaging doesn’t stop most people from having sex.
The COVID-19 corollary, “stay at home,” isn’t going to keep most people from going out either.
The coronavirus is here to stay for the foreseeable future, so we need to find the pandemic version of safer sex.
As we pull out of lockdowns, our political and public-health messaging has to shift from promoting social chastity to urging people to reduce the risks of social interactions when they venture out.
In short, we need to embrace a harm-reduction philosophy, individually and collectively.
Harm reduction refers to policies and practices designed to minimize negative health, social and legal impacts of a particular activity.
The public-health approach usually aims to lessen the harms of substance use. If you’re going to drink alcohol, don’t drink to excess. If you’re going to use drugs that pose a risk of overdose, don’t use alone.
Harm-reduction policies also involve creating programs like supervised injection sites with clean needles as an alternative to people injecting drugs in an alley, with shared needles.
So what’s the equivalent in dealing with an epidemic threat like coronavirus?
If you’re going to meet people, keep that number as low as possible, and practise physical distancing. The larger the number of people in your social bubble and the closer your contact, the greater the risk of infection.
If you’re going to gather in small groups, do so outdoors rather than indoors, because transmission risks are lower.
Harm reduction is also going to require some fundamental rethinking of how we use physical space, from broadening sidewalks to altering workplace configurations.
Unfortunately, there is no detailed playbook – and no app – that can provide us with precise risk calculations or ideal practices.
We’re going to have to find our comfort zones.
Public health and political leaders have spent many weeks issuing dire warnings about risk and earnest pleas for people to stay home and lock down.
Those measures were never meant to be permanent, because they are not sustainable in the long term.
But it’s easier to scare people than to unscare them.
It’s also much easier to confine people than to establish rules for safe, smooth deconfinement. In fact, that should read ‘relatively safe’ deconfinement.
We have to recognize that there is no risk-free way of living with a novel virus.
As we loosen the rules, there will be flare-ups and outbreaks of cases. That is inevitable.
What is important is that they be manageable. That’s where the test-trace-isolate mantra comes in.
When new cases of illness pop up, public-health needs to have the capacity to test quickly, trace the contacts of the sick, test them, all within 24 hours, and then isolate the infected to prevent further spread.
Some provinces, like B.C., have that ability so they can open up more quickly and broadly. Other provinces, like Quebec and Ontario, have demonstrated that they do not.
Because the risks to the public vary in different parts of the country, so too do the rules. As frustrating and confusing as that may be, it makes sense.
What the public needs now are not rigid rules, but guidance and some common-sense leadership.
When the rules are that it’s okay for a cleaning lady to come to a home, but it’s not okay for granny to visit, you are sending a mixed message.
When it’s okay for a foursome of middle-aged men to play golf, but it’s not okay for four teenagers to skateboard in a city park, that reeks of unfairness.
When you continue to ban essential family caregivers from understaffed, overburdened care homes, it is verging on criminal.
As we muddle out of lockdown, the lines drawn in the sand will be imperfect, but they must be perceived as reasonable and fair.
That is particularly important in a time when distrust in authority is great and skepticism in science is not far behind. Beyond the rules and edicts, we also need to let individuals find their own comfort zone, their own risk tolerance.
We have to shift from living in fear of COVID-19 to living smartly with coronavirus.
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André Picard