How to lead your life, see people and be safe now that COVID is here to stay.

I began to write this article because I am organizing a music retreat in January 2025 for 30 people, mostly seniors, at a United Church retreat property in a small town in Ontario. We’ll be singing and eating together for 3 days. The question is what should we do to make sure the retreat is as safe as possible? And the larger question is how do we ensure that gatherings with seniors occur as safely as possibly?

Of course the safest thing we can do from an infectious disease perspective is to stay home and see no-one, but then we risk the cardiovascular consequences of an inactive lifestyle and the psychological consequences of social isolation. So what is a reasonable compromise?

COVID and Flu Facts:

When COVID began in 2020 the death rate for people over 65 was 20%. ONE in FIVE died! Fewer in younger groups but it was a very deadly virus. The fear was real and the precautions we needed to take were absolutely necessary.

What has changed?

COVID is now endemic – meaning regularly occurring within the community. It means that we have to live with it whether we like it or not, much the same way as we live with flu. Although COVID is still a serious disease, the virus circulating now is not the virus we feared in 2020 and 2021, and by now it is not a “novel virus.” Almost everyone has had some exposure to COVID-19 either by having been infected, or by serial vaccination, or both. Also the virus has changed. The Omicron variants and its descendants upended the COVID risk story. The virus has changed to be more contagious but less deadly than it was at the beginning, and the current strains are less likely to cause long COVID.

Even though overall the virulence had declined, COVID still kills in the over 65 age group and some people are particularly vulnerable. In addition to age, multiple illnesses, infirmity, certain specific illnesses, and medications may seriously increase the risk of COVID. In addition there are other severe infectious diseases to consider preventing, especially flu which is also potentially life-threatening in that age group.

On the other hand, there is no question that social isolation is especially bad for seniors’ mental health and is a risk for dementia. We have to lead our lives.

Right now in the Fall of 2024 if you are healthy and under age 65 you can have a nasty case of COVID and feel terrible but it is not likely to kill you or have long term consequences. It is also possible to have a case and think you have a mild head cold and never realize you have COVID.

In the over 65 age group things are different. The people dying of COVID are almost exclusively seniors. In Canada there were 113 deaths from COVID in the 2 weeks of Sept, 8 to 21 2024. A quick and dirty calculation suggests that there will be about 3000 deaths at that rate in a year, all but a handful in seniors.

A comparison to flu is interesting.

There were 8594 deaths from flu in Canada in 2018. 2019 had 6,945, 2020 had 6,037, 2021 had 4,115, and 2022 had 5985 deaths.

Interestingly, when we socially isolating a lot in 2021 flu deaths dropped to half of pre-pandemic levels.

In general multiply Canadian numbers by 10 to get a rough estimate of the United States scope.

Vaccines:

In general, unless someone has a life-threatening allergic reaction to vaccines, or a serious reaction to a prior COVID or flu shot, there is no medical reason not to get COVID and flu shots and keep them up to date.

“I don’t want to do what the government tells me to” is not a valid medical reason. Whatever the government says is irrelevant. Make your own decisions even if they agree with government recommendations.

“I don’t believe these vaccines are safe” is not a valid medical reason. They have been proven time and again to be safe. The COVID shot – the “new” mRNA vaccines – have been given literally billions of times over the last 4 years and have proven to be the safest vaccines ever made. The flu shot has been around for many years. It got a bad reputation when Gerald Ford was president of the USA and still carries absolutely undeserved stigma in 2024.

“The vaccines don’t necessarily prevent COVID and flu”. True but it’s playing the odds in your favour. A left handed pinch hitter against a right handed pitcher is more likely to get a hit than a rightie, not guaranteed, but baseball managers play those odds all the time. Both shots prevent most cases and, again, if you do get either you are likely to have a much milder case.

To be clear, all vaccines have some risk. There trick is to balance risk against the benefit. For both flu and COVID shots the benefit far outweighs the risk. You are far more likely to prevent severe illness than you are to have a severe reaction.

“I generally distrust the medical system and experts.” OK – I can’t gain your trust in one article. All I can say is that I respect your position but it has consequences. At some point, if for instance you want to come to the music retreat, you won’t be able to. That is because the group has agreed that they have a greater responsibility to each other than any individual has to themselves. Your choice, but there is no room for being angry or resentful. The group respects your choices; you have to respect the group’s. Personally I think that participation in a group with that sense of values and trust far outweighs whatever benefit someone might get from remaining opposed to vaccines, but that is still your right.

“In spite of everything you have said I am still too afraid of reactions to vaccines and/or I have a needle phobia.” Fair enough, no one wants to force you to do something you are unable to. You might be able to get help in managing these fears, but if you can’t, you can’t. Just recognize that you should accept the consequences - the very real chance of getting very sick, and the responsibilities – to respect that you may be a risk to others around you and avoid gatherings with vulnerable people.

Ultimately, we vaccinate because it protects us, and/or the people we love, or just to protect the vulnerable people in our community we may meet in the movies.

If you are under 65 without other risk factors

COVID is like any other respiratory virus. If there weren’t tests for it, you wouldn’t know or care if you had COVID or a cold. I think you’d be crazy NOT to be vaccinated. Why get sick and have to take unpaid leave from work if you don’t have to?

Additionally the case for everyone including younger people getting a flu shot has been made long ago and is still valid. Flu is a nasty disease in any age group, can be deadly in the same vulnerable group as COVID is, and the loss of economic productivity from it is staggering.

HOWEVER if you are interacting with people who ARE vulnerable you have a different set of circumstances and, I believe, different responsibility. COVID and flu shots help keep the cases of circulating virus down and lower the risk for everybody – those vulnerable people among our families, friends, neighbours, and community.

Risk:

In deciding to have in person gatherings we have in essence said “we accept the risk of being together, but we should do everything reasonable to reduce the risks we can.” We have to balance the science of COVID against everyone’s personal risk and risk tolerance. In the case of our music group we rely on its members to be as safe as possible. It is a matter of trust, and respect for others.

Let’s look at some analogies. When patients come to the office or the ER we do not know who has HIV. We can’t test everyone before they are seen in the ER, and we don’t want to stigmatize individuals. Hence we use UNIVERSAL precautions when taking blood, which is a great idea because there are other deadly blood-borne pathogens to be protected from as well.

Caregivers in nursing homes get the flu shot, not necessarily to protect themselves, but to protect their vulnerable patients.

We rely on “herd immunity” with childhood vaccines. If something like 80% of kids are immunized then the risk of ANYONE catching diphtheria or whooping cough is almost zero. But what has happened since more people are refusing childhood vaccines? – a rise in those diseases we thought we had conquered.

What about rapid tests?

Current Ontario guidelines say that rapid tests have little value in most cases.

“Rapid antigen tests are not recommended for one-off testing (e.g. before a social gathering) by people who are asymptomatic and without known exposure to someone with COVID-19…”

“If an asymptomatic individual without a known exposure to a COVID-19 case decides to perform a rapid antigen test …for example prior to a social event/gathering/visit in a non-highest risk setting…, they should complete the test as close to the event as possible …ideally within a few hours of the event… and should understand important limitations of rapid antigen test use for this purpose…”

The fact is that rapid tests done when the chance of having COVID is low in the first place add very little useful information. The best information I can find suggests that a negative test indicates that a person is likely not contagious at that moment. Unfortunately, the chance of actually detecting a true positive in someone without any symptoms is low. Another problem is that rapid tests are difficult to find.

What is a reasonable approach to reduce risk for gatherings with vulnerable people like the music retreat?

Here are the questions. Suppose we all stay away from the retreat if we have even a hint of symptoms, or if we have had contact with flu or COVID in the past week. In that case is a requirement for immunization necessary? Is rapid testing just prior to an event useful?

Here is a possible strategy – suppose we say that unvaccinated individuals should not attend a gathering unless everyone attending agrees. It is not up to the vulnerable people to stay away if there is an unvaccinated individual; it is up to the unvaccinated individual to respect the needs of the group. The unvaccinated individual, IF they are to attend, they MUST rapid test just before coming.

The problem with this strategy is that it makes for a complex set of decisions and communications in which many people may feel uncomfortable disclosing their medical or risk status. So I do not think it is a FAIR approach even though it may be scientifically defensible.

Though I personally believe that an unvaccinated individual who has had no contacts, no symptoms AND A NEGATIVE RAPID TEST (one of the few cases where a rapid test may provide useful information) poses little risk, I believe it is the wrong decision for the group. We have to rely on and trust that others are respecting everyone else’s individual risks.

Given that trust is key, to lower the risk of infectious diseases EVERYONE must up to date with COVID vaccines and flu shots, (or have had recent COVID infection) and EVERYONE has to follow the “Golden Rule” of staying away if they have even a hint of symptoms, or if there has been contact with flu or COVID in the past week. Rapid test use could be discretionary.

I’d recommend RSV shots as well but RSV is not as prevalent in adults, not everyone is eligible for a free one and $240 is a lot for most of us.

What about someone who has a true medical contraindication to vaccination? In specific cases, in groups that know each other, accommodating one person is possible if the group agrees. If that person follows the golden rule AND rapid tests just before coming, then the risk is low. This is different in concept than saying that the golden rule plus rapid tests are good enough for everyone. In this latter case there are too many unknowns. Too many in the group may let immunization lapse, or there may be more than one unvaccinated person and no one in the group knows the risk they are accepting. In the former, everyone in the group knows and agrees to accept the additional risk of that one person.

This way we can be together with friends, family and community knowing that we can trust the people around us to do the best they can to protect themselves and others.

The best way to protect yourself is to be vaccinated.

The best way to protect others is to be vaccinated. It’s that simple!