The war on COVID-19 has a lot in common with the war on drugs. Just as it is unrealistic to believe we can ever achieve a drug-free society, it is unrealistic to believe we can achieve a COVID-free society. While case numbers seem to be ebbing right now, and vaccinations are revving up, the risk remains that new, more virulent and contagious strains will emerge, resistant to the vaccines and to the immunity derived from having already been infected. Humans are social animals, and as people resume the in-person interactions they psychologically need and crave, new outbreaks are prone to occur.
This pandemic has a way to go before it runs its course. Even then, we can expect COVID-19 to remain a part of life for the foreseeable future.
It is time to embrace a strategy long advocated by reformers who deal with risky substance use and addiction: harm reduction. Harm reduction is nonjudgmental. It focuses on reducing the harm associated with the use of certain drugs and away from an abstinence-based approach that so often fails. Harm reduction is not a difficult concept for medical practitioners to grasp. When doctors prescribe medications to overweight, borderline diabetic, hypertensive patients who are unable or unwilling to make the necessary lifestyle adjustments to correct their health problems, they are practicing harm reduction.
In the case of substance use, harm reduction uses methods such as needle exchange or syringe services programs, safe consumptions sites, anonymous drug testing for contaminants and potency, and medication-assisted treatment for dependency or addiction with drugs such as methadone, buprenorphine, or even pharmaceutical-grade heroin to prevent withdrawal and stabilize life.
It is unrealistic to believe COVID-19 can be eradicated. Only one virus that infects humans has ever been eradicated––smallpox––and that took 200 years. The likelihood is that COVID-19 will become endemic, making oscillating or seasonal appearances. Dealing with this reality via oscillating lockdowns is unsustainable.
We have already seen some of the harms resulting from the abstinence-based approach to the pandemic. These harms are not only economic, though poverty is a social determinant of health. Children are losing out on developing critical social and cognitive skills due to school closures, and poor children in inner cities have been hit the hardest. Children and adults are experiencing mental health deterioration. Suicides are increasing, as are drug overdoses. Many illnesses are going undiagnosed that will lead to increases in late-stage cancer and other medical problems in coming years. Income disparities are widening. Pockets of rebellion against pandemic policies are multiplying and respect for public health and governmental institutions is fading.
We need to move away from an abstinence-based approach and adopt measures that allow us to return to as much of a normal life as possible.
A key harm reduction tactic is vaccination. Even as new variants develop, the immunity derived from vaccination or from previous infection means that a recurrent COVID-19 infection is much less likely to be severe or require hospitalization. Vaccination also reduces spread by moving the population toward herd immunity. As vaccinations increase, it becomes reasonable for people to resume dinner parties, home gatherings, and other social activities providing all involved have been immunized—either with a vaccine or by having survived infection.
Coexisting with the virus means mask-wearing will still make sense in dense crowds with unknown people who might be carrying the virus. And we should keep our distance from vulnerable friends or family members when outbreaks occur. It also means frequent hand-washing. This might be a good time to abandon the handshake for good.
A centrally planned, one-size-fits-all approach will be inequitable and ineffective. Government should provide updated and accurate information so that individuals and private organizations can devise their own best practices. Restaurants, theaters, shops, and other places of business should have leeway to develop their own evidence-based safety measures, free of micromanagement from governmental authorities. The consuming public will reward or punish these establishments based on results. The same goes for protecting the most vulnerable, such as those in nursing homes. Public health agencies should provide useful guidance but should minimize micromanagement.
As hospital wards and intensive care units begin to decompress and the number of newly confirmed cases heads down, this is a good time to think about how to live in a world in which COVID-19 is endemic—one in which viral flare-ups are inevitable. If we look at the future through the lens of harm reduction then hopefully these flare-ups will mean just a temporary inconvenience from a flu-like or cold-like illness for the overwhelming majority of us.
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