On March 1, Ontario and Alberta lifted most of their COVID-19 restrictions, including indoor capacity limits and proof of vaccination in most settings. This isn’t the first time certain restrictions have been lifted—provinces have removed and re-imposed restrictions as case counts have fallen and risen throughout the pandemic. But this time, most COVID-19 provisions are off the table: Almost all restrictions are gone this week in Ontario and Alberta. Quebec and Prince Edward Island intend to follow suit in the coming weeks. And Saskatchewan lifted its restrictions on Feb. 28, removing a mask mandate in most indoor settings and mandatory isolation mandates for those with COVID-19. Public health officials have cited high vaccination rates and declining hospitalizations as key to their decision.
For those now accustomed to wearing masks and avoiding crowds, returning to some semblance of pre-pandemic normalcy might feel strange, even scary. Below, epidemiologists weigh in on how to protect ourselves once restrictions are lifted, what infection rates might look like in the coming months and what we can learn from countries where restrictions have already been lifted.
Should we even be lifting restrictions?
Laura Rosella, an epidemiology professor at the University of Toronto who sits on Ontario’s COVID-19 Modelling Consensus Table, says that lifting restrictions is “appropriate” given that cases are decreasing and we have tools like vaccines to protect ourselves from the virus. But she favours a gradual easing of restrictions that assesses the risk of new variants instead of the abrupt changes we’re seeing.
The World Health Organization has similarly advised against prematurely lifting all restrictions as countries continue to grapple with the Omicron variant. In Canada, we may eventually see the BA.2 variant, a highly contagious strain of the Omicron variant that appears to spread more easily, and that could result in more infections or smaller waves of cases. “The risk of dropping all restrictions at once is that you might have to bring some back,” Rosella says. “And the risk of COVID-19 hasn’t gone away.” Public health officials, she adds, need to be clear on what the criteria are for reinstating restrictions and which ones might return under which circumstances.
Is COVID-19 endemic?
COVID-19 isn’t yet endemic. An endemic disease is one that we can reasonably predict and understand. We know the flu, for example, will come around every winter and for the most part, know what its severity will be. But we still don’t know enough about COVID-19, with its new variants and varied infection rates, to know what to expect.
“There was a massive change just between the Delta and Omicron variants,” says Rosella. “People are talking about COVID-19 being endemic in the long run, but I don’t foresee that just yet.”
Even with what we know about the virus, Rosella says we’re far off from pinpointing patterns or seasons when COVID-19 will be most prevalent. And, even if we did reach that point with COVID, calling a disease endemic doesn’t mean it’s no longer a threat—endemic diseases can either be severe or mild and common or uncommon in the wider population.
What can we expect to see as restrictions are lifted?
Unsurprisingly, we can expect to see case counts rise as restrictions are lifted. Rosella says that the potential arrival of the BA.2 variant might cause a rise in cases come March, and afterward we’ll likely still see outbreaks (caused by Omicron or future variants) for the next year or so globally. This is already happening in places like Hong Kong, whose healthcare system is overwhelmed by a surge in Omicron cases.
How have other countries fared after lifting restrictions?
In February, Denmark became one of the first European countries to lift most COVID-19 restrictions: Face coverings aren’t required in malls or on public transit, few places require proof of vaccination and there are no capacity limits on restaurants or bars. Once restrictions were lifted, the country saw some of its highest case counts so far during the pandemic. Still, high vaccination rates among Danes has meant fewer ICU admissions and hospitalizations and cases are now on the decline overall, though the country is still averaging about 24,000 new infections each day.
But we can’t predict how countries will fare without restrictions based on Denmark’s example, says Troels Lillebaek, a professor and infectious disease specialist at Statens Serum Institut, a research institute under the Danish Ministry of Health. How a country fares without restrictions will depend on its vaccination rate, how prevalent the virus is within the population, and the capacity of the healthcare system to withstand outbreaks. “There isn’t a one-size-fits-all solution to loosening restrictions,” he says.
It’s hard to predict what will happen in Denmark in the coming months, especially if a new variant arrives. But Lillebaek says that even in that case, we know more about the virus now and have effective tools to protect ourselves, so any public health measures that needed to be implemented wouldn’t start from scratch. The Danish prime minister has also said that restrictions may return if needed.
We’ve been isolating for the last two years. What if I’m not ready to live without restrictions?
The transition to life without restrictions might be difficult for some, and that’s made even more uncertain with new variants, potential outbreaks and fear for the safety of children, elderly family members and vulnerable loved ones. Don’t expect to be able to just shake off those worries when we’ve lived with them throughout the pandemic, says Cynthia Carr, an epidemiologist based in Winnipeg. To cope effectively, we should seek out help when we need it and approach these changes at our own pace—if you’re not comfortable dining at a restaurant without proof of vaccination just yet, that’s okay.
How worried should I be if I’m vaccinated and boosted? What if I’m immunocompromised or around people who are?
Although you might be healthy, fully vaccinated and otherwise unworried about getting sick, others around you might not be. Taking steps to minimize risk—being mindful of who you come into contact with and self-monitoring for symptoms, for example—is always a good idea, especially if you live with people who are elderly or immunocompromised. When there’s transmission of the virus and restrictions are lifted, vulnerable groups are most at risk, says Lillebaek. In other words, Rosella says, try not to live in fear without throwing caution to the wind.
For now, there aren’t provincial policies to protect those who are immunocompromised—some of whom don’t respond to the vaccine at all and have little protection against the virus. And neither will most immunocompromised people be able to isolate themselves completely once restrictions lift. The onus then falls on us, says Rosella, to limit exposing those who are most vulnerable to the virus.