When Can I Safely Return to Normal Life? Part 1

CredibleMind Ambassador Blog by Leo Bierman, MS, LAc | View Original Blog

The most difficult part of this subject is that life is probably not going to be the same, and we will become accustomed to a new “normal.” Here in the US, the economy has taken a massive blow, tens of thousands have died, tens of millions have lost jobs, and we are in the beginning of a growing mental health crisis, a “second curve” that will last long after the pandemic has ended. There will continue to be risk of infection and spread of COVID-19 until we have either an effective, widely distributed treatment, very large percentages of recovered (and hopefully immune) people, or perhaps a vaccine.

It is important that we are honest and realistic about this. In the US, our future is quite unknown, and any sense of normalcy, as far as we can see now, is very far off.

Unfortunately, clashing economic and political forces compound the difficulty of assessing our near and long-term future.

Current decision-making is focused on “reopening” the economy by relaxing restrictions on public gathering and social distancing. Many politicians are pushing for reopening dates that are far earlier than what medical and epidemiological experts recommend. If politicians decide to reopen before the disease is under control (as is already underway), then anyone who returns to normal life will face danger. High-risk groups face particular danger via increased risk of infection, and even lower-risk groups can have very severe, even deadly cases. This means we need to understand what safe reopening really looks like, and to make decisions for ourselves as to what level of risk is really acceptable for us.

For safe reopening, we will need to have many factors in place. Medical professionals have advised that relaxing restrictions requires that rates of new cases and deaths be decreasing for 14 days, that we have widespread testing, thorough contact tracing, enough healthcare capacity to deal with another surge, sufficient PPE supplies, and more. For a deeper understanding of what a medically-responsible reopening would look like, see this useful table.

Even upon such reopening, there needs to be a slow and gradual relieving of select social distancing measures over a 1–2 month period. During and after that, high-risk groups would still have to shelter-in-place until cases drop precipitously and stay low for a number of months. This means that for most places in the US, we are many months and many policy decisions away from being able to safely return to anything like normal life.

Unfortunately, the current political climate, and the state of testing, of our healthcare system, of our PPE supplies, our case and death rates, and more suggest that we will likely not have the necessary precautions in place when reopening begins in many regions, which means reopening may occur in an unsafe environment.

What does this mean for you?

It is important to be aware of this and to assess how much risk you are willing to face. How you should approach this depends on a lot of factors, the first of which are where you live and the state of the outbreak and its control in your area. Some other factors include your own medical risk level, as well as those of those close to you, and your economic situation.

Government orders to reopen do not mean that you are safe to return to normal life

The push for early reopening is motivated primarily by economic factors, and only secondarily by the safety or needs of ordinary people. It is understood that there are real medical impacts of not reopening economic activity from the increased illness and deaths associated with unemployment and lack of access to medical care. It’s important to know what your real risk level is when you make decisions about returning.

Government policy decisions around reopening are not the markers to look to when deciding whether to change your behavior and return to your previous ways of life. Your safety, the safety of your loved ones, and the safety of the general public is determined by the state of the pandemic, how controlled it is, and how prepared we are for addressing new cases.

Without widespread and continuous testing, and any real case tracking, there is absolutely no guarantee of safety when we reopen. Testing is key for knowing when this pandemic is sufficiently contained in your area. Without widespread testing, know that your risk of exposure to the virus is unknown.

I need to work to survive, what do I do?

There is no doubt, we have been placed in a very difficult circumstance. Not only are many Americans out of work because of the pandemic, but our social safety nets are often critically weak or non-existent. For countless Americans, this means that going back to work seems like the only option for survival.

Our leaders are making big decisions for us. Sometimes these are in our best interest, sometimes they are not. The harsh reality is that early reopenings, just like the rest of this pandemic, will not affect everyone equally. Reopening will mean that the poorest and most disenfranchised will be the first to return and face risk, just as they are taking the brunt of the pandemic right now.

Early reopenings may only marginally help the working class, and will put the poorest at risk, while the richest will in many cases be able to continue enjoying the safety of social distancing. This ugly reality is laying bare the extreme class, racial, and economic inequality present in the US. What would actually help, and what we should be demanding right now, instead of early reopenings, are healthcare, housing, and food security for everyone immediately. Then, through robust collaborations of government, businesses and community groups, we can demand long-term action supporting all the “social determinants of health.” The CDC has set goals for Health Impact in 5 years, (see HI-5 here), to address income security, neighborhood safety, housing stability, food security, social support, access to healthcare and education — all major determinants of wellbeing for every American.

If reopening occurs in your area before the required factors above are in place, we recommend that you continue social distancing and sheltering-in-place as you have been, if possible. If this is not possible for financial or other reasons, do your best to take all possible precautions. This means minimizing exposure to public or crowded places, socially distancing as much as possible (the more you can do this the better), and following all recommended safety protocols such as use of a mask, hand-washing, etc. For further details on re-entry, check out this excellent article in the New Yorker.

What else can I do?

As it is unclear when or if life will ever return to how it was, it can be wise to also make some contingency plans.

Here are some ideas to consider:

• Start growing food now if you can, and share with your community. Anything helps! Think of the victory gardens during WWII.
• If your livelihood is gone or threatened, learn about job transitions and consider alternatives to make a living in case your job doesn’t return. I know, this is easier said than done, and for some this may not be possible.
• Figure out how you and your loved ones or community can support each other if some of you remain unemployed.
• Look up local “Mutual Aid” networks, which are networks of people dedicated to helping one another with any needs that may come up during crises. See if you have one in your area, you can help support others with what you have, and they can support you. If you can’t find one, start one yourself! We need to take care of each other.
• Demand action addressing social determinants of health such as income, healthcare, food, education and secure housing from your local and federal government, as these are key to both our health and the health of the country.

What does the future look like?

None of us know. However, given the pandemic response here in the US, and the push for early reopening, I believe we can expect certain things to occur. If we reopen too early, we can expect further surges. This means more deaths, more overwhelmed healthcare systems, even longer subsequent shutdowns, and an even more precarious economy, perhaps even a depression.

To keep yourself safe, pay attention to the state of your region’s pandemic situation, not just government orders to reopen. A simple rule-of-thumb is that if there is not widespread testing and contact tracing in your area, and cases and deaths have not been decreasing for at least 2 weeks, know that there is likely a great deal of risk if you return to “normal life” as we used to know it.

Although there is much uncertainty, there are things you can do now from the perspective of your mental and emotional health to make the transition easier.

Continue reading in Self-Care is Key to the Mental Health Crisis: Part 2