What is the price of returning to pre-pandemic life, according to Harvard scientists

As COVID-19 numbers drop and mandates lift, the question remains: is it possible to avoid the trade-off between returning to pre-pandemic lifestyles and an increase in COVID-19 related deaths?

To find an answer, researchers at Massachusetts General Hospital, Boston Medical Center, and Georgia University of Technology in the United States conducted a simulation study projecting the future of the COVID-19 pandemic in every state.

The analysis, which was published in the journal JAMA Health Forum, assumes that the current rate of vaccination is maintained in the future, and models different dates for the lifting of mandates. In most states, the easing of masking mandates and other restrictions resulted in some “rebound” in COVID-19-related deaths; however, delaying the date for the lifting of mandates did little to lessen the possible increase in deaths.

“The inevitable spike in mortality was directly attributable to the Ómicron variant; when we repeated the analysis, assuming the infectivity of the previous Alpha and Delta variants, the model did not project such an increase in mortality after the relaxation of mask mandates,” said co-author Benjamin P. Linas, professor of medicine at Boston University School of Medicine.

One of the most important factors in predicting the magnitude of the uptick in mortality following the relaxation of mandates was the degree of community immunity at the time of the lifting of the mandate. Therefore, communities with a high percentage of residents vaccinated and/or who have undergone COVID-19 are likely to have lower mortality rates.

“There is a difficult dilemma on the horizon,” said co-author Jagpreet Chhatwal, director of the MGH Institute for Technology Assessment and adjunct professor at Harvard Medical School. “While there is ample evidence in our analysis that a lifting date of March 2022 leads to a spike in mortality in many states, the simulation also suggests that with the Ómicron variant, as long as states eliminate mandates they will face the same difficult choice between increasing mortality. by COVID-19 and the freedoms of returning to a pre-pandemic norm.” He added: “The only intervention that can mitigate this impossible choice is continuous vaccination against COVID-19 with reinforcements.”

While a delay in lifting mask mandates or restrictions on social gatherings may not completely prevent future increases in COVID-19 related deaths, the results could help state public health officials weigh different options.

“The arguments for the removal of restrictions must be explicit within the cost-benefit framework, examining the cost of restrictions versus the cost of mortality from COVID-19,” said co-author Jade (Yingying) Xiao, a doctoral student at Georgia Tech. “At the same time, those in favor of maintaining the restrictions must recognize that 'just a little more' will not be enough.”

Researchers point out that the highly transmissible Delta and Ómicron variants are likely to continue to claim a large number of victims nationwide, but if a less transmissible viral strain were to become the dominant strain, rebound morbidity and mortality rates would be substantially lower. “If this were the case, it would probably be possible to lift the restrictions more safely by the beginning of the second quarter of 2022,” concluded co-author Turgay Ayer, director of Business Intelligence and Health Analytics at the Center for Health and Humanitarian Systems at Georgia Tech.

According to recent research published in the scientific journal Nature, some researchers think that the lifting of restrictive measures in the world is happening too fast. In Switzerland, people no longer need to wear masks in most public places. And while those who test positive for COVID-19 must isolate themselves for five days, all other restrictions have disappeared. “Lifting the masks was premature and I don't really understand why it was done,” said Isabella Eckerle, co-director of the Geneva Centre for Emerging Viral Diseases in Switzerland. He added that polymerase chain reaction tests are showing positivity rates of more than 35% in the country, and only seven out of ten people have received at least one dose of a vaccine (the same proportion of UK adults have received three doses).

Several countries that have removed restrictions have seen subsequent increases not only in cases, but also in hospitalizations and deaths, although the link between cases and serious outcomes has been dissociated, according to Deepti Gurdasani, an epidemiologist at Queen Mary University in London. “Although some deaths after a positive test are incidental, there is a very large proportion that they are deaths from COVID-19. It's a very worrying situation, and that doesn't even speak of the impact of prolonged COVID,” he stressed.

Gurdasani would like to see measures implemented that could help minimize the impact of easing restrictions on the number of cases and deaths. For example, he says, if wearing masks is optional, he should focus more on properly ventilating buildings.

But others think that high rates of immunity from recovery and vaccination in some places mean that many of the interventions designed to hinder the spread of COVID-19 are now debatable. “We are in a different place now,” said Müge Çevik, who is researching infectious diseases and medical virology at the University of St Andrews, UK. “It is now clear that we cannot prevent infections, so the focus must be on preventing serious outcomes.” She is optimistic that people won't start “going crazy” as soon as the rules about masks and socializing are relaxed; instead, there will be a gradual return to normality.

Joël Mossong, epidemiologist of infectious diseases at the Luxembourg Health Directorate, supports the lifting of restrictions in his country. “We've seen some deaths, but nothing of the kind we witnessed last winter, even last spring,” he said. “The argument for maintaining restrictions is really gone, and I think we are now at a stage where the strategy to remove restrictions is the right way to go.”

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