COVID-19, Five Years Later.
COVID-19, Five Years Later
Times of upheaval—such as the pandemic—can be opportunities to reshape society, in ways good and bad.
The shock and dismay of March 2020 are now five years behind us. Back then, COVID-19 was suddenly everywhere and nowhere, an invisible but deadly element, a new pathogen with delayed symptoms and sometimes no symptoms at all. We were all in danger and dangerous to others, a new kind of confusion. COVID-19 left us with an awareness of our own mortality—we were not invulnerable, not individually, not collectively.
COVID-19 is no longer the world’s deadliest infectious disease, a notorious title that was passed back to tuberculosis, an older respiratory illness, just this year. While COVID-19 remains a dangerous infection, particularly for the elderly and immunocompromised, I wonder, five years out, what is the legacy of COVID-19? What did we learn? Which of the acute societal changes from the first year have stuck around? Has COVID-19 been epoch-changing?
COVID-19 turned out to be a textbook virus. It produced its worst health outcomes among persons with certain pre-existing medical conditions; it generated immunity that waned and allowed re-infection; it created post-acute problems we have come to call Long COVID. Medically, we have learned quite a bit during these five years. We now know that N95 masks, which form a tight seal around the nose and mouth, are the best protection against viruses transmitted via tiny aerosol particles. We know the 6-foot rule only slightly reduces the risk of transmission. We know that buildings without proper ventilation are especially dangerous. We know that surface contamination, of which we were very scared, was irrelevant. We know that Long COVID presents differently in different people, following varying timelines. We know that public health, in the form of mass vaccination campaigns, is life-saving when distributing a vaccine that is both effective and safe. We know that these five years have left us with new public health methods: waste surveillance, non-government-based case tracking platforms, mRNA vaccines well-tested and now commonplace. We know that COVID-19 still causes thousands of deaths and that vaccine boosters remain critical public health tools for the high-risk to reduce mortality.
Yet looking back at public health, we have to keep in mind that we didn’t always offer succinct messages that “followed the data.” We still cautioned about the full reopening of society even after vaccination had become widespread, implying that the vaccines were less effective than we claimed they were. At the same time, the CDC’s credibility suffered with its insistence on administering a vaccine to certain populations where it had only marginal benefit; this over-reach may have unfortunately raised lasting questions about guidance on today’s urgently-needed vaccines against measles and diphtheria. Public health by its very nature is a voluntary activity, dependent on trust. During the next pandemic, who will the public trust? How can trust be maintained? Can we be directed by data, even when such data is inconvenient?
Societally, we had equally stark discoveries from COVID-19 that we would do well to remember. The government and its bureaucracies were incredibly effective in many ways. In one month in year one, 90 million stimulus check payments went out to 90% of eligible households. Unemployment insurance expanded broadly. Ninety-five percent of firms with <500 employees got a PPP loan. Employment roared back reaching all-time highs. Child poverty was reduced to a record low. But in other ways government failed: OSHA issued unenforceable recommendations for worker protections. Keeping schools closed, when the morbidity risks to children were low, while allowing restaurants and bars to open created a generation of students falling behind.
After acute changes, many parts of society have returned to, or surpassed pre-pandemic activity: travel, restaurant meals, carbon emissions, public transportation, the invisibility of essential workers, masklessness, hugs and handshakes as social greetings.
But there are also some notable COVID-19 era social remnants. Telehealth exploded. Online shopping accelerated. Working from home grew, although socioeconomic and digital inequality remain. Inner city real estate occupancy remains degraded. Many retirements have been postponed. Movie theater visits have suffered in comparison to streaming services. Schools and universities have blended face-to-face with virtual options. Many of us still react differently when we hear someone coughing nearby. Loneliness and isolation have persisted, certainly for older Americans. Prior to COVID-19, we had become inured to bowling alone; but suddenly we were bowling alone at home. Today we have a greater awareness of our mental health more generally; we don’t want to stop bowling.
What, notably, has not taken place now that we are five years out? There has been no commission to investigate COVID thoroughly enough to the prevent recurrence of a viral pandemic. There has not been any real progress in Long COVID research. We have not seen meaningful changes in our private vaccine manufacturing capacity to respond to the next pandemic. There is no COVID-19 Memorial Day, despite over a million Americans dead from the disease.
We have signs of a form of social amnesia, as Americans did in the years after the Influenza epidemic of 1918. We have moved the health aspects of the pandemic to the background of our everyday lives. Our inability to defend against a virus embarrasses us, feels insulting to our sense of agency and our perceived technological capacities. And there remain important unanswered questions for the next time around. How much economic pain are we willing to endure for short-term health security if a new pandemic occurs?
Perhaps the primary story of the years 2020-2025 was not about health at all, but about politics. A conspiratorial right and a status quo-leaning left grew only more reactive to each other. A president came and went and came back. He may be the dominant legacy of COVID-19. COVID-19’s arrival, and its precipitation of and temporal overlap with issues of race and sudden fiscal collapse, have been overshadowed by the question of whether American democracy will endure.
After COVID-19, we can state unequivocally that science saves lives. But also that some conspiracies never die. Times of upheaval—such as the pandemic—can be opportunities to reshape society, in ways good and bad.
Michael Stein, MD
Dean Ad Interim
Boston University School of Public Health
mdstein@bu.edu
Previous Public Health Matters are archived at: https://www.bu.edu/sph/news/articles/category/public-health-matters/
