after the pandemic essay

I Thought We’d Learned Nothing From the Pandemic. I Wasn’t Seeing the Full Picture

M y first home had a back door that opened to a concrete patio with a giant crack down the middle. When my sister and I played, I made sure to stay on the same side of the divide as her, just in case. The 1988 film The Land Before Time was one of the first movies I ever saw, and the image of the earth splintering into pieces planted its roots in my brain. I believed that, even in my own backyard, I could easily become the tiny Triceratops separated from her family, on the other side of the chasm, as everything crumbled into chaos.

Some 30 years later, I marvel at the eerie, unexpected ways that cartoonish nightmare came to life – not just for me and my family, but for all of us. The landscape was already covered in fissures well before COVID-19 made its way across the planet, but the pandemic applied pressure, and the cracks broke wide open, separating us from each other physically and ideologically. Under the weight of the crisis, we scattered and landed on such different patches of earth we could barely see each other’s faces, even when we squinted. We disagreed viciously with each other, about how to respond, but also about what was true.

Recently, someone asked me if we’ve learned anything from the pandemic, and my first thought was a flat no. Nothing. There was a time when I thought it would be the very thing to draw us together and catapult us – as a capital “S” Society – into a kinder future. It’s surreal to remember those early days when people rallied together, sewing masks for health care workers during critical shortages and gathering on balconies in cities from Dallas to New York City to clap and sing songs like “Yellow Submarine.” It felt like a giant lightning bolt shot across the sky, and for one breath, we all saw something that had been hidden in the dark – the inherent vulnerability in being human or maybe our inescapable connectedness .

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But it turns out, it was just a flash. The goodwill vanished as quickly as it appeared. A couple of years later, people feel lied to, abandoned, and all on their own. I’ve felt my own curiosity shrinking, my willingness to reach out waning , my ability to keep my hands open dwindling. I look out across the landscape and see selfishness and rage, burnt earth and so many dead bodies. Game over. We lost. And if we’ve already lost, why try?

Still, the question kept nagging me. I wondered, am I seeing the full picture? What happens when we focus not on the collective society but at one face, one story at a time? I’m not asking for a bow to minimize the suffering – a pretty flourish to put on top and make the whole thing “worth it.” Yuck. That’s not what we need. But I wondered about deep, quiet growth. The kind we feel in our bodies, relationships, homes, places of work, neighborhoods.

Like a walkie-talkie message sent to my allies on the ground, I posted a call on my Instagram. What do you see? What do you hear? What feels possible? Is there life out here? Sprouting up among the rubble? I heard human voices calling back – reports of life, personal and specific. I heard one story at a time – stories of grief and distrust, fury and disappointment. Also gratitude. Discovery. Determination.

Among the most prevalent were the stories of self-revelation. Almost as if machines were given the chance to live as humans, people described blossoming into fuller selves. They listened to their bodies’ cues, recognized their desires and comforts, tuned into their gut instincts, and honored the intuition they hadn’t realized belonged to them. Alex, a writer and fellow disabled parent, found the freedom to explore a fuller version of herself in the privacy the pandemic provided. “The way I dress, the way I love, and the way I carry myself have both shrunk and expanded,” she shared. “I don’t love myself very well with an audience.” Without the daily ritual of trying to pass as “normal” in public, Tamar, a queer mom in the Netherlands, realized she’s autistic. “I think the pandemic helped me to recognize the mask,” she wrote. “Not that unmasking is easy now. But at least I know it’s there.” In a time of widespread suffering that none of us could solve on our own, many tended to our internal wounds and misalignments, large and small, and found clarity.

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I wonder if this flourishing of self-awareness is at least partially responsible for the life alterations people pursued. The pandemic broke open our personal notions of work and pushed us to reevaluate things like time and money. Lucy, a disabled writer in the U.K., made the hard decision to leave her job as a journalist covering Westminster to write freelance about her beloved disability community. “This work feels important in a way nothing else has ever felt,” she wrote. “I don’t think I’d have realized this was what I should be doing without the pandemic.” And she wasn’t alone – many people changed jobs , moved, learned new skills and hobbies, became politically engaged.

Perhaps more than any other shifts, people described a significant reassessment of their relationships. They set boundaries, said no, had challenging conversations. They also reconnected, fell in love, and learned to trust. Jeanne, a quilter in Indiana, got to know relatives she wouldn’t have connected with if lockdowns hadn’t prompted weekly family Zooms. “We are all over the map as regards to our belief systems,” she emphasized, “but it is possible to love people you don’t see eye to eye with on every issue.” Anna, an anti-violence advocate in Maine, learned she could trust her new marriage: “Life was not a honeymoon. But we still chose to turn to each other with kindness and curiosity.” So many bonds forged and broken, strengthened and strained.

Instead of relying on default relationships or institutional structures, widespread recalibrations allowed for going off script and fortifying smaller communities. Mara from Idyllwild, Calif., described the tangible plan for care enacted in her town. “We started a mutual-aid group at the beginning of the pandemic,” she wrote, “and it grew so quickly before we knew it we were feeding 400 of the 4000 residents.” She didn’t pretend the conditions were ideal. In fact, she expressed immense frustration with our collective response to the pandemic. Even so, the local group rallied and continues to offer assistance to their community with help from donations and volunteers (many of whom were originally on the receiving end of support). “I’ve learned that people thrive when they feel their connection to others,” she wrote. Clare, a teacher from the U.K., voiced similar conviction as she described a giant scarf she’s woven out of ribbons, each representing a single person. The scarf is “a collection of stories, moments and wisdom we are sharing with each other,” she wrote. It now stretches well over 1,000 feet.

A few hours into reading the comments, I lay back on my bed, phone held against my chest. The room was quiet, but my internal world was lighting up with firefly flickers. What felt different? Surely part of it was receiving personal accounts of deep-rooted growth. And also, there was something to the mere act of asking and listening. Maybe it connected me to humans before battle cries. Maybe it was the chance to be in conversation with others who were also trying to understand – what is happening to us? Underneath it all, an undeniable thread remained; I saw people peering into the mess and narrating their findings onto the shared frequency. Every comment was like a flare into the sky. I’m here! And if the sky is full of flares, we aren’t alone.

I recognized my own pandemic discoveries – some minor, others massive. Like washing off thick eyeliner and mascara every night is more effort than it’s worth; I can transform the mundane into the magical with a bedsheet, a movie projector, and twinkle lights; my paralyzed body can mother an infant in ways I’d never seen modeled for me. I remembered disappointing, bewildering conversations within my own family of origin and our imperfect attempts to remain close while also seeing things so differently. I realized that every time I get the weekly invite to my virtual “Find the Mumsies” call, with a tiny group of moms living hundreds of miles apart, I’m being welcomed into a pocket of unexpected community. Even though we’ve never been in one room all together, I’ve felt an uncommon kind of solace in their now-familiar faces.

Hope is a slippery thing. I desperately want to hold onto it, but everywhere I look there are real, weighty reasons to despair. The pandemic marks a stretch on the timeline that tangles with a teetering democracy, a deteriorating planet , the loss of human rights that once felt unshakable . When the world is falling apart Land Before Time style, it can feel trite, sniffing out the beauty – useless, firing off flares to anyone looking for signs of life. But, while I’m under no delusions that if we just keep trudging forward we’ll find our own oasis of waterfalls and grassy meadows glistening in the sunshine beneath a heavenly chorus, I wonder if trivializing small acts of beauty, connection, and hope actually cuts us off from resources essential to our survival. The group of abandoned dinosaurs were keeping each other alive and making each other laugh well before they made it to their fantasy ending.

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After the monarch butterfly went on the endangered-species list, my friend and fellow writer Hannah Soyer sent me wildflower seeds to plant in my yard. A simple act of big hope – that I will actually plant them, that they will grow, that a monarch butterfly will receive nourishment from whatever blossoms are able to push their way through the dirt. There are so many ways that could fail. But maybe the outcome wasn’t exactly the point. Maybe hope is the dogged insistence – the stubborn defiance – to continue cultivating moments of beauty regardless. There is value in the planting apart from the harvest.

I can’t point out a single collective lesson from the pandemic. It’s hard to see any great “we.” Still, I see the faces in my moms’ group, making pancakes for their kids and popping on between strings of meetings while we try to figure out how to raise these small people in this chaotic world. I think of my friends on Instagram tending to the selves they discovered when no one was watching and the scarf of ribbons stretching the length of more than three football fields. I remember my family of three, holding hands on the way up the ramp to the library. These bits of growth and rings of support might not be loud or right on the surface, but that’s not the same thing as nothing. If we only cared about the bottom-line defeats or sweeping successes of the big picture, we’d never plant flowers at all.

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Read these 12 moving essays about life during coronavirus

Artists, novelists, critics, and essayists are writing the first draft of history.

by Alissa Wilkinson

The world is grappling with an invisible, deadly enemy, trying to understand how to live with the threat posed by a virus . For some writers, the only way forward is to put pen to paper, trying to conceptualize and document what it feels like to continue living as countries are under lockdown and regular life seems to have ground to a halt.

So as the coronavirus pandemic has stretched around the world, it’s sparked a crop of diary entries and essays that describe how life has changed. Novelists, critics, artists, and journalists have put words to the feelings many are experiencing. The result is a first draft of how we’ll someday remember this time, filled with uncertainty and pain and fear as well as small moments of hope and humanity.

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At the New York Review of Books, Ali Bhutto writes that in Karachi, Pakistan, the government-imposed curfew due to the virus is “eerily reminiscent of past military clampdowns”:

Beneath the quiet calm lies a sense that society has been unhinged and that the usual rules no longer apply. Small groups of pedestrians look on from the shadows, like an audience watching a spectacle slowly unfolding. People pause on street corners and in the shade of trees, under the watchful gaze of the paramilitary forces and the police.

His essay concludes with the sobering note that “in the minds of many, Covid-19 is just another life-threatening hazard in a city that stumbles from one crisis to another.”

Writing from Chattanooga, novelist Jamie Quatro documents the mixed ways her neighbors have been responding to the threat, and the frustration of conflicting direction, or no direction at all, from local, state, and federal leaders:

Whiplash, trying to keep up with who’s ordering what. We’re already experiencing enough chaos without this back-and-forth. Why didn’t the federal government issue a nationwide shelter-in-place at the get-go, the way other countries did? What happens when one state’s shelter-in-place ends, while others continue? Do states still under quarantine close their borders? We are still one nation, not fifty individual countries. Right?

• A syllabus for the end of the world

Award-winning photojournalist Alessio Mamo, quarantined with his partner Marta in Sicily after she tested positive for the virus, accompanies his photographs in the Guardian of their confinement with a reflection on being confined :

The doctors asked me to take a second test, but again I tested negative. Perhaps I’m immune? The days dragged on in my apartment, in black and white, like my photos. Sometimes we tried to smile, imagining that I was asymptomatic, because I was the virus. Our smiles seemed to bring good news. My mother left hospital, but I won’t be able to see her for weeks. Marta started breathing well again, and so did I. I would have liked to photograph my country in the midst of this emergency, the battles that the doctors wage on the frontline, the hospitals pushed to their limits, Italy on its knees fighting an invisible enemy. That enemy, a day in March, knocked on my door instead.

In the New York Times Magazine, deputy editor Jessica Lustig writes with devastating clarity about her family’s life in Brooklyn while her husband battled the virus, weeks before most people began taking the threat seriously:

At the door of the clinic, we stand looking out at two older women chatting outside the doorway, oblivious. Do I wave them away? Call out that they should get far away, go home, wash their hands, stay inside? Instead we just stand there, awkwardly, until they move on. Only then do we step outside to begin the long three-block walk home. I point out the early magnolia, the forsythia. T says he is cold. The untrimmed hairs on his neck, under his beard, are white. The few people walking past us on the sidewalk don’t know that we are visitors from the future. A vision, a premonition, a walking visitation. This will be them: Either T, in the mask, or — if they’re lucky — me, tending to him.

Essayist Leslie Jamison writes in the New York Review of Books about being shut away alone in her New York City apartment with her 2-year-old daughter since she became sick:

The virus. Its sinewy, intimate name. What does it feel like in my body today? Shivering under blankets. A hot itch behind the eyes. Three sweatshirts in the middle of the day. My daughter trying to pull another blanket over my body with her tiny arms. An ache in the muscles that somehow makes it hard to lie still. This loss of taste has become a kind of sensory quarantine. It’s as if the quarantine keeps inching closer and closer to my insides. First I lost the touch of other bodies; then I lost the air; now I’ve lost the taste of bananas. Nothing about any of these losses is particularly unique. I’ve made a schedule so I won’t go insane with the toddler. Five days ago, I wrote Walk/Adventure! on it, next to a cut-out illustration of a tiger—as if we’d see tigers on our walks. It was good to keep possibility alive.

At Literary Hub, novelist Heidi Pitlor writes about the elastic nature of time during her family’s quarantine in Massachusetts:

During a shutdown, the things that mark our days—commuting to work, sending our kids to school, having a drink with friends—vanish and time takes on a flat, seamless quality. Without some self-imposed structure, it’s easy to feel a little untethered. A friend recently posted on Facebook: “For those who have lost track, today is Blursday the fortyteenth of Maprilay.” ... Giving shape to time is especially important now, when the future is so shapeless. We do not know whether the virus will continue to rage for weeks or months or, lord help us, on and off for years. We do not know when we will feel safe again. And so many of us, minus those who are gifted at compartmentalization or denial, remain largely captive to fear. We may stay this way if we do not create at least the illusion of movement in our lives, our long days spent with ourselves or partners or families.

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Novelist Lauren Groff writes at the New York Review of Books about trying to escape the prison of her fears while sequestered at home in Gainesville, Florida:

Some people have imaginations sparked only by what they can see; I blame this blinkered empiricism for the parks overwhelmed with people, the bars, until a few nights ago, thickly thronged. My imagination is the opposite. I fear everything invisible to me. From the enclosure of my house, I am afraid of the suffering that isn’t present before me, the people running out of money and food or drowning in the fluid in their lungs, the deaths of health-care workers now growing ill while performing their duties. I fear the federal government, which the right wing has so—intentionally—weakened that not only is it insufficient to help its people, it is actively standing in help’s way. I fear we won’t sufficiently punish the right. I fear leaving the house and spreading the disease. I fear what this time of fear is doing to my children, their imaginations, and their souls.

At ArtForum , Berlin-based critic and writer Kristian Vistrup Madsen reflects on martinis, melancholia, and Finnish artist Jaakko Pallasvuo’s 2018 graphic novel Retreat , in which three young people exile themselves in the woods:

In melancholia, the shape of what is ending, and its temporality, is sprawling and incomprehensible. The ambivalence makes it hard to bear. The world of Retreat is rendered in lush pink and purple watercolors, which dissolve into wild and messy abstractions. In apocalypse, the divisions established in genesis bleed back out. My own Corona-retreat is similarly soft, color-field like, each day a blurred succession of quarantinis, YouTube–yoga, and televized press conferences. As restrictions mount, so does abstraction. For now, I’m still rooting for love to save the world.

At the Paris Review , Matt Levin writes about reading Virginia Woolf’s novel The Waves during quarantine:

A retreat, a quarantine, a sickness—they simultaneously distort and clarify, curtail and expand. It is an ideal state in which to read literature with a reputation for difficulty and inaccessibility, those hermetic books shorn of the handholds of conventional plot or characterization or description. A novel like Virginia Woolf’s The Waves is perfect for the state of interiority induced by quarantine—a story of three men and three women, meeting after the death of a mutual friend, told entirely in the overlapping internal monologues of the six, interspersed only with sections of pure, achingly beautiful descriptions of the natural world, a day’s procession and recession of light and waves. The novel is, in my mind’s eye, a perfectly spherical object. It is translucent and shimmering and infinitely fragile, prone to shatter at the slightest disturbance. It is not a book that can be read in snatches on the subway—it demands total absorption. Though it revels in a stark emotional nakedness, the book remains aloof, remote in its own deep self-absorption.

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In an essay for the Financial Times, novelist Arundhati Roy writes with anger about Indian Prime Minister Narendra Modi’s anemic response to the threat, but also offers a glimmer of hope for the future:

Historically, pandemics have forced humans to break with the past and imagine their world anew. This one is no different. It is a portal, a gateway between one world and the next. We can choose to walk through it, dragging the carcasses of our prejudice and hatred, our avarice, our data banks and dead ideas, our dead rivers and smoky skies behind us. Or we can walk through lightly, with little luggage, ready to imagine another world. And ready to fight for it.

From Boston, Nora Caplan-Bricker writes in The Point about the strange contraction of space under quarantine, in which a friend in Beirut is as close as the one around the corner in the same city:

It’s a nice illusion—nice to feel like we’re in it together, even if my real world has shrunk to one person, my husband, who sits with his laptop in the other room. It’s nice in the same way as reading those essays that reframe social distancing as solidarity. “We must begin to see the negative space as clearly as the positive, to know what we don’t do is also brilliant and full of love,” the poet Anne Boyer wrote on March 10th, the day that Massachusetts declared a state of emergency. If you squint, you could almost make sense of this quarantine as an effort to flatten, along with the curve, the distinctions we make between our bonds with others. Right now, I care for my neighbor in the same way I demonstrate love for my mother: in all instances, I stay away. And in moments this month, I have loved strangers with an intensity that is new to me. On March 14th, the Saturday night after the end of life as we knew it, I went out with my dog and found the street silent: no lines for restaurants, no children on bicycles, no couples strolling with little cups of ice cream. It had taken the combined will of thousands of people to deliver such a sudden and complete emptiness. I felt so grateful, and so bereft.

And on his own website, musician and artist David Byrne writes about rediscovering the value of working for collective good , saying that “what is happening now is an opportunity to learn how to change our behavior”:

In emergencies, citizens can suddenly cooperate and collaborate. Change can happen. We’re going to need to work together as the effects of climate change ramp up. In order for capitalism to survive in any form, we will have to be a little more socialist. Here is an opportunity for us to see things differently — to see that we really are all connected — and adjust our behavior accordingly. Are we willing to do this? Is this moment an opportunity to see how truly interdependent we all are? To live in a world that is different and better than the one we live in now? We might be too far down the road to test every asymptomatic person, but a change in our mindsets, in how we view our neighbors, could lay the groundwork for the collective action we’ll need to deal with other global crises. The time to see how connected we all are is now.

The portrait these writers paint of a world under quarantine is multifaceted. Our worlds have contracted to the confines of our homes, and yet in some ways we’re more connected than ever to one another. We feel fear and boredom, anger and gratitude, frustration and strange peace. Uncertainty drives us to find metaphors and images that will let us wrap our minds around what is happening.

Yet there’s no single “what” that is happening. Everyone is contending with the pandemic and its effects from different places and in different ways. Reading others’ experiences — even the most frightening ones — can help alleviate the loneliness and dread, a little, and remind us that what we’re going through is both unique and shared by all.

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How Life Could Get Better (or Worse) After COVID

How do pandemics change our societies? It is tempting to believe that there will not be a single sector of society untouched by the COVID-19 pandemic . However, a quick look at previous pandemics in the 20th century reveals that such negative forecasts may be vastly exaggerated.

Prior pandemics have corresponded to changes in architecture and urban planning, and a greater awareness of public health . Yet the psychological and societal effects of the Spanish flu, the worst pandemic of the 20th century, were later perceived as less dramatic than anticipated, perhaps because it originated in the shadow of WWI. Austrian psychoanalyst Sigmund Freud described Spanish flu as a “ Nebenschauplatz ”—a sideshow in his life of that time, even though he eventually lost one of his daughters to the disease. Neither do we recall much more recent pandemics: the Asian flu of 1957 and the Hong Kong flu from 1968.

Imagining and planning for the future can be a powerful coping mechanism to gain some sense of control in an increasingly unpredictable pandemic life. Over the past year, some experts proclaimed that the world after COVID would be a completely different place , with changed values and a new map of international relations. The opinions of oracles who were not downplaying the virus were mostly negative . Societal unrest and the rise of totalitarian regimes, stunted child social development, mental health crises, exacerbated inequality, and the worst economic recession since the Great Depression were just a few worries discussed by pundits and on the news.

Other predictions were brighter—the disruptive force of the pandemic would provide an opportunity to reshape the world for the better, some said. To complement the voices of journalists, pundits, and policymakers, one of us (Igor Grossmann) embarked on a quest to gather opinions from the world’s leading scholars on behavioral and social science, founding the World after COVID project.

The World after COVID project is a multimedia collection of expert visions for the post-pandemic world, including scientists’ hopes, worries, and recommendations. In a series of 57 interviews, we invited scientists, along with futurists, to reflect on the positive and negative societal or psychological change that might occur after the pandemic, and the type of wisdom we need right now. Our team used a range of methodological techniques to quantify general sentiment, along with common and unique themes in scientists’ responses.

The results of this interview series were surprising, both in terms of the variability and ambivalence in expert predictions. Though the pandemic has and will continue to create adverse effects for many aspects of our society, the experts observed, there are also opportunities for positive change, if we are deliberate about learning from this experience.

Three opportunities after COVID-19

Scientists’ opinions about positive consequences were highly diverse. As the graph shows, we identified 20 distinct themes in their predictions. These predictions ranged from better care for elders, to improved critical thinking about misinformation, to greater appreciation of nature. But the three most common categories concerned social and societal issues.

1. Solidarity. Experts predicted that the shared struggles and experiences that we face due to the pandemic could foster solidarity and bring us closer together, both within our communities and globally. As clinical psychologist Katie A. McLaughlin from Harvard University pointed out, the pandemic could be “an opportunity for us to become more committed to supporting and helping one another.”

Similarly, sociologist Monika Ardelt from the University of Florida noted the possibility that “we realize these kinds of global events can only be solved if we work together as a world community.” Social identities—such as group memberships, nationality, or those that form in response to significant events such as pandemics or natural disasters—play an important role in fostering collective action. The shared experience of the pandemic could help foster a more global, inclusive identity that could promote international solidarity.

2. Structural and political changes. Early in the pandemic, experts also believed that we might also see proactive efforts and societal will to bring about structural and political changes toward a more just and diversity-inclusive society. Experts observed that the pandemic had exposed inequalities and injustices in our societies and hoped that their visibility might encourage societies to address them.

Philosopher Valerie Tiberius from the University of Minnesota suggested that the pandemic might bring about an “increased awareness of our vulnerability and mutual dependence.”

Fellow of the Royal Institute for International Affairs in the U.K. Anand Menon proposed that the pandemic might lead to growing awareness of economic inequality, which could lead to “greater sustained public and political attention paid to that issue.” Cultural psychologist Ayse Uskul from Kent University in the U.K. shared this sentiment and predicted that this awareness “will motivate us to pick up a stronger fight against the unfair distribution of resources and rights not just where we live, but much more globally.”

3. Renewed social connections. Finally, the most common positive consequence discussed was that we might see an increased awareness of the importance of our social connections. The pandemic has limited our ability to connect face to face with friends and families, and it has highlighted just how vulnerable some of our family members and neighbors might be. Greater Good Science Center founding director and UC Berkeley professor Dacher Keltner suggested that the pandemic might teach us “how absolutely sacred our best relationships are” and that the value of these relationships would be much higher in the post-pandemic world. Past president of the Society of Evolution and Human Behavior Douglas Kenrick echoed this sentiment by predicting that “tighter family relationships would be the most positive outcome of this [pandemic].”

Similarly, Jennifer Lerner—professor of decision-making from Harvard University—discussed how the pandemic had led people to “learn who their neighbors are, even though they didn’t know their neighbors before, because we’ve discovered that we need them.” These kinds of social relationships have been tied to a range of benefits, such as increased well-being and health , and could provide lasting benefits to individuals.

Post-pandemic risks

How about predictions for negative consequences of the pandemic? Again, opinions were variable, with more than half of the themes were mentioned by less than 10% of our interviewees. Only two predictions were mentioned by at least ten experts: the potential for political unrest and increased prejudice or racism. These predictions highlight a tension in expert predictions: Whereas some scholars viewed the future bright and “diversity-inclusive,” others fear the rise in racism and prejudice. Before we discuss this tension, let us examine what exactly scholars meant by these two worries.

1. Increased prejudice or racism. Many experts discussed how the conditions brought about by the pandemic could lead us to focus on our in-group and become more dismissive of those outside our circles. Incheol Choi, professor of cultural and positive psychology from Seoul National University, discussed that his main area of concern was that “stereotypes, prejudices against other group members might arise.” Lisa Feldman Barrett, fellow of the American Academy of Arts & Sciences and the Royal Society of Canada, echoed this sentiment, noting that previous epidemics saw “people become more entrenched in their in-group and out-group beliefs.”

2. Political unrest. Similarly, many experts discussed how a greater focus on our in-groups might also exacerbate existing political divisions. Past president of the Society for Philosophy and Psychology Paul Bloom discussed how a greater dismissiveness toward out-groups was visible both within countries and internationally, where “countries are blaming other countries and not working together enough.” Dilip Jeste, past president of the American Psychiatric Association, discussed his concerns that the tendency to view both candidates and supporters as winners and losers in elections could mean that the “political polarization that we are observing today in the U.S. and the world will only increase.”

These predictions were not surprising— pundits and other public figures have been discussing these topics, too. However, as we analyzed and compared predictions for positive and negative consequences, we found something unexpected.

The yin and yang of COVID’s effects

Almost half of the interviewees spontaneously mentioned that the same change could be a force for good and for bad . In other words, they were dialectical , recognizing the multidetermined nature of predictions and acknowledging that context matters—context that determines who may be the winners and losers in the years to come. For example, experts predicted that we may see greater acceptance of digital technologies at home and at work. But besides the benefits of this—flexible work schedules, reduced commutes—they also mentioned likely costs, such as missing social information in virtual communication and disadvantages for people who cannot afford high-speed internet or digital devices.

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Amid this complexity, experts weighed in on what type of wisdom we need to help bring about more positive changes ahead. Not only do we need the will to sustain political and structural change, many argued, but also a certain set of psychological strategies promoting sound judgment: perspective taking, critical thinking, recognizing the limits of our knowledge, and sympathy and compassion.

In other words, experts’ recommended wisdom focuses on meta-cognition, which underlies successful emotion regulation, mindfulness, and wiser judgment about complex social issues. The good news is that these psychological strategies are malleable and trainable ; one way we can cultivate wisdom and perspective, for example, is by adopting a third-person, observer perspective on our challenges.

On the surface, the “it depends” attitude of many experts about the world after COVID may be dissatisfying. However, as research on forecasting shows, such a dialectical attitude is exactly what distinguishes more accurate forecasters from the rest of the population. Forecasting is hard and predictions are often uncertain and likely wrong. In fact, despite some hopes for the future, it is equally possible that the change after the pandemic will not even be noticeable. Not because changes will not happen, but because people quickly adjust to their immediate circumstances.

The future will tell whether and how the current pandemic has altered our societies. In the meantime, the World after COVID project provides a time-stamped window into experts’ apartments and their minds. As we embrace another pandemic spring, these insights can serve as a reminder that the pandemic may lead not only to worries but also to hopes for the years ahead.

About the Authors

Igor Grossmann

Igor Grossmann, Ph.D. , studies people and cultures, sometimes together, and often across time. He is an associate professor of psychology at the University of Waterloo, where he directs the Wisdom and Culture Lab.

Oliver Twardus

Oliver Twardus is the lab manager for the Wisdom and Culture lab and an aspiring researcher. He will be starting his master’s in neuroscience and applied cognitive science in September 2021.

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The Way Ahead: Life After COVID-19

Mouaz h al-mallah , md, msc.

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CORRESPONDING AUTHOR: Mouaz H. Al-Mallah, MD, MSc Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, US [email protected]

Received 2021 Oct 29; Accepted 2021 Nov 3; Collection date 2021.

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/ .

Much has changed in the 2 years since the start of the coronavirus disease 19 (COVID-19) pandemic. The need for social distancing catalyzed the digitization of healthcare delivery and medical education—from telemedicine and virtual conferences to online residency/fellowship interviews. Vaccine development, particularly in the field of mRNA technology, led to widespread availability of safe and effective vaccines. With improved survival from acute infection, the healthcare system is dealing with the ever-growing cohort of patients with lingering symptoms. In addition, social media platforms have fueled a plethora of misinformation campaigns that have adversely affected prevention and control measures. In this review, we examine how COVID-19 has reshaped the healthcare system, and gauge its potential effects on life after the pandemic.

Keywords: COVID-19, coronavirus, cardiovascular disease, vaccine

Introduction

In December 2021, after many months of living with the COVID-19 pandemic, the world is still looking for a way out of this healthcare crisis. As of this writing, more than 250 million people globally have been infected with SARS-CoV-2, the virus that causes coronavirus disease 19 (COVID-19), and nearly 5 million individuals lost their lives battling the complications of severe acute respiratory syndromes. 1 Many communities experienced multiple surges of the virus, with changes in normal life and restrictions to daily activities. The intensification of vaccination efforts brought about hope for a possible end to the pandemic. However, the continued emergence of variant strains and vaccine hesitancy have been persistent challenges in the US and globally. In this article, we review the long-term effect of COVID-19 on healthcare systems and envision the future of life after the pandemic ( Figure 1 ).

The long-term effects of the coronavirus disease 19 (COVID-19) pandemic on the healthcare system.

Since the beginning of the pandemic, there have been accelerated efforts to sequence the genetic material of the virus and build effective vaccines that decrease the risk of infection, hospitalization, and mortality. 2 At the time of this writing, more than 10 vaccines have been approved by local healthcare authorities in different parts of the world. 3 The pandemic has also driven innovation in the novel field of messenger ribonucleic acid (mRNA) vaccines. The US Food and Drug Administration (FDA) has approved the use of the Pfizer-BioNTech mRNA vaccine and given emergency use authorization to Moderna. 4 The mRNA vaccines have shown excellent efficacy against many of the strains, including the beta and delta strains.

More recently, booster doses have been approved by the FDA for individuals aged 65 years and older as well as individuals with comorbidities, in long-term care facilities, or at increased risk for COVID-19 exposure and transmission due to occupational or institutional settings. 5 Furthermore, the FDA has also given emergency use authorization for the Pfizer-BioNTech vaccine in individuals aged 12 to 17 years and, as of October 29, in children aged 5 to 11 years.

Although the fast-tracked vaccine production time led some skeptics to hypothesize safety concerns, the rate of adverse events has been very low. One complication that gained significant attention is myocarditis. 6 , 7 , 8 Emerging data have shown that young men are the most commonly affected demographic. Furthermore, the risk was elevated in the setting of a recent COVID-19 illness and after the second dose of the vaccine. 6 , 7 Although the rate of myocarditis is low and the majority of patients recover, the risk of recurrence in patients who developed myocarditis with the first dose or in patients with recent myocarditis is unclear. Similarly, the rate of recurrence after the second or booster doses also is unclear.

Vaccine Mandates

Multiple state and federal governments have issued vaccine mandates, and they have become a highly contested political issue in the United States. The Biden administration issued an executive order on September 9, 2021, requiring all federal employees to vaccinate. 9 Some state and local governments have also followed. 10

Multiple US healthcare systems have also issued COVID-19 vaccine mandates for employees. On March 31, 2021, Houston Methodist became the first healthcare system to mandate the vaccine for employees, and a wave of other healthcare systems followed suit. 11 As of this writing, more than 2,500 hospitals or health systems have followed Houston Methodist and mandated vaccines for their clinical and nonclinical staff. 12

Combating Misinformation

Since the beginning of the pandemic, misinformation has spread throughout the Internet and on social media platforms. 13 People have questioned the existence of the virus, the strain on healthcare systems, and the benefit of masks as well as emphasized the benefits of unproven therapies, many of which were useless and even harmful. 14 Political agendas have also played into the misinformation campaigns. Studies have shown that these misinformation campaigns have had measurable effects on the intent to vaccinate and created widespread fear and panic, ultimately contributing to the reduced number of people willing to vaccinate. 13 , 15 , 16 Tackling this will require concerted efforts by the government and private sector, particularly social media companies, to implement evidence-based communication strategies. 17 Individuals should also assume responsibility in seeking out accurate, evidence-based information for their own consumption.

Telemedicine

As many states and cities implemented measures to reduce transmission, telehealth emerged as the ideal tool to continue patient care while protecting the health of both patients and providers. Many patients preferred this option, especially when hospitals were dealing with record numbers of COVID-19 infections. In 2020, telemedicine was the main means by which ambulatory care was provided, accounting for 10% to 20% of visits when virus transmissibility was low and as high as 80% of visits during the surges. 18

Accordingly, the US Department of Health and Human Services relaxed enforcement of software-based Health Insurance Portability and Accountability Act violations, the Centers for Medicaid and Medicare Services provided waivers for telehealth reimbursements, and, in many instances, commercial insurances provided the same either directly or through mandates provided by local state governments. 19 , 20 The removal of regulatory and reimbursement barriers led to a dramatic increase in the use of telehealth, with some institutions reporting multifold increase in telehealth visits. 21

The pandemic also served as a catalyst for innovation in the software and hardware necessary for telemedicine. 22 For example, important tools were developed to enable secure connections with physicians and allow remote vital sign and weight monitoring. 23 , 24 Unfortunately, not all have equally benefitted from the expanded use of telehealth. Data indicate that minorities and disadvantaged groups often lack access to telehealth-based care. 25 Although the positive response and uptake by physicians and patients indicates the likelihood of telemedicine continuing past the pandemic, it remains to be seen whether the regulatory and reimbursement aspects will continue.

Post Covid-19 Condition

There is a growing body of evidence that some patients have prolonged recovery and/or residual symptoms after acute infection with COVID-19. The World Health Organization has defined this as “post COVID-19 condition.” Common presentation includes shortness of breath, palpitation, anxiety, and depression lingering for several months after acute infection. 26 , 27 Recent data also suggests that post COVID-19 condition might not be limited to somatic symptoms, with studies showing a 7-fold increased risk of developing depression and mental health issues. 28

Although the cause of these symptoms is not clear, one possible link that partly explains the prolonged shortness of breath experienced by some patients is COVID-19–associated myocarditis and the associated microvascular dysfunction. 26 As the pandemic continues and therapeutics improve survival from acute infection, the number of patients reporting post COVID-19 condition is predicted to grow. Several medical centers have already established clinics to better coordinate care and conduct research on the long-term impact and treatment of COVID-19. 29

Collateral Damage

Many patients delayed regular and preventive care during the pandemic due to fear of contracting COVID-19. 30 , 31 Such change in health-seeking behavior also extended to emergency conditions, with studies showing how some patients did not seek care for new onset chest pain. 32 Indirect indicators of this are the reduced rates of cardiovascular testing globally and within the United States 33 , 34 and the increased rate of myocardial infarctions and other emergencies seen on the trailing end of COVID-19–infection surges. 32 There has also been an increase in late complications of myocardial infarction such as ventricular septal rupture, a rare occurrence in the prepandemic reperfusion era and one partly explained by delayed care and ignored early warning signs. 35

Disparities in Healthcare

The pandemic exposed significant disparities in healthcare delivery, particularly among minorities. They were more likely to be affected by misinformation campaigns and less likely to accept research supporting clinical therapies and vaccines. Understanding the disparities and identifying measures to bridge the gap will be an important area of research for policy.

Globally, the pandemic also exposed significant inequities regarding vaccine access. While many developed countries were able to reach vaccination rates as high as 70%, rates in low-to-middle-income countries have remained low. 35 As the delta variant has clearly shown, no one is safe until everyone is safe. To this end, the World Health Organization and the COVAX (COVID-19 Vaccines Global Access) alliance have been a vital source of affordable vaccines. 36

Changes to Medical Education

The pandemic resulted in significant changes to both graduate and continued medical education. Much like patient-physician encounters, postgraduate training programs limited large face-to-face gatherings and transitioned all teaching to online platforms. 37 Residency and fellowship recruitment interviews also shifted to online settings. Lastly, there has been an exponential increase in the number of continued medical education offerings, with many societal meetings and conferences transitioning to online or hybrid formats. 38

The medical community has, for the most part, been very receptive to these changes, and it has afforded unforeseen advantages to trainees. Residency and fellowship applicants no longer need to bear the logistic and financial burden of in-person interviews. More importantly, virtual meetings and conferences have significantly increased audiences and, by extension, enabled the wider dissemination of medical knowledge.

The COVID-19 pandemic has dramatically changed clinical practice, medical education, and research. Beyond the immediate increase in morbidity and mortality, the healthcare system is having to deal with a growing cohort of patients with lingering symptoms. Misinformation, vaccine hesitancy, and vaccine inequity will be continuing challenges to attaining herd immunity. Clinicians, educators, and healthcare administrators will also have to determine how best to leverage the transition to virtual platforms. Lastly, healthcare leaders and policy makers will have to help the country and world chart a course through the end of the pandemic.

The coronavirus disease 19 (COVID-19) pandemic has dramatically changed clinical practice, medical education, and research.

It has brought about new challenges for the healthcare system, such as how best to combat misinformation, address the disproportionate impact on minorities and marginalized groups, and treat the ever-growing population of patients with lingering “long COVID” symptoms.

The pandemic has also catalyzed much needed change in vaccine development, telemedicine, and medical education.

Addressing these challenges and charting a way forward will require the concerted effort of clinicians, healthcare leaders, and policy makers.

Competing Interests

Dr. Al-Mallah has completed and submitted the Methodist DeBakey Cardiovascular Journal Conflict of Interest Statement and none were reported.

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