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History has lessons to teach us about how societies respond in the wake of pandemics
Lancet editor Richard Horton has described the UK’s Covid-19 lockdown as “the greatest imposition of restricted civil liberties ever seen in peacetime”. The seemingly never-ending tail to our own latest lockdown, with no loosening predicted until May at the earliest, feels like a prison sentence that hasbeen doubled on appeal.
As we go into the second year of the pandemic with our lives turned upside down, it is reasonable to ask what will our post-pandemic lives look like? The old normal seems unlikely to return. What can history tell us about post-pandemic life? The 1968 Hong Kong flu saw hospitals overwhelmed around the world. The dead went unburied. Essential services were disrupted as workers fell ill. Yet once it passed, this lethal pandemic had no enduring impact on European societies.
The 1920s were different. In the aftermath of the First World War and the Spanish flu pandemic of 1918-19, which killed up to 100 million people, an era of unprecedented hedonism and artistic creativity ensued. Could this be our future? Older people, acutely conscious of “losing” two years of their lives, will want to make the most of the time left to enjoy life. And for the younger set, it’s easy to foresee an understandable pent up desire to party, exploding into excess.
One lasting legacy of the prolonged lockdowns is likely to be the increased use of digital technologies. Many people have been forced to work, meet and shop online. For many who have now experienced the benefits of such novel ways of doing things, there may be no going back. Many businesses have found that their employees can be just as productive working from home as at their office desk.
Many professionals have enjoyed the absence of a daily commute, greater freedom to manage their own time, and the convenience of meeting and collaborating on Zoom. Some are predicting the end of the office and the demise of business travel. Most medium and large sized businesses will continue to see the benefit of bringing staff together at least some of the time. Instilling corporate culture and coordinating complex tasks are often best achieved through close contact.
Business travel is expensive, disruptive, time-consuming and, as illustrated by the pandemic, often unnecessary. It seems set to decline significantly.
I’ve noticed a marked uptick in “sale agreed” signs in our part of rural Ireland in recent months. The media is full of stories of those who have remained trapped last year in small urban apartments, feeling like they are enduring solitary confinement. And many who can work from home are calling halt, swapping city apartments for detached houses well out in the countryside.
The pleasures of the city – museums, cinemas, restaurants, bars and, above all, other people – are of no use if they are unavailable. But cities bounce back – even from plagues far more devastating than Covid-19. Demographics may change, but cities are not going to disappear And what about our professional lives? Telemedicine has boomed. For many of us with major concerns about “hands-off” medicine, the experience has been a good one.
It seems likely that for certain conditions and particular presentations of illness, a telephone or video consultation may be the new normal. Vaccinations, screening tests, and severe musculoskeletal problems don’t lend themselves to care via telehealth. But telehealth services can deal with a wide range of problems, including skin issues, minor infectious diseases like the flu or cold, psychological issues and minor orthopaedic problems like sprains. Physicians can also prescribe medications after a video or phone discussion.
And there’s no getting around “hands-on care” for trauma or surgical procedures. But patients who require ongoing care for chronic conditions might do best with a hybrid arrangement of telemedicine and hands-on medicine. Similarly, alternating in-person visits with telephone calls might be useful for prenatal care, which typically requires a mother-to-be to check in a dozen or more times during the course of a pregnancy. Prior to Covid-19, telehealth use was growing but represented a small percentage of healthcare consultations. During the peak of the first wave of infections in the US, there was a dramatic rise in telehealth.
For example, the University of Michigan had a 2,500 per cent increase in telemedicine consultations. It’s fair to predict a new normal for general practice and for hospital outpatient services. It is impossible to argue – either economically or clinically – for the level of repeat real-time visits to outpatient departments we had prior to lockdown. Normality, for all of us, will be a very different beast in our post-pandemic world