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The End of the Beginning
A look back at the first two years of COVID-19
COVID-19 celebrated its second-anniversary last week and like many people I have already started to think about things in terms of BC and AC (Before COVID-19 and After COVID-19). Given the anniversary it seems like a good time to reflect on the last two years and think about what we have learned from this pandemic.
I want to start by looking at the numbers, as painful as this is. In the last two years, over 450 million people have been contracted COVID-19 worldwide. Over six million people have died from the disease. In the United States, seventy-nine million people have had the coronavirus and almost one million have died. These are staggering numbers and, while things are much better now than they were in 2020, we are not done with this disease. We may never be done with it.
The last two years have seen unprecedented economic events as countries dealt with shutdowns, restrictions, and mandates. In the US, we watched a very healthy, growing economy change almost overnight. In the early stages, we watched unemployment skyrocket because of lockdowns. It was so bad, the government infused $5 trillion in deficit spending into the economy just to keep everything afloat. It was like pumping blood and plasma into a patient with incredible bleeding.
To put all this spending in a unique perspective, we injected almost as much cash into our economy over the last two years as the total economic output of Japan. We spent more money on government assistance than the entire German economy.
If anything, this pandemic has taught us all a great deal. Many of these lessons were difficult, but many were also necessary. One of the major things we learned was just how much the global healthcare system can handle. Our medical professionals and facilities were introduced to a completely new virus and a massive influx of patients in a very short period.
For many countries, this almost completely overloaded their capacity to care for patients. We all remember images of patients overflowing Italian hospitals and images of mass cremations in Indian parking lots that will haunt us for years. In this country, we built mobile hospitals and drive-thru testing. Quite frankly, the US healthcare delivery system performed incredibly well.
Not one, but three effective vaccines were developed, tested, and distributed in a time frame that previously thought was impossible. This saved millions of lives throughout the world. We were lucky that mRNA research has been going on for a good fifteen years before this pandemic but this was a huge feat.
Our hospitals, physicians, and nurses showed an incredible ability to expand capacity as much as possible and learn the best practices for treating this virus on the fly. The pharmaceutical industry stepped up in more ways than just the vaccines. Current therapies, like Hydroxychloroquine, were quickly tested and new treatments were developed.
We went from nothing on a novel virus to having several effective vaccines, new therapies, and now oral medication to treat COVID-19. This is incredible and we should be thankful for the people who worked on these advances and those who provided excellent and compassionate care in extremely difficult circumstances.
So, that is all the good. I would be remiss if I ignored the not-so-good. This pandemic has shown us some major flaws in our thinking and delivery systems. When this whole thing started, experts compared the COVID-19 discussion to other defeated diseases such as Polio, Smallpox, or Measles. Like those diseases, the key is achieving herd immunity so the virus would not have enough transmission to keep going. Think of it like starving a fire of its fuel or oxygen.
Two years later we have learned that getting to herd immunity is not likely and as such we will probably be dealing with COVID-19 (at least in some form) for many years to come. This problem is two-fold.
First, the distribution and administration of the vaccine in lesser developed countries have been abysmal. After nearly two years, only fourteen percent of people in poor countries have received at least one dose of a vaccine. That alone makes it so that herd immunity is not possible.
Second, many developed countries have not, and most likely will not, achieved herd immunity because vaccination rates are not high enough. Right now, seventy-seven percent of the US population has had one dose of a vaccine and only sixty-five percent is fully vaccinated. Less than half of those fully vaccinated have received a booster shot. Those numbers are not high enough for herd immunity on a virus that has shown a propensity to mutate and become more infectious. These vaccines are highly effective, have next to no risk, are free, and are readily available. How could we have not possibly achieved a better result than this? Unfortunately, it points to another thing we learned from this pandemic.
The US is extremely polarized right now and the pandemic has exposed and expanded many of the cracks already present in our society. COVID-19, how it started, how it should be treated, and if you should get vaccinated has become a dividing point and political football in the US and other countries. Something that should never have become a political issue has become the political issue.
So where do we go from here? What does the future look like and how is it likely to impact healthcare in this country? While no one has a perfect crystal ball and things are still developing and changing rapidly, I think we have enough information to make some pretty good, educated guesses right now. We economists like to call those “Projections” or “Prospects,” but we know they are educated guesses at best.
Because of the massive spending that was required to keep the US economy going, our debt to GDP ratio grew from 108% in 2019 to 133% in 2020. This is a huge increase and the highest debt to GDP ratio in our country’s history. We know that the 2018 inflation rate was 2.4% and that in early 2022 it had risen to 7.9%, a forty-year high. What is more concerning is that this is before the large spike in gas prices. We are still experiencing supply change shortages and a very difficult labor market.
All of these factors point to some very tough economic waters in our future. Many economists are now being to talk about recession, and some are even using the “d” word … depression.
These things added to the very real problem of burnt-out healthcare professionals, which in turn means significant pressure on healthcare costs in the years to come. This pressure will no doubt be transferred to doctors and hospitals by the insurance companies. Calls for Medicare for All, or some like alternative, will continue to be heard. We even have had some new thoughts spring up: price and wage control in the healthcare industry.
It has been a long and hard two years. Many of us just want this to be over so we can back to normal. To be honest with you, I am not sure that is possible. I am not sure we are going to see “normal” for some time. It seems to me that our situation is more akin to the one Winston Churchill described at the end of the Battle of Britain. When they survived the air war, Churchill told the people of his country, “this is not the end. This is not the beginning of the end, but I may be the end of the beginning.”
Here is to the end of the beginning.