The most obvious place to start is with the health-care system. Hopefully, people are already considering how to strengthen the medical supply chains that broke early in the pandemic and stayed broken too long — including reforming the reimbursement systems that reward medical procedures rather than basics such as protective equipment. We need to reward nursing homes for the basics, too, like cleaning and infectious-disease control, rather than costly extra services — a perverse system that damn near amounted to geronticide when the pandemic hit. These things should have been fixed decades ago; the next best time is right now.
Also in need of scrutiny are the failures that crippled so many public health agencies, up to and including the Centers for Disease Control and Prevention and the World Health Organization. We need accountability for those failures, but also to adequately fund public goods like pandemic preparedness and keep them funded. Harold Pollack of the University of Chicago’s School of Social Service Administration says, “My biggest fear is that public health is boring until it’s not, and then it gets boring again.” Covid-19 has taught us that we need to stay interested even when nothing appears to be happening.
But we’ve also learned some good things, notably just how fast biomedical innovation can move when we really try. The Food and Drug Administration found ways to speed up clinical trials without reducing their rigor. Governments used subsidies to fund development and guaranteed purchase orders to mitigate the financial risks for drug companies that used their own money. Those workarounds can’t solve every hard technological problem, but we should be looking for more problems they can solve — in or out of the world of health care.
And how about the nonmedical things we could be doing to control infectious disease? Are we going to bring handshaking back, and if so, why? Should we accelerate the arrival of a cashless, touchless payment economy, despite the loss of privacy? How much do we need to beef up the ventilation systems in public spaces? Any chance we’ll keep wearing masks on subways, in malls, in movie theaters? And if not, at the very least, can we collectively agree to stop going to work sick — even if that means more generous paid sick leave?
Of course, a lot of us might just stop going into work — or at least stop going in so much. I doubt that the office is truly over; in fact, the pandemic has highlighted the value of personal contact. But it’s easy to imagine most office workers getting their collegial fix in a couple of days a week.
That, in turn, probably means reimagining homes — who still loves the open-concept home after nine months of 24-hour family time? Quick commutes become less valuable, personal living space much more so, which represents an extinction-level event for a lot of commercial real estate owners, and the ancillary businesses that serve commuters, particularly in New York and San Francisco. Exurban estates with good views, on the other hand, might well enjoy a renaissance.
Business travel is also due for reconsideration — and without business travelers, the travel industry will collapse. While you might expect that means some fantastic deals for leisure travelers, it’s more likely to mean the reverse, since travelers on an expense account often subsidize bargain-hunting tourists. The resulting declines will crush hotels, airlines and their workers, plus the budget of every city with a significant tourism or convention business.
Governments now realize that some manufacturing — such as personal protective equipment — may be too important to leave offshore, given that other governments might seize that production in an emergency. And companies have learned the dangers of building “just in time” supply chains that snake through three continents, none of which holds more inventories than they need for this week’s sales. Their customers now understand those risks, too, if they’ve spent hours scouring stores for toilet paper or months waiting for a new refrigerator.
In fact, we should expect big changes in anything that could be filed under “borderless economy.” When the chips were down, governments slammed borders shut, grabbed whatever they could for their own citizens and worried about everyone else later, if at all.
How much will that change even once people start getting vaccinated, especially if those vaccines are distributed unevenly? What are the politics of reopening rich-world borders to immigrants from places where covid-19 is still endemic? How many people will want to vacation in those places? How will that impact economic convergence between rich and poor countries?
I have no answers to those questions, yet; I don’t even know if these are the right questions. The only thing I’m quite sure of is that 2022 won’t look quite like 2019 — or anything else that any one person can now imagine.