A look back on 2021: A doctor’s reflections on our second COVID-19 year

As we approach the end of the year, there is still much uncertainty about COVID-19 and what the new year will bring. While I can’t predict what will happen in our third pandemic year, I want to offer a few reflections:

• Science has served us well over the last 22 months of the pandemic. We had highly effective and very safe vaccines less than a year after the first case of COVID-19 and monoclonal antibodies just a few months later. We’re on the verge of having available antiviral pills. But we haven’t come together to best use the science, and many remain unvaccinated. We’ve fallen short on basic low-tech public health measures that could save many lives, including masks in crowded indoor spaces and rapid testing.
• Many are grieving. It’s impossible for most of us to fully comprehend the tragedy of more than 800,000 deaths in the U.S. alone and 140,000 children losing their primary or secondary caregiver. During this holiday season, let’s remember and appreciate those who died prematurely, including thousands of healthcare workers.
• There has been remarkable global cooperation during the pandemic. Chinese researchers shared the genome of the novel coronavirus less than two weeks after the illness was identified, and South African researchers spread the word on Omicron within days of detecting an increased rate of positive tests. But we haven’t done an adequate job getting lifesaving vaccines to developing countries. This increases the risk of future variants. We’ve imposed travel restrictions to delay introduction of new variants, but not removed them promptly when they were no longer useful.
• The virus keeps on throwing us curveballs. We learned that transmission of COVID-19 is airborne and surfaces aren’t especially dangerous, but just when we think we understand the virus, there is more unexpected news. Even more contagious variants have caused new waves of COVID-19, and recent breakthrough infections make even vaccinated and boosted people worried for their safety. Long COVID-19 has caused severe suffering, but the healthcare delivery system has often downplayed symptoms, and disability insurance is especially ill-suited to disabilities that can’t be confirmed by an objective test.
• Keeping people safe is good for health and good for humanity – it’s also good for the economy. Communities that have higher vaccination rates and follow public health guidelines generally have quicker economic recoveries, and people decrease their travel, encounters and economic activity when they perceive high risk – even without lockdowns or rules.
• Healthcare disparities have worsened the impact of the pandemic. The pandemic has led to disproportionate sickness and death among people of color – and we’ve seen an increase in hate crimes against Asians. Lower-wage employees have been least able to take the time to get vaccinations, and they are most likely to live in medically underserved areas. Vaccination rates of Black people continue to lag vaccination rates of white people – at least in part because of a long history of being discriminated against in our medical system. We need better health metrics, a more diverse healthcare workforce and better plans to address social determinants of health.
• Employers will continue to play an important role in keeping employees, families and the community safe. Employers have stepped up to improve worker safety in many ways during the pandemic. Many have increased paid sick leave, and most have created scheduling flexibility and paid time for employees to get vaccinated. Employers have paid for COVID-19 testing and treatment and offered increased virtual care, often with lower or no out-of-pocket costs to employees.

Employers and employees pivoted quickly to remote work – helping protect many. Employers also improved ventilation and implemented policies and processes to help improve safety for the many Americans who could not do their jobs from afar. They’ve also increased access to mental healthcare – as depression and anxiety and opioid deaths have all skyrocketed.

The demands of 2022 will continue to be great. Healthcare costs may increase due to pent-up demand or go lower because elective surgeries and care are delayed again due to overwhelmed health systems. Parents who are relieved that their children are finally back in school are worried that a new wave of infections could lead to more home schooling. People who are vaccinated are worried that their immunity might have waned, while those who are not vaccinated often feel their concerns have not been addressed.

Bonnie Henry, the provincial health officer in British Columbia, said in the spring of 2020 “ Now is the time to be kind, be calm and be safe.” These words still ring true as we approach 2022.

Author

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Jeff Levin-Scherz, MD

Population Health Leader, Health and Benefits, North America

Jeff is an internal medicine physician and has led WTW’s clinical response to COVID-19 and other health-related topics. He has served in leadership roles in provider organizations and a health plan and is an Assistant Professor at Harvard Chan School of Public Health.

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