A Lasting Legacy: Long-Term Implications of the Coronavirus Pandemic
Using foresight to enhance our understanding of the current crisis and explore future implications for the US and the world
With the coronavirus raging, it’s hard enough to think about how to get through the next few weeks, let alone to plan for the next two, five, or even ten years. It’s clear this crisis represents a transformational moment in our lives, and for our country, and the world. But what direction that transformation takes, whether it will lead to a better or worse world, depends on our ability to think in longer terms now.
The following is a look at what foresight analysis can tell us about the long-term implications of the coronavirus pandemic. Foresight analysis is a set of tools designed, not to predict the future, but to help us better understand how and why things change and to map out the possibilities arising from changes we identify today. From there, we can take action to ensure a better world.
The Current Situation (and How We Got Here)
We know the bleak present too well. The virus is impacting virtually every country on Earth with a global count of 1.9 million confirmed cases and 118,623 confirmed deaths as of the afternoon of April 13th. Countries around the world are enacting social distancing and other mitigation efforts, health systems are overwhelmed, and economies are grinding to a halt. But how did we get here? What is it about the virus, and what is it about today’s society that combined to drive this explosive pandemic?
The best evidence suggests the novel coronavirus behind the COVID-19 disease evolved naturally in a host animal (bats and pangolins are suspects), and made the jump to humans through close interaction with infected animals at a market in Wuhan, China, potentially as early as November 2019. This makes the novel coronavirus another in a growing list of zoonotic viruses that arose from human-animal interaction (from HIV/AIDs to Ebola, SARS, and MERS). The virus is highly contagious and can even be transmitted by asymptomatic carriers, so it’s little wonder that the outbreak spread from its initial source.
For our foresight analysis, we also want to know why the virus appeared when and where it did, and why we’re seeing more zoonotic outbreaks over time. We know increasing human-animal interaction is the key, so what are some of the drivers behind increased contact with animals (wild and domesticated)?
Global drivers of increasing human-animal contact
- expansion of wilderness/urban interfaces — more urban areas reaching into once wildlands
- increasing demand for meat (and other animal products) — driven by rising incomes
- meat production using potentially unsanitary practices — intensive animal farming, wild-caught meat, unregulated animal markets
- climate change — shifts in animal ranges/migration patterns to new areas (especially expansion of mosquito ranges)
- habitat loss — animals are forced to move into human areas
- population growth and density — more people, more chances of interaction
Looked at in this way, the increase of zoonotic outbreaks is no surprise. And it’s also no surprise that the coronavirus appeared in an animal market selling wild-caught animals in a densely populated city, in an increasingly affluent country demanding more meat and animal products.
The next set of questions from our foresight point of view, then, are: 1) what are the drivers of the virus’s spread around the world once it emerged? 2) what about our globalized society made it vulnerable to such an outbreak? and 3) why are some countries proving more or less vulnerable?
Note: the arrows indicate the direction of potential change in the driver, the +/- symbols, whether that change increases or decreases vulnerability. For example, an increase ↑ in the strength of international organizations decreases vulnerability (-), and a decrease ↓ in the strength increases vulnerability (+).
Global Drivers of Vulnerability
↑- /↓+ the strength and capability of international organizations
↑- /↓+ the extent of international cooperation
↑- /↓+ the level of international aid
↑- /↓+ the effectiveness of each country’s efforts to contain the virus
↑+ /↓- the level of global trade and the complexity of global supply chains
↑+ /↓- the number of international travelers and tourists
↑+ /↓- the number of international migrants, refugees, and internally displaced persons
National Drivers of Vulnerability
↑- /↓+ the health system’s capacity and effectiveness
↑- /↓+ the government’s effectiveness and level of transparency
↑- /↓+ the health system’s capacity and effectiveness
↑- /↓+ the strength of social safety nets
↑+/↓- population size and density
↑+/↓- population age
↑+/↓- prevalence of morbidity in the population
↑+/↓- population mobility
↑+/↓- the level of income/wealth inequality
↑+/↓- the extent of integration with the global economy
By identifying these drivers, we can see why the current global system was conducive to the virus’s spread and why different countries are proving more or less resilient. In the case of the US, the direction of many of these drivers point toward greater vulnerability: a population with more preexisting conditions, a health system geared to keep costs down rather than having excess capacity for surges, a lack of strong social safety-nets making it harder for sick people to stay at home, rising income inequality and growing food and health deserts, and a high level of integration with the global economy.
Here are two conceptual maps illustrating how these drivers tie together
Virus Scenarios (short- to medium- timeframe)
Now we have a better sense of how we got here. But before we can explore the long-term implications of the pandemic, we have to address the fact that the pandemic is still very much unfolding. Based on the current situation (and our current understanding of the virus), there are a number of key uncertainties around the virus and our responses to it that could directly shape those long-term implications.
Key Uncertainties
Seasonality? — Will the coronavirus act like the flu, with a decline in cases during summer and a resurgence in the fall/winter?
Seasonality could mean an additional wave primed to hit just as social distancing measures fade in the fall — but would also give time to prepare during the summer. No seasonality would mean a longer, harder slog in the near term.
Duration of immunity? — How long will those who recovered from the virus remain immune from reinfection?
The longer the immunity lasts, the smaller the susceptible population will become. Short duration immunity could enable larger and longer additional waves.
Mutations? — Viruses mutate rapidly. While the coronavirus appears to be mutating in expected ways, that could change.
Mutations could make the coronavirus more or less lethal and change the ways in which it behaves, which could complicate vaccine efforts.
Permanent injury to those infected? — It appears that the virus (and the body’s response to it) could cause lasting damage to the heart and lungs and even the brain. This would have serious ramifications if true.
An increase in long-term morbidity would create additional drains on the health system and leave more people vulnerable to other diseases.
Level and accuracy of testing and contact tracing? — How widespread will testing become? Will enough be tested? Are test results accurate enough? Will we pursue thorough enough contact tracing?
Containing the current outbreak and preventing a resurgence and later waves will hinge on large-scale, accurate testing and thorough contact tracing.
Treatment/vaccine timing, effectiveness, and availability? — When will treatments/vaccines become available, how effective will they be, and how quickly can they be distributed?
Timely, effective, and widely available treatments and vaccines would significantly reduce the virus’s long-term impacts, while an extended period without such treatments and vaccines would worsen those impacts.
The extent of penetration into rural communities? — How far will the virus spread outside of urban areas?
Rural populations across the US are especially vulnerable to the virus as they tend to be older, have a higher prevalence of preexisting conditions, and have less access to health services.
Duration of social distancing measures? — How long will social distancing measures remain in place?
Will such measures be kept in place long enough to truly keep the curve flat, or will they be relaxed too soon, allowing a rebound?
Natural disasters during an outbreak? — What will the impact of hurricane season and fire season have on efforts to combat the virus?
Large-scale evacuations and crowded emergency shelters could provide new opportunities for the virus to spread.
The extent of penetration into developing countries? — How widespread will the virus become in developing countries, particularly in the megacities of the Global South?
Social distancing is a much greater challenge in densely populated areas. The virus’s spread into such areas would be devastating both for host countries and the world.
Scenarios
From these uncertainties, we can build a number of scenarios for how the virus could play out in the US over the next few months to a year. Below are some possibilities:
- The Next Wave — the virus proves seasonal, while immunity for those who recover is only temporary, allowing a new wave of disease to sweep around the country and the northern hemisphere during the fall/winter as conditions become favorable and social distancing and immunity fade.
- Whack-a-Mole — new virus hotspots continue to appear in urban areas as social distancing measures are eased, and as travelers bring in new cases from hard to control hotspots in the world’s megacities. These new hotspots are increasingly able to be identified and contained through rigorous testing and contact tracing.
- A Lingering Sickness in America — many areas of the country no longer see cases and return to normality, but the virus has penetrated into rural America and lingers in minority communities and other disadvantaged areas of the country. Coupled with virus-induced long-term morbidity, the strain on the health system remains high in those areas least able to afford it. The chance for new virus waves remains, triggering increased anti-minority sentiment.
- A Hard Fought Battle — Widespread, accurate testing, antibody tests, effective treatments, and contact tracing curtail the virus enough for the US to carefully reopen. The arrival of an effective vaccine eventually sees the virus largely vanquished.
Long-Term Societal Implications
Many different elements can go into creating a forecast, from extrapolating trends to surveying subject matter experts. Here we combine the drivers and uncertainties identified in the previous sections with emerging signals of change and existing forecasts (gathered through horizon scanning) to develop a list of long-term implications that could stem from the pandemic of 2020. These implications, in turn, can be used to create a series of alternative future forecasts.
Long-Term Implications using the SPHERES framework
The SPHERES framework is a simple tool for horizon scanning that helps us to consider the different facets of an issue in order to generate a more comprehensive analysis. SPHERES stands for:
Social — the ways in which we relate to each other and view ourselves and society
Political — how we make decisions and how we use/share/take/lose power
Health & Population — how we manage our health and demographic challenges
Economic — how we create value and earn a living
Regulatory — the legal frameworks that support society
Environmental — the natural world and our relationship to it
Science & Technology — the tools and knowledge that enable us to reshape our world
How might the pandemic impact each category (globally and in the US)?
Note: these are potential implications, good and bad, not necessarily what we want to have happen.
Social
- Lasting changes in social norms around hygiene and social interaction
- More social interactions move online, particularly to massive multiplayer games
- Reassessment of which jobs are essential to society’s functioning and a greater appreciation of the people carrying out those jobs
- Increasing concern for how we care for our elders
- Further divisions between urban and rural populations
- Internet access becomes a protected human right as some people are left out of the telework/health/education boom
- The shift from individualism to collectivism
- Greater appreciation of green spaces
- Increasing concern over the treatment of minorities, but also increased fear of the other (minorities, immigrants)
Political
- Efforts to combat the virus (societal surveillance, greater centralization of power, long-lasting emergency powers) further weakens democracy and strengthens authoritarianism
- Increasing public support for surveillance and the decreasing importance of personal privacy
- Move to mail-in, and online/digital ballots for elections expands the franchise (though could also threaten to disenfranchise those in internet deserts)
- Return of the technocrat — the pandemic renews peoples’ faith in experts
- Strengthening of populist/ethnonationalist movements over border controls and immigration
- China further asserts itself through a new health silk road
- The US returns to international leadership as the virus proves (again) what happens in one country doesn’t stay in that country
Health & Population
- Health becomes a global public good
- A push to address health and food deserts in order to improve population resilience
- Public health workers treated as first responders
- Rising mental health issues from increased isolation, virus-related PTSD, fear of crowds
- Rising mental and physical health issues from an increase in domestic abuse
- Long-term morbidity from permanent damage caused by the virus, including respiratory, cardiac, and brain damage
- Continuing disproportionate impact on minorities and a longer-lasting impact on rural communities
- A flood of patients returning to hospitals after putting off elective health procedures
- Accelerated loss of rural hospitals (if no push to close health deserts)
- Food supply disruptions
Economic
- More companies embrace telework and flex-work options
- More protections for gig workers
- Enhanced online learning and career training/retraining
- Reordering of global supply chains
- Increasing focus on local/national production, especially of medications and equipment
- Increasing focus on flexible production for better surge capacity
- Economic recessions/depressions ripple around the world, particularly in the developing world where additional disruption from the virus is likely to be greatest
- Long-lasting labor disruptions especially if multiple economy shutdowns required
- Strengthening of state capitalism as governments take a greater role in managing their economies
- Widening inequality within and between countries
- Greater efforts to redistribute wealth
- Those without access to high-speed internet left behind in career and education
- Lasting disruption to global energy markets as demand for oil continues to fall — lower oil prices may also undercut growth in renewables
- Millennials become even more of a lost generation
Regulatory
- Expansion of social safety nets and laws protecting workers
- Health insurance no longer tied to employment
- New laws supporting basic universal income
- The increasing role of the state in managing the economy
- Increasing oversight of genetic technologies to prevent purposeful or accidental release of bioengineered pathogens
- A reinvention of e-government in the wake of online infrastructure overload
- Expansion of protection for wildlands and new regulations for controlling the wild/urban interface
Environmental
- Banning of wild-caught meat and a greater crackdown on animal trafficking
- Increasing emphasis on locally produced goods and food
- Lower rates of travel, tourism, and international transport of goods reduce global carbon emissions
- Negative impact on renewable energy due to low oil prices
- Efforts to slow or reverse habitat loss
Science & Technology
- Rise of teletourism and better virtual reality
- Increasing focus on the need to improve communication infrastructure — new solutions to bring high-speed internet (and therefore telehealth and telework options) to rural areas
- Increasing deployment of distributed smart energy grids to enhance local sufficiency
- 3D printing and distributed manufacturing become widespread as a solution to providing on-demand emergency supplies, reducing reliance on fragile supply chains, and ultimately, dematerializing global trade
- New AI tools for drug discovery and pandemic modeling
- Increasing use of crowdsourced science and open source, global collaboration
- New tools for detecting novel viruses before they enter the human population
- Growth of state surveillance tools (facial recognition, mobile phone tracking/geolocation, social network tracing, transaction tracing, etc.) as the same technologies used to track the virus can also be used to track the people
- Drones become even more ubiquitous, especially for delivery, law enforcement, and health applications
This list, of course, is only a sample of the myriad impacts that could stem from such a globally disruptive event. From here, we could sketch any number of alternative long-term futures, but even without that, this list of implications provides some important takeaways that may just help us create a preferred future out of the current chaos.
Takeaways:
- The pandemic has exposed serious shortfalls with our current socioeconomic and health systems that could, perhaps, drive a push for stronger social safety nets, worker protections, and addressing of unequal access to services
- There are likely to be lasting health impacts long after the virus is gone, and these impacts are likely to be unequally distributed both within and between countries
- Heightened awareness of social norms and attitudes toward others may help Western societies transition toward a more collectivist mindset
- The pandemic has also exposed weaknesses in democracy and enhanced the appeal of authoritarian solutions
- New technologies will likely increase our resilience and lessen our impact on the natural world (smart health devices, telepresence technologies, distributed manufacturing, etc.)
One way or another, the current coronavirus pandemic will end. And when it does, it is vital that we have a long-term plan in hand to ensure that the lessons of the pandemic are not forgotten and that the world can be made the better for it.
