Covid-19: What is the New Normal?

Or What Should it Be?

Iris Borowy – Shanghai University

Published in: https://medium.com/@irisborowy/covid-19-what-is-the-new-normal-or-what-should-it-be-

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Five months into the pandemic, it is increasingly clear that coping with Covid-19 is likely to be a long-
term current rather than a quick wave. In some way, the disease will be with us until there is either a
vaccine available in large quantity or an effective herd immunity, acquired after 65 to 95% of the global
population have been infected. At the moment, over one-hundred groups around the world are
competing with one another trying to find a vaccine, and it is highly probable that one or several will
come up with a workable vaccine sometime in the nearer future. The Serum Institute of India is making
a big gamble by mass producing already now a vaccine which is still in the trial stage in Oxford. If the
gamble pays off and the vaccines proves to be effective, the best-case scenario foresees a large
quantity of effective vaccine by September. But this is hardly assured. The vaccine may disappoint.
Finding an improved version or an alternative may take longer. Or there may not even be a vaccine.
Decades of research designed to find a vaccine for HIV/AIDS or Dengue fever have, so far, been
unsuccessful, and is also possible for Covid-19, though, admittedly, rather improbable. Meanwhile,
though infection under-reporting is vast and there may be between six and ten times as many infected
people as officially registered, this is still nowhere near enough to create herd immunity anytime soon.
It is, however, enough to maintain a risk of a larger outbreak. Nobody knows exactly how long it will
take until life is back to what used to be considered normal. A recent study by the Center for Infectious
Disease Research and Policy at the University of Minnesota suggests one to two years. Laurie Garrett,
expert on pandemic preparation and author of the 1994 book The Coming Plague, is thinking of three.
For a while, Covid-19 is here to stay.

Nevertheless, the next months and years will be different from previous months. People cannot live in
crisis mode for extended periods of time. It contradicts the very concept of crisis as an unusual,
exceptional period. There is no scientifically exact number by which a disease ceases to be viewed as
a pandemic, and though infections, disease experience and mortality form part of the picture, the
categorization is social as well as medical. As Gina Kolata has recently pointed out, when a disease no
longer disrupts everyday lives in ways that are too obvious to overlook, people may just “get tired of
panic mode and learn to live with a disease.” In the process, the disease becomes part of a new normal.

Concepts of normality are constantly readjusted. Some causes of death create controversy as people
question whether they are acceptable to this degree or at all. Examples include deaths through warfare,
gun violence, road traffic accidents, suicides, abortions, alcoholism, domestic abuse and many other
causes. Not everybody will agree with all examples in the list. Different people will find different
categories objectionable. Some categories are ideologically sensitive. Discussions about health and
dying are inevitably political. Recently, the case has been made that Covid-19 might get normalized in
the United States. That, in some months, a daily toll of several thousand deaths will be considered
acceptable. In other countries, this idea seems more far-fetched, but, as governments everywhere are
grappling with the question of how to reconcile health and economic concerns, views will evolve.
Governments, stake holders and citizens should begin thinking about what kind of “normal” they want.
Economic Consequences

Almost universally, the economic price of social distancing and lockdown measures has been
staggering. Over thirty million people have registered as unemployed in the US alone. The IMF expects
eight leading industrial countries to experience a recession this year. Christine Lagarde, president of
the European Central Bank, has warned that the eurozone economy could contract by up to twelve
percent. The Chinese economy has contracted for the first time in half a century and facing rising
unemployment. African countries are facing a combination of high debts with dwindling possibilities
to repay them as remittances and demands for African raw material in crisis-affected economies
elsewhere are drying up. In the words of economist Joshua Gans: “Perhaps the largest contraction in
economic activity since the Great Depression is taking place.“

Fears that the anti-epidemic measures are so crippling production, employment and income as to bring
devastation has provoked concerns about their suitability in several parts of the world, as people
complain they will not die of the virus but of hunger. Concerns transcend political spectrums. President
Trump has long warned of the cure being „worse than the disease“ and urges ending economic
restrictions soon. So do a number of conservative commentators as well as Simon Tisdall at The
Guardian, a journal Trump would no doubt consider fake news. Mukhtar Karim, CEO of the Lady
Fatemah Charitable Trust, argued lockdowns were a method invented by the wealthy and alternative
means had to be found for the poor. However, alternatives are difficult to find, and he did not offer
any. Probably, there cannot be one-size-fits-all solutions, but clearly, the economic consequences of
the pandemic need to be taken as seriously as the pandemic itself.

Oftentimes, the question is portrayed as a simple case of either or: either economy or pandemic
control, either economic recovery or health. A recent study US National Bureau of Economic Research
commented on the „difficult tradeoff here concerning lives versus material goods, with little ongoing
discussion about how this tradeoff should be assessed and acted upon.” This statement seems true
but simplistic. There is no clear binary choice between “lives and material good”. Instead, the economy
and health are interlinked. At its easiest level, a working economy needs a healthy work force. Keeping
the economy working at a time of a pandemic as though it did not exist makes no sense. It is unrealistic
to assume that companies will keep working when their employees fall ill in large numbers. Which
responsible owner would keep production open? And which irresponsible owner could when workers
are either in hospital or at home, frightened to go to work? Tyson Foods in Iowa did not. To an extent,
economic insecurity can mask this problem, forcing workers to accept high health risks because they
cannot afford to stay home. But in the absence of other protective measures, this only postpones a
problem of economic losses induced by burgeoning rates of illness and related deaths. By contrast,
there is some evidence that prioritizing public health measures early may actually benefit the economy.
A study of the economic effects of the Spanish Flu of 1918 reveals that US cities which acted early, fast
and aggressively and kept non-pharmaceutical interventions in place recovered faster after the end of
the pandemic than those that did not.

However, even an early intervention and low health burden will not allow a quick return to the world
before Covid-19. Rather than thinking of the virus in militaristic terms as an enemy to be fought and
defeated, addressing it is a “battle” to be won with the help of “warriors”, we may be better served
conceiving of it as part of the new biological and social ecology of human lives, something that is here
to stay for a while. In March, the study of King’s College, which seems to have made the governments
in the UK and the US change their policies regarding Covid-19, predicted a need for a prolonged period
of alternative phases of tightening and relaxing restrictions. Recently, Japan, has suggested that its
citizens embrace new routines new routines for life during the next months or years, which would
include not speaking on public transportation, not sitting next to one another while eating meals and
exercising at home. The post-Covid-19 world may be different, and the impact may be felt for longer
than imagined just recently.

The risks of prolonged economic restrictions and social distancing are real. David Beasley, Executive
Director of the World Food Programme, has warned of famines of biblical proportions. WHO is
expecting mental health problems. And it is already clear that injuries and deaths are increasing due
to an increase in domestic violence wherever there is a lockdown. We need to explore ways in which
both the immediate burdens of the crisis and the long-term vulnerability of societies can be mitigated.
More often than not, they may be one and the same.

One may find inspiration from past experience with economic crises. If historical precedent serves as
any guide, the economic recession may actually counter-act some of the negative health effects of
Covid-19. Past economic crises, including the Great Depression of the 1930s, have coincided with
declines in mortality and increase life expectancy, an effect believed to reflect a reduction in health
hazards through work stress, increased air pollution, smoking and alcohol consumption, sleep
reductions, road traffic accidents, work injuries and mobility. All these are crucial social determinants
of health. This does not mean that all was well, as the exception of rising suicide and alcohol-related
deaths rates showed. But it means that there were more people who lived longer than died earlier
because of the Depression. Similar results have been found elsewhere, including for the financial crisis
of 2008-2012 where, contrary to expectation, mortality declined and population health improved in
the countries in Southern Europe that were hardest hit. Some research found that there was little
difference between countries reacting with different policies. Other studies have found that austerity
measures increased mortality levels and led to deteriorating health levels or that effects differ
according to governmental commitment to health protection. These findings, have also been
contested. Besides, short term effects of economic growth or contractions differ from long-term
effects of wealth and poverty.

Economic systems are complicated and multi-factorial, and so is human health. It involves factors such
as family support or other drivers of resilience, which are not easily captured through conventional
frames of GDP or national policy. But these events offer opportunities to review how the social
determinants of health – and, by extension, human well-being in general - fare in a given society. In
many ways, crises do not so much represent breaks from established structures as that they test the
strengths and weaknesses of these structures. Just as hard times can deepen or break a marriage,
times of crises reveals strengths and weaknesses in social conditions which, in calmer times, are more
easily hidden. Covid-19 has done just that.

Inequality

Possibly the most disconcerting aspect of the pandemic has been the way it has upstaged social
inequality. The virus clearly has the capacity to strike everybody equally, including celebrities and
prime ministers, so in a reasonably equal world, these all groups in society should be affected equally.
Obviously, this is not so. Inequalities have been most obvious and best documented for minorities in
the Anglo-Saxon countries. In the UK, after accounting for demographic differences, Bangladeshi
hospital fatalities have been found twice those of white British people, Pakistani deaths 2.9 times as
high and black African deaths 3.7 times as high. In the USA, black, Hispanic, Native American and
immigrant communities have been disproportionately hit. Though African Americans only form 30% of
the population of Chicago they represented 72% of those who have died from the disease. Similar
numbers have been reported from Louisiana and other parts of the US and from elsewhere. Migrant
workers have been another particularly vulnerable group: in Singapore, cases surged among
dormitories for migrant workers. In rich Geneva, one thousand people lined up for food parcels, many
were immigrants, and they were found to have tested positive for coronavirus at twice the average
national rate. In China, it is estimated that 50 million migrant workers have been prevented by travel
restrictions to return to urban centers for work. And it is not only minority groups who are
disadvantaged. Women, hardly a minority, have been disproportionately affected by unemployment,
many working in low-paying jobs such as cashiers, hotel clerks, office receptionists, hospital technicians,
teachers’ aides.

The effects of poverty may be even more devastating and far-reaching in low-income countries. In
many African countries, where the health sector is weak and the majority of people work in the
informal economy without access to health insurance or compensation payments and few, if any,
opportunities for social distancing, the damage caused by Covid-19 threatens to be devastating. It also
threatens to have lasting effects. The Global Partnership for Education fears that millions of children
who stay out of school now, because schools are closed, will not go back when they open because they
will need to work for family income, and that girls will be especially affected. This will only increase
their vulnerability to any future social and health crisis.

Reasons combine disadvantages of race, gender and poverty, ranging from poor access to healthy
foods, limited education and skill level, high unemployment, and increased risk for diseases such as
cardiovascular disease, diabetes, and asthma. Poor people are more likely to live in crowded housing,
to work blue collar jobs that cannot be shifted online, to work for low wages that force them to go to
work in order to feed themselves and their families even if they would rather stay home.

In short, this is a different way of saying that in unequal societies, national or global, those on the lower
end of the social ladder suffer worse health. This finding is hardly new. It was forcefully demonstrated
already ten years ago in the Marmot Report. The current crisis has only highlighted it further,
prompting journalist Polly Toynbee to comment that:” Poverty kills people: after coronavirus we can
no longer ignore it.”

Some conditions are more difficult to change than others: putting the work of waiters, truck drivers or
meat factory workers online is objectively difficult or, more likely, impossible. But there is no objective
reason that these and other jobs should form part of gaping differences in access to income, housing,
food, healthcare, sports and respect. Reducing poverty and inequality would reduce infections and
deaths. It would also spread them more evenly, thereby strengthening social cohesion and the feeling
of “being in this together” which, in turn, increases the popular acceptance of painful preventive
measures and mutual support. The sheer enormity of the inequality as a challenge should not prevent
considerations and discussions. Research and proposals exist such as those by Richard Wilkinson and
Kate Pickett and the author.

Age

In addition to race and class, and probably more so, Covid-19 has divided societies by age. Regardless
of all other factors, the risk of hospitalization and death rises sharply with advanced age, earning it the
ironic epithet of “boomer remover”. It is a risk factor we can do least about, nor do we want to, since
most people would rather live to old age than die young. But it is a factor that raises questions of
generational justice, and about the extent to which one generation can or must be expected to make
sacrifices for the other.

Some people, apparently have taken the epithet remarkably seriously. For instance Texas Lt. Gov. Dan
Patrick in the United States, proposed the idea that old people should be ready to sacrifice themselves
to safeguard the economic future for their children. His suggestion prompted an immediate backlash.
But others have voiced similar concerns. Boris Palmer, mayor of Tübingen, Germany, wondered aloud
whether, given that the average age of people dying of Covid-19 in the country has been 81 years,
whether too much effort was invested in saving people who would die soon anyway. His Green Party
has distanced itself from this view. The age differential is what economist Joshua Gans has rightly called
“a recipe for a virus being able to divide and conquer those who need to mount a response by creating
a debate regarding whether that fight was worth it.”

Perspectives differ. Nina Kohn, Visiting Professor at Yale, has argued that the lackluster reaction to
Covid-19 in some places betrayed a systemic devaluation of older lives. By contrast, 18-year-old
climate change activist Jamie Margolin has called on the elderly to be as mindful of the safety of young
people with regard to climate change as young people are expected to be of theirs with regard to
Covid-19. Regardless of whose perception is (more) correct, the crisis does demonstrate that health
risks as well as environmental risks affect different generations differently, and that if open discussions
do not address this issue in an honest, transparent way, the issue is likely to attract knee-jerk attacks
of one group claiming victimization by the other. This is not helpful since the question is real, for Covid-
19 as much as for climate change, species extinction, plastic pollution, soil degradation and a host of
other risks with the potential to affect the lives of millions in the future. Different generations can and
should be expected to both receive and provide solidarity. It is unlikely that we (as nations, as societies
or as humanity) will arrive at either just or efficient solution without weighing the pros and cons of
different choices.

Reviewing the Old Normal

On a different level, Covid-19 invites a critical re-evaluation of current socio-economic structures by

provoking anti-epidemic strategies which resemble large-scale social experiments that would have
been impossible at other times.

Perhaps the visually most striking effect has been on air pollution, as lockdowns have forced the
suspension of industrial work in various parts of the world. As an unintended side effect, Covid-19 has
revealed the grotesque amount of air pollution we have accepted as normal. The pictures showing the
dramatic reduction in air pollution, notably of NO2, in industrial centers are nothing short of amazing.
A recent study of urban air quality found that the air in 31 out of 40 cities studied had substantially
improved during a lockdown month. People in Jalandhar, India were stunned to see the Himalaya,
which had long been hidden from view. The change is not only aesthetic, it will save lives. According
to one calculation, the temporary reduction in pollution may have prevented the deaths of 4,000
children under 5 and 73,000 people over 70 years in China alone. Presumably, it is also easing the
burden of the epidemic. Recent research in the Netherlands has demonstrated that “atmospheric
particulate matter with diameter less than 2.5 is a highly significant predictor of the number of
confirmed COVID-19 cases and related hospital admissions.” But of course, air pollution is not a specific
risk factor for Covid-19 alone. Every year, an estimated seven million people around the world die
prematurely because of exposure to ambient air pollution.

If we should be having discussions on how to balance trade-offs between economic restrictions and
public health measures regarding Covid-19, why should we have any less regarding the trade-offs
between incomes and deaths with regard to air pollution? They are both perfect examples of the
fateful triangle of health, which ties health to both the economy and the environment. It requires
thoughtful analysis and weighing of evidence and interests, and we ignore it at our peril.

The pandemic has also revealed the risks inherent in existing globalized economic structures.
Fragmented production with pronounced local specializations and long supply chains between
different places comes with dependencies that are unremarkable when everything goes well. But, as
we have just learned, sometimes every does not go well. Covid-19 has laid bare the global reliance on
China and India for medical-pharmaceutical supplies. While the face masks have turned into a poster
child of production outsourced to and largely dominated by Chinese manufacturers, they are only a
minor component of a larger market concentration. Roughly half of all generic drugs in the United
States are imported from India, which, in turn, imports about 70 percent of active pharmaceutical
ingredients (API) from China, the world’s largest supplier of these substances. It does not require a
trade war for this constellation to be problematic. Interrupted production cycles during lockdown,
increased domestic demand and suspended transportation lines can all create painful scarcities in
potentially crucial products. While these dependencies may be particularly risky in the health sector,
in principle high-level globalization presents similar risks with regard to manufacturing in general, as
industrial components produced in an industrial hub like China are needed for manufacturing in most
national economies in the world. When this country experiences production problems, global supply
chains are severely affected, causing economic implications of the pandemic early on, effectively
spreading unemployment faster than the virus. More resilient, decentralized production structures
might be helpful.

Within countries, Covid-19 has amply demonstrated the importance of effective administrative
infrastructures, particularly in the health sector. If nothing else, the dramatically different provision
with intensive care units in different countries has been exposed. It has also drawn into question the
wisdom of the development of the last twenty-five years, during which intensive care unit beds have
steadily decreased almost everywhere in Europe. So have investments in other areas of healthcare
preparedness. However, effective coping with pandemic requires a combination of unglamorous
administrative tasks that make sure regulations are in place and in line with requirements, equipment
is available, information is clear and known, and essential workers are protected. Such structures are
possible in different political systems, though they are difficult to reconcile with a special, Anglo-
American type of capitalism which has treated the state as an enemy and starved administrations of
funds and able people, has proved disastrously incompetent to address the pandemic, with literally
tens of thousands of people paying for it with their lives.

There are many more instances in which measures directed at countering Covid-19 has revealed risks
in current ways of life otherwise considered normal: one is the price of everyday mobility. One study
indicated that the lock down in California cut collisions and fatalities in traffic accidents by half. Another
interesting policy has been the ban on alcohol, put in place in several countries. The effects in South
Africa are still being debated: supporters cite 5,000 fewer admissions to trauma units and a reduction
in deaths to due to violence and traffic accidents, while critics questions whether these changes are
the result of an alcohol ban or of other measures of social distancing, and argue that the regulation
increases the consumption of unlicensed liquor and social discrimination by affecting mainly poor
people. In many ways, these discussions mirror similar findings of historians on the effects of the
prohibition during the 1920s, which is more far complex and nuanced than the popular image of
blanket failure.

Little of this is new. There have been discussions on the injustice and public health burdens of racism,
inequality, environmental degradation, road traffic accidents and alcoholism for many decades. Nor is
it a complete list. All that Covid-19 adds is a tangible demonstration of otherwise less visible aspects
and a reminder of the degree to which, in the words of the declaration of the 2017 Health in All Policies
Conference “Health is a political choice, and as such any political, economic, social and ecological
decision has health and equity impacts.” Decisions will not be of an either-or yes-no kind. It is
unrealistic to assume a world with perfect equality, without any environmental impact of economic
activities, without mobility or international trade and without any alcohol would be either possible or
desirable. Decisions are about degree. How much inequality, climate change, pollution, trade, mobility
and alcohol do we want and for which economic and health outcomes?

It is very possible that, under the influence of economic fears and the propaganda of lobbies pursuing
interests of their own, most societies will seek to return to the status quo ante, adding Covid-19 to the
list of accepted, rationalized or denied risks. There is ample historical record for that. But it may also
be that it brings about changes of thinking. There is precedent for that as well. Fifty years ago, it was
widely accepted in industrialized countries that approximately 20 out 100,000 people would die of
road traffic accidents every year. In the USA, the rate was 25/100,000, which is lower than the Covid-
19 death rate of 21/100,000 at the time of writing (though this will change) in what is considered a
public health crisis. Today, after targeted public health campaigns and legislation, road traffic deaths
at such a rate would trigger an outcry. Twenty years ago, it was widely accepted that non-smokers
would have to live with the health risk of second-hand smoke. Today, it is considered normal in many
countries that smoking in the public is limited. The Me-too movement is just the latest example of
changing popular attitudes regarding what is acceptable or normal. Covid-19 may provide an
opportunity to re-think what is acceptable with regard to societal risks and resilience.

Such reconsiderations are not a matter or academic or ideological interest. The Covid-19 pandemic is
not the worst case. As far as historical pandemics go, it is reasonably mild, highly infectious but not
particularly lethal, and killing mostly the elderly who are unlikely to leave behind traumatized young
orphans. Things could be worse. A lot worse. And chances are, they will be sometime in this or the next
century. As public health experts have been pointing out, a growing number of pandemics is all but
certain, reflecting the way humans are increasingly encroaching onto the last refuges of wildlife and
their pathogens, as melting permafrost may be releasing old viruses and climate change expands the
range of existing ones, and, finally, as there are every more people in the world all of whom are
becoming more urban and more mobile.

And diseases are hardly the only shock societies are going to face. Climate change with its increases of
floods, droughts, food insecurity, changing disease spectrums, heat stress etc. is only the most obvious
example, one whose onset has already begun and whose increasing severity is certain. But, just as
Covid-19 was unexpected, more unexpected crises are unknown but certain: the next earth quake or
tsunami, the next infestation of locusts devouring harvests or giant hornets wiping out pollinating bees,
the next explosion of a supervolcano or an asteroid impact may be just around the corner. They may
also be centuries away. Whichever, coping will reflect the resilience – or lack there-of – of societies at
that point.

Future generations may very well look back to 2020 as a trial run, a good opportunity to learn.

If we learn.