Experts Discuss Mapping a Post-Pandemic World

By Brandon R. Reynolds

What does the future look like after the pandemic? What changes will become permanent, and what opportunities for change still lay before us?

In the third installment of UC San Francisco’s three-part series, “COVID-19: The Path Forward,” a panel of health and policy experts met March 23 to examine COVID-19’s impact on our society and look ahead to how we rebuild and prepare for future pandemics.

The general outlook of the participants was summed up by moderator Bob Wachter, MD, chair of the UCSF Department of Medicine: “There is a light at the end of the tunnel, but there still is a tunnel,” he said.

For now, progress is tenuous, said George Rutherford, MD, professor of epidemiology and biostatistics. “The variants are of concern, and ongoing transmissions are of concern,” he said. He estimates a return to something like normalcy, if all goes well, by late summer or fall.

That progress might also backslide, said Stefano Bertozzi, MD, MPH, professor of health policy and management and dean emeritus of the UC Berkeley School of Public Health. “There's a very good chance that we're going to have a brief honeymoon and then it will get worse again,” he saidi. “I'm worried as we increase vaccination, that we will be applying selective pressure to the virus to develop vaccine-escaped mutants.”

The inequities of class and race threaten to slow the vaccination process, said Eric Goosby, MD, professor of medicine at UCSF and United Nations Special Envoy on Tuberculosis. “It's a race with vaccination, especially in those populations that can be most harmed from it: elderly populations, comorbidities, et cetera,” he said.

Indeed, the pandemic “shattered this notion that we are an equitable society,” said Dayna Long, MD, co-director of the Center for Child and Community Health at UCSF Benioff Children's Hospital Oakland. “My hope is that our path forward is really allowing us to have hard conversations about structural inequities that lead to these related life events, such as poverty and inequality.”

Inequality wasn’t only exposed by the pandemic, it was a driver of it, said Margot Kushel, MD, professor of internal medicine and director of UCSF’s Center for Vulnerable Populations.

“This pandemic is a story of essential workers living in overcrowded housing,” she said. Contact tracing among the Latinx population sometimes found 15 people in a household – the only way they could afford to live and work in the Bay Area. More housing is critical to staving off future health and economic crises, said Kushel.

“There’s no medicine as powerful as housing,” she said. “Can we see beneath the tip of the iceberg and realize that we can't have a healthy economy with a million housing units short that we have in California for extremely low income households?”

A silver lining of the pandemic has been the increased adoption of telehealth. Bertozzi pointed out that though the shift from in-person to virtual care was rocky at first, he thinks in the long term it will be a positive as telehealth becomes a more viable and efficient method of healthcare delivery.

Wachter agreed. “It opens up a path for access to populations that didn’t have access before,” he said. “It also opens a path to really change the dynamics of the health care system in interesting ways.”

Telehealth also allows health care providers to deliver more consistent care, said Long. “For many of our patient populations, telehealth has been an amazing way for us to stay connected,” she said.

And more opportunities for positive change lie ahead, if only we pay attention to the problems laid bare by the pandemic.

“It would be a great irony of COVID, which has shown so many of our disparities, if we just replicate those without actually making sure that we do the work that we need to do,” said Kushel. “Because the potential is enormous of what we could accomplish.”