The Pandemic May End Soon – That’s the Problem

To predict the future is a folly of fools.

Not because it is difficult, but because it is irrational. The future never follows a predictable, rational trajectory from the present, it is always irrational. And to extrapolate events from the past onto the present to predict the future is too rational to be correct.

None of us could have predicted the behavioral responses we saw during the pandemic. While epidemiologists had warned of the inevitability of a pandemic for years, once COVID-19 arrived, the response was decidedly unpredictable.

We could not have anticipated the capacity constraints upon the healthcare system, the mental toll the lockdowns placed on society, nor the enormous financial burden placed on families and businesses alike.

COVID-19 was a systemic shock to the entire world with reverberations extending across all facets of life. Amidst the reverberations were a constant stream of reactions and counter-reactions as we attempted to make sense of what was unfolding around us, as it was unfolding in real time.

Now that the vaccines have arrived, and we have become more adept at implementing social distancing guidelines, we are beginning to see the end of the pandemic. We feel a sense of relief that things will return back to normal.

This is where we are sadly mistaken.

To assume life will return to pre-pandemic norms is ridiculous, as most know the world has permanently changed. But we should not assume we know how the world will change, or how this new normal will behave.

Sure there are some things we can predict – healthcare will become more digital, more decentralized, and less reliant upon infrastructure. But how those predictions will manifest will be anything but predictable. And will likely unfold in irrational, unpredictable ways.

Interestingly, thinking irrationally is how we can best project the future. While we can predict certain broad concepts, we cannot predict how those broad concepts will appear with any degree of certainty.

This comes across as a bit of a contradiction. The more granularly we attempt to predict something, the more irrational the trajectory becomes. It is easy to say that telemedicine is the future of healthcare – that makes too much sense. But it is another thing altogether to create protocols for telemedicine that assumes we know how patients will integrate telemedicine into their everyday healthcare experience.

Any attempt at creating such protocols comes from interpreting how healthcare was before the pandemic, and how telemedicine would fit within that no longer existent model of healthcare.

It will inevitably be wrong. This is the genesis of the contradiction.

The future of healthcare is largely based upon our predominant perceptions of where healthcare is going. But our behavioral responses – how we behave along the path towards this future – is based upon what we do not know. The uncertainty defines our behavior, our response to incrementally unfamiliar clinical decisions that in aggregate pave the path forward along this irrational trajectory towards the future.

We know schools will reopen, children will go out and play with their friends, and we will all soon be able to gather in large crowds. We have known for weeks now that by the end of summer the vaccine will be available to whomever wishes to receive it, and social distancing guidelines will have been largely lifted.

What we cannot predict is the behavioral response of the public to the reopening. Rather than assuming we know how the public will respond to a perceived sense of normalcy, we should assume we do not know how they will respond.

And allow the unknown to guide our understanding of public behavior.

The pandemic has been nothing short of a global trauma, a sustained, consistently low level of stress that overwhelmed the world for over a year. While we all experienced the same stress, we all responded differently. So it only makes sense that we will respond in unique ways now that the global trauma is approaching its last days.

People have grown accustomed to life in a pandemic, now they must again readjust to life post-pandemic. The fear of the unknown will dictate people’s response to the unknown.

Some may respond to the economic stresses they can no longer hide from. Some may respond to the acute mental stresses that have overwhelmed so many during the pandemic.

The response to this unknown is unpredictable because each person will identify a different aspect of the unknown to respond to. As we each have cultivated a unique approach to the uncertainty.

The most important thing we can do is allow time for people to properly adjust and acclimate to life post-pandemic. And not assume that everyone will find a straightforward, rational response to life post-pandemic. The adjustment period will be difficult – especially difficult for some more than others.

We should be diligent to monitor for warning symptoms and signs among our peers. We were largely caught blindsided to the mental angst the public felt during the pandemic.

We should not make the same mistake again, and blankly assume life will be better for everybody post-pandemic. Transitioning out of the pandemic will be stressful for many individuals, and we should be mindful of the struggle they will surely face.

State and federal governments should implement policies to help people transition into post-pandemic life. Healthcare providers should be mindful that patients may experience new stresses now that life is transitioning out of the pandemic.

It may be something as innocuous as being scared of walking into a large crowd. It may be something as impactful as thoughts of suicide as new life pressures emerge post-pandemic.

The threats may be subtle or overt, existential or overtly psychological, but one thing is for sure – they will appear in unique and unpredictable ways, and affect different people differently.

We saw what happened when we did not pay attention to our peers during the pandemic. Suicides and overdoses spiked to unprecedented levels. We should ensure we are ready for the end of the pandemic – and all the new stresses that may come our way as we move into this new future.

So to predict the future, to anticipate the behavioral responses from the public emerging out of the pandemic, start by refuting what is rational.

Assume what we believe to be true, to be wrong – while remembering that the future is fundamentally irrational.

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Vaccine Passports: what we need to know

The COVID-19 pandemic has killed more than half a million people in the US and has seriously impacted our daily lives. The granting of Emergency Use Authorizations for COVID-19 vaccines has been a game changer in helping to reverse the pandemic onslaught. Demand for the vaccines currently far exceeds supply nationwide. They have become the golden ticket that can transport us back to a time when routine activities, such as attending school or taking vacations, didn’t seem fraught with danger. What’s the best way to go about re-establishing these activities? One idea that’s getting discussed seriously is giving those who have been immunized a vaccination passport (VP).

What is a vaccination passport?

Let’s start by clarifying some terminology. VPs are documents that show that someone has been given a vaccine(s) and is therefore presumed to be immune from getting and sharing that disease. These are distinct from diagnostic tests to determine if a person is or is not infected with a particular virus (PCR and viral antigen tests) or has been exposed to a virus (antibody tests). VPs are the modern day equivalents of the “letters of transit” that played a key role in the film Casablanca. They’ll enable you to travel freely.

Why give vaccine passports?

Vaccinated people are unlikely to transmit the virus that causes COVID-19 with others, though this has yet to be definitely proven. So, what’s the primary rationale for giving vaccination passports? It seems the goal is to incentivize people to get vaccinated. Folks might be more likely to seek out the vaccine if it bestows upon them certain privileges, such as being able to travel freely. While the idea might sound appealing at one level, the road to vaccine passports is pockmarked with political potholes and littered with logistical land mines.

Administrative issues

There are a lot of important questions that need to be answered before VPs can become widespread; it’s unlikely there will be a “one size fits all” solution. What might VPs look like? Pieces of paper (that could easily be lost or counterfeited), or a digital key or document you store on your smartphone (that many older folks still don’t have)? If you lost one, how would you get it replaced? Would your vaccination records be tied to your other medical records, and if so, what kind of privacy and security protections would be needed to safeguard your data? How would the passport administrator verify that you got vaccinated in the first place? Who is responsible for correcting any errors that crop up? Given how much we’ve struggled as a nation to simply solve the scheduling of vaccinations, VPs might be significantly more difficult to manage.

Who’s going to run the program?

A coalition of health tech leaders (including Epic, the Mayo Clinic, Microsoft and Salesforce) has started the Vaccination Credential Initiative to create an internationally accepted digital health card. Its vision – as stated on its website – is “to empower individuals to obtain an encrypted digital copy of their immunization credentials to store in a digital wallet of their choice. Those without smartphones could receive paper printed with QR codes containing World Wide Web Consortium (W3C) verifiable credentials.” Some European countries (e.g. Denmark) are working on developing their own immunization passports, and the President of the European Union Commission has voiced support for them.

We already have a hodgepodge system designed to keep folks with COVID-19 from traveling. Many airlines are requiring proof of non-infectivity to board a plane – these are distinct from VPs. The methods adopted vary from airline to airline: United uses Travel Ready Center, American uses VeriFly while others use Common Pass. Saga cruises are the first in the UK to demand proof of vaccination, but not everyone is on board with the concept. The World Travel and Tourism Council stated its opposition to allowing travel only by those who have been vaccinated, on the grounds that it is discriminatory.

Discrimination concerns

The concept of gaining advantage from one’s immunological status is not a new one. In New Orleans in the mid 19th century, great economic value was attached to those who survived the onslaught of epidemic waves of yellow fever. A mix of structural racism and a system valuing “immunocapital” ranked men and women highly if they were yellow fever survivors. Those that had not had the disease yet found it difficult to obtain work or obtain credit and women could not marry. Slaves were similarly revalued, with larger assessments attached to survivors. This legacy of viral discrimination casts a long shadow over current discussions surrounding vaccination passports.

Also problematic is the fact that not everyone will be eligible for VPs. Some people can’t be vaccinated for medical reasons but would still like to participate in whatever activities the passports enable (such as travel opportunities). These individuals will likely file complaints if they are denied VPs, arguing that they’re discriminatory in nature. Vaccine opponents will no doubt also file lawsuits seeking to block the use of VPs, claiming they represent an attack on their freedoms and personal choice.

Others may be shut out of VP programs because they don’t have the computer skills to register online, a problem that’s turned out to be widespread with the vaccinations. Don’t have any ID? In some places this prevents the most vulnerable from getting the COVID-19 vaccine, and therefore VPs as well. Many Black and marginalized communities are already deeply suspicious of the medical establishment, and wary of receiving a COVID-19 vaccine. Restrictions that prevent these groups from participating in various societal activities because they don’t have VPs will echo the Jim Crow days of poll taxes and literacy tests that were required to vote.

Enforcement issues

VPs bring up a similar issue as mask mandates: who is going to enforce them? It is one thing for a cruise line to do so, since reservations are required and extensive paperwork needs to be filled out in advance. Who is going to keep non-vaccinated people out of restaurants or concerts that require proof of vaccination? We’ve already seen anti-maskers storm department stores, ignore requirements to wear masks on planes and even kill a security guard who confronted them.

Black market for vaccine passports

Many airlines are now requiring proof of a negative COVID-19 test before they will let their customers fly. This has led to a black market for fake negative COVID-19 test results for those who are looking to game the system. Similarly, bogus cards claiming that the cardholder was exempt– for medical reasons – from having to wear a mask, have been manufactured and distributed. It’s not hard to imagine that a similar market will emerge for VPs.

Overcoming vaccine hesitancy

Given the multitude of issues and concerns listed above, moving forward with issuing vaccination passports seems highly problematic. If the primary purpose of having VPs is to drive up immunization rates, that can be better accomplished by running public service announcements and ads illustrating how liberating it is to start doing normal activities once vaccinated. A nationwide campaign to do just that is already in the works. I personally can think of a better use for the time and money that will be spent on establishing VPs: use them to focus efforts on overcoming vaccine hesitancy in concert with combatting the high tide of online vaccine misinformation and disinformation.

Source: Technology Networks

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