Mar. 15 2021

Ten Lessons from Our Pandemic Year

The one-year anniversary of the start of the pandemic is a somber time of reflection on the lives lost, the illness and suffering experienced, and disruption and separation inflicted by COVID-19. It is also a time to celebrate the contributions of front-line workers and public health scholars and practitioners. And while there is still much to learn about COVID-19, we can seize the opportunity to assess what the pandemic has taught us.

Columbia Mailman School faculty shared their thoughts on lessons learned over the past year, from virus co-morbidities to what the pandemic revealed about the health of our country. These lessons are crucial as the world works to inch its way toward ending the current pandemic while taking steps to prevent the next one. This knowledge may also help policymakers address other health crises, from systemic racism to climate change.

“Today, with the largest immunization effort in the history of the world underway, we are guardedly optimistic. There are significant challenges ahead, to be sure, but we have in our sight an end to the pandemic. We will take with us many lessons, both tragic and inspiring,” said Dean Linda P. Fried.

Ten Lessons

The pandemic exposed and worsened underlying inequalities in our healthcare system and society at large, as seen with higher rates of COVID-19 infection and death in communities of color. The crisis also deepened the economic divide.

“It is ironic that the United States, the richest country in the world, has been the most severely affected by the COVID-19 pandemic. This pandemic shined a light on our fractured health system, the fragility of the public health structures, and the deep health and economic disparities that plague our country. This requires a serious reckoning, not only to figure out what happened and why, but most importantly to put in place urgent remedies. Not doing this would be a betrayal of all those who suffered and those who lost their lives to this pandemic.” – Wafaa El-Sadr

“We have seen the very people who have helped us survive the pandemic, the essential workers, bear a disproportionate burden of illness and death, due to racist housing policy and the disproportionate placement of toxic facilities in their neighborhoods.” – Terry McGovern

The pandemic revealed the consequences of underinvestment in public health prevention. Slow and incomplete public health mandates led to ERs overcrowding and unnecessary deaths.

“For this pandemic and the next, we need to recognize the indisputable value of early public health interventions in preventing deaths and sparing us the need to overwork the immense courage of our hospital providers.” – Charles Branas

“Funding for public health represents less than 3 percent of the nation’s total medical bill. This underinvestment contributed to a tragic shortage of public health workers to engage in needed pandemic activities, such as diagnostic testing and contact tracing. We need to commit to a massive investment in the nation’s public health workforce and infrastructure.” Michael Sparer

“With COVID-19, all 6,090 hospitals became battlegrounds. Given that pandemic preparedness has not been part of routine healthcare delivery, nor has there been an incentive to build a better infrastructure, there must be specific federal funding allocated that is sustained in perpetuity to ensure bio-preparedness… Americans must invest in long-term solutions, build back better, invest in preparedness, and sustain the gains. Regardless of the cost, this investment will pay massive dividends during the next pandemic.”
Craig Spencer and Syra Madad (from their letter in The Lancet)

The pandemic was the result of a fragmented and politicized public health response in a hyperconnected nation and globe, and an absence of leadership at the top. It exposed the consequences of wealthy countries that prioritized national, not global health, and how increased global inequalities could undermine the effort to suppress the virus.

“As countries as poor as Thailand, as rich as Australia, and as large as China completely contained transmission within their borders, it showed how failed leadership within a divided nation means inevitable failure.” – Peter Muennig

“If we look around the world, many, if not most, countries have failed to contain the spread of COVID-19. There are a myriad of reasons, but science denial, a lack of cooperation, and the absence of an evidence-based, well-communicated response mark the countries most impacted.” – Jeffrey Shaman

The pandemic demonstrated the damage wrought by poor communication and misinformation. Falsehoods about vaccine safety and the origins of the virus were pervasive, and the latter fueled discrimination against Asian-Americans. 

“Misinformation led to widespread confusion about risk reduction behaviors during a time when the public’s cooperation in adhering to these behaviors was critical. A major lesson learned has been the critical importance of good, clear two-way communication with the public, and the importance of improving health literacy so that the public can better navigate the sea of misinformation that especially permeates on social media.” – Sandra Albrecht

“In a pandemic, public officials need to effectively communicate what is happening, and why, and the public needs to trust that it should follow the scientific and political guidance they are hearing. The Trump Administration not only failed to effectively communicate, it also politicized the response so that wearing (or not wearing) a mask became a political statement rather than a simple act of infection prevention. Going forward, we need to work not only on better communication but on rebuilding trust in our public health and governmental institutions.”
Michael Sparer

The pandemic showed that pandemics can inflict long-term damage on physical and mental health, some of which may not yet be fully understood. People with “long haul” syndrome from COVID-19 can suffer from persistent and debilitating symptoms like dizziness, forgetfulness, headaches, and fatigue.

“In some people, we can implicate organ damage involving the lungs, the heart, and the nervous system. In others, we don't see obvious organ damage. A viral syndrome may precede the onset of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). We speculate that COVID-19 may trigger ME/CFS and are exploring this through immunological, metabolomic, proteomic and genetic studies of people with ME/CFS and COVID-19.” – Ian Lipkin 

“Approximately 10-20 percent suffer enduring health- especially mental health effects after recovery, and the secondary consequences of lockdowns appear likely to substantially increase or exacerbate mental disorders.” – Ezra Susser

The pandemic showed that science can develop effective testing, infectious disease modeling, and vaccines at incredible speed, although testing in the U.S. was unnecessarily delayed. Technology also allowed millions to work from home and receive remote medical care, although unequal access to the internet and remote work has increased inequalities. Masks, a low-tech, non-pharmaceutical intervention, are helping prevent the spread of COVID and other infectious diseases like the flu, although it took us too long to understand their importance.

“Before COVID, vaccines took at least five years to develop but in less than one year from the start of this pandemic, people were receiving injections of one of three authorized, highly protective vaccines. This truly spectacular achievement reflects what science and hard work can accomplish.” – Jessica Justman

“Science and technology can be used to good effect, but without clear leadership, messaging and public health policy, the benefits of these tools are lost.” – Jeffrey Shaman

The pandemic showed how hard-hit communities can be resilient. Through collective mobilization and mutual aid, local communities rallied to help those in need, such as through food banks and community refrigerators. Mass protests following the killing of George Floyd have raised public consciousness around structural racism.

“Communities that bore the brunt of the pandemic came together to help one another by sharing food and essential supplies, checking on vulnerable neighbors, cheering on front-line workers, rallying for open streets, booking vaccination appointments, and more.”
Diana Hernandez

The pandemic demonstrated how school closures, job loss, and isolation strain mental and physical health. On the plus side, businesses and schools found ways to reinvent themselves.

“There will be a need to considerably expand mental health resources to address not the mental health consequences of the pandemic, but also as a way to address the physical health consequences too.” – Sandra Albrecht

“COVID-19 has changed the way we orient our students to the problems of structural racism in the United States and its impact on health. Student organizations such as CIPHER and MENTOR have worked with community-based organizations to provide assistance here in Washington Heights and Harlem and have learned first-hand how the pandemic has hurt these communities and how much these organizations have served as the first line of defense against its impact.”
Robert Fulliove

“Many cities rapidly moved large numbers of homeless people from congregate shelters to vacant good-quality hotels, demonstrating that homelessness is not an intractable problem and that ending homelessness depends primarily on the political will to do so.” – Ezra Susser

The pandemic wreaked havoc on cities, with revenue lost to public transit, entertainment, and tourism. Cities too adapted, designating open streets for pedestrians and cyclists and allowing for the proliferation of outdoor dining. Absent automotive traffic, cities saw sharp drops in air pollution.

“Throughout history, plagues have been transformative for civilization. They have shaped the way that we organize ourselves and live our lives, almost always for the better. One of the many examples is the installation of sewage and sanitation systems following global urban cholera outbreaks that brought life expectancy down to 30 in most cities.” – Peter Muennig

COVID-19 showed that a global pandemic can happen and inflict serious loss of life, even in the world’s richest countries. It also showed that a pandemic can happen again.

“The proverb says that ‘forewarned is forearmed,’ and all experts on emerging infectious diseases and pandemics have strongly advocated more effective global surveillance and early warning systems as the first step. Some of the main lessons of this pandemic are that early warning is not enough; political will and leadership, clear and consistent communications based on the best (and often evolving) scientific evidence, and the rapid implementation of public health measures may make the difference between a runaway pandemic and a manageable outbreak.”
Stephen Morse (from his article in Disaster Medicine and Public Health Preparedness)