COVID-19 now haunts flu season: What other long term impacts can we expect?

It’s been a rough few days for anyone following flu season data. While China has eased zero-COVID restrictions in the face of protests, despite currently experiencing a surge in case count (along with Japan), North American hospitals face what the American Medical Association is openly calling a “tripledemic”: a wave of flu, Respiratory Syncytial Virus (RSV), and COVID-19 cases pushing depleted medical systems to and beyond capacity. On December 2, the US Centers for Disease Control (CDC) released grim data about a flu season worse than any in recent years, with a cumulative hospitalization rate for Week 47 (November 19 to 26) four times higher than most every season since 2010-2011, and hospital admissions having almost doubled in a single week. COVID-19 cases, too, have jumped 28 percent in the past two weeks.

In the short term, the CDC notes that the forms of flu people are catching are at least in the same genetic subclade as, or otherwise antigenetically similar to, the viruses included in this year’s seasonal flu vaccine. The same basics for individual civic responsibility (e.g., of getting vaccinated if one can) therefore apply. So too does the CDC’s return to recommending that people mask indoors. The season ahead might be difficult, as hospital services are already struggling, but we can always do our part to flatten the curve, and to advocate for better health system funding and staff supports along the way.

Acting short term, thinking long term

But while adjusting to the difficult flu season on hand, we would do well to also monitor the data we’re gathering about long term impacts of the COVID-19 pandemic.

News media has struggled with how best to report on a range of long term impacts not just from the disease itself, but also from how our societies have re-organized themselves during seasons of lockdown and related restrictions on socioeconomic, medical, and mobility choices. As with immediate reporting on the virus itself, a delicate balance is required between sharing the most up-to-date announcements and allowing for the data to mature.

Implicit in this struggle is managing our overconfidence that we can get a lock on what’s going to happen to us next. It might seem a touch extraordinary, after all the surprise turns in our recent economic, political, and world history, but forecasting remains a common and highly sought-after human activity, for better and for worse.

In 2020, the University of Waterloo, Waterloo Institute for Complexity & Innovation, and Templeton World Charity Foundation launched World After COVID, a collection of topical experts’ answers to five questions about the psychological and societal changes to expect after this pandemic. The International Monetary Fund did something similar, by gathering the reflections of six prominent thinkers on how pandemic will have changed the world.

But if many of their answers feel generic to you, you’re not alone. It should further come as no surprise that a 2021 study of psychological scientists’ judgments of societal change from COVID-19 found that neither experts nor laypeople were any better, as a group, at making predictions about how the pandemic would unfold.

The study also noted two striking factors in expert responses. First, psychological scientists often offered predictions “outside [the] scientists’ areas of expertise, with justifications based on intuition/heuristics and analogical reasoning”. Second, these topical experts did no better at weighing in on outcomes retrospectively than when asked to predict what was going to happen: “Prospective judgments were indistinguishable from retrospective judgments and accuracy of both was largely at chance.”

Most everyone wants to know What next? What can we expect to happen to our systems in the next five, ten, or twenty-five years as a result of this once-in-a-century transformation?

The impulse is a good one, but it’s also historically made us vulnerable to prophetic and related magical thinking. It can lead us to overestimate what is knowable, latch on to early data at cost to ongoing research, cultivate overconfidence in the wrong experts for the job, and distract from what is in our agency to implement here and now.

So let’s take a look at some of what does seem to have emerged as solid knowledge in a few subject areas impacted by COVID-19, and then ask how we can better approach the great many uncertainties that still lie ahead.

Medical outcomes for health and wellbeing

Before diving into ill effects, it bears noting and celebrating the obvious positives, on a medical front, from our years-long engagement with COVID-19. This virus compelled a prioritization of mRNA vaccine research, a field that had previously been languishing, and led to a rapid mobilization of resources to develop better testing labs and protocols. Our species launched into a race for a vaccine that not only aided in mitigating COVID-19’s impact worldwide, but also fast-tracked other vaccine research. We learned more about trained immunity, among a wealth of other subfields, and even our current wave of long COVID sufferers is bringing much-needed attention to our species’ longstanding struggle with other postviral syndromes, such as Chronic Fatigue Syndrome, Lyme Disease, and herpesvirus-induced “mono”.

But all these advances emerged because of the grave and ongoing cost of COVID-19 to human wellness. Public and private research bodies now routinely publish on the projected long term health risks associated with contracting even low-grade or asymptomatic COVID-19 (to say nothing of severe and/or multiple cases). A massive review in August 2021, for Scientific Reports, outlined 50 long term effects of the disease (fatigue, headache, attention disorder, hair loss, and respiratory issues being the most common), and we’re only just beginning to figure out how to mitigate the worst and most abiding of these symptoms.

Learning outcomes and personality changes

Education studies similarly note a negative impact on human outcomes. A 2021 analysis of school closures in the Netherlands found significant learning losses, and a 2022 analysis across Europe not only corroborated those findings but also identified their role in exacerbating pre-existing class-based and racialized inequalities. This month a third European study, on cross-national educational achievement, will offer a fuller picture on existing gaps. In October, the US received a “national report card” that saw reading scores drop to 1992 levels, math scores yield their largest decrease on record, and zero states achieve improvements on average test scores.

Also in October, a meta review of mental health outcome studies highlighted increases in sadness, anxiety, depression, substance abuse, suicidal tendencies, PTSD, and inability to cope with crisis scenarios, up to hysteria and paranoia. Increases in gender-based violence, homelessness, mass unemployment, and overall poverty were obvious related outcomes (as was the partially immunizing effect of being more financially stable during quarantine and lockdown: we do know what will fix much of this!).

Plenty of neuropsychiatric complications have been identified as part of COVID-19 infection profiles, but there may also be long term consequences to the massive shift in cultural routines under pandemic rules. A recent study published by PLOS raised the possibility that “population-wide stressful events can slightly bend the trajectory of personality, especially in younger adults”. In particular, they saw an increase in neuroticism and declines in agreeableness and conscientiousness for young adults in Years 2 and 3 of the pandemic. The latter two traits (when higher) are associated with greater educational achievement, reduced risk of chronic illness, and better overall economic outcomes.

And yet… a cautionary note for biological changes

That same study, though, was widely reported around a different facet of researchers’ stated findings. The part elevated by most media was the claim that overall trait changes were “equivalent to about one decade of normative personality change”. Striking stuff! The kind of claim that makes for great headlines.

It bears noting, though, that authors in this analysis were also surprised by an original drop in neuroticism during Year 1 of the pandemic. (Again, we’re not very good predictors of as many things as we’d like to think we are.) After the fact, scientists surmised that this drop in neuroticism might have emerged from a broad sense of “we’re in this together” that informed our first months with COVID-19. Then the abiding nature of this pandemic, its long term impacts on everyday life, and the huge toll it took on civic confidence in government and third-party organizations, wore us back into our usual old neurotic selves.

So goes the latest explanatory model, at least. But with so much see-sawing in human outcome over the past three years also comes the reminder not to treat the above claim (about our having undergone a decade’s worth of personality change) as if it describes a non-malleable outcome. Our understanding of human behavior is still developing.

Another set of data, around genetics, has similarly been bungled more than effectively conveyed in mainstream reports on scientific discoveries. In December 2020, a stem cell biologist and gene regulation specialist launched a heated debate through a preprint article on bioRxiv, which advanced the hypothesis that genetic sections of SARS-CoV-2 (COVID-19) could integrate into human chromosomes and linger in our genes well after initial infection.

The debate about long term genetic impact was muddied by anxiety over how this claim would read to anti-vaxxers, while the world was still scrambling for a COVID-19 vaccine and very much needed widespread uptake once found. Some scientists worried that this genetic claim would fuel panic about mRNA-based vaccines damaging human DNA, even though messenger RNA generally doesn’t work like that. Nevertheless, an April 2021 follow-up confirmed that RNA from COVID-19 could indeed integrate into the genome of an infected cell, explaining why some positive test results suggested the production of viral RNA well after initial infection and patient recovery.

Does this mean we’ll be passing on COVID-19-modified genes? Not that we know as of yet, but this requires a better understanding of epigenetics (the study of modifications to gene expression—not to the code itself) than has currently reached a lay readership. There are indeed epigenetic impacts of COVID-19, including the way the virus mimics and disrupts the regulatory role of a cellular protein that helps switch genes on and off (and which seems to explain the longevity and severity of acute infection for some people).

But there is a huge difference between COVID-19 impacting gene expression (as it has been illustrated to do in cord blood cells during pregnancy), and successfully transferring as part of the base human genome from parent to child. We know from preceding pandemics that survival selectivity will probably play a small role in the dominant immune system genetics for our species, but our level of technological mitigation far surpasses that of our Black-Plague ancestors, so even then our genetic outcomes are far from guaranteed.

Economic and labor force impacts

Market analysis also quantified some of the long term impacts of COVID-19, either directly through infection and post-COVID disease, or indirectly, through burnout and preventative avoidance of possible workplace exposure to the disease.

One Mercer study in October noted that COVID-related absences and disabilities are an ongoing issue for nearly half of the surveyed large employers (i.e., businesses with 500+ employees), and that a third claim direct impact to their operations by “absences for acute illness, isolation, or quarantine”. The Brookings Institution offered a modest estimate of $170 billion in lost wages due to two to four million US citizens having left the workforce from long COVID, while Harvard economist David Cutler hazards a whopping $3.7 trillion in economic costs to long COVID, with 59 percent of the cost stemming from lost quality of life, and the rest from lost wages and higher spending on health care.

This is on top of concerns in 2020, by the Organisation for Economic Co-operation and Development (OECD), about the pandemic’s long term impact on the financial trajectory for a generation just joining the labor market. These young people were most likely to be engaged in the sort of “low-paid and insecure” employment that was most affected by unemployment early in the pandemic. Drawing on research from the ongoing impact of the 2007-2008 financial crisis on the last major cohort entering the workforce, the OECD feared a heavy “toll on future employment prospects and earnings” for this labor force as well.

How has this historically backed concern panned out? Complexly. According to Pew Research published in February, many workers have been able to leverage the pandemic’s switch to working from home to optimize their working lives, and also to reduce its overall role in their schedules. However remote work is more readily taken up by college graduates and already upper-income workers, and there remain many job categories where in-person labor is a necessity. The US gig workforce (more precarious, with higher health risks) continues to show stark racialized, ethnic, and age-demographic skewing, with consequences including a widening gap in existing health and socioeconomic disparities.

(And that’s not even taking into the account the fact that the most comprehensive research on worker welfare in pandemic is self-admittedly skewed toward “high-income countries due to the more expansive literature available on this topic”.)

Two years on, the World Health Organization (WHO) offers especially bleak statistics with respect to healthcare in particular: a critical bottleneck industry in the prevention of worsening impacts for workers in other sectors. The WHO’s most recent Global Health Workforce Statistics yield “a projected shortfall of 10 million health workers by 2030, mostly in low- and lower-middle income countries”, but with significant impacts for all countries. This is due to long term, systemic under-funding of formal education and job training, a mismanagement of employment and deployment strategies, and a paucity of performance and data monitoring even in countries with “major unmet health needs”.

There’s no such thing as a free guru to answer all our anxieties about the future. But we can make ourselves slightly better situational respondents to specific research questions, if properly trained and narrowly tasked.

Speaking with caution about the future

The list goes on. We also gained a wealth of key environmental data from this years-long “natural experiment” in the reduction of human impact on our surrounding ecological systems, but that topic merits fuller discussion in the context of our ongoing failure to meet climate change mitigation targets despite what pandemic has taught us.

The more pressing point is this: With so much so clearly impacted in a wide range of topical areas relevant to human welfare, how do we navigate the data better?

Two general approaches have emerged. One, building on the failure of topical experts as a group to offer useful predictions, involves leaning in to the identification and cultivation of “superforecasters”: individuals who show more consistently accurate results when asked for probabilistic predictions of future events.

This research pathway precedes pandemic, with a 2015 study arguing for four key factors conducive to the creation of superforecasters: cognitive ability, skills pertinent to the task at hand, motivation and commitment, and operating in an “enriched environment”. These factors are striking because they emphasize the learned component in such outcomes, and this accords well with further research, in 2016, on how more training and practice can improve predictive accuracy in short-burst, highly localized assessment contexts.

In other words: There’s no such thing as a free guru to answer all our anxieties about the future. But we can make ourselves slightly better situational respondents to specific research questions, if properly trained and narrowly tasked.

Digging into the present instead

There’s another direction that works well, too, and which was perhaps best exemplified by the British Academy, when asked for an independent review to address the long term societal impacts of COVID-19. The reports they produced in 2021 (Shaping the COVID Decade and The COVID Decade) outline nine areas of policy-relevant concern, and advocate for concrete sociopolitical changes to improve outcomes in those domains. What makes these documents so useful is that they leave off trying to ascertain what will happen, and focus more on what the world at this moment is revealing in the way of inequalities and vulnerabilities around pandemic—and focus their remedial efforts there.

As noted in “The longtermism that works—and the kind that doesn’t“, sticking to improving the present might be a less glamorous form of forecasting, but it nonetheless allows us to work for a better world ahead: Absent the grandiose assertions. Absent the cults of personality around singular thinkers often speaking well outside their topical wheelhouses.

When we curtail our overconfidence in supposed predictive prowess, we also mitigate the failure to get it right even in retrospect, as noted in the aforementioned study of experts and lay persons who both failed at that task. There, the problem was that people were still being asked to assess an outcome based on intuitive reasoning rather than a much more curious and constructive “Well, let’s take a look at the data together, shall we?”

It is very easy for secular folks, especially from seasoned atheist traditions, to recognize the dangers of this behavior in forms of religious rhetoric. But the same danger exists in secular realms as well—buoyed by a media economy that loves coming to sensational and over-simplified conclusions about the ongoing and messy state of scientific research. And it does us no favors when trying to rebuild vital civic confidence in organizations entrusted with the responsibility to advise us wisely on public health concerns, along with other imminent threats to human welfare.

So keep an eye on unfolding data—about the concerning state of flu season, yes; but also about what the world around us, still deeply affected by COVID-19 (the virus, and our sociopolitical responses to it), is telling us we need to do to improve human outcomes. And not just to stave off what might or might not come to pass, but because it matters now.