The cases are coming. Or so it would seem.
But two years into a pandemic, when fatigue and disillusionment have combined into disbelief, it is hard to discern fact from fiction – particularly when the many sources of pandemic information have been less than reliable.
It is an inevitable outcropping whenever science delves into the realm of uncertainty. We try to piece what we know until what we see becomes the narrative we tell. And as our knowledge changes, so does the narrative. Only it changes differently per person.
And to further complicate matters, the story of the pandemic is not over just yet. As we move farther away from the acute phase of the pandemic into a painfully prolonged endemic phase, we see a changing narrative – from one of uncertainty to that of complexity.
We now know the pandemic was never a series of waves, one mighty wave followed by another. The pandemic is in reality a series of small, regional waves that at times coalesced into a large wave and at times canceled out to give the appearance of never having been there.
It is precisely this illusionary element that gave rise to the many narratives explaining – or explaining away – the pandemic.
Complex is an often used term that few understand. In healthcare, it is best understood through systems thinking. In that field, complex means what is seen at a smaller level does not necessarily reflect what is seen at a larger scale. As the scope changes, so does the perspective.
This applies to all frames of reference, large and small, and in the moment and upon reflection. When we look at the pandemic as a whole and its smaller, regional influence, comparing what we know now to what we experienced back then, we notice certain trends. First impressions matter, even when we do not know what we are looking at.
In New York city, the early days of the pandemic ravaged the city in ways we have not seen for centuries. In rural America, the pandemic was at first quite mild, only to then come with the same fury as its urban counterparts.
The same trend of fluctuating onsets applied to different age groups. COVID-19 first affected the elderly and then made its way to younger populations. And while this is not unique to COVID-19, what was unique about the pandemic is how much the first impressions shaped the overall perspective of the pandemic.
Younger, rural patients still to this day do not take the pandemic as seriously as the elderly or those living in urban communities, despite the fact that younger patients have been disproportionately – when adjusted for age appropriate life expectancy – affected and the pandemic took more lives in rural America more than anywhere else.
We can blame politics. We can blame youthful ignorance. And we can come up with narratives to justify the blame. But in reality, the pandemic is a complex mix of emotions and viral epidemiology. There is no convenient narrative to justify all that we observed and continue to see.
Instead of trying to explain what we see, we should try to contextualize our observations. In mathematics, this is called a ratio, a balance between a numerator, what we see, and a denominator, the context through which we see what we see. Healthcare, at its most fundamental level, is a ratio.
A complex ratio: An observation and its context, and action with its perception. This is healthcare, whether or not we acknowledge it as much. It is how we see the pandemic and how we view our individual health.
The act of eating is quite different for an obese patient under stress at work compared to a young patient binging after a long night of excessive alcohol abuse. No act in healthcare is independent of its context.
How each person constructs their individual ratio determines what they see, and accordingly what they react to. It explains why though COVID cases may be rising, we seem to bury the news under the sands of preexisting perceptions.