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.
Per capita national health expenditures from 1960-2020
The data categorizes expenditures as national health expenditures, health consumption costs, personal health costs, administrative costs, and public health activities cost.
Source: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group; U.S. Department of Commerce, Bureau of Economic Analysis; and U.S. Bureau of the Census.