The real long-term impacts of Covid-19

Something has to be done. 

That was the stance of policymakers after the terror attacks of Sept. 11, 2001. That certainty, coupled with a fraught political environment, resulted in frenzied decision-making and some of the most globally consequential and disastrous decisions of the last several decades. Consider: 

• the erosion of privacy and civil liberties in a growing national security state
• catastrophic wars
• spiking xenophobia 
• Islamophobia 

Also consider that the event marked an inflection point locally, for the city whose actual skyline was shifted in a day. Decades later, state and city policy choices in response to, or accelerated by, the 9/11 attacks have shaped the socioeconomic life of the city, and particularly downtown Manhattan.

Will Covid-19 bring the same upheaval to New York City? 

What happens in the next few months and years will cement political legacies and impact our metropolis in indelible ways, starting with immediate decisions around how to keep fending off the Covid-19 virus itself.

Messaging: Large segments of the public have felt frustrated with official messaging throughout the pandemic, and there’s no question that significant missteps have been made, but it’s also very difficult to craft a cohesive and science-based outreach and awareness strategy when the scientific understanding itself can shift dramatically in a matter of weeks, if not days. That applies equally now: we’re all treating this as a waning crisis, and it is, for now. But there’s absolutely no guarantee that this is over, and as we speak new variants are emerging globally, slowly building up momentum across the United States.

Variants, masks, closures

It is absolutely possible that we’ll see a new version of this virus with the transmissibility of Omicron and lethality of Delta, at which point two things need to happen: administrations at the local, state, and federal levels need to act fast to communicate the extent of the threat and take executive action, such as renewed mask mandates, restaurant closures, and restrictions on congregation, but more importantly, people would need to comply.

New York’s political leadership in general seems less than enthused about this prospect. Mayor Eric Adams has been open about his exasperation with restrictions, and his effort to “slowly peel [them] back, as I stated over and over again. We want to do it layer by layer,” as he said just last week. Gov. Kathy Hochul recently dropped the statewide indoor mask mandate, and both would probably view it as a political liability to reinstate restrictions, probably correctly. Still, as leaders it’s their job to make what could be unpopular decisions if done in service to the broader public health.

The trouble is that the kind of fatigue triggered by Sars-CoV-2 infection isn’t the one we most have to worry about here. Fatigue with limitations on daily living are real, and we haven’t yet really had the experience of trying to revert to crisis posture after the pandemic has all but been declared over. It’s not clear that most New Yorkers, and particularly those who have historically been at higher risk, will readily accept them. Some polling has shown that the populations most worried about Covid-19 now are people who self-identify as “very liberal,” which in New York City does not typically mean the Black and Brown communities who were hardest-hit throughout the pandemic.

Loss of learning

These communities also have some broader goals and objectives that run counter to the idea of massive restrictions, in particular around economic activity and education. While students across the city’s massive, one-million-student-strong public school system fell behind during school shutdowns, English language learners and those with disabilities predictably found themselves particularly affected. It ultimately doesn’t matter how quickly teachers and administrators are able to adapt to pandemic circumstances; something is lost when school goes remote, and at developmental ages, it’s very difficult to get back.

Children whose parents are unable to hire tutors or pay for additional programs to help get them back on track—which is to say, who aren’t at least upper middle class in this city—are at the highest risk for permanent learning loss. This is a real and significant consequence of further restrictions and cannot be ignored, and so any potential response has to adapt to this reality. Even in the absence of the need for further restrictions, it is imperative for backfilling missed education to be made a significant priority, given its potential to become a very long-lasting issue.

This means active policy interventions like providing publicly funded tutoring as a matter of course and understanding that returning students will have not only academic deficiencies, but social and emotional ones that must be dealt with just as seriously. What many of these conversations ultimately miss is that the failure to properly educate children isn’t just an immediate problem, it’s a mass social detriment for potentially whole generations. Starting behind puts kids behind, sometimes for life.

Rich people’s pandemic was different

On the economic front, large corporations mostly weathered the pandemic, and the richest Americans actually got significantly richer. The brunt of the impact was felt by very small, community businesses, the kind that ultimately make up about 90% of all city businesses and employ half the city’s workforce, and which are likely to be both helmed by and employing immigrants and ethnic minorities. Lockdowns wreaked havoc on local commerce and forced many small businesses to shutter permanently.

There won’t be much appetite for restrictions that further risk economic harm to communities’ economic lifeblood, which means policymakers should understand that there will be an expectation that further Covid control measures, if necessary, will come paired with plentiful economic assistance, as well as the kind of rapid adaptation that can help keep businesses afloat—think open streets and to-go cocktails.

Health and disease and destruction

One almost direct parallel between the long-term management of Covid-19 and the long-term management of 9/11—the presence of a poorly understood, somewhat unpredictable and persistent health hazard for those affected. In the case of 9/11, this took the form of the cancers and respiratory illness that manifested slowly over the years, sickening and  eventually killing those first responders and residents that had survived the initial attack sometimes years later. Much the same on a catastrophically broader scale can be expected out of long Covid, the umbrella term for a host of chronic symptoms that typically include fatigue, brain fog, shortness of breath, and which can last for months or, as far as we know so far, years.

Doctors divide the long Covid into three broad categories; the first two—ongoing symptoms from cell damage caused by the virus itself, and the immediate impact of post-hospitalization and prolonged ICU stays—are a little better understood and are likely temporary, essentially reactions to having had the virus in the first place. The third—symptoms that develop after an initial infection due to continuing impact on the immune system from inflammatory markers—is the least understood and potentially most dangerous in the long run.

Some estimates point to as many as 10 to 30% of Covid sufferers, even those who never had symptoms, developing some form of long Covid, which is an enormous challenge that we’ve barely scratched the surface of considering in depth, let alone addressing. NYChas had about two million confirmed Covid-19 cases, which is likely a significant undercount. Even at the most conservative estimates of incidences of long Covid among this population, we’re talking two hundred thousand people with poorly understood, currently untreatable, and debilitating chronic symptoms. We should come to realize sooner rather than later that this isn’t an issue that’s just going to go away; to some extent, we’ll have to reorient our society to accommodate this reality. This will have implications for long-term healthcare spending, but also our understanding of work and socialization.

The horror of the last couple years also comes with an opportunity to better prepare. I hate to be the bearer of bad news here, but this won’t be the last pandemic, maybe not even in  this decade. As much as we all want to simply put Covid-19 behind us and move on, there are valuable lessons to excavate from our performance this time around, including the massively detrimental impact of decades of closing hospitals in the very communities that were ultimately most affected. Socially, one benefit might be a greater direct awareness and appreciation for the notion of acting collectively for social good. As the threat of climate cataclysm keeps closing in, that’s something we could all do with more of.