White Coat, Black Art

'Like the roaring '20s,' but not for everyone: What history tells us about life after COVID-19

Post-COVID life will eventually be “like the roaring ’20s” that followed the 1918 influenza pandemic, but it’ll be a bumpy ride to get there, says a doctor and medical sociologist who studies the impact of pandemics.

Doctor and medical sociologist explains what previous pandemics can tell us about what to expect next

Life after COVID-19 could eventually lead to an exuberant period similar to the 'roaring '20s' of the 20th century, as depicted in this 1920s movie still showing a woman in an iconic flapper dress, but inequality will keep some groups away from the party, say experts who study the social determinants of health. (Charles Phelps Cushing/Getty Images)

Originally published on Jan. 8, 2021

Post-COVID life will eventually be "like the roaring '20s" that followed the 1918 influenza pandemic, says a doctor and medical sociologist who studies the impact of pandemics, but it'll be a bumpy ride to get there. 

Going back thousands of years, there's a pattern to how societies have responded to epidemics, including the flu pandemic that preceded the 1920s, said Dr. Nicholas Christakis, a former hospice doctor, medical sociologist and professor at Yale University.

People get more religious and more risk averse. They spend less and drink less. 

"There are all these sort of psycho-social responses and economic responses to the spread of a deadly germ that are pretty typical of human populations. And so when all of this is over … we will unravel a lot of those things."

That loosening of pandemic shackles was among the factors that gave rise to the first "roaring '20s," and could help to create a similar era in this century, he said.

Nicholas Christakis, a former hospice doctor and author of Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live, said any 'roaring '20s' that follows the current pandemic will not likely start until 2024 or later. (HBG Canada)

However, there are a number of hurdles to overcome before we can begin to put the pandemic behind us, and doing so will be harder for disadvantaged groups, said Christakis, who is also author of a new book called Apollo's Arrow: The Profound and Enduring Impact of Coronavirus on the Way We Live

"We are in for, still, I would say about a year, into early 2022, of what I would consider to be the initial pandemic period," he told White Coat, Black Art host Dr. Brian Goldman. 

"And until that time, we're going to still have to wear masks. We're going to have to physical-distance. There's going to be intermittent school closures and business closures and gathering bans. People are going to be worried still."

But in early 2022, said Christakis, "we'll reach a very important milestone, which is when we will reach something called herd immunity."

Other public health leaders, including Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases in the United States, have also pegged the beginning of 2022 as the likely time frame for sufficient immunization to achieve herd immunity.

"And then we will enter the intermediate pandemic period, which will last a couple of years until 2024."

That's when the post-pandemic period can truly begin, Christakis said.

"At that point, the biological and epidemiological force of the epidemic will be behind us. The virus will still be there. It could still cause people to get infected — even kill some people — but it will no longer have that epidemic power that it had before." 

Then a recovery from the social, psychological and economic impacts of the virus can get underway in earnest. 

"If you look at the history of epidemics … this takes time," he said. Consider that Canada alone lost three million jobs in March and April of 2020 when the pandemic started, or that thousands of businesses have closed, for example. "The travel industry has been decimated. People's children have missed lots of school. And so I think that will take a year or two … and here I think we'll finally return to normal."

'Will relentlessly seek out social interactions'

Once a relative normal is achieved, many people will be ready to let off some steam. 

"What typically happens is people get less religious. They will relentlessly seek out social interactions in nightclubs and restaurants and sporting events and political rallies. There'll be some sexual licentiousness. People will start spending their money after having saved it. They'll be joie de vivre and a kind of risk-taking, a kind of efflorescence of the arts, I think."

Think of how the 1920s became known as the "jazz age" and gave rise to the Harlem Renaissance, a revival of African American art and literature. 

Amélie Quesnel-Vallée, a sociology professor at McGill University who holds the Canada Research Chair in Policies and Health Inequalities, said she's deeply concerned about the ways inequality will affect how some groups recover from the COVID-19 crisis. (Owen Egan)

But just as the COVID-19 crisis has highlighted inequality in society by disproportionately affecting some groups, not everyone will be equally able to enjoy the fruits of a 1920s-style period of exuberance and prosperity that emerges, he said.

For example, because women have been both more affected by job loss and more likely to carry the caregiving burden for sick loved ones or children who are out of school, we may "lose 10 or 20 years of gains in women's labour market participation," said Christakis.

People with low income are also especially vulnerable to COVID-19 and its many complex socio-economic side effects.

"It's hard for me to imagine a world in which being poor...doesn't place you at greater risk for a pathogen... The rich are able to insulate themselves from many risks to their health and safety," he said.

Medical sociologist Amélie Quesnel-Vallée, a professor at McGill University in both the departments of sociology and epidemiology, says COVID-19 has reinforced that "the social determinants of health will play out no matter what."

She points out that although the first cases in Canada were among the relatively affluent who could afford to travel abroad, "within a matter of weeks, it had spread to most deprived neighbourhoods that were affected by high residential density and low socio-economic status, and those individuals who were more likely to find themselves in positions of not being able to physically distance."

Those low-income workers — more likely to be people of colour — have been more dramatically affected by both the illness and loss of income, said Quesnel-Vallée, who holds the Canada Research Chair in Policies and Health Inequalities and a PhD in sociology. "Tiff Macklem, the governor of the Bank of Canada, actually in October really sounded the alarm bell about that group," pointing out that their labour force participation was about 20 per cent below their pre-pandemic levels. 

People line up at a Service Canada office in Montreal on March 19, 2020. By April 2020, 6 million Canadians had applied for the Canada Emergency Response Benefit (CERB). (Paul Chiasson/The Canadian Press)

Likewise, people who did not qualify for the Canada Emergency Response Benefit — perhaps because they work outside of the formal economy in "grey market" jobs, or did not meet minimum income requirements from the previous year — represent a third group of disproportionately affected people who are not well poised to recover well from the pandemic, she said.

Long-term impacts on health and economic status

These groups may not easily be able to get a foothold into the labour market again, either because their work will have disappeared with a business that shuttered, or an industry — such as tourism — that could be altered for years to come, or because younger entrants to the labour market will take those jobs, said Quesnel-Vallée. 

People's economic situation determines their health…​ ​​​​​​When COVID ends, if they make it, they're going to be much poorer than before.- Cecilia Benoit, professor of sociology, UVIC

Cecilia Benoit, a professor of sociology at the University of Victoria, said these barriers to stable employment will directly affect the health of those disadvantaged groups.

"People's economic situation determines their health," said Benoit, pointing out that people from Indigenous communities, for example, are three times more likely to have health problems.

"When COVID ends, if they make it, they're going to be much poorer than before."

Cecilia Benoit, a medical sociologist and professor of sociology at the University of Victoria, said a strong social safety net could help prevent the groups who've suffered the most from COVID-19 from slipping through the cracks when our country begins to come out of the crisis. (University of Victoria)

A strong social safety net could help prevent these groups from slipping through the cracks, she said.

"I think the best solution right now would be a universal basic income, where they don't have to be means-tested, they don't have to meet some eligibility criteria," said Benoit, who holds a PhD in sociology.

"CERB and the other programs the government have put in place, they were never geared for really poor people. They're geared for people who already have a fair amount of footing in the economy." 

That kind of security will help people keep their housing, have enough food and from there, "try to get themselves back into some kind of jobs," she said.

Christakis said another aspect of post-COVID life will be increased disability.

Health workers screen patients at a walk-in COVID-19 test clinic in Montreal on Wednesday, March 25, 2020. (Paul Chiasson/The Canadian Press)

"Probably five times as many people will be disabled from this condition as die of it — pulmonary fibrosis, myocarditis, renal insufficiency, neurological problems." He estimates that in the United States where he lives that could mean 2.5 million more people with disabilities. 

Although Christakis told Dr. Brian Goldman that he, too, has grown weary of the COVID-19 pandemic, taking a look at the broader historical picture gives him something to be grateful for.

"Plagues are part of the human experience. And we're not the first generation of people to face such a threat.

"But we're the first generation of human beings ever to face such a threat in a moment [that] coincides with the capacity to develop an actual drug or vaccine that stops it in real time. So that is great news." 

Written by Brandie Weikle. Produced by Dawna Dingwall.


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