COVID-19 Was a Turning Point for Health

In 2021, the United States was at a turning point. We had just lived through the acute phase of a global pandemic. During that time, the country had experienced an economic crisis, civil unrest, a deeply divisive federal election, and a technological revolution in how we live, work, and congregate. The emergence of COVID-19 vaccines allowed us, finally, to look ahead to a post-pandemic world, but what would that world be like? Would it be a return to the pre-COVID-19 status quo, or would it be something radically new?

It was with these questions in mind that, in 2021, I partnered with my colleague Michael Stein to write a series of essays reflecting on the COVID-19 pandemic. Our aim was to engage with the COVID moment through the lens of cutting-edge public health science. By exploring the pandemic’s intersection with topics like digital surveillance, vaccine distribution, big data, and the link between science and political decision-making, we tried to sketch what the moment meant while it unfolded and what its implications might be for the future. If journalism is “the first rough draft of history,” these essays were, in a way, our effort to produce just such a draft, from the perspective of a forward-looking public health. I am delighted to announce that a book based on this series of essays has just been published by Oxford University Press: The Turning Point: Reflections on a Pandemic.

The book includes a series of short chapters, structured in five sections that address the following themes:

Lessons

This section looks at the COVID-19 moment through the lens of what we might learn from it, toward better addressing future pandemics. It tackles challenges we faced in our approach to testing, our successes and shortcomings in implementing contact tracing, the intersection of the pandemic and mass incarceration, and more. Many of these lessons emerged organically from the day-to-day experience of the pandemic, reflecting “unknown unknowns”—areas where we encountered unexpected deficits in our knowledge, which were revealed by the circumstances of the pandemic. Chapter 8, for example, explores the necessity of public health officials speaking with care, mindful that our words may be used to justify authoritarian approaches in the name of health, a challenge we saw in the actions of the Chinese government during the pandemic.

Story

Our understanding of large-scale health challenges like pandemics depends on more than collections of data and a timeline of events. It depends on our stories. The narratives we accept about the pandemic will do much to shape our ability to create a healthier world before the next contagion strikes. This section explores the stories we told during COVID-19 about what was happening to us and looks ahead to the narratives that will likely define our recollections of the pandemic moment. It addresses narratives around the virtues and limits of expertise, the role of the media as both a shaper of stories and a character in them, the hotly contested narrative around vaccines, and the role scientists, physicians, and epidemiologists played in shaping the story of the pandemic as it unfolded.

Ethics

This section explores how our values informed what we did during COVID-19 through the ethical considerations that shaped our engagement with the moment. These include the ethical tradeoffs involved in questions of digital surveillance, scientific bias, vaccine mandates, balancing individual autonomy and collective responsibility, and the role of the profit motive in creating critical treatments. At times, these reflections reach back into history, grappling with past moments when we failed in our ethical obligations to support the health of all, as in a chapter discussing how the legacy of medical racism shaped our engagement with communities of color during the pandemic. Such soul-searching is core to our ability to evaluate our performance during COVID-19 and face the future grounded in the values that support effective, ethical public health action.

Emotions

As human beings, we do not process events through reason alone. We are deeply swayed by emotion. This is particularly true in times of tragedy like COVID-19. Understanding the pandemic, and learning from it, means coming to terms with the emotions of that time, the feelings that attended all we did. Grief and loss, humility and hope, trust and mistrust, compassion and fear—both individual and collective—were all core to the experience of the pandemic. The simple act of recognizing our collective grief, as several chapters in this section try to do, can help us move forward, acknowledging the emotions that attend tragedy as we work toward a better world.

The Future

To think comprehensively about COVID-19 is to think not just about the past but about the future. We seek to understand the pandemic to prevent something like it from ever happening again. This means creating a world that is fundamentally healthier than the one that existed in 2019. This final section looks to the future from the perspective of the COVID-19 moment, with an eye toward using the lessons of that time to create a healthier world, as in Chapter 50, which addresses the challenge of rebuilding trust in public health institutions after it was tested during the pandemic. The section also touches on leadership and decision-making, shaping a better health system, shoring up our investment in health, the future of remote work, and next steps in our efforts to support health in the years to come.

I end with a note of gratitude to Michael Stein, who led on the development of this book. It is, as always, a privilege to work with him and learn from him. I look forward to continued collaborations in the months and years to come, and to hearing from readers of The Turning Point as we engage in our collective task of building a healthier world, informed by what we have lived through and looking to the future.

A version of this essay appeared on Substack.