Do you clearly remember the choices you made a few years ago during the early days of the COVID pandemic? Did you painstakingly wipe down your groceries before putting them away, quarantine your mail three days before opening it, or hoard toilet paper while others were unable to find a roll? Is the nasty argument with your brother-in-law over children's COVID vaccination fully forgotten, or does a twinge of annoyance still flicker when he speaks at family gatherings?
Author
- Erica Charters
Professor, Global History of Medicine, University of Oxford
Much has changed in the five years since the World Health Organization (WHO) declared COVID a pandemic . Although COVID has not disappeared, traditional metrics indicate that the pandemic has ended . No longer considered a medical or political emergency, it has transitioned from a pandemic to an endemic disease - a disease that is accepted as part of normal life in our societies, rather than a crisis.
The COVID virus (Sars-CoV-2, to give it its official name) has changed over the past five years. Its contagiousness and the severity of disease it causes have shifted with the emergence of new variants. This viral evolution can help to explain why public health messaging from only a few years ago can seem locked in a bygone age, like "maintain social distancing" stickers that no amount of scrubbing can entirely remove.
But, like the virus, we too - as societies - have changed since the start of the pandemic, which explains the medical and scientific discord we are experiencing. Why, for example, did advice on mask-wearing change so often and vary so widely? Why did vaccine hesitancy increase as COVID receded? Why was herd immunity so controversial , and why was natural immunity so provocative?
Just as viruses evolve through interaction with human hosts, so human societies evolve in response to interaction with pathogens. Drawing on detailed analysis of multiple disease outbreaks, historians have long pointed out that epidemics follow a predictable pattern.
They begin as medical crises, but soon also become social and political dramas as communities respond to the fear that an epidemic unleashes. Epidemics, especially when a new disease emerges, create uncertainty about medical knowledge and disrupt existing political and social orders. This is because our usual framework for understanding what is happening, what to do, and who to trust is shaken by the authorities' bewilderment and impotence in the face of widespread contagion.
As many of us recall from the time the WHO declared COVID a pandemic, the start of a disease outbreak focuses everyone's attention on the pathogen and the uncertainty that it brings. As a result, this first stage synchronises the attention of medical authorities, social organisations, political institutions and citizens.
But as the epidemic proceeds, this shared focus unravels. In part, this reflects differing timescales : while microbes spread and mutate quickly, bureaucratic institutions shuffle slowly behind, each at its own pace. In time, social organisations and bureaucracies find themselves out of sync with the reality of disease in society.
Five years after the WHO declared a pandemic, we have unravelled our sole focus on pathogens to include focus also on social, political and economic concerns.
We are less bewildered and fearful and so able to discuss policy choices clinically, as observers rather than as players caught up in a horrifying and dystopian drama .
We have more - and varied - data available, integrating rates of infection and death with other factors, such as socioeconomics, demography, logistics and geography .
At this stage, we are better able to understand what might have been misunderstood at the time, redrafting our own narratives of the start, climax and end of the pandemic.
Anthropologists and historians alike observe that humans are cultural, as well as rational, creatures. As well as conducting scientific research, humans also necessarily craft narratives: overarching explanatory frameworks that make sense of the world.
The end stage of an epidemic is a crucial period of sense-making . This is when we conduct social forms of postmortem analysis and retrospective diagnosis, including allegations of responsibility and culpability as part of the political process of reconciliation .
These narratives will probably shift again, just as they did throughout the pandemic, as we gain more data and longer-term perspectives.
Historians and scientists are still uncovering data from epidemics hundreds of years ago that provide new explanations - both biological and social - for their patterns. The explanation behind the modern decline of plague, for example, has shifted from a sole focus on human activity (sanitation and quarantine), to include animal reservoirs and vectors (whether rats, gerbils or fleas), as well as long-term climate and environmental change .
Shifting narratives
These shifting narratives are not simply the result of new data, but the outcome of our own shifting interests, perspectives, fears and priorities.
The experience of a pandemic produces more than simply data on pathogens, or about the costs and benefits of public health responses. It also alters a society's understanding of itself, challenging old orthodoxies and revealing new ones, in line with the society's altered social, cultural and political insights.
Such reassessment necessarily involves recasting existing narratives to identify heroes and villains, fools and sages, victims and victimisers. These new narratives about the past, in turn, shape a society's response to future public health challenges.
Pandemics offer a valuable opportunity to observe that although public health measures and hygiene practices draw on scientific data and expertise, they are fundamentally shaped by a society's cultural and political priorities.
Erica Charters does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
