July 22, 2020

As promised yesterday, time to head back into the Accidental Plague Diaries. Here, in Seattle, the first US epicenter back in those distant days of this past February, the population saw how quickly and silently Covid-19 can spread and they take the potential dangers seriously. In my wanderings around town, I’ve seen excellent adherence to masking and social distancing by the general population and, from what I can tell from the data available to me, transmission in Seattle proper is way down. The rest of the state… not quite so good. I assume that’s a combination of rural population politics combined with substandard living conditions for agricultural workers on the other side of the Cascades.

The question I keep getting asked by family and friends is some variant on what’s coming next or what is the new normal going to look like. Now, I have no degree in futurology or futurism or future studies or whatever it may be called (I’m not sure if there’s even a higher education program in such things outside of one of the more obscure for profit colleges where they send you a PDF file diploma in exchange for a tuition check). So you’ll have to bear with me as I attempt to answer this. I may be right, I may be hopelessly wrong but it’s what I see from where I stand in mid-July of this benighted year. I’m not going to go into everything that I see trending, but will stick within those areas where I have a certain amount of expertise.

Healthcare: The healthcare system was going to enter a system of intense strain in about a decade, even without the presence of pandemic illness due to the demographics of American society. The aging of the boom, its wish to remain forever young, and its demands that the health system provide quick fixes to the complex issues of aging were going to tax the system and that process has just been sped up considerably and shown where the cracks are about a decade ahead of schedule. Some things that I think are here to stay: more and more primary care will be moved away from office visits to virtual visits, especially for the management of chronic illness. People will get one or two appointments a year in the office and others will be on-line, checking through a list of potential issues, looking for problems. More and more of these routine visits will also be devolved from physicians to Nurse Practitioners and Physician Assistants. Access to specialty care is likely to move back towards a more gatekeeper mechanism requiring referrals and more workup through primary care before a specialty appointment can be kept as the system continues to try and limit face to face contacts for the protection of both patients and health care providers. There will also likely be more rapid development of house call programs, home health will expand its service lines, and the home hospital model is likely to gain additional interest in an attempt to keep ill people who can be handled in a situation other than the hospital setting out of a place where the sick congregate and they are more likely to become infected. Hospitals will continue to work to separate out Covid services physically from other parts of hospital care leading to something akin to the old TB pavilions and sanitariums of a century ago.

Aging: There is going to be more and more push for housing appropriate for multi-generational families as older people will be more and more loathe to enter senior communities where they may be cut off from interacting with their grand children and great grandchildren. As more people work from home, there will be other adults in the home to assist an elder and I think we’ll continue to see the collapse of the nuclear family as an ideal for the extended family. Elders are also going to want to be more connected to community and looking for senior housing integrated into urban areas rather than separated in suburban areas where they are trapped if they cannot drive. Older people, understanding their vulnerabilities, are going to be among the last to return to full social interactions which is going to have a huge impact on such things as audiences for performing arts events and dining patterns. There’s going to be a huge demand for services that can clean and disinfect in various ways so that they feel more secure in their environments.

Fashion: I am not Miranda Priestly and I have no training in this, but I know enough about the history of costume to know that historical events are reflected in clothing trends. As more and more work is decentralized and more and more jobs are done at home, there is going to be a decline in formal business apparel for clothes that will look smart and professional, but will also be comfortable and appropriate for other household tasks. I think the necktie will likely disappear as it’s a vector for disease transmission (they aren’t washed enough). As more clothes are bought online, they will be designed and cut to fit relatively well for various body types to minimize returns.

Real estate: As there will be fewer opportunities to socialize, people are going to want to know their neighbors more and socialize on the street. Older neighborhoods which were designed for that with sidewalks and front porches, will become more desirable and newer neighborhoods designed strictly around the automobile less so. There is also likely to be a renewed interest in living in central cities versus far flung suburbs. Commercial real estate is going to be in trouble as more and more businesses realize they can work perfectly efficiently without so much office space. There will be far fewer commuters and businesses that rely on heavy commute traffic will suffer.

Performing Arts: I think there will be a decentralization of music-theater away from NYC and other cultural capitals and an increased recognition that good art doesn’t depend on the imprimatur of particular critics or branding. Smaller, more facile companies that are willing to take radical steps to envision new ways of bringing content to a public starved for entertainment will do better than large, overhead heavy traditional companies that really only know one way of doing things. Ultimately, I think we’re going to get some exceptional artistic works from this period from creatives who use all of this societal uncertainty to springboard to something new. It’s always worked that way. The financial structures underpinning the arts in this country are in trouble (and have been for years) so we’re going to have to decide as a society what we want to do about that.

It’s going to change. Be prepared. Change is neither right or wrong, it just is. It’s what allows us to move forward a society to something better. It’s scary and painful and no one likes to give up the familiar – inertia is a powerful force – but ultimately the choice is to either grab hold of it and go along for the ride or resist it and let it grind you into the past. I’m doing my best to do the former, although I find it as difficult as everyone else does. In the meantime, I’ll continue to do the three basic things that we can all do to curb the pandemic.

Wear a mask.

Keep my distance.

Wash my hands.