HomeHealthThe pandemic didn't really change the way Americans think about the disease

The pandemic didn’t really change the way Americans think about the disease

youHomas McDade, a biological anthropologist at Northwestern University, still remembers an ad for cold medicines he saw in late 2019. The ad showed a visibly ill businessman walking through an airport, “and the message was, ‘You can overcome this. You can do it,’” says McDade.

That message did not age well. Just a few months later, the virus that causes COVID-19 it began to spread around the world, prompting health officials to plead with people to stay home no matter what, but especially if they were feeling sick. Suddenly, fighting a disease was not considered admirable, but irresponsible, selfish and dangerous.

Since then, countless articles and op-eds have argued that the pandemic would usher in a “new normal” in which people would think more about illness, companies would be more generous with sick time, and everyone would stay home. when they are not well. It seemed like it was happening, at least for a while. Millions of people worked and learned from home, many for the first time; comparing symptoms became a national pastime; and photos of homemade test strips displaced vacation photos on social media.

But now, with the pandemic effectively over—at least in terms of the federal responseif not epidemiologically, it appears that the promised new normal never fully materialized.

Eric Shattuck, a research assistant professor at the University of Texas at San Antonio, studies “disease behavior:” the constellation of behavioral changes that people adopt when ill, such as lethargy, social withdrawal, and decreased appetite. Much of disease behavior is biological, driven largely by inflammation in the body. But the extent to which people engage in these behaviors depends on cultural norms about how we’re “supposed” to act when we’re sick, Shattuck says.

Although urges to stay home and “flatten the curve” changed behavior early in the pandemic, they were not enough to lastingly alter mainstream cultural messages about hanging in there and moving on, Shattuck says, largely because they were not supported. . through supportive policy changes, such as increased access to paid sick leave and affordable child care.

“We can see that people are paying more attention and listening to their bodies more,” Shattuck says, “but if the conditions aren’t in place for them to stay home or work from home… it may not really change the large-scale behaviors.”

The start of the pandemic brought a flurry of new sick and family leave policies, but many were temporary or did not apply equally to all workers. As of March 2022, 77% of private industry workers had access to paid sick time, just slightly more than the 75% who did it in March 2020according to the US Bureau of Labor Statistics (BLS). But that top-of-the-line stat doesn’t tell the whole story.

Read more: As People Return to Offices, Misery Returns for America’s Working Moms

While 96% of people working in the administration, business and finance sectors had access to paid sick leave in 2022 (along with the option to work remotely in many cases), only 62% of workers of the service industry had it, up from 59% in 2020. Only about 40% of the lowest-paid private industry workers had paid sick time in 2022, compared with nearly all of those earning the most, as the BLS data shows.

Overall, during the first two years of the pandemic, only 42% of absences from work related to illness, child care or personal obligations were compensated. according to the report of the Urban Institute, an economic and political research institute. Many workers, especially those who can least afford it, still have to choose between getting paid or getting paid. It’s hard to blame people for choosing the latter.

Even people who have paid sick time often overcome their illnesses, and that hasn’t changed during the pandemic. In some ways, says Kai Ruggeri, an assistant professor at Columbia’s Mailman School of Public Health who studies population behavior, the rise of remote work actually made it harder for people to justify taking sick leave. A lot of people seemed to think, “What’s the difference, if you do a few things from your laptop in bed?” says Ruggeri.

In 2020, researchers surveyed people with COVID-like symptoms about whether they worked while sick. (About a quarter of them ended up testing positive for COVID-19, while the rest had other respiratory illnesses.) Approximately 42% of people with COVID-19 worked remotely or in person while sick, and 63% of people sick with another respiratory illness did so. A 2023 study it even found that, within a group of around 250 healthcare workers with symptomatic COVID-19, half worked at least part of the day anyway.

That may be because many workers still feel pressure (expressed or not) from their employers to show up regardless of their health, says Terri Rhodes, executive director of the Disability Management Employer Coalition, which provides employers with guidance on absences in the workplace. The pandemic did not change that. “The general sentiment I get from employers is, ‘We just want to end (the pandemic)’,” Rhodes says. “There’s a huge push right now for productivity and earnings and ‘just getting back to work,’ as opposed to mental health, wellness and sick days.”

The old normality, the one that values ​​stoicism, productivity, not stopping for a second, has been difficult to uproot. But there have been changes in the way we think about the disease: the fact that people are even talking about sick leave policies and forming opinions about the merits of vaccines and masks (For better or worse) suggests that there has been a cultural shift around health and disease, says Ruggeri.

As director of the Annenberg Public Policy Center at the University of Pennsylvania, Kathleen Hall Jamieson oversees research projects that assess how much the American population knows about health and science. Over the course of the pandemic, Jamieson says, he has seen two contradictory things happen in parallel: General scientific literacy grew, even as more people began to believe conspiracy theories and misinformation.

The fact that the majority of the US population got vaccinated and wore masks at the height of the pandemic suggests that most people generally understood how the virus spreads and how to slow transmission, Jamieson says. in a survey By the time COVID-19 vaccines became available to the general public, around three-quarters of respondents correctly answered questions about the safety and efficacy of the injections. Results like those show “an amazing level of public literacy on a subject we knew nothing about in January 2020,” Jamieson says.

Read more: This emergency is over. Now is the time to prepare for the next pandemic

Concepts that were previously foreign to most of the general public, such as incubation periods and airborne transmission—also became part of the regular conversation. “No one knew what an R value was” before, says Ruggeri. “There were people calling me and asking me to explain it to them.”

For many people, the pandemic was the first introduction to a “blind spot” in the medical world, such as a 2022 research review Put it: post-acute illness. Viruses ranging from influenza to Epstein-Barr can cause potentially debilitating long-term complications, but that reality went largely unnoticed until dozens of people developed prolonged symptoms of COVID—from brain fog and memory loss to chronic fatigue and pain—in roughly the same amount of time. For some people both in the medical field and in the general public, these long-term symptoms reframed what a seemingly “mild” illness could do.

In addition to increased scientific literacy, Dr. Yuka Manabe, a professor at Johns Hopkins Medicine who specializes in infectious diseases, has noted an increased desire for “diagnostic certainty” among patients. In 2019, someone with a respiratory illness might have been content to say they were sick and leave it at that, but many patients now want to know exactly what they have and where they got it. “I hear a lot of people say, ‘I have a cold, but don’t worry because it’s not COVID, I got tested,’” Manabe says.

The unprecedented availability of home tests likely contributed to that desire for certainty, and consumer demand for COVID-19 diagnostics appears to have declined. transferred to other conditions, also. In a 2022 survey, 82% of adults ages 50 to 80 said they were at least somewhat interested in using home tests in the future. And in fact they may have the opportunity. In February 2023, the United States Food and Drug Administration (FDA) licensed the first combination flu vaccine at home and COVID-19 test.

But while COVID-19 turned some people into amateur disease detectives, many others, about 40% of American adults, according to federal data—medical care delayed or avoided during the pandemic. A 2022 study found that low-income people and those with pre-existing conditions were likely to delay care in 2021, suggesting that financial stress and fear of the virus played a role. another study from 2022 found that people were more likely to skip doctor visits during the pandemic if they had previously had bad experiences with health care.

It makes sense that people who had previous bad experiences — a group that tends to include people of color, low-income people, the uninsured — may have walked away from the medical establishment during the crisis, even when others literally trusted it. with their lives. Add in partisan polarization, which made even basic practices like masking and vaccination feel like political statements, and it’s no surprise that people responded very differently to the same health threat. How could there be a single new normal when the old normal varied so much by race, class, gender, and age?

Despite the divisions, however, Jamieson says he is optimistic that at least some of the knowledge gained during the pandemic will remain, ready to be deployed should there be a similar threat in the future. For many people, behaviors like wearing a mask and washing hands have become habitual during the pandemic, and “habitual behaviors are not unlearned,” Jamieson says.

Although far fewer people are wearing masks now than at the height of the pandemic, Manabe says she’s noticed people are now more quickly wearing one when they have respiratory symptoms, a sign she says people understand how pathogens spread. and they want to protect others. .

“This kind of social altruism is really welcome, from my point of view,” says Manabe. “We are trying to move forward as a society in the post-COVID era.”

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write to jamie shower me in jamie.ducharme@time.com.

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