Unlike pandemics, catastrophic hurricanes, earthquakes and other environmental disasters leave obvious traces of devastation: flattened neighborhoods, power outages and collapsed highways. Recovering from a natural disaster is also readily discernible. Debris is removed. Electricity is restored. Infrastructure and home repairs proceed.
Equally complex and painful, recovery from a calamitous epidemic happens mostly out of sight. What epidemics and disasters do share are invisible wounds that neither hammer and nail, nor vaccines and antivirals, can close.
On alert for so long, exhausted Americans can easily spot signs that the health crisis is over. Having pandemic experts point to future catastrophic outbreaks and next-generation medical interventions implies the current one has passed. Similar cues come from economists reporting low unemployment and a rebound in gross domestic product (GDP) growth, federal leaders winding down the nation’s emergency response infrastructure and epidemiologists charting the fall in COVID-19 cases and deaths nationwide.
Other trends are not as encouraging. According to the Kaiser Family Foundation, U.S. residents lost 14.8 million years of life due to excess deaths from March 2020 to December 2022, with people of color bearing the lost potential disproportionately. Black and Hispanic children are missing their primary caregivers at twice the rate of white children. The guardians left behind are emotionally depleted. While 4 in 10 adults overall experienced high levels of psychological distress during COVID-19, Black and Hispanic adults reported greater levels of anxiety, depression, substance abuse and suicidal ideation compared to their white peers.
Humans being human, how we make and interpret signals is a random process that society and culture ultimately shape. That includes indicators of the nation’s recovery from COVID-19.
Indicators of skewed pandemic impacts — ones spilling into the next generation — are deeply unsettling. Yet, recent developments threaten to pull our eyes away and see it’s time to move on. The federal government is rolling up the pandemic-era safety net of the Medicaid continuous enrollment option, the increased, refundable Child Tax Credit and free diagnostic tests, treatments and vaccinations. Benefitting many Americans, these interventions were especially important to the persons most at risk of viral and fiscal casualty.
By limiting signs of recovery to epidemiological and economic trends, decisionmakers risk dismissing the nation’s mass trauma and severely tattered social fabric. We will be even more vulnerable to a global epidemic today than in 2020 if we fail to process the collective grief, loss and — for communities of color, people with disabilities, low-income and unemployed individuals and other vulnerable groups — the sting of neglect. Emotional repair efforts are crucial to reinstate the trust in public institutions and one another that an effective pandemic response requires.
A genuine “build back better” policy for COVID-19 includes tending to the nation’s damaged psyche, lest unresolved trauma stunt the flourishing of both individuals and nations. Psychiatrist Bessel van der Kolk has underscored that traumatic events can permanently alter a person’s biological stress responses, memory and behavior long after they pass. Philosophers, political scientists and health experts have embraced the metaphor of “the body politic,” prescribing corrective statecraft or public interventions as proper “treatment” for societal ills and large-scale health crises.
Research affirms that addressing the psychosocial needs of disaster-affected communities hastens individual recovery and community resilience. Building resilient health systems is a common slogan among public health experts urging greater pandemic protections. But as some scholars point out, resilience can be maladaptive if people must harbor the scar tissue of unresolved trauma without having the chance to remove the wounding shard at the center.
Individual healing from trauma may take place in the privacy of a clinic, but we require a public setting for collective trauma recovery. Practices like truth-seeking and reconciliation could guide the body politic toward post-COVID-19 recovery. Truth commissions, for instance, have been formed to facilitate healing after major crises and prolonged historical trauma, such as the dismantling of apartheid in South Africa and Canada’s reckoning with its residential school system that separated Indigenous children from their families and culture.
Public acknowledgment of mass suffering, its unequal distribution and needed system repairs is the pandemic recovery sign that is now lacking. Reticence toward a national, bipartisan COVID-19 commission suggests even less federal appetite for truth and reconciliation.
Forward-looking state and local authorities and community partners, however, can implement critical, participatory reviews of jurisdictional pandemic experiences. Peers show the way. Greensboro, N.C., courageously self-examined a 1979 racially motivated massacre. Maine held a truth, healing and change commission to grapple with the state’s child welfare system treatment of the Wakanabi people.
As the adage goes, “What gets measured gets done.” But relying solely on metrics like unemployment, GDP, infections and deaths to denote recovery obscures the pain of surviving a pandemic. Applying metrics that reflect the values of truth, reconciliation and transformation would bring us closer to genuine readiness for the next health crisis.
Monia Schoch-Spana, Ph.D., and Sanjana Ravi, Ph.D., MPH, are senior scholars at the Johns Hopkins Center for Health Security and co-direct PanREMEDY, an initiative to develop pandemic recovery metrics that drive equity in the U.S.
