We survived 2020! Now what?

I may be tempting fate by saying we survived 2020 when there are still 10 days left in the year as I write this, but I’m willing to take the risk. 2020 was officially “a lot,” with a global pandemic, a US presidential election marked by a level of vitriol not seen since the run-up to the Civil War, and systemic racism laid bare for all to see – not like it wasn’t plenty visible before, but now it cannot be swept under the rug anymore.

Not that everything has been dark and dire – medical science has long pursued “real world evidence,” the idea that all the data collected over the course of the delivery of medical care across a population could be synthesized into better medical treatment. The COVID pandemic pushed that concept onto the actual dashboard of care delivery, accelerating treatments and vaccines at a speed not seen before in the history of science.

But that same real world evidence data synthesis also made clear just how much systemic bias – gender, race, socio-economic status – is baked into healthcare systems and healthcare delivery, in the US and globally.

As we drag ourselves across the 2020 finish line, I’d like to present some pros, some cons, and some open questions we’re left with as we move into 2021.

First, the cons:

• The world is drowning in a misinformation flood that prevents rational decision making about issues related to public health, civil rights, and even what facts are – figuring out how to combat this will take massive, concerted, global efforts
• The global economy is a hot mess – the real downside here is how the fortunes of the ultra-wealthy have grown during the pandemic, with most of humanity left to figure out how to keep themselves going during shutdowns and job loss, along with loss of health coverage through their employers if they did lose their jobs
• Any thought that humans are Earth’s apex predators should be completely erased by now – nope, viruses and bacteria rule the planet’s roost, we’re just along for the ride, with every other living thing
• Systemic bias and racism are totally a thing – it’s up to us, all of us, to work together to erase it from medicine, from science, from civil society (this is actually a “pro” opportunity, too)

On to the pros:

• Science has moved at light speed in the face of the pandemic – SARS-CoV-2 emerged in late 2019; the virus’ genomic profile was published in January 2020, making scientific study of transmission and possible treatments easier
• Development of vaccines to combat the novel coronavirus happened within a calendar year – the usual timeline on vaccine development is 5 to 10 years
• The world has been able to watch science happen in near real-time – as someone who tracks #epitwitter and #medtwitter and #EmergencyMedicine has gotten a front row seat to how medicine, and the science that informs it, isn’t a white-coated academic process, it’s a battle against time involving uncertainty and human cognition – “here’s what we know right now” is as good as it gets, moment to moment; adding those moments together is what reveals the scientific basis for vaccines and treatments

The open questions we’re taking into 2021:

• How long with vaccine immunity last? That’s a question only time and data can answer.
• How can we humans finally recognize that we’re a species, not separate groups of [insert ethnic or national identification here], and start working together to solve human problems? Like, say, income inequality and racism?

You’ll be hearing me again on all of the above through 2021. If you have any ideas on either of those “open question” bullets, hit me up on the Twitters at @MightyCasey.

Here’s to all of us surviving 2021, too.