ALBANY – As with the 1918 Spanish flu, the most lethal pandemic in recorded world history, the 2020 Covid-19 health crisis promises to bring sweeping changes and improvements in public health in the face of mounting criticism that many governments were slow-footed in responding to the new pandemic.
But the 2020 coronavirus outbreak, by the nature of a much-changed Earth in the past 102 years, could propel even faster embraces of robotic operations on manufacturing plant floors, hotel check-in desks and dairy farms while pressuring new ways for medicine to better plan for pandemics of the future.
It will permanently change how Americans enjoy sports, the size of future restaurants and grocery store designs for decades to come.
Interviews and email exchanges between The Buffalo News and experts in various fields – from health care and education to restaurants and professional sports – revealed a common link among all of them: long-term, societal changes are coming, no matter how much normalcy returns across the country when the virus outbreak is contained.
There will be the obvious changes, from new cleaning standards at public places already implemented and certain to stay in some form to a more serious approach by the federal and state governments to stockpile pandemic-response materials. The less publicly visible: improved food distribution networks to address logjams that kept plentiful supplies at markets from reaching consumers and still-unknown ways to keep health care workers from being stretched so thin.
Short-term changes will, in some cases, be extensions of public health and safety measures imposed as crisis steps with Covid. But what about the long term? What might happen long after the pandemic dust settles?
Health officials have their hands full just thinking about tomorrow let alone years ahead. But they recognize that testing for coronavirus has been inadequate and one that, even in a high-testing state like New York, varied depending on one’s ZIP code.
The ability to multitask has also been raised by experts. Non-elective procedures were all but halted in many facilities, but so, too, was access to basic health care for medical, dental, vision and other health needs. The American Cancer Society last month reported that 27% of people in active cancer treatment programs saw their care interrupted; 13% said care was delayed with no clue when treatments would begin again.
Health care experts say national standards will have to be addressed for the long term for issues like wearing masks in public. There is talk of more one-stop shopping so consumers don’t have to run to one place for a blood test and another for an X-ray.
Telehealth will be permanently embraced by many physicians for at least some patients – and battles can be expected with insurers over reimbursement rates that should change for doctors who could end up seeing more patients in a day via remote means.
“That genie is not going back in the bottle,’’ said Ian Morrison, a California-based international health care consultant and futurist who has advised health systems and major corporations. He talked of a permanent reliance on telehealth not just for doctor visits, but other health fields – so long as insurance reimbursement and regulatory changes are retained and expanded.
Morrison anticipates two other changes in the long term: more health care consolidation among hospitals and physician practices that have been financially hit hard during the pandemic. “Hospitals are hopeful that volumes return but it will be challenging given the public health challenges of returning to normal,’’ he said.
The pandemic is pushing the health sector in other key ways, including speeding up ways to identify and test drug candidates and create new paths to vaccine development, said Clifford Goodman, senior vice president of OptumServe Consulting, a health and human services policy and analytics firm whose clients include federal and state governments, hospitals, health systems and nonprofits.
In addition, new approaches are being developed and high-powered analytics employed to better identify at-risk populations, transmission of viruses and earlier virus hot spot locations that, in turn, will help with decisions like how to better direct health care services and improved tracking, he said. That all involves everything from layering large amounts of insurance, pharmacy, socioeconomic and other data.
“As much as we have called attention in recent years to great and often widening disparities in health care access and outcomes, the pandemic reminds us how widespread these disparities are, and why we must continually probe for and knock them down throughout the health care system,’’ said Goodman, a policy expert on health technology assessment and innovation, regulation and access issues.
Is the term "rush hour" about to become an anachronism?
As many employers and employees have learned, working from home can be as productive as heading to the office. In 2018, 5.2% of Americans worked full time out of their home, according to Census Bureau statistics.
Some estimates say that 40% or more could now be working from home, and even more in states like New York with nonessential companies ordered by Gov. Andrew M. Cuomo to keep workers out of the office – an edict now only starting to be partially eased.
Two researchers at the University of Chicago Booth School of Business estimated that 37% of U.S. jobs can plausibly be done from home.
“I don’t think it’s controversial to believe that Covid has at least catalyzed changes in technology and working culture that allow more tasks to be done remotely in the future,’’ said Brent Neiman, one of the report’s authors.
The study examined which kinds of jobs could be done remotely – such as insurance, legal, scientific and a range of professional classifications – and which could not, such as agriculture, construction, hotel, restaurant and retail positions.
Jobs that can be done from home also typically pay more; the 37% of U.S. jobs that could be done from home would account for 46% of all wages earned, the Chicago researchers found.
In New York State, the study estimated that 38% of jobs in the Buffalo area could be performed at home.
Technology already changed the idea of shopping. The pandemic has continued the evolution.
Grocery stores have had to adapt as much as any sector still in business: restricted hours, online shopping systems crashing, and creation of in-store shopping protocols.
Expected to outlast the coronavirus: Most stores won’t take down plexiglass dividers erected at checkouts, some will continue the one-way aisle routing requirements for shoppers, and cleaning protocols further strengthened.
Mike Durant, president and CEO of the Food Industry Alliance of New York, a trade group of 800 independent and chain supermarkets, convenience stores and wholesalers, said stores have long had food safety practices in place. But, additional disinfecting procedures at checkout lines between shoppers could be permanent for some and 24-hour store hours might not return for some grocers.
Durant said the gig economy will increasingly play a role in grocery operations as many shoppers will want to continue online shopping from home with demands for more delivery options. Also, will in-store dining continue?
“While the industry has and is essential during this health crisis, they have had to adapt swiftly. When the economy reopens they will have to adapt again to the consumer behavior changes. It will be a fascinating and uncharted journey,’’ Durant said.
The roar of the crowd might be replaced by the sound of silence.
Cuomo has been calling for pro leagues to start playing games, which would present social distancing dangers for players, staff and those involved in moving a team from one city to the next – even with stadiums closed to fans in at least the near term. Cuomo has approved the return of horse racing and auto racing, but without spectators.
Vince Gennaro thinks it will be a long time before most stadiums and arenas are “packed,’’ as Trump believes. Gennaro is associate dean of the Tisch Institute for Global Sport in the New York University School of Professional Studies, and is also a baseball metrics expert, author and serves as a consultant to MLB teams.
“People will come back much more slowly than we’ll be permitted to," Gennaro said of pro sports fans. “They’re not necessarily going to trust the system." Early on, after fans are eventually let back in to attend sports contests in person, attendance might be 30% to 40% of normal.
Long term, Covid is going to be the catalyst for such technological changes long talked about but not truly advanced: virtual reality, or VR, and other media forms that will reduce the number of fans in stadiums and arenas. Gennaro believes technology companies are going to step up efforts to convince pro teams like the Buffalo Bills to install virtual reality systems in stadiums to draw fans locally and nationwide. He structured VR pricing that could vary depending on a camera’s location in a stadium.
“It will feel like you are there and you’ll be able to do this in the suburbs of Buffalo and one of your buddies is in New Orleans and another friend is in Tallahassee. And you all went to college together at UB and you’re big Bills fans. Now, you can watch it together on VR," Gennaro said.
“All of this technology would have been a gradual, slow adoption. I think it gets drastically accelerated now,’’ Gennaro said.
Gil Fried, an expert on stadium safety issues and chair of the sports management department at the University of New Haven, said Covid raises a slew of stadium questions: the future of tailgating at games; how to screen people going into stadiums for fever or coughs; how to ensure people clean hands in the bathroom and how to keep those facilities clean; creation of new space between seats that would lower capacity levels; how food is cooked and dispensed; and even whether ketchup and mustard pumps can remain at stadium food places.
Fried said the average big stadium in America would cost about $1 million to sanitize. Who pays? How often?
Hardest hit by new safety requirements: smaller colleges, high schools and the like. And youth leagues have dozens upon dozens of issues to consider. In a paper he recently authored, he wrote of challenges for youth baseball leagues, from issues like insurance coverage of baseball fields to restrictions on players carpooling to games, reducing access to ball field bathrooms, keeping turned off all water fountains and specific procedures if a coach, player or ump tests positive for Covid.
For pro sports fans, Fried predicts owners will have to drop ticket prices by up to 25% if they are truly going to lure all but the most die-hard of fans back to stadiums.
“It’s going to affect all phases of sports,’’ Fried said.
On the mental checklists of "things people miss," going out to eat seems a popular choice.
But when the opportunity returns, favorite restaurants might not be there to greet them.
The mega-restaurants have already been in trouble, but they will increasingly disappear, replaced by more smaller, fast-serve outlets in the post-Covid era, says David Scott Peters, a Phoenix-based restaurant industry professional who coaches independent-owned restaurants – including in the Buffalo area – how to grow.
Covid has forced many restaurants to close, and tens of thousands of their workers have been laid off in New York. Peters worries one-fourth will not reopen because they had failing business models or no models at all. “They were not operating well enough. They were operating under cash flow systems and the moment the cash flow stopped they still had bills from the past and they didn’t have enough money in the bank to survive," he said.
Restaurateurs also will have to better embrace meal delivery services, though governments, as seen in San Francisco, will have to step in with regulations to prevent them from commission-gouging restaurants.
Restaurant owners – to allay customer concerns – also will have to fully embrace additional sanitary rules. “I think you’re going to see pieces we put in place based on Covid, like extra cleaning, that are finally going to be enforced and become part of our habit and culture,’’ Peters said.
Martin Ford, a Silicon Valley author and futurist who specializes in robotics and artificial intelligence, believes the pandemic will greatly accelerate automation at everything from retail to manufacturing sectors like auto plants.
“There are a lot of jobs in those environments, but the workers are doing things that the robots can’t yet do. Primarily picking and stowing inventory. Robots are getting better, however, and gradually these environments will become less labor intensive,’’ Ford said.
A top labor leader is worried.
“Automation was a concern long before the coronavirus. The pandemic only serves to highlight the long-term economic threat we face as a society if more and more businesses move in that direction,’’ said Mario Cilento, president of the state AFL-CIO.
Cilento said a move to increase automation – especially at a time of historic jobless levels – would be catastrophic. Job-killing automation moves by car makers, supermarkets, hotels and others will mean fewer jobs and therefore less money in the economy to spend.
“Shame on the business community or anyone who uses the pandemic as a means to satisfy their own financial greed,’’ Cilento said.