Momentous global events are always followed by significant and lasting societal changes. Think of the way our lives permanently changed after the terror attacks of September 11, 2001, for example. The same kinds of changes have now taken place in the aftermath of the COVID-19 pandemic, leaving most adults pining for the "good ole days" before masks, Zoom meetings, and vaccine cards.

In the first part of this two-part article, we discussed some of the most obvious and noticeable changes that society has undergone and will undergo in the wake of the pandemic. Employment and travel will never be the same, of course, but some of those changes could be seen as silver linings along with the dark cloud of COVID-19. One major effect was the exposure of worldwide healthcare inequality, which has resulted in untold casualties but will hopefully lead to reform.

In this second part of the article, we'll discuss some of the less-obvious and unexpected effects on society left by the COVID-19 pandemic.

Changing Interpersonal Relationships and Routines

According to a Pew Research project launched in March 2021, many Americans reported that the pandemic had altered their ability to engage with family and friends. Among the 41 percent of people who answered Pew's question related to relationships, the most common comments had to do with missing loved ones, losing touch with those who they once met regularly, and struggling with feelings of isolation. Almost a third of the respondents (28%) reported that their mental and physical health had suffered because of isolation, disruption, loss, and anxiety induced by the pandemic. Experts agree that many people will suffer lasting, post-traumatic effects from the pandemic, especially those who experienced pandemic-related loss of loved ones, long-term illness, or severe financial hardship.

Interestingly, 33 percent of respondents mentioned some positive impacts of the pandemic, such as spending more time with spouses, children, and other family members because they were unable at times to attend work and school. Also, about 32 percent of the Pew survey respondents reported other positive outcomes associated with the COVID-19 pandemic, including the slower, less-stressful pace of their lives; getting things done around the house; pursuing rest and relaxation; picking up new hobbies; and a tendency to eat junk food less often while exercising more often.

Long-haul COVID-19 Patients

Study results from the University of Washington published in February 2021 show that 31.3% of hospitalized COVID-19 patients and 32.7% of COVID-19 outpatients eventually developed long-haul COVID symptoms. Long-haul COVID (also called "long COVID" and "COVID-19 syndrome") is defined as a COVID case in which symptoms persist for four weeks or longer. Common symptoms may include the following:

• Fatigue
• Shortness of breath or difficulty breathing
• Cough
• Joint pain
• Chest pain
• Memory, concentration or sleep problems
• Muscle pain or headache
• Fast or pounding heartbeat
• Loss of smell or taste
• Depression or anxiety
• Fever
• Dizziness when standing
• Worsened symptoms after physical or mental activities

Presently, long-haul COVID is poorly understood, but according to research by the University of California Davis, long-haul COVID has been developing in up to one in three COVID patients regardless of pre-existing symptoms or demographics such as age, obesity, or high blood pressure. This means that of the 471 million COVID-19 cases reported to date, nearly 160 million people worldwide may already suffer from long-haul COVID, which will affect their ability to recover, re-enter society, and lead healthy post-pandemic lives.

Successive Waves of COVID-19

It's great to see many areas of the world considered "low risk" by the Centers for Disease Control. It's great that travel and gathering restrictions are being slowly lifted. And it's very pleasant to see the smiling faces of neighbors and friends instead of face masks. However, most experts say that we are not out of the COVID-19 woods and that the world will almost certainly see additional waves of COVID-19 infection, perhaps indefinitely into the future.

As COVID-19 moves out of the pandemic stage and into the endemic stage, it may permanently enter our worldwide societal consciousness and our global health reality, perhaps not too different from seasonal illnesses such as the common cold and influenza, and even illnesses that breakout periodically, such as chickenpox.

According to a report by Fortune, COVID and pandemic conditions will most likely subside in spring and summer 2022, following the patterns and trends of many respiratory illnesses. However: "We're going to have another wave in six to eight months," says Mark Dybul, a Georgetown University professor and immunologist. Dybul says that it's likely that the next wave will be more vaccine-resistant and more transmissible.

Future Pandemics

Experts have been warning us about global pandemics for decades. While these warnings have helped abate several outbreaks that could have been as deadly or more so than COVID-19, the forewarnings did little to prevent COVID-19 itself from becoming a pandemic. And even though the ravages of the COVID-19 pandemic seem to be easing, these same experts say that more pandemics are on the way, meaning masks, hand sanitizer, vaccines, travel restrictions, Zoom meetings, and all the rest will be part of our lives for the foreseeable future.

Why is this? According to international nonprofit health organization GAVI, there are five major reasons for the past and future emergence of global viral pandemics:

1. Increased global travel and mobility. In 1990, 1 billion people traveled by air, a number that more than quadrupled to 4.2 billion by 2018. With more people moving across the globe, viruses and the diseases they cause have greater opportunity to "see the world."

2. Increased urbanization. In 1950, roughly 66 percent of the world's population resided in rural areas, while the remainder lived in urbanized areas. By 2050 this figure will reverse, with two-thirds of the world's population residing in urbanized areas. One major result of this shift is the rise and spread of transmissible diseases.

3. Climate change. The World Health Organization has estimated that climate change will kill a quarter of a million people a year between 2030 and 250 through the spread of infectious diseases such as malaria and dengue fever. The increased risk of flooding, brought on by more frequent and extreme weather, also suggests that outbreaks of waterborne diseases are more likely.

4. Increased contact between humans and animals. COVID-19 is considered a "zoonotic" disease, meaning it can pass between humans and certain animals. Experts have speculated that the virus originated in an animal species. With increased global travel, increased urbanization, and climate change, more people are coming into contact with more animals, which increases the chance that a virus circulating in an animal population will make the jump to humans.

5. Worldwide healthcare worker shortage. Another World Health Organization report regarding nurses showed that the constant migration of nurses from low- and middle-income countries to high-income countries has left many nations in Africa, Asia, and Latin America with too few nurses and other health workers to adequately care for their populations under ordinary conditions. This of course means that there are also too few troops on the ground to defend against potential pandemics.

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