How crises disrupt and evolve society

Evolutionary changes, wars, natural disasters – and now a virus – all change the world and society as we know it. Covid-19 has pushed digitalization forward in ways that previously were unforeseeable, and healthcare is one of the most affected sectors.

In 1347, the bacterium Yersinia pestis was carried along the Silk Road from Asia. An overpopulated Europe was already suffering from 50 years of famine. Ships carrying infected rats arrived in Genoa that year. In just four years, 40 percent of Europe’s population died from the pandemic that would become known as the Black Death.

Between 1290, when the famine began, and 1430, when the pandemic began to recede, Europe lost 75 percent of its population. The Black Death remains one of the great­est catastrophes in human history.

So why am I talking about the Black Death? As a disease, Covid-19 is not comparable: Yersinia pestis is a bacterium, Covid-19 is a virus. The mortality rate for Yersinia pestis was extremely high, while for Covid-19 it is much lower.
Nonetheless, they share a common feature: both were enormous shocks to the system for the global community. And shocks are also extreme catalysts of change.

History has shown how major crises change the world, initially for the worst, with poverty, disease and death, but then something new often emerges. Out of new knowledge and discoveries, new needs and behaviors, and new opportunities that arise, society is compelled to develop and to find new solutions, to chart out a new course.

The world wars not only redrew the world map; they also brought about fundamental changes in society. Political regimes fell and new ones emerged. A colonial world order was supplanted by two superpowers and a cold war, but also by international treaties and organizations such as the UN and the EU, and financial support packages that led industry to change course and prepare to innovate.

Natural disasters have wiped out entire species and then paved the way for new ones. On a smaller scale, they have also led to innovations such as earthquake-proof buildings, flood defences and improved aid efforts.

And pandemics like the Black Death and Covid-19 have led to new insights and knowledge in medicine and healthcare.

An Exponential digitalization

But Covid-19 will also leave a more lasting imprint on history. The virus has paved the way for exponential digitalization. E-commerce and home delivery of goods ordered online have exploded. We have learned to work and learn digitally. We socialize via monitors and games.

Lockdowns and isolation have most likely accelerated the rate of digitalization in many industries, too. When suppliers of parts and components stopped production, the benefit of fully automated processes became obvious.

Not least, the health services and healthcare sector has been profoundly affected, having undergone fundamental change. Just as during the Black Death, new technology has either contributed to, or resulted from, the current situation.

Prior to the Black Death, the role of medical science was led by the Church. The physicians were monks with close religious ties, who received their training at monastic schools in the largest countries or city-states. Like the Church, medical science was extremely conservative. The Black Death changed both medical practices and training. For example, treatments such as blood-letting and poul­tices of goat dung proved utterly ineffective in curing diseases. Slowly but surely, practices based on experience influenced medical training. Instead of cramming patients together, patient groups were kept separate from each other, goat dung was replaced with oils, healing was aided by fresh air, and different types of masks were used to ­treat patients.

Some parts of the healthcare service have suffered from an almost Luddite view of technology.

During the Covid-19 pandemic, the health sector has also suffered a shock, and many measures have been implemented to prevent it from collapsing altogether. However, this shock has accelerated the rate of digitalization. This sector is already one of the most high-tech sectors we have; apart from modern weapons systems, medical and technical equipment is among the most advanced and most expensive there is. But some parts of the healthcare service have suffered from an almost Luddite view of technology. A one-sided focus on security and privacy in particular has hindered digitalization. Compared with most other sectors, the level of friction for staff and patients has been and remains alarming.

Take hospitals as an example. Until the Covid-19 shock, staff at Oslo University Hospital were not allowed to use Skype to communicate with each other or with practices outside the hospital. The first surge of the virus marked the first time that health personnel were allowed to run applications on their home computers, where they could, for example, view live-streamed lung examinations of Covid-19 patients and advise on-duty personnel on how to improve the situation for their patients. This demonstrates that thorough assessments were made between benefit and risk to allow for pragmatic solutions to be used in these exceptional times. And it took a virus to make it happen.

As recently as February this year, for example, the Norwegian company Confrere was struggling to get general practitioners in Norway to start using video consultations. Apart from companies like Kry and Hjemmelegene, general practitioners have little competition to deal with. Despite patient demand, there was little motivation for change. When the Covid-19 virus broke out in the Nordic region, the use of video consultations exploded, and any self-respecting general practitioner now provides this service. It’s better for the patients. Better for the doctors. Better for the private sector. And it took a virus to make it happen.

Rapid change

Finally I would highlight the process of testing and getting test results. I myself was tested for Covid-19 in February 2020. Everything was done manually, the information was chaotic, but we did get the test results relatively fast because we were among the first to be tested in Norway. In July, our children were tested again, and this time the entire process was completely automated! And this happened rapidly – not only in terms of technology, but also in terms of regulatory amendments, which can often take years. Now all laboratories submit their test results to Emsis, a national database which can be accessed by patients and healthcare personnel alike via the patient’s core medical records available at helsenorge.no. So remember – before the outbreak of the Covid-19, Norway had no national infrastructure for test results! All it took was a shock and a few months to fix it. And it took a virus to make it happen.

Last but not least, I want to mention the coronavirus tracing app in Norway. Attempts by national authorities to implement virus tracing using mobile phones have been contested in many countries. Nonetheless, the Covid-19 virus has proven the necessity to grant ”some” access to highly sensitive personal data and often biometric data, and at rapid speeds. If we view this in connection with the critical need to make patients’ medical records, case summaries and test results digitally accessible, we can easily subscribe to Yuval Noah Harari’s analysis: ”The corona-virus pandemic could prove to be a watershed event in terms of enabling greater surveillance of society. People could look back in 100 years and identify the corona-virus epidemic as the moment when a new regime of surveillance took over, especially surveillance under the skin which I think is maybe the most important development of the 21st Century, is this ability to hack human beings.” Assuming that this capacity is used properly in terms of privacy and security, I believe that the extent to which it will prove to be good for society and for individuals is difficult for us to envisage today. And it took a virus to make it happen.

Now that we – hopefully – will return to normality during 2021 and 2022, it is vital that society, exemplified here by the healthcare services, does not revert to the old normal and reverse the digital quantum leaps that were brought about by the shock the Covid-19 pandemic caused. Those nations and companies that manage to seize the opportunities that have emerged will be the winners.