Remembering the pandemic

President Joe Biden’s administration has officially ended the national health emergency in the United States, allowing the remaining pandemic restrictions to expire on May 11. Other countries have already taken similar steps, and more are expected to follow suit. With the World Health Organisation no longer considering Covid-19 a global health emergency, it seems that the virus and its massive death toll will soon fade from memory, along with N95 masks and PCR tests. But this collective forgetting jeopardises efforts to secure consistent funding for public health.Our ability to forget something as catastrophic as a pandemic is partly a coping mechanism, reflecting the emotional immune system that enables us to move on with our daily lives. As devastating as the pandemic’s social and economic impact has been, it has left an indelible mark on only a relatively small subset of the population, including survivors of lost loved ones, health professionals and other frontline workers, the immunocompromised, and those experiencing long Covid or other related health issues.While tragic events often inspire us to pursue reform, our willingness to act is often short-lived, making it difficult to affect lasting change. This pattern is particularly evident in the news coverage and Google search trends that follow tragedies such as mass shootings, tsunamis, and earthquakes, which typically show an initial surge of interest that gradually fades over time.To create and retain memories, the human brain undergoes a complex process that involves multiple interrelated stages, such as encoding, consolidation, and retrieval. When presented with new information, our brains process it by modifying neurons in the hippocampus, a critical centre for memory, along with other regions like the amygdala, which handles emotional memories. Together, these neurons form a physical representation of the memory called an engram.A significant portion of the information we encounter can be lost unless it undergoes memory consolidation, which frequently occurs during sleep and helps to stabilise and retain memories in the long term. During this process, the hippocampus effectively "replays” the memory, which is then distributed to cortical neurons for extended storage. During the final stage, memory retrieval, the trace neurons within the hippocampus and cortex are reactivated.Every day, we are bombarded with an overwhelming amount of information that our brains struggle to retain. Given that forgetting and remembering are inextricably linked, this "infodemic” further aggravates our tendency to forget. Moreover, the process by which our brains assess risk is deeply personal and influenced not just by data but also by our own biases and needs.As Covid-19 fades from our collective consciousness, we are reminded why so many people were eager to forget the 1918 influenza pandemic and embrace the joys and risks of the Roaring Twenties. But collective amnesia threatens to leave us woefully unprepared for future airborne disease outbreaks, forcing us to re-learn fundamental lessons about the importance of masking, ventilation, and shifting activities outdoors to prevent transmission.The 1918 pandemic infected a third of the world’s population and claimed more than 50 million lives, surpassing the combined military casualties of World Wars I and II. Yet, despite its enormous human toll, there are no permanent memorials or days of remembrance for its victims. Before 2020, if you asked people to name the deadliest event of the twentieth century, very few would have cited the virus. Only recently, historians such as Guy Beiner have begun to explore this pattern of forgetting. Without rituals of remembrance to commemorate the millions of lives lost to Covid-19, we risk perpetuating the cycle.People often have a more positive view of the future than the past as a way of building psychological resilience. This future-oriented positivity bias arises because, unlike the unchangeable past, the future offers endless possibilities. But our tendency to look forward also impedes progress on issues like pandemic preparedness, as it leads us to believe we are better equipped than we are.Numerous academic bodies, think-tanks, public-health organisations, and governments have published detailed recommendations on how to improve pandemic preparedness, but there has been no coordinated and comprehensive effort to implement them. Three years after the start of the pandemic, we still lack clear explanations for why our public-health agencies are understaffed and underfunded, why supply chains failed, why Covid-19 misinformation was allowed to run rampant on social media platforms and cable news outlets, and why our public-health responses remain reactive rather than proactive.To ensure that we are better prepared for future pandemics, prominent medical and scientific figures in the US have proposed creating a Covid-19 Pandemic National Task Force modelled after the 9/11 Commission, but proposals have languished in Congress. In the face of other crises, it seems that many would rather forget the destruction wrought on our societies by the pandemic and return to "normal.”But as difficult as it may be to break the cycle of normalisation that enables us to forget tragedies such as mass shootings and pandemics, it is necessary that we do. We must acknowledge how our biases endanger our lives and those of future generations. There are clear, evidence-based policy roadmaps that could help us reduce gun violence and improve pandemic preparedness, potentially saving countless lives and preventing immeasurable suffering. To implement these measures successfully, however, we must avoid the trap of division and distraction.It has taken Ireland more than 150 years to build memorials and museums commemorating the impact of the Great Famine of the 1840s. We cannot afford to let the same happen with Covid-19. To ensure that we heed the lessons of the pandemic, we must memorialise its ongoing effects, enact days of remembrance, update school and university curricula, establish permanent museum exhibits, and build monuments. Our ability to remember the past could affect billions of lives in the future. — Project Syndicate* William A Haseltine, a scientist, biotech entrepreneur, and infectious disease expert, is Chair of the global health think tank ACCESS Health International.