Over the course of the next several weeks, JP Marvel will publish the series “2025: Long Term Effects of COVID-19”, an exploratory imagining of life in 2025, after COVID-19. Each series entry will provide a hypothetical 2025 reflection on the pandemic’s impact since 2020, focusing on a key aspect of American industry, commerce, government, society, or culture.
Before COVID-19 became a crisis in the United States, Americans had long debated the state of healthcare. Some believed that the country inefficiently and inequitably delivered medical services to its population. Others questioned why the US led the world in healthcare spending but not in positive outcomes. Everyone argued about who should be responsible for paying for healthcare. Depending on who you asked, the healthcare “villain” may have been the government, employers, pharmaceutical companies, hospitals, doctors, insurance providers, illegal immigrants, or a combination of “offenders”. The finger-pointing temporarily paused when COVID-19 hit because Americans had more pressing concerns like overwhelmed hospital ICUs, inadequate PPE and ventilator supplies, and extreme safety concerns for healthcare providers and patients alike. We focused on “flattening the curve”, isolating COVID-19 patients, and developing treatments and vaccines in record time. In time we succeeded, and now in 2025 we are back to debating the old healthcare questions, albeit passing them through a different experiential filter.
When COVID-19 reached pandemic status in the US, many Americans no longer felt safe visiting hospitals, clinics, and medical practitioner offices to seek medical attention. Knowing that COVID-19 carriers were necessarily congregating in those locations, many of us rescheduled annual physicals, cancelled physical therapy sessions, and postponed elective surgeries. Alarmed, healthcare providers pivoted, widely adopting telemedicine to address non-critical health issues without requiring in-person contact.
Prior to 2020, a tiny percentage of US doctors conducted telehealth visits. Once Americans started testing positive for the coronavirus, that percentage quickly climbed to 50% within a few months. Today, more than 90% of doctors utilize telehealth in some form, and the overwhelming majority of all routine care visits and consultations are now conducted remotely. This has led to significant time and cost savings for both patients and healthcare providers. A telemedicine visit can save up to $120 per visit based on the subject matter and location of the facility. Moreover, many of these visits have been structurally organized to leverage the expertise of nurses and physician assistants, thereby freeing up doctors in many cases to focus more on critical care patients. For those who still prefer the in-person medical attention, a large and growing network of clinics are open to fulfill their needs. CVS Health is leading the clinic explosion: in the last 5 years, the company has increased the percentage of Minute clinics in its stores from 10% to 25%.
US hospitals have remained the central hub for US healthcare services, but they were structurally reorganized to operate better in a pandemic-threatened world. COVID-19 overwhelmed smaller hospitals, and many eventually closed or were absorbed by larger ones. Surviving hospitals reallocated more staff to provide general healthcare, both routine and critical in nature. These hospitals were also forced to divert more resources to their ICUs, accepting all critical patients regardless of their healthcare coverage. Simultaneously, they saw a dramatic drop off in elective procedures, which are typically high margin for providers. Not surprisingly, hospitals hemorrhaged money during the peak months of the pandemic. In an act of survival, administrators refocused on hospital core competencies, going so far as to section off building wings for specialty care and elective procedures as well as redirecting COVID-19 and other critical care patients to isolated wings or satellite locations.
COVID-19 had a particularly harsh impact on the elderly: in many states, at least a third of virus fatalities were nursing home residents. This stark reality convinced many elderly people, and their caretakers, to take another look at late-life housing options. Today, we are seeing a number of notable trends including the following: more elderly individuals are living at home longer; home health aides, house calls, and home-delivery of medical products and solutions services are in high demand; younger family members are living closer to their elderly parents and grandparents; and nursing home capacity is falling.
The general public and politicians still grumble about the pharma and biotech industries, and yet they appreciate – and promote – their necessity more after COVID-19. Once the pandemic started, eyes turned to the pharma industry for the speedy development of treatments, vaccines, and testing methods. Several companies provided the necessary solutions, which were adopted in record time thanks in part to more accommodative governments and healthcare regulators. In the US, prior to COVID-19 an experimental drug took twelve years on average to make its way from the lab to a medicine cabinet. If the drug showed early clinical promise, it might be granted “fast track” status, thereby shaving 3-4 years off its development lifecycle. Now in 2025, most credible medical development is on the fast track. The FDA has loosened restrictions, and the government regularly co-sponsors research with vast sums of capital, allowing companies to explore more discovery paths and accelerate trial timelines. Big Pharma’s impressive response to COVID-19 did not go unnoticed: the public and Washington were effectively won over, casting votes and allocating tax dollars that only further enriched the industry. Dissenting murmurs are still occasionally heard among the chorus of cheers (for good reason, as the escalating costs to the healthcare system are gargantuan), but for now they have a diminutive voice in the public discourse.
Drug development companies are also turning to more Artificial Intelligence and machine learning to streamline lab processes, hastening the discovery process. AI can screen vast patient databases quicker, extracting usable information to identify opportunities and forecast success probabilities. For these companies, speed is vital because every day is a day of R&D cash burn, which will factor into the cost and profitability profiles of the final product.
After successful discovery, drugs are moving faster through the clinical phase than they did prior to COVID-19. One key reason is the widespread adoption of the virtual clinical trial. Traditional in-person clinical trials are burdensome, time-consuming, and expensive. Moreover, willing patients are more difficult to come by due to residual safety concerns. Consequently, clinical trial administrators took a page from hospital directors, adopting many tools of telemedicine to convert classic trial models to more flexible remote-based ones. This transformation significantly reduced administrative burdens and dramatically expanded the patient applicant pool. Today, many patients can participate in trial studies from home, recording and transmitting data to companies with the help of monitoring devices, smartphones, and other technologies.
The “domestication” of medical diagnostics has not been limited just to clinical trial work. Nearly all diagnostic testing in 2020 was performed in either a hospital, clinic, or lab; this is no longer the case in 2025. When the pandemic hit, many people felt unsafe traveling to locations for COVID-19 testing. To assuage those fears, drive-thru testing facilities were created. Still, people still had to leave the safety of their homes and interact with a medical professional. The public pressed for a better solution. After all, diagnostic testing is an exceptionally common and vital element of healthcare, whether a blood draw or saliva swab is used to positively identify a COVID-19 infection, strep throat, cancer, venereal disease, or any other thousand possible ailments. Healthcare providers quickly realized that the success of telemedicine in part hinged on their ability to follow a consult with a biological screening that stayed within the patient’s controlled environment. As such, whenever possible primary care physicians are recommending patients use at-home tests instead of traveling to testing facilities. Diagnostic healthcare companies have responded in kind, ramping up the development of new and better tests that can either be mailed directly to the home, performed online, or picked up at a local pharmacy. Overall, this “domestication” trend has lowered overall costs to the system. increased test accuracy, and improved health outcomes. For sure, the adoption of remote diagnostic has exploded.
After COVID-19, the pharmaceutical industry and to a lesser extent the medical device industry began pulling back on its foreign manufacturing. In the years leading up to the pandemic, many companies had shifted their manufacturing capacity abroad – to Ireland and China, mostly – to take advantage of cheaper labor costs, more favorable tax rates, and less onerous regulation. The coronavirus, however, revealed serious equipment shortages and deficient drug-making capacity with US borders. Some pundits voiced concerns about a country like China contaminating exported pharmaceuticals, especially the generics many Americans rely upon regularly. Although these concerns may have been ill-founded, they were alarming enough to prompt Washington to create incentives to bring production back to the US. Since it takes 3-4 years to build production plants, we are just now seeing a large block of manufacturing facilities opening domestically.
A topic Americans continue to argue about almost as much if not more than drug prices is healthcare coverage. In 2020 84% of Americans received healthcare coverage from either an employer or the government, the employer making up the majority. When the pandemic hit, 30 million people lost their jobs, and the government took on a higher burden of the coverage. Today, employers remain the dominant provider, but they are passing on more of the expense to employees than they did in the past. More companies have adopted high deductible health plans, which charge much lower premiums to the employer and shift more cost to the employees. Some companies have replaced traditional healthcare plans with Health Reimbursement Arrangements (HRAs) – effectively shifting the time, responsibility, and cost of researching providers and procuring a policy to the employees. Medicare enrollment remains elevated due to legacy 2020 job losses, and the individual insurance market continues to expand, along with its premiums. Obamacare introduced mainstream America to concepts like single payer healthcare and public options; these topics were revisited when Trump was elected in 2016 and he set forth, unsuccessfully, to repeal his predecessor’s work. Heading into the 2026 midterm elections, the country expects another heated round of debate on healthcare coverage and who, ultimately, should pay for it.
COVID-19 was the biggest, most dangerous health event in most living Americans’ lifetimes. Our healthcare system has responded by making significant changes to drug discovery and manufacturing, healthcare delivery and coverage, and medical technology development and adoption. Suffice to say, five years later, we are far better equipped to handle another pandemic should it strike.
We will have more reports in the coming weeks on what the world might look like in 2025…