Three Years In, How the Pandemic Has Changed Our Lives (and How It Hasn’t)

COVID-19 has had an impact on how we think, how we spend and how we interact with others

Collage of COVID-related images such as zoom meetings, masks, COVID tests, vaccines, vaccine card

Sean McCabe / Getty Images

David Hochman with Leslie Goldman,

AARP

En español

Published March 07, 2023

As we enter year four of COVID-19, life in America is a tale of two pandemics.

In noteworthy ways, the greatest health crisis of our time appears to be ending — mask-wearing has greatly dwindled, restaurants are booming, concert venues are again selling out as music makers return to the stage, and President Joe Biden announced that the federal emergency declarations will end on May 11.

Yet, with immunity waning and only 41 percent of older Americans protected with the updated booster, scary headlines have rebounded: A contagious new strain of COVID has emerged, and though overall hospitalizations are down, Americans 70 and up are admitted with COVID at a rate four times higher than that of the general population, and most fatalities are among people over 64. Nothing is normal about this new normal. From health care to travel and family time, we’ve sorted out what’s changing, and what’s not.

Health and well-being

With wisdom and know-how, older Americans adapted and got through it...

Though alcohol use and fitness have proved serious challenges.

Vaxxes have been critical. A near-universal share of older adults — an astounding 94 percent of those 65 and older — were fully vaccinated against COVID-19. That’s a level health authorities hope to achieve for older adults getting the all-critical bivalent booster shot despite the lag. “The hesitancy and partisanship around vaccines that more broadly affected the pandemic response has not shown up among older Americans, and that really paid off,” says Ashish Jha, M.D., the White House COVID-19 response coordinator.

Older Americans have fared better psychologically. The vast majority of the 1.1 million lives lost to the virus in the U.S. have been over 65, but even with that devastating toll, “older people overall had the experience, the resources and the resilience to ride out this storm better than middle-age and younger generations,” says Laura Carstensen, director of the Stanford Center on Longevity. Coming out of COVID, Americans ages 16 to 24 rated their physical and mental health as poor — much worse than those over 65 did. And older adults these past few years were the least likely to report psychological stress, headaches and fatigue.

Telehealth and urgent care have surged. Medicare telehealth visits in 2020 increased to 52.7 million, from approximately 840,000 in 2019, and continue to number in the millions. When we do see a practitioner, it is often in a discreet corner of a pharmacy or superstore as Walgreens, CVS and Walmart pushed in to urgent care, health screenings and even minor wound and injury care. That’s not going away. Amazon rolled out a virtual medical clinic that treats common ailments such as allergies, hair loss and skin conditions. CVS spent $8 billion last fall on a network of doctors and clinicians who make house calls. “Their interest is to take over the home,” Eric Topol, M.D., a professor of molecular medicine at Scripps Research in San Diego, told The New York Times.

However... fitness may suffer. After coronavirus shutdowns, online fitness increased, but 50 percent of gym members said they would not return to their gym. Nearly 1 in 5 adults over 50 reported a deterioration in the quality of sleep during COVID. Nearly 2 in 5 Americans 70 and up said they delayed medical services. “I’m seeing patients who are three and four years behind on colonoscopies and mammograms, and that’s led to delayed discoveries of — and more advanced — cancers,” says Jeannette Guerrasio, a Denver internist. Nearly half of those 65 and older who contracted COVID say they are less able to engage in physical activities such as walking and exercising.

Then there’s a troubling trendlet. Though older Americans as a whole weathered the pandemic better psychologically than younger generations, there have been pockets of despair.

Substance abuse among older adults has increased the past few years. We’re not talking about the occasional gummy with cannabidiol — though CBD use is way up among older folks. The percent of alcohol-related deaths among Americans over 65 reached record highs in 2020. Death from opioids among those 65-plus also trended up (though in terms of sheer numbers of substance abusers, younger Americans far outstrip their older counterparts). Older adults can be reluctant to receive treatment at facilities tailored to younger populations. As Guerrasio says, “I hope one lesson for older people coming out of COVID is to be more open to saying, ‘I need help.’ ”

Philadelphia Phillies fans scan their phones for ticketless entry at the gate prior to the Major League Baseball game between the Philadelphia Phillies and the Atlanta Braves on April 1, 2021 at Citizens Bank Park in Philadelphia, PA. (Photo by Rich Graessle/Icon Sportswire via Getty Images)

Paperless digital ticketing has become the standard at sporting events and concert venues. Phillies fans scan their phones for ticketless entry at the gate prior to the Major League Baseball game between the Philadelphia Phillies and the Atlanta Braves on April 1, 2021 at Citizens Bank Park in Philadelphia, PA.

Icon Sportswire / Getty Images

Work and the economy

From the office to retail, life is beamed onto screens, big and small...

Although the supply chain crisis has slowed the marketplace.

Online shopping takes off but struggles to fulfill its promises. Months of quarantine recalibrated how Americans earn, shop, invest and save. In a blink, cash was gone, and swiping or typing credit card details became the coin of the realm — that’s fine if you’re not managing age-related dexterity or cognitive issues. Among those who never bought online before 2020, 40 percent were doing so within a month, and, for older Americans, it was everyday items we’d never depended on the internet for: toothpaste, tomato sauce, thumbtacks, lunch — and it all magically arrived, via contactless delivery, after we tracked it to our homes.

Work has moved toward home. “Going” to work? Not so much anymore. Before the pandemic, 95 percent of commercial real estate in U.S. cities was occupied. Now it’s below 50 percent, in what some call “the office apocalypse.” One-third of business travel is likely gone forever, predicts Jeffrey Cole of USC’s Center for the Digital Future. “Zoom is a lot easier and cheaper than getting on a red-eye to New Jersey,” he notes.

Forty-one percent of boomers say they’d prefer to continue teleworking after the pandemic. There are some downsides to sales meetings at the kitchen table. The average after-hours work increased by 28 percent. These and other work changes were part of a remaking of the American labor force, as roughly half of all workers began looking for other jobs in what came to be called the “great resignation.”

However... mass layoffs, particularly in tech, continue, and many Amazon Prime customers complain that “next day” or two-day shipping means three-, four- or five-day shipping. Big competitors such as Walmart, Target and Home Depot (and let’s not even discuss home furnishings retailers) saw huge delivery snarls the past couple of years, pegged to everything from unprecedented congestion in ports and COVID lockdowns affecting Chinese exporters to American labor shortages. American supply chain fragility has affected everything from how long it takes to get new appliances to what foods are on grocery shelves to which medications are in critically short supply (among them: amoxicillin, Adderall and Tamiflu).

Family and community

The relationships that really mattered went even deeper...

Though for many of those age 50-plus, isolation and loneliness soared — and our children struggled.

Family ties have improved. Among families with multiple generations under one roof, nearly 80 percent report having better relationships with family and kids, including with adult children, since the pandemic. In part, it was simply a matter of spending quality and quantity time together with those who matter most. A 2021 Pew Research Center study counted 59.7 million U.S. residents living in multigenerational homes; that’s four times the number reported in 1971.

Relationships stabilized, divorce decreased. For older adults, relationships did surprisingly well. Two-thirds of respondents in one survey reported that relationship quality stayed the same during the pandemic, and more than 1 in 5 reported their relationship quality got better. A 2022 survey by Monmouth University found that 90 percent of adults 55-plus are extremely or very satisfied with their relationships, and three-quarters said their happiness levels stayed the same. Predictions of a divorce uptick were unfounded; the national rate actually dropped by 12 percent in 2020.

Downsize — say what? If you think all that housebound time made older people want to move or go smaller, think again. Recent data from an AARP survey shows that adults 50 and older overwhelmingly want to remain in their homes for the long term; only about one-third of older people said they plan to relocate to another community. Aging in place will require some fixes, research shows. A third of AARP poll participants said they would need to modify their residence so they or loved ones could continue to live there if they had physical limitations. And desire and reality are not in sync: In 2022, boomers made up the largest share of U.S. home sellers, at 42 percent.

However... on the flip side, family bonding during COVID didn’t mean as much to the nearly 26 million Americans 50 or older living alone (up from 15 million in 2000), including a growing number — about 1 in 6 Americans 55 and up — who do not have children. “For older people living on their own, loneliness and isolation became a very real pandemic side effect,” says Diane Ty from the Milken Institute.

Then there are our kids and grandkids, Gen C — as in Generation COVID, children born around 2016 and after — who researchers say seem slower to develop. Babies born during the pandemic vocalize and interact verbally much less than their pre-COVID counterparts did, according to two studies. Some say it could be attributed to caregiver stress and lack of exposure to the outside world, while others blame it on increased screen time or mask-wearing, since babies learn to speak by watching mouths move. In 2021, the U.S. surgeon general declared a mental health crisis among young people.

People dine outdoors at Shake Shack in Madison Square Park during the fourth phase of the coronavirus reopening on August 12, 2020 in New York, New York. The fourth phase allows outdoor arts and entertainment, sporting events without fans and media production.

Masks have largely disappeared, and people are flocking to cafés and restaurants.

Roy Rochlin / Getty Images

Travel and leisure

Life’s pleasures — food, flights and entertainment — returned...

Though staffing remains a huge issue.

Sports, never gone, roared back. “The pandemic bubble” — in which players quarantined together, tested constantly and played to near-empty arenas — “saved sports and kept fans in their seats,” albeit at home, says Abraham Madkour, publisher and executive editor of Sports Business Journal. With stadiums full again, we’re seeing changes that will likely linger: paperless ticketing; refreshments ordered through apps and screens, and a better overall home-viewing experience.

Movies and weddings are on the upswing. After countless nuptials got bumped in 2020 and 2021, the number of planned U.S. weddings in 2022 jumped to 2.5 million, up from 2.1 million in 2019, before the pandemic. Hollywood is doing well, too, with some big caveats. Theaters sold about $7.46 billion worth of tickets in the United States in 2022, led by mega-sequels to Top Gun and some beautiful blue creatures in Avatar.

Speaking of screen time, it’s off the charts. The average time a U.S. adult spent looking at a screen each day increased 60 to 80 percent during the pandemic. That’s everything from phones and video calls to the television shows and movies we binge — one view is that we have the world at our fingertips, so why go anywhere or do anything?

Travel has resumed. “We are eating out again, visiting faraway friends, taking family trips — activities that were unthinkable even during parts of last year, especially for older folks,” says Pauline Frommer, editorial director of Frommer’s guides. After years of isolation, multigenerational travel is up 50 percent. Even cruise lines — the original petri dish of the coronavirus — are booking up again. Older travelers are going the extra mile: Nearly 40 percent of people 65 or older say they prioritize traveling out of state, and more than half those travelers prioritize trips to visit family or friends.

At the same time, smaller cities are thriving. “The pandemic provided a necessary reset button for many destinations,” says Bert Sperling, founder of the website Best Places, who says the influx of new populations in towns across America means “things are a lot more cosmopolitan in places like Billings and Missoula and Boise” than in 2019. “You can get a great cappuccino where you couldn’t get one before.”

However... moviegoing is still down 34 percent from the pre-pandemic year of 2019. The problem hasn’t been only a fear of crowds but a movie shortage, as many films — including most smaller, independent films — went straight to streaming and productions in general were slowed by COVID. Although hotels and restaurants are busy again, widespread staff shortages mean “you might not see daily housekeeping or receive the attentive service you did before 2020,” Frommer says. Ditto on reliable flights or counting on your luggage to arrive safely; witness the Southwest Airlines debacle this past holiday season. “Travel insurance is suddenly booming for cruises and vacation rentals,” she says.

Retirement plans

We are focusing hard on money...

But cracks appear in the nest egg.

Financing our post-work years is focus number one. Across four generations surveyed in a recent poll, 76 percent said their life priorities changed due to the pandemic, and 56 percent said they were prioritizing retirement savings. Regardless of respondents’ political affiliation, Social Security is a unifier. Retirees this year are getting an 8.7 percent Social Security cost-of-living adjustment, the biggest in decades, which is fortunate: 40 percent of boomers said they expected Social Security to be their primary source of retirement income. Savings found some renewed vigor too. More than 4 in 10 near-retirees in one 2021 survey said that they had started saving more since the pandemic began.

However... Retirement has been postponed. Millions retired early during the pandemic, but with a tight labor market and rising prices on almost everything, “unretiring” is in vogue. So is extending one’s retirement horizon. COVID prompted about a third of Americans to change the age they anticipate retiring, with nearly 40 percent of respondents in one survey adding three to five years, and 35 percent adding nearly a decade of expected work years. Even as the average American nest egg fell by 11 percent in 2022 to $86,869, down from $98,800 a year earlier, according to another survey, the amount Americans think they need for retirement increased by 20 percent over that same period, to at least $1.25 million.

Rethinking how we think

We are feeling good...

Though the divide with others is real.

Fear of death has dropped and happiness has risen. Perhaps the most hopeful news three years after the start of the pandemic is that older people managed to stay the happiest during those years. Surveys consistently show that, compared with younger populations, people 60-plus score more positively on a wide variety of daily emotions. About 2 in 3 of the oldest adults, 80 and older, say they are living their “best possible life” or close to it, compared with just 1 in 5 younger adults, according to National Geographic and AARP research.

“The pandemic showed how important the perspective of age can be,” says Carstensen, from the Stanford Center on Longevity. Even the fear of death is decreasing with age in the time of COVID, the study shows. Though more than 20 percent of people 49 and younger say they fear death “extremely or very much,” those numbers fall to 10 percent among respondents ages 70 to 79 and to 4 percent in those 80-plus.

Stress has actually decreased. In a well-publicized study last fall, scores of young adults reported being moodier and more prone to stress during the pandemic. But for older people, that wasn’t true. Older people reported getting less neurotic. “I think because older adults have so much more stability in their personality, social support networks and day-to-day activities, they were disrupted much less than younger people,” says Angelina Sutin, the Florida State University researcher who oversaw the study.

However... even after all this upheaval, we remain a country firmly divided. When the nonpartisan Pew Research Center surveyed people in 17 countries, Americans were the most likely to say their society was split along partisan, racial and ethnic lines. The U.S. also reports more religious division than almost any other country surveyed. If all this information isn’t troubling enough, all the misinformation should be: Rumors about unproven miracle cures, claims about dangerous technology lurking in masks and about the efficacy of vaccines — “false information takes us back a step for every step forward,” internist Guerrasio says, “and older people cannot afford that.”

What does a future with COVID look like?

We asked 3 experts for their takes on coexisting with the ever-evolving virus

By Leslie Goldman

Do you think COVID-19 will be with us forever, like the flu?

Monica Gandhi, M.D., associate division chief of the division of HIV, Infectious Diseases and Global Medicine, UCSF/San Francisco General Hospital: Yes. The fact that COVID can be spread before a person is symptomatic, lacks clear distinguishing symptoms and is carried by animals (nearly 30 species) all make it essentially impossible to eliminate. Vaccines are excellent at protecting against severe disease, but they won’t make this virus go away.

Will COVID always be more dangerous than the flu or the common cold?

Gandhi: I don’t think so. We rarely admit people — including older people — to the ICU with COVID or COVID-related pneumonia anymore. That’s thanks to widespread immunity (more than 95 percent of Americans have antibodies, a result of vaccination, natural immunity or both); good inpatient and outpatient treatments like remdesivir and Paxlovid, respectively; and the fact that the omicron variant and its subvariants are less likely than earlier strains to infect lung cells.

Will getting the current booster help me at all if I come into contact with new variants?

Eran Metzger, M.D., director of psychiatry, Hebrew SeniorLife, Boston: Yes. It may not keep you from contracting COVID altogether, but it can help prevent severe illness. Like an annual flu vaccination, these boosters are tailored to the new strains but boost your immunity to the virus in general.

Will there eventually be an annual vaccine, like there is for the flu?

Gandhi: If COVID-19 settles into more of a winter respiratory virus — and I think it will — a yearly booster for people age 65 and up will eventually be recommended to maintain strong immunity and stay in the lower range of danger. Vaccination is particularly important for older individuals with comorbidities like heart disease or emphysema.

Many people are confused about Paxlovid. Must you be very ill to take it? 

Emily Landon, M.D., medical specialist for the High-Consequence Pathogen Preparedness Program, University of Chicago Medicine: Anyone over 50 with COVID should absolutely take it, regardless of how ill they feel. Paxlovid acts like a cleanup crew, clearing away some of the virus so your immune system has an easier job. That means less risk of becoming very sick. And preliminary evidence suggests it may help reduce the risk of long COVID.

The earlier you take Paxlovid after becoming sick, the faster and better it works. Make sure your prescribing physician is aware of any other medications you take, as it can interact with some drugs, such as statins.

What is your advice to older adults regarding masks?

Landon: With mandates lifted, masking is now a very personal decision. There are still excellent reasons to try to avoid COVID, including the fact that we’re just beginning to understand the long-term consequences of having it. Ask yourself, “Is skipping the mask in a certain environment worth getting COVID?”

In some cases, like a granddaughter’s wedding, you might say yes, enjoying the celebration mask-free feels like an acceptable trade-off. And if you are vaccinated, boosted and have no underlying conditions, your risk of ending up with severe illness is low. In other instances, like grocery shopping, you might say no. Personally, I consider masking nonnegotiable anytime you’ve got many people packed into confined spaces, such as airports, airplanes, buses or the gym.

Research shows nearly 100 percent of planes have COVID in their wastewater after any given flight, which means at least one person on the plane is COVID-positive. My mom is 76 and still masks on planes and at church, but not when golfing or meeting friends outdoors. Basically, any time you spend masked reduces your risk. But it must be a well-fitting N95, KN95 or KF94 mask; fabric masks don’t really help.

My loved one lives in a long-term care facility with frequent COVID outbreaks. Will I ever be able to visit them safely?

Metzger: When the pandemic started, long-term care settings like nursing homes went on strict lockdown. We’re now seeing lasting health effects caused by such draconian isolation: depression, post-traumatic stress disorder. Some doctors collectively refer to these as “the second pandemic.” That, combined with high vaccination rates, has resulted in many nursing homes becoming more flexible about visitation.

We also know that loneliness is a risk factor for many chronic conditions, including depression, dementia and heart disease. So, visiting your loved one with precautions in place, such as vaccinations and masks, may not only be possible but also beneficial. Ask if there is a COVID-free area where you can visit, such as a private family room. If you won’t encounter staff or residents on the unit with COVID, the risk is minimal.

Editor's note: Answers have been edited for clarity and brevity.

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