Japan hosted the 2020 summer Olympics, staged in the summer of 2021 due to a year-long Covid-19 delay. Japan, by any number of metrics did extraordinarily well at the games, coming in third in the gold medal haul, handily outperforming other traditional Olympic powers. And yet, despite this success, many Japanese athletes felt compelled to deliver tearful apologies at their ‘failures’ on winning silver medals.
The curious case of Japanese regret in a moment of triumph can only be explained when we remember that data (in this case, the medal type and count) are simply one input that drives our construction of meaning and truth. The Olympics were held amidst substantial local controversy as Japan was facing a surge in its Covid-19 cases. This made for added pressure on the host country to do well, so much so that anything short of gold was seen as a failure. This was a dramatic reminder of the powerful role that our expectation of success plays in our perception of that very success.
Take the Covid-19 summer of 2021 in the United States. What started as a season of optimism, with President Biden declaring a summer of freedom with the Covid-19 vaccine, quickly turned sour when, less than a month later, a majority of Americans again thought that the worst of the pandemic was ahead of them, rather than behind them. The rise of the delta variant fueled the dramatic change in American public perception as the US started seeing an increase in Covid-19 cases which had been waning over the earlier months of summer. But the delta variant was not doing anything that was unanticipated. The delta variant was driving viral spread among those who were unvaccinated, with a clear inverse correlation between state-level vaccination rates and new Covid-19 infections. Critically, those who had received the vaccine had a very low risk of re-acquiring Covid-19, and were at even lower risk of being hospitalized or dying from Covid-19. In addition, we had a precedent for how we were going to do with the delta variant as the UK preceded the US by about a month in its epidemic curve and readily showed that we could expect a waxing—and then a waning—of new infections principally among the unvaccinated in the US.
The return of the delta variant inexorably colored the US summer of 2021, in large part because after the third wave of Covid-19 in spring of 2021, our national expectation was that the worst was over. But stories about “breakthrough” infections returned Covid-19 to the headlines, displacing any sense we may have had that we were in a dramatically different phase of the pandemic—although we were. We entered the summer of 2021 expecting gold and instead got silver.
All of this suggests the importance of managing expectations always, and particularly in acute health crises. It matters little how many medals you win as a country—what might matter more is whether you won more, or fewer, than you expected. Similarly, Covid-19 teaches us that baseline expectation setting—and an awareness of the role that expectation plays in our own psychology—is critical for health if we are to be reasonably grounded in a data-informed reality. We want to make health decisions that are neither informed by unfounded exuberance, nor by irrational malaise, and to avoid the unwarranted defeatism that can arise when we devalue silver medals.
Michael Stein & Sandro Galea
As we re-emerge from the pandemic, 2021 stands to be a turning point year for public health. In The Turning Point’s weekly essays, we reflect on what we learned during 2020, and what we are learning during 2021, that can guide us to the creation of a better, healthier world.
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