Never before has health care been so intertwined with the economy. To borrow from Wall Street, the so-called bear tells us to shelter in place, not only to avoid getting COVID-19, but to keep from overwhelming the health care system. Meanwhile, the bull says we must reopen the economy to avert yet more job losses than those 30-plus million during the past five weeks. In doing so, we might mitigate increasing food and shelter insecurity and limit widening health and wealth disparities.

It would seem that for now Hawaii has dodged the COVID bullet, despite the fact that it was quite late in initiating its shelter-in-place strategy, and quite an outlier in terms of extending it for another month, despite relatively few confirmed cases. We are well-advised to look beyond the date that various services and activities first reopen.

COVID’s impact on the economy will be of great duration, far reaching and undulating. There is a real chance that, when Hawaii once more accepts visitors from around the world, more waves of isolation might be called for. Perhaps it is time to think even more seriously about green initiatives as we reopen the economy.

Qualitative changes to the trajectory will come only when there is ready availability of viral and antibody testing and the ability to securely determine who is contagious and who may now be immune to COVID. The trajectory also will change when we have an effective vaccine, but that will not come as soon as we would like. A scientifically proven, Food and Drug Administration-­approved treatment, possibly remdesivir, also would be impactful. However, research is still incomplete.

In the meantime, we must take stock of the new normal. Manakai O Malama quickly pivoted to add telemedicine services. While we anticipate many returning to face-to-face visits, we expect that telemedicine is here to stay. When visitors, restaurants and large public gatherings are given the green light, how many will feel safe enough to avail themselves of the opportunity? How many will continue to work from home and decide on home school for the keiki?

Nationally, the management of COVID may swing the next presidential election. Also, now that the pandemic has exposed the weak underbelly of the private-­public patchwork of American health care, there is likely to be a greater outcry for universal access. In addition, with so many parents lacking jobs to pay for college, and so many graduates unable to find work, there will be a stronger push for loan forgiveness and free public college.

While the CARES Act is sustaining countless small businesses through June 30, many still will fail after that. At the same time, earnings for Microsoft, Google and Amazon have been largely positive. Wealth will be further consolidated into the companies that are too large to fail. Still, the Federal Reserve’s unparalleled bailout leaves a burden of national debt that will weigh heavily on generations to come, impacting taxes and entitlement programs and posing the risk of rising inflation.

On the global stage, as one Irish journalist put it, for the first time the U.S. is more to be pitied than envied. China, meanwhile, is emerging as the greatest influencer. Its Belt and Road Initiative will swoop up economies that are now too fragile to resist in the absence of American leadership. The alpha spat between Russia Prime Minister Vladimir Putin and Saudi Crown Prince Mohammed bin Salman caused oil prices to drop into the abyss as a glut maxed out storage capacity, the result of their rise in output. What, then, of the stability of the other weak, oil-dependent economies of Venezuela, Brazil, Iran, Iraq, Nigeria and Libya?

Lest we fall headlong into our big, glossy screens, there is but one real choice, and that is to breathe, live in the moment, and to cherish our loved ones and our community. There never has been a more important time than the present to aspire to the Hawaiian term “malama pono,” that is to care and heal in a balanced, wholesome way. We must tend to our relationships, and our bodies.

In order to strengthen your ability to persevere, should you come down with the virus, be sure to maintain physical activity by setting small, attainable, weekly goals while at home to continue a sense of productivity. Be mindful when cooking and eating, and get a medical examination to ensure you’re as healthy as possible. Too many still neglect necessary care for chronic diseases such as obesity, diabetes, high blood pressure, elevated cholesterol and heart disease.

Now more than ever is a fresh opportunity to make amends, to reach out and express support and gratitude to those who have supported us. It is a time to let go of what we grasp too tightly and to relax our fixed views. It is a time to be open to change and to fully appreciate our island life.

Ira “Kawika” Zunin is a practicing physician. He is medical director of Manakai O Malama Integrative Healthcare Group and Rehabilitation Center (manakaiomalama.com). Please submit your questions to info@manakaiomalama.com