It’s important to examine the first-order failures of the pandemic response.
It’s important to examine the first-order failures of the pandemic response.
I wrote my first column on the pandemic almost two and a half years ago, before it was a pandemic, and in that column I explained my experience with issues relating to viral epidemics. Briefly, at the end of the Aughts I co-chaired two congressional commissions with Senator Bob Graham on the national-security dangers of biological agents. Senator Graham and I were so concerned by what we learned that we then started a nonprofit organization that conducted what is still the only stem-to-stern evaluation of America’s pandemic-resilience capabilities.
In October 2011, our nonprofit issued a report card on the public-health system’s preparedness for a global event. After what has happened in the last 30 months, no one will be surprised to learn that the system as it existed then got failing grades. Since that time I’ve lectured on the subject and also participated in war games involving hypothetical pandemic-response exercises.
In certain pockets of the country and in certain aspects of life, pandemic measures persist. And the virus itself lingers, though cases and deaths have become unlinked, thanks to widespread immunity. But Americans are largely — and rightly — acting as though this pandemic is coming to an end. So it’s time for another assessment, this time not of the government’s preparedness but of its performance during the emergency.
In my view, the response to Covid-19 was reasonably satisfactory through the spring of 2020. The federal government was stockpiling supplies, vigorously investigating different therapeutics, and collecting and disseminating data about the virus; state governments were managing the medical response to the pandemic curve, with everything that entails.
I would have bet good money that no vaccine could be produced within a year at the earliest; the fact that the federal government managed to get the vaccine and begin distribution inside of about ten months is the one unquestionable success of the pandemic response, particularly given the backward state of vaccine science only a decade earlier.
Which is not to say that comprehensive vaccine mandates made a whole lot of sense — especially given the highly age-stratified nature of the risks posed by the disease.
I also understood the original spring 2020 lockdowns. They gave authorities time to gather information about the virus, catalyzed the public understanding that a serious pandemic was upon us, and allowed everyone a breathing space to consider how best to balance risk in their own lives.
But as the spring of that year turned to summer, too many jurisdictions began losing perspective, placing too much focus on disease suppression and too much faith in the efficacy of lockdowns as a suppression tool, and failing to recognize the downside consequences of the restrictions they were imposing and the need to balance against them.
In any major endeavor, it’s important to choose the strategic goal — to define what constitutes success — and to pursue it with discipline. The goal in pandemic response is to minimize the total human harm over the duration of the pandemic. Human harm includes of course the serious illness and death caused by the disease, but it also includes the deprivations people suffer when the normal patterns of life are seriously disturbed.
Until Covid-19 appeared on the scene, public-health authorities generally recommended against lockdowns as a means of controlling viral spread. This paper from the pre-Covid literature (published in 2006) represents the prevailing view of public-health authorities at that time, which was, as I heard often during those years, that “we isolate the sick, not the healthy.”
The basic logic behind this formula is simple. Because highly contagious viruses are, well, highly contagious, lockdowns are of questionable value in suppressing transmission, but they do most certainly cause or aggravate a number of human deprivations, including loneliness, depression, anxiety, abuse, addiction, untreated illness, and severe economic dislocation.
In other words, the “juice” you get with lockdowns — the viral suppression — isn’t likely to be worth the squeeze. That’s why the 2006 paper concludes by stating as an “overriding principle” that “communities faced with epidemics or other adverse events respond best and with the least anxiety when the normal social functioning of the community is least disrupted.”
The response to Covid-19 over the last two years has validated that principle. Most jurisdictions imposed prolonged and severe lockdowns, but some did not; and comparing the disease curves of the ones that did with the ones that didn’t never showed any clear connection between the lockdowns and suppression of serious illness and death. Nor is there any correlation now, among the 50 states, between the severity of lockdowns and the number of Covid deaths per million.
If lockdowns worked, the correlation should be there. There should have been a reasonably clear and consistent inverse relationship between lockdowns and infection, illness, and death. But there wasn’t. There was a lot of noise but no signal — plenty of sound and fury, but whether it signified anything is greatly in doubt.
The story internationally is the same. Sweden is the great outlier in Western Europe — the country that most visibly resisted heavy-handed lockdowns — and its rate of Covid deaths is well below the European average.
Of course there are many factors that affect viral transmission, and it is possible the lockdowns significantly reduced transmission but that the effect was negated by other factors peculiar to the more heavy-handed jurisdictions. But the chance of that is not robust, much less proven, and in any event possible benefit isn’t enough when the downside consequences of a prolonged lockdown policy are so great.
The human harms of enforced isolation are no less real for being in most cases just below the surface. We know that limiting access to health screening and elective procedures for a prolonged period will lead to deaths that were preventable. We know that keeping kids out of school, and shutting them off from recreation and social contact, will limit their opportunities and induce various childhood traumas. We know that social isolation aggravates addiction, abuse, mental illness, unemployment and business failure, and deaths of despair.
We don’t know how great the damage has been or will be, because it is difficult to quantify, and because by and large governments have been too focused on viral suppression even to attempt to quantify it. But the harm has been substantial, its effects will be with us for a very long time, and it appears more and more likely that it will end up overwhelming the direct medical impact of the disease.
To be sure, no matter what governments did or didn’t do, the pandemic would have generated harm downstream of its immediate effects on individual health. The very presence of a highly contagious and potentially deadly disease would of course interrupt normal social and economic interaction. But this effect cuts both ways: Even without mandated restrictions, much of the public would have voluntarily limited activities that tend to spread the disease. The difference is that lockdowns prevent individual people from balancing and therefore minimizing the risks of harm based on their own circumstances.
I will use my family as an example. My 91-year-old mother-in-law lives with us, so we are, obviously, in the high-risk category. Of course we knew that until a vaccine was available she would have to restrict her activities. She didn’t go to the casino for over a year (a sacrifice for her and the casinos), and we ate out (one of her real pleasures) much less often, but we encouraged her to continue doing aquatic exercise classes with other senior citizens at the community pool, because the risk of transmission there is low and exercise is so important to her mental and physical health.
Unfortunately, the pool and restaurants were closed for long periods. The casinos, on the other hand, remained open.
Aside from the most obvious deprivations of lockdown policy, it has also aggravated the distrust of government, undermined the credibility of leaders who themselves violated the restrictions they were imposing on everybody else, and turned the police in some jurisdictions into, at best, busybodies and spies and at worst something reminiscent of security forces in authoritarian regimes. To justify such extraordinary measures, and get compliance with them, public-health officials harped on the dangers posed by the disease, to the point of creating a kind of hysteria among parts of the population.
Heaven knows Covid-19 is bad enough without painting it as worse than it is. It’s not the flu, but it’s not the Spanish flu either. The direct risk it poses to most of the population is quite small, and the overall infection fatality rate is much lower than was originally feared. Yet many political leaders, having failed to pay sufficient attention to the danger of a pandemic in the first place, evidently tried to atone by constantly overestimating the actual risks.
That created a self-reinforcing cycle: Fear of viral transmission led to lockdown; justifying the lockdowns required emphasizing the danger; heightened visibility of the danger made it more and more difficult to get out of lockdown; continued lockdown inevitably provoked opposition; sustaining the lockdowns in the face of opposition required even greater emphasis on the danger, and so on, until a balanced response to the pandemic became in many jurisdictions impossible.
It didn’t help that the most prominent public-health leaders circled the wagons, suppressing or shouting down dissenting views, even when they came from distinguished scientists with highly relevant expertise. The messaging about the virus was so unbalanced, and the resulting fear so pronounced, that by the spring of 2021, over a third of Americans overestimated by a factor of ten the danger of hospitalization from Covid-19 — a fact that by itself shows the utter bankruptcy of public-health communication regarding the disease.
This cycle of miscommunication and fear is the only way I can explain the first-order policy failures that have occurred.
I can understand why the schools closed in the spring of 2020 during the chaotic early phase of the pandemic. But they should have been open in the fall of 2020 at the latest, with appropriate accommodation for high-risk personnel. Instead, millions of American kids were denied an education for the better part of a year and a half, at the same time that the government was heaping their generation with trillions more in national debt.
Yes, there is a risk of children transmitting the disease, or becoming seriously ill themselves. But the risk is quite low, and the schools had the summers of 2020 and 2021 to prepare for it; and given the catastrophic harm of prolonged school closures to students, and to the broader community as well, the risk should have been accepted to the extent it could not be mitigated.
The Great Barrington Declaration, written in October 2020 by three distinguished epidemiologists and since then signed by over 50,000 medical scientists and practitioners, should have been given much more serious consideration than it was. It advocates a policy of “focused protection” for high risk demographics combined with much lighter restrictions on the rest of the population.
The Declaration deserved better than to be ignored or dismissed on the ground that it would just “let the virus rip” or because of the logistical difficulties of focusing protection on the higher-risk population. If we know anything about Covid-19, we know that the risk it poses to younger people is very small. A policy that allowed them to circulate while isolating the elderly, if it could have been implemented, would have minimized the secondary harms to the young without increasing the primary risk to the vulnerable — exactly the kind of balance we should have been seeking if the object was, as it should have been, to minimize total human harm over the duration of the pandemic.
And why would focused protection have been so hard to implement, compared to the difficulty of locking everybody down? Isolating the elderly and frail from the virus had to be easier than isolating everyone from everybody else. In fact, I was concerned as early as May 2020 that the challenge of enforcing general restrictions would distract authorities from the more urgent task of shielding the truly vulnerable, and therefore actually increase the danger for the elderly. As it turned out, as of the time vaccination was beginning, a third of Covid deaths had occurred in nursing homes.
Finally, the authorities were reluctant even to admit, much less take advantage of, the growing natural immunity as the pandemic moved through its various stages. The strength of any highly contagious coronavirus is its ability to penetrate the population despite attempts to suppress transmission. The weakness of such viruses is that they only get one shot at infecting their hosts, because those who have been infected and recover have immunity, at least for a season.
It’s true that when the pandemic began we didn’t know the duration of that immunity, but we knew as time passed that it had to be substantial, because if that were not true there would have been thousands of confirmed cases of reinfection. There weren’t. The Omicron variant has been somewhat more effective at penetrating natural immunity, but it didn’t even appear until six months ago.
The almost complete absence of reinfection is the big dog that never barked in this pandemic. I cannot imagine why the authorities never even attempted to use it to mitigate the secondary harms of the disease.
If the infection fatality rate of the virus is around 0.5 percent — and it could be much lower — that means that there are right now, and without including those who have been vaccinated, upwards of 200 million Americans who have already had the disease and recovered. As the pandemic wore on, more and more of those individuals were tested and diagnosed; we knew who they were, knew they had recovered from infection, and therefore knew that it was extremely unlikely that they could get it again or transmit it.
Those people represented a tremendous resource for their families, friends, and communities.
They could have been allowed to visit sick relatives and encouraged to help their older neighbors. They could have worked when other employees were ill or isolating. The teachers among them could have helped the schools stay open; health professionals among them could have kept screenings and elective procedures available; those with sufficient resources could have supported small businesses by eating out more often or going more often to the barber or the salon or the gym.
There is in America a great reservoir of charity, optimism, and fighting spirit. It should have been allowed to express itself in some way other than wearing a mask to go to the grocery store.
Natural immunity is not bulletproof protection, but that is not a sufficient reason for failing to take advantage of it. Once a deadly virus has seeded in a population, no policy is entirely without risk. The whole point of pandemic resilience is to prepare as much as possible in advance and then during the emergency identify the risks that should be accepted because of their potential rewards. In the years before Covid-19, government failed at the first task; and now it has, on the whole and in consequential ways, failed at the second.
Too many jurisdictions in the Western world fought this pandemic war the way the Great Powers fought World War I. They relied on a kind of trench warfare, running their battalions again and again against the virus at its strongest point — its ability to find vectors of transmission — and suffering each time great and growing loss in return for at best modest and temporary gains. By the summer of 2020 at the latest, they should have stepped back, evaluated their tactics, and sought policies aimed at the enemy’s weakness rather than its strength.
There should have been more Floridas and fewer Californias.
We can hope to be better prepared for the next pandemic that hits our shores. Advances in vaccine science and therapeutics should make it possible to develop medical countermeasures — to go from “bug to drug” — more quickly and certainly. Hospitals should have better plans to surge ICU capacity. If the people who run the National Governors Association have a brain in their heads, every sitting governor will have participated in tabletop exercises to prepare for the next public-health emergency.
The government might even try implementing the recommendations Senator Graham and I made over ten years ago. Political leaders and health advisers must keep the main goal of the response firmly in mind: to minimize the total human harm over the duration of the pandemic.
Winston Churchill said once that “all wisdom is not new wisdom.” In responding to Covid-19, we had the public-health wisdom of the past at our disposal. Would that we had followed it.