How Well Was COVID19 Handled? What Should We Have Done Differently?

The COVID19 pandemic saturated the news for a good eighteen months or better. Lately we don’t hear much about it anymore. If topics jawed about by the usual talking heads are to be gauged, everyone is over the whole pandemic thing. Few places still require masks and few people still voluntarily wear them. This, of course, ignores the fact that, with some six-and-a-half million people dead as a result of COVID infection, and ten times that many who got it and lived, there are a good deal of people who had their lives changed dramatically and permanently as a result of the pandemic. But now that the virus is endemic in a seemingly less pathogenic variant, it is a topic that has taken leave of the rapidly shifting zeitgeist of our modern times. Now is the time for postmortems by commentators and historians. That’s what I’m about to do here (as a commentator, not a historian).

This post inspired by this one on Quillette by George Case.

One of the issues that still gets discussed (when the pandemic is discussed at all) was about whether the various measures that were implemented were more harmful than helpful. People of course want someone to blame for the current issues caused by the pandemic and our responses to it. I made the following two points in a July 2021 post on this blog that I think are still relevant to this discussion:

First, it is difficult (if not impossible) to determine whether the measures we have taken to reduce the spread of the virus has helped: since we don’t have a control group (a world in which no measures were taken) to compare the infection rate and death rate to. What we can do, however, is compare influenza rates between years to see how the measures we have taken helped with the spread of that disease (and attempt to extrapolate to COVID): and the data show that the rates of influenza dropped precipitously during the COVID measures. This is not definitive proof that the measures we took to slow the spread of COVID were effective against COVID, but it certainly suggests that things could have been a lot worse had we done nothing.

The second thing to remember, though, is that it was not COVID that caused our current economic issues, but the measures we took to slow the spread of COVID. Just like how most symptoms of an illness are not directly caused by the pathogen itself, but by our body’s attempt to fight the illness, our economic issues that have resulted from the pandemic are mostly as a result of our own attempts to fight the disease.

Only with these two things in mind can we accurately assess whether or not our reactions were commensurate with the threat and whether or not we should have done more or less to combat the spread of the coronavirus.

That the measures taken to reduce the transmissibility and pathogenicity of COVID would have negative effects is predictable. If that were not the case, then some of those measures could conceivably be permanent in an effort to prevent pandemics from happening at all. But ideally such measures are only implemented when necessary, and only for as long as necessary. Both of those conditions (when necessary and for as long as necessary) are important. The first, discussed at length in the Quillette article by Case, has to do with whether or not certain policies actually did anything to help, or even if they were a waste of time, effort, money, and/or good will. He compares the COVID measures to those taken during World War 2:

The Second World War lasted six years, during which countless grand and small policies were devised, and countless trillions of dollars were spent, to win it. Since 1945 and in subsequent decades, observers have contrasted the contemporary reports of the conflict’s progress with information since gleaned from hindsight that suggests some of the policies were ill-advised and many of the dollars were wasted. Celebrated turning points hailed by Allied propaganda, like the Battles of Midway or El Alamein (1942) or Stalingrad (1943), were still followed by years of suffering and death, and the enormous Anglo-American bombing campaign against Germany (1942–45) has been criticized as a misallocation of manpower and resources that had less effect on the Nazi war machine (and at a greater cost in civilian and aircrew lives) than its planners predicted. Numerous shortsighted diplomatic maneuvers, tactical blunders, and inadequate weapons could also be named, whatever patriotic leaders and a compliant press might have argued to justify them at the time. No one contends that the Allied military commanders—or the frontline fighting men—weren’t dedicated to the cause of victory, but what we know now indicates that even some of their most ambitious operations and heroic sacrifices may not have been worth the results.

So too over the last couple of years: the sealed borders, the stop-start shutdowns of businesses, schools, and offices, the enforcement of social distancing and masking regimes, and the sprawling vaccination programs and public expenditures, have all been cited as crucial to our eventual triumph over an unprecedented threat. But then, the same was said about the Canadian Army’s casualty-strewn raid on German-occupied Dieppe in 1942, the forced evacuations and internments of American and Canadian citizens of Japanese origin, the bloody Allied slog through the rugged defenses of Italy, the aerial apocalypses visited upon Dresden, Tokyo, Hiroshima, and Nagasaki, and the postwar heel of Joseph Stalin’s USSR across eastern Europe. Subsequent scholarly study has raised serious doubts about their strategic value, their long-term geopolitical consequences, and their very morality. Even after a gratifying conclusion, we’ve critically reassessed the decisions of the politicians and the generals, we’ve weighed the war’s effects on our economy and our society, and we’ve wondered if we might have won sooner, better, or if we might have prevented the war to begin with. In coming years, we may be asking the same sorts of questions about this very different calamity, managed and mismanaged by a different set of authorities, which has shattered another generation and which will leave its own lasting scars on all of us.

Some of the consequences of our pandemic measures are things I experience in my life. I work as a math and science tutor at a university. A lot more students are struggling with their coursework than before the pandemic. Many of the classes are still conducted completely or partially online, which appears to result in some professors exerting less effort to foster success among their students. And, whether out of persistent fear or virtue signaling, there are still people who wear masks on campus (not very many, but I see one or two people every day at work with a mask on).

Other issues have cropped up in the news, too. One notable one is that people’s immune system seem to have atrophied somewhat with all the measures taken. For instance, the uptick in both flu and Respiratory Syncytial Virus (RSV) infections. Again, in my position as a tutor at a university I’ve definitely noticed a lot of both students, faculty, and staff who have gotten sick with anything ranging from a cold and up to fairly severe illnesses (one professor I know was out for several weeks). 

But it is the second condition I mentioned, that measures are implemented only for as long as necessary, that people are also worried about. So-called COVID passports are among those long lasting policies, and the slippery slope of how the government might implement a social credit system in the same vein (i.e., you need official documentation attesting to your virtuousness in order to receive certain privileges). The trampling of civil liberties in response to a crisis is as old as the state itself. The term “never let a good crisis go to waste” has been attributed to many people (e.g., Rahm Emanuel), but every attribution is to a government official or politician of some kind. Indeed, where the full quote attributed to Rahm Emanuel is “You never want a serious crisis to go to waste. And what I mean by that is an opportunity to do things that you think you could not do before.” This is because the government, especially in a democracy, must at least pay lip service to justifying some policy or law as being to the benefit of the constituents. A crisis offers a great justification. Civil liberties only exist because of constraints imposed on the government itself (e.g., the U.S. constitution is almost entirely about what the government is and is not allowed to do, not what the people are allowed to do), and so government officials who feel hamstrung by those restrictions are always looking for an excuse to loosen the restraints, and once it is done temporarily, it becomes much easier to extend policies indefinitely (think of the post-9/11 policies like the Patriot Act, or even further back to the Espionage Act) or to reinstate such policies for lesser crises in the future. As such, it is a legitimate worry whenever policies meant to address a crisis are implemented, and thus it should only be done with caution.

On the other side of the ledger, there is a legitimate need to have temporary measures to address crises. What those measures are is certainly open to discussion, and surely should be commensurate with the severity of the crisis, but it would be absurd to say that nothing ought to be done when a pandemic arises. I may not be a card carrying libertarian anymore, but I do still maintain many libertarian sympathies. But it is during a crisis like a pandemic when implementation of temporary policies restricting some civil liberties (commensurate with what is likely to prevent harm) is a legitimate function of the government. And, as I discussed above, I’m probably more worried than the typical average person about the slippery slope of having those temporary policies be extended indefinitely, but that fear should keep us skeptical and cautious, but not irrationally contrarian.

If it can be agreed that some level of temporary emergency policies are legitimate, the question obviously then becomes: which policies were commensurate with the level of danger posed by COVID, and which ones are likely to be a net benefit in reducing the transmissibility and pathogenicity of the virus? Masks? Social distancing? Lockdowns? Mandatory vaccinations? Phone apps that monitor where we go and who we interact with?

This question has two parts: (1) what was the actual danger posed by COVID, and (2) what measures were commensurate with that danger?

For (1) according to the World Health Organization (WHO) the total number of cases worldwide (as of November 21, 2022) is 634,522,052 and the total number of deaths worldwide is 6,599,100. The site Our World in Data puts those numbers at roughly 638 million and 6.62 million respectively. In June of 2022, Galvani et al. reported that the United States had over 973,000 reported deaths attributed to COVID-19 as of March 14, 2022, with the United States representing 16% of the documented worldwide mortality burden of the virus, while only composing 4% of the global population. WHO also reported in December of 2021 that over half a billion people have been pushed further into poverty due to healthcare costs associated with COVID infections.

There is skepticism about the death toll, with people accusing hospitals of attributing deaths “due to” COVID with deaths either “with” COVID (see this, this, and this) or even hospitals outright lying in order to receive government money. In the latter case, the claim is that in the U.S. fatalities not associated with COVID at all are being attributed to COVID in order to gain a Medicare add-on payment of 20% as per the Coronavirus Aid, Relief, and Economic Security Act (CARES Act), (the CARES Act was signed into law by former U.S. President Donald Trump on March 27, 2020). These claims have been largely debunked, but even if we say hypothetically that this practice was rampant both within and outside the U.S. and the true number is that only 10% of the deaths attributed to COVID were actually caused by COVID, that’s still some 600,000 people worldwide who died from COVID in just two years, which is not a trivial number (it’s more than the number of Americans who died in all of World War 2 and in half the time).

But, of course, the healthcare costs are not the only costs. In October of 2020, the estimated costs of the pandemic (including the economic costs, mental health costs, and so forth, caused by the measures taken against the pandemic) was $16 trillion USD. In April of 2022, it has been shown that this cost estimate was largely born out (within a range of $10 trillion and $22 trillion). Whether that price tag was worth it is certainly a matter of debate, and likely to be debated by scholars and historians for many years to come, but it’s important to keep in mind that economic costs don’t just mean that rich people failed to make greater profit. It is also reflective of things that hurt everyone, such as shortages of goods, rising inflation, job loss, and the associated physical and mental health costs of those things.

COVID cases and deaths worldwide (Source)

As for (2) whether the measures taken were commensurate with the danger posed by COVID, there were, broadly speaking (at least here in the United States), three types of measure taken: masks, social distancing, and pharmaceutical. Masks took on a politically symbolic meaning during the height of COVID. See the references at the bottom of this post for some of the scientific literature on the effectiveness of mask wearing. To summarize, the evidence appears to suggest that there is at least some effectiveness to mask use when the policy is observed by a critical mass of people. As far as the masks go, although it took on such symbolic importance in the culture war theater of COVID19, and even though wearing a mask is uncomfortable and annoying, it seemed to me the policy that was least invasive and easiest to prevent from being extended indefinitely. As such, to me it seemed to be the best policy to adopt, especially with the costs of adherence even if it turned out not to be all that effective being minimal.

Social distancing was probably the policy with the greatest potential for the highest effectiveness (and for someone like me was not a difficult policy to adhere to) since coming in proximity to one another is a necessary condition for the spread of the virus. Social distancing, of course, wasn’t some voluntary guideline people could choose to follow. So-called non-essential businesses were forced to temporarily close and/or go to online-only. There was money made available, but the fraud that resulted is widely attested to in the news media. The result, however, was that a lot of small and mid-sized businesses struggled, or even went out of business, while big business seems to have largely thrived during the COVID era. Online work and online schooling have resulted in myriad effects, but a couple that get mentioned quite often are the mental health effects of fear and isolation caused by the pandemic and the measures taken, and setbacks in learning (i.e., students are now struggling as a result of the less-than-adequate online classrooms and teacher shortages). There are also accusations here in the U.S. that the current rate of inflation was at least partly due to all the pandemic relief money given out to people.

COVID impact on small and medium-sized enterprises (SMEs)(Source)

Another issue is that the measures (possibly mixed with an unhealthy dose of isolation related mental health issues) have resulted in a growing distrust of societal institutions, further adding to the political polarization that was already occurring prior to 2020. Part of this is due to distrust of science, but another part has to do with the lies about the origins of the SARS-CoV-2 virus. Whether the virus came from a lab or from a natural source (bats and/or pangolins) became another politically significant symbol, where belief in one hypothesis or another (and, of course, vociferously voicing that belief) became a refrain that advertised one’s political allegiance. While as far as I can discern from the scientific evidence (rather than news media and other talking heads) the virus appears to have been created in a lab, most likely in the service of so-called gain-of-function research.

The third of the measures I mentioned was pharmaceutical. The rapid drive to develop a vaccine for COVID19 was followed closely by both the pro- and anti-vaccine people alike. The actual development of the vaccine was not that costly in terms of economic impact, but it has become a major political football to be kicked around by all sides, with some being so pro-vaccine that they believe it ought to be mandated and that penalties be imposed on those who fail to comply. Others see the vaccine as suspicious and/or harmful and think it ought to be refused by everyone. Still others (with Joe Rogan being a visible person promoting this view) is that the vaccine is probably unnecessary for most people, perhaps only required by those who are predisposed to complications caused by COVID. Others, and I fall somewhere in this camp, think that the vaccine is probably a net good for everyone to take, but do not think it ought to be mandated.

In the end, it is probably still too early to really determine if the measures taken against COVID were worth the price we had to pay (and are still paying, and likely to continue paying long into the future). I would say again that some measures were necessary (i.e., it would have been wrong to have just done nothing), but future scholars and historians are almost certain to find that some of the measures cost more than their benefits warranted, just as George Case said in the Quillette piece about historians who study World War 2. But an honest look at what the costs and benefits were is a necessary propaedeutic to any meaningful study of the subject. But, as Case points out, it is always difficult to determine while in the midst of a crisis just which measures were helpful and which could have been jettisoned or rejected altogether. I hope that this post at least laid out some of the issues that need to be considered as we reckon with the COVID years and their lasting impact on society and the economy.

References About Mask Wearing

Mask wearing in community settings reduces SARS-CoV-2 transmission

An evidence review of face masks against COVID-19

The Impact of Community Masking on COVID-19: A Cluster-Randomized Trial in Bangladesh

Face masks effectively limit the probability of SARS-CoV-2 transmission

Efficacy and practice of facemask use in general population: a systematic review and meta-analysis

Effectiveness of face masks in blocking the transmission of SARS-CoV-2: A preliminary evaluation of masks used by SARS-CoV-2-infected individuals

Mask Effectiveness for Preventing Secondary Cases of COVID-19, Johnson County, Iowa, USA

Effectiveness of Face Mask or Respirator Use in Indoor Public Settings for Prevention of SARS-CoV-2 Infection – California, February-December 2021

Need for more robust research on the effectiveness of masks in preventing COVID-19 transmission

Unmasking the mask studies: why the effectiveness of surgical masks in preventing respiratory infections has been underestimated

To mask or not to mask: Debunking the myths of mask-wearing during COVID-19 across cultures