The COVID-19 pandemic has been devastating and tragic. It is not over yet, and it remains to be seen whether the world can achieve a state of normalcy in the near future. The vaccine rollout is well underway, especially in developed nations, but new variants and the abandonment of safety measures may allow the virus to continue to reap a harvest of death and sickness for many more months.
When one looks back at the way the pandemic occurred there are many interesting facets to explore. I will look at a few in this essay. No doubt there will be exhaustive research in the years ahead to attempt to shed light on the many mysteries of the pandemic. There are so many variables to consider and so much data to analyze. It will take a vast effort to comprehend its course and there will certainly be multiple conflicting theories, but hopefully a much better understanding of how to manage through a pandemic of this nature will emerge.
The first thing I will describe are the interesting comparisons between COVID and the yearly influenza that have stubbornly diminished the gravity that many people assigned to the pandemic. Trump and his entourage trivialized COVID initially by comparing it to the flu, and armchair epidemiologists still continue to come up with fatality rate comparisons that in their minds equate COVID and the flu.
First, one look at the hospitalizations and healthcare overload crises that continue to occur with COVID should be evidence enough that there is a vast difference. However, putting that aside, the impact of COVID compared to the flu is dramatically different. Unfortunately, the CDC itself unwittingly contributed to the confusion on this comparison.
In 2004 the CDC changed its methodology for reporting flu ‘burden’. In fact, no one knows how many people die from the flu each year. Very few (less than 500 each year) deaths can be directly linked to the flu via positive tests for the virus. Instead, the CDC uses a statistical analysis of deaths from diseases that the flu may cause – primarily pneumonia – and estimates the number of deaths.
The change in reporting was made to encourage vaccination. There was a concern that people were not taking the flu seriously. So, a public relations effort was initiated to more or less ‘scare’ people into getting the vaccine. It was done with the best of intentions, but the unintended consequence was to make large numbers of deaths seem like the typical result of any virus. The CDC’s PR campaign estimates the number of yearly flu deaths at 30k – 60k. The actual death numbers could be a few thousand.
Critics will retort that COVID deaths are also inflated. However, this is unlikely to be the case because COVID deaths have almost all been verified by testing for the virus, and the deaths correspond very well with the excess deaths that have occurred (the number of deaths in excess of the statistically reliable yearly average).
Few people understand statistics. The IFR (infection fatality rate) of COVID has been difficult to pin down in real time but it is estimated to be between 0.8 and 1.0, meaning about one out of a hundred COVID infected people will die. The IFR for the flu is estimated at 0.1, but given the uncertainties and history of flu death assignment, the true number is probably much lower. The 10-fold difference (or much greater in all likelihood) is huge, but somehow people have continued to play down the dangers of the COVID pandemic in comparison to the flu.
Another interesting aspect of the pandemic is the history of preventive measures different countries took to combat the spread of COVID-19. There are many mysteries surrounding the manner in which the pandemic developed and spread. For example, the lack of catastrophic impact in many developing nations in Africa is very hard to understand, even accounting for differences in average age.
The primary countermeasures used by developed nations were the following: economic shutdown or partial shutdowns, forbidding or severely limiting group activities, encouraging and enforcing social distancing and mask-wearing, and severely curtailing travel.
The countries that strictly enforced these measures in the first wave of the pandemic were successful in either totally eliminating the contagion (New Zealand, Australia, Japan, Vietnam, Hong Kong, Taiwan, Korea, China and others) or reducing the level of contagion to a ‘manageable’ level. For example, Europe was able to get their positivity rates (% of tests that were positive for COVID) under 1-3% and resume relatively normal life from mid-May to mid-September because they locked down until the rates were very low and conducted mass testing and tracking programs thereafter.
The USA, under a President who encouraged states to abandon lockdown much earlier than they should have and expressed skepticism of masks and other social measures, never achieved a positivity rate below 7-8% and never mobilized enough testing and tracing to subdue the virus. Thus, the USA was unable to resume anything close to normal life.
Some countries, and in particular the European countries, ran out of patience with the lockdowns and social measures and the late summer holiday period sparked a new, invigorated outbreak that has continued to defy control measures to this day.
The USA has continued to have a high case rate and a high death rate throughout, though not as dramatic recently as some of the European nations.
The last confusing aspect of COVID that I want to address here is the tendency to grade the performance of individual countries by looking at the death rate per million and then do comparisons based on this statistic. This is specious reasoning. Each country faces a unique set of circumstances and its performance must be based on an overall analysis of its response, not just on a single statistic. Brazil, universally condemned for its poor response, has a death rate of 1754/M today, while the UK has one of 1867/M. The UK made some mistakes, especially early on, but to suggest that somehow Brazil outperformed the UK based on this statistic would be ludicrous.
It is very difficult to compare one nation with another. There are so many variables to consider. However, it is clear that the countries who have had strong public adherence to basic health measures such as masks and social distancing have fared much better than countries where people are skeptical of medical advice and stubbornly insisting on their ‘freedom’ to do as they please.
The dilemma every country faces – whether to sustain economic and social activity versus enforcing healthcare policies and regulations – is not easily navigated. What is clear is that the countries who aggressively pursued public health policies from the start fared much better than those (like the USA) that dithered and abandoned their efforts at the earliest opportunity.
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