Who’s to Blame for a Million Covid Deaths in America?

"“Something clearly went wrong,” Anthony Fauci told me, reflecting on the long pandemic, in an interview for The New York Times Magazine. “I don’t know exactly what it was.”

It has been a brutal three years. As the Covid-19 death toll first grew past 100,000 and then did that 11 times over, the country cast around desperately for those to blame, not just for the growing mountain of American deaths but also for unprecedented disruptions to the lives of survivors.

It was China’s fault, or Donald Trump’s, or the spring breakers in Daytona Beach or those selfish enough to travel home for Thanksgiving. It was those who forced essential workers to stay on the job and those who kept ordering delivery from them. It was the people who socialized in “pods” and those who weren’t strict enough about them. It was the Sturgis motorcycle rally in 2020. It was those who cut the line to get vaccinated, then those who didn’t get vaccinated, then those who stopped wearing masks once they did. It was conservatives who called Covid a disease of the elderly, and it was liberals who called it a terrifying, society-ordering risk. It was the governors who reopened and those who didn’t, and those who insisted that Omicron was mild and those who insisted it wasn’t. It was the teachers unions. It was the kid who infected the whole fourth grade. It was the parents who didn’t feel safe reopening classrooms at all. It was the people who didn’t bother to install air-filtration systems despite billions in federal funding and those who didn’t stage randomized control trials to measure the actual threat of transmission in schools. It was people who didn’t talk enough about long Covid and people who never talked about anything else. It was those undermining the vaccines and then those overlooking their shortcomings. It was mask holdouts, once we could no longer complain about mask mandates. It was the unvaccinated and it was Joe Biden saying “pandemic of the unvaccinated.” It was the C.D.C. revising its thresholds for local spread, then telling you it was safe to return to work after five days even without a negative test. And it was those people who kept annoyingly insisting that the pandemic wasn’t over, when, in truth, well, it both was and wasn’t.

It was the virus, in the end, in ways hardly any of us were comfortable acknowledging. And so many, instead, pointed fingers at one another, whether we wanted more done or less. Perhaps out of a desperate need to believe that it was actually possible to defeat Covid-19, we chose to tell morality tales about pandemic response.

Many of those tales centered on the same octogenarian, sometimes as hero and sometimes as villain. Anthony Fauci had already been canonized for his work during the AIDS epidemic and found himself sainted again for “standing with the science” whenever he found himself standing next to Donald Trump.

When Fauci retired in December, after leading the National Institute of Allergy and Infectious Diseases for nearly 40 years, roughly 2,000 people were dying of Covid each week, yet anyone pointing it out sounded hysterical.

At least 30 states have passed measures limiting the government’s ability to enact public health measures in future pandemics. Surveys of public health officials suggested that even faced with a deadlier and more transmissible virus, many experts believe the country should probably do less to stop it. The month that Fauci retired, a national survey found that just 55 percent of Americans said they trusted the country’s public health institutions to manage a future pandemic.

It’s hard to know now how much of that decline in confidence was inevitable — a result of trying to offer concrete public health guidance despite unavoidable scientific uncertainty.

But there were also undeniable mistakes, including by Fauci himself: describing the threat as “minuscule” in February 2020, advising against mask-wearing at first, moving slowly to acknowledge aerosol spread and downplaying the risk of post-vaccination infections in the summer of 2021.

We were told, again and again, that the lab-leak hypothesis was a conspiracy theory, though many of those saying so had entertained the possibility quite seriously themselves. We were told to expect herd immunity when as little as 60 percent of the country had been infected or vaccinated, and that once we’d gotten our shots, we could count on leaving the virus behind.

Policies we somewhat improvised, often collectively and out of fear, tended to yield to feelings of regret powered by hindsight and resentment. Almost certainly, schools stayed closed longer than they needed to. American vaccination rates never approached the levels of many peer nations. Clinical trials hadn’t even tested for vaccines’ effectiveness against transmission, and with little good data on boosters for the young, the F.D.A. authorized them anyway. And while we heard an awful lot about gaps in both uptake and death rates by partisanship, we somewhat whistled past those by education, income and race that were also significant. There was no effective federal paid sick leave after the initial pandemic panic, and when the public health emergency ends next month perhaps 15 million Americans could soon be booted off Medicaid.

In 2020, liberals believed that ending the pandemic was a matter of electing a new president who would simply waltz in and hit the “science” button.

But while the new administration spoke more compassionately about the brutality of the pandemic, it also suggested it was primarily up to individuals to protect themselves. “We have the tools,” ran the mantra.

Nearly four times as many Americans have now died of Covid-19 since Election Day 2020 as had before it. And the ongoing death rate, while much lower than earlier in the pandemic, is holding remarkably steady at a rough pace of 100,000 Americans per year.

The casual normalization of Covid deaths over three years is a national moral failing. But today, much of the moral fervor of the pandemic has dissipated, and perhaps, as a result, we can begin to see the shape of our experience and response a bit more clearly.

Almost no nation in the world defeated Covid, and few managed to navigate it without an awful lot of death.

The United States did worse than its peer countries, all told, but it was not an extreme outlier in terms of excess mortality. Things were not always more restricted here than in many other rich countries, but often looser, school closings perhaps aside.

So what might success have looked like? According to The Economist’s gold-standard excess-mortality database, the United States has experienced between 1.3 million and 1.4 million “excess” deaths over the course of the pandemic.

Based on the size of our population, if Americans had died instead at the same rate as people did in Germany, among the lowest rates in the large rich countries of Europe, it would have meant about 975,000. If we had done as well as Japan, whose response was routinely celebrated, probably 500,000.

And if the United States had managed the same rate as Britain, which managed to distribute vaccines at an astonishing rate, it would still have surpassed a million.

Comparisons like these aren’t neat, given obvious national differences. But taken together they do suggest two big things. First, no matter how it responded, no large country was able to hold back Covid’s lethal threat.

And second, perhaps as many as half of American deaths could have been avoided. At least in theory.

But more than half of those people died after the mass rollout of vaccines began. In a proudly individualist country, where deaths were determined more by vaccination rates than by anything that gets described as “lockdown,” it is striking how little attention is paid to the role of vaccine skepticism and how much rhetorical fire is still spent adjudicating the mitigation arguments of the first year.

You may think the details of those early months are etched into your brain. But to revisit them is to take an unnerving trip through the pandemic looking glass. Donald Trump hadn’t yet made the right totally indifferent. Pandemic anxiety was probably greatest among a class of Silicon Valley conservatives who later became among the loudest critics of mitigation policies. The media was still reassuring the public, even telling us to worry more about the flu. And as mayors and governors contemplated school closings and shelter-in-place rules, they often talked about public panic as a greater threat than the virus. Health officials like Fauci did too.

If we had moved more assuredly early on to suppress spread, would the result have been all that different? Perhaps not, despite the mitigation fervor of those first months, given the pandemic’s many twists and turns. When I put the question to Fauci, he answered, remarkably, “I don’t know.”

Doubts like these appeared almost simultaneously with the virus, however sustained or oppressive the public health consensus seemed at the time.

“You are losing this argument, doctor,” then-CNN anchor Chris Cuomo told Fauci on May 4, 2020, less than two months after the W.H.O. had declared a pandemic. “People are fatigued.”

“For sure, for sure,” Fauci acknowledged. “That’s a very difficult choice: How many deaths and how much suffering are you willing to accept to get back to what you want to be, some form of normality, sooner rather than later?”

It wasn’t entirely a rhetorical question, and Fauci was clear about how he saw the obstacles. “People are going to make their own choices,” he said. “I cannot, nor anybody, force people under every circumstance to do what you think is best.”

It had been barely six weeks since the first shelter-in-place guidance had been issued. Across the country those “lockdowns” were already lifting. The country had just recorded its 70,000th official Covid death. More than a million would follow."

The biggest, Omicron, wave in China was late compared with biggest our waves in the West. Vaccines were available to everybody in China at that time. Who wanted to get vaccines, had them in China at that time. Therefore Chinese had more control over their personal life during the pandemic. 

 

In the event of a deadlier pandemic and major war, China's ability to delay a large wave of deaths could give it an advantage in war.

 

These are the main differences between our response to Covid and China's.