The Lessons of the Pandemic

With infection and death rates having fallen dramatically since their peak, with the number of vaccinations increasing—although not as rapidly as earlier in the year—and with travel, in-person shopping, and socializing expanding rapidly, life in the United States is returning to what was normal before 2020. Notwithstanding the recent uptick in infections due to the appearance of the more contagious “Delta” variant of the coronavirus, the end of the Covid-19 pandemic, if it has not actually arrived, is within sight. The virus will not disappear entirely but its impact seems to be on the way to becoming manageable, like that of an ordinary flu: annoying, still occasionally lethal, but not the cause of massive social disruption.

The decline of the pandemic affords a useful vantage point for assessing the American response to it. How well did the United States do—what did it do well and what, in retrospect, did it do poorly—in the beginning, the middle, and the end of this chapter in the nation’s history?

Responsibility for the failure to keep the coronavirus out of the United States does not rest with the American people or their government. Whether it originated in a laboratory or by transmission from an animal to a human, the chance to stifle it completely was lost when, after its initial appearance in the Chinese city of Wuhan, the Chinese government, employing a familiar communist tactic, denied its existence, suppressing news of the virus rather than the virus itself. Whether the local leadership in Wuhan or the national government in Beijing bears the major share of the responsibility for what happened—and what did not happen—is not clear, and will never be clear without a thorough, objective, retrospective study of the developments in Wuhan. This the Chinese authorities are unlikely to permit or conduct themselves, and, if they should conduct it, are unlikely to make public. What is clear is that, because of China’s ideologically driven initial failure to deal effectively with the virus, the 600,000 Americans who have died from Covid-19 may be counted, like tens of millions of people over the course of the previous century, as victims of communism.

When it did reach the United States, Covid-19 caught the country less than adequately prepared. This was, in one sense, unsurprising: a hundred years had passed since the last comparable episode—the influenza pandemic of 1918, which killed 675,000 Americans and 50 million people worldwide. Even so, on the basis of elementary prudence and the recommendations of several reports, the country should have had adequate stockpiles of personal protective equipment, especially face masks, but did not. Nor were the nation’s hospitals prepared for massive admissions of very ill people.

A serious shortcoming in the beginning stage of the pandemic was the failure to develop and supply in sufficiently large quantities cheap, reliable, easily administered tests for the presence of the virus. This handicapped initial efforts both to track and to cope with its spread. Other countries did better. The deadliest failure was the decision, made by New York Governor Andrew Cuomo and other political leaders, to move infected people into nursing homes, thereby placing tens of thousands of the most vulnerable Americans at heightened risk. An appreciable percentage of Covid fatalities stemmed from this egregious error.

Once it was clear that Covid had arrived in North America, the most sweeping and controversial measure adopted was the decision, taken state by state, to put the country in lockdown. It had the aim of “flattening the curve”—that is, spacing out the infections (although not necessarily reducing the number of people ultimately infected) so as not to overwhelm the country’s medical infrastructure.

Hospitals were ultimately not overwhelmed. Since the disease is spread in aerosol fashion through the air, it is logical to conclude that the lockdowns made an important contribution to preventing what public health officials feared might happen. Yet the available data do not provide convincing evidence for this. What is known so far does not establish a strong correlation between the presence of lockdowns and low rates of infection. It may not be possible to gauge reliably the impact that lockdowns had. In a June article in Vox, a public health specialist at the Kaiser Family Foundation was quoted as saying that “a surface-level analysis of Covid-19 outcomes and state-level policies misses many other factors that differed across boundaries and over time that also had an influence,” which leaves analysts in a position of “trying to draw firm conclusions about whether certain policies worked or not from data that can’t tell us that.” Still, it is important to make a continuing effort to collect more and better data, and to do further analysis based on those data, in the hope of arriving at such conclusions.

In the months-long middle part of the pandemic, once the virus had established itself in North America, two broad methods of coping with it were available: social and medical. In the social category, three “nonpharmaceutical interventions” (NPIs) were widely if unevenly practiced: the wearing of face masks; what became known as “social distancing” but in fact involved physical separation—a distance of six feet being generally recommended; and the avoidance of crowds.

Here, again, the available data do not lend themselves to firm conclusions about how well each technique worked, although a consensus does seem to have formed among public health professionals that mask-wearing did and does limit the transmission of the virus. Particularly vexing is the question of how effective school closings were. The virus produces mild symptoms, or none at all, in young people, which argues in favor of keeping schools open. Yet even without symptoms the young can transmit the disease to older, more vulnerable people: teachers in the classroom and parents and grandparents outside it. In retrospect, the closures probably did limit the spread of Covid, but also undoubtedly inflicted educational and psychological damage on children who did not attend school.

The NPIs had three unfortunate but probably unavoidable consequences. First, they had an uneven impact across American society. The risks were unequal. Those who could take advantage of the internet to work at home were far less likely to be infected than those who had to continue to commute to sometimes crowded workplaces. The considerable economic damage the pandemic and the responses to it imposed was also unequally distributed. Fortunate professionals, already the most affluent segment of society, simply did their jobs online, sometimes even more productively than before. By contrast, millions of workers and small-business owners lost their jobs and their businesses entirely.

In coping with Covid-19, all countries had to strike a balance between, as The New York Times columnist Thomas L. Friedman put it, saving lives and saving livelihoods. Since the formula for striking that balance is a matter of ethical preference rather than scientific fact, there can be no final verdict on how well the United States managed it. Still, in assessing the national performance in this area it is important to try to determine whether differently designed NPIs could have contained the disease while doing less economic damage, and which, if any, of these measures were ineffective and therefore did needless economic harm while doing nothing to restrain the spread and diminish the severity of the disease.

The second consequence of the NPIs is that they became absorbed into the sharply polarized politics of the United States. Rather than simple public health measures, mask-wearing and social gatherings became marks of cultural preference and political allegiance. In politically well-adjusted societies not everything is politically contentious. The measures for coping with the pandemic did not, unfortunately, meet this standard of political health.

Third, and relatedly, the measures deemed desirable for mitigating the impact of the virus, and especially the efforts of state and local governments to enforce them, came into conflict with the deeply ingrained libertarian and anti-government strains in American culture. Americans have practiced insistent, even militant individualism going back to the founding of the Republic, as had the colonists before then. In important ways, such attitudes have served the country well, giving rise throughout American history, for example, to the kind of nonconformist, sometimes even rebellious initiatives that make for successful entrepreneurship. The same attitudes that produced Steve Jobs, it might be said, limited mask-wearing and social distancing in the United States.

In the middle part of the pandemic the medical approach to coping with it achieved modest success. A few drugs helpful in mitigating Covid’s effects were found, but none that could relieve them entirely. In the longer term, however, medicine succeeded resoundingly. A national effort produced vaccines that have proven both safe and effective. The recent increase in infections indirectly testifies to their usefulness: a reported 97 percent of the serious new cases involve unvaccinated people. Moreover, the vaccines were produced in record time. The average vaccine takes five years to bring to the point of widespread distribution. Many take much longer. Some never arrive: the world continues to lack a vaccine, for example, for HIV/AIDS.

This remarkable, revolutionary, and entirely beneficial accomplishment represents a magnificent achievement by American biomedical scientists, and those in Great Britain and other countries as well. It is equally the achievement of the nation’s often maligned pharmaceutical companies, whose active participation in the development and production of the vaccines made them possible. Under the auspices of “Operation Warp Speed” (authorized by President Trump), a partnership between the government and the private sector made it possible ultimately to bring the pandemic, with all its costs in lives and economic damage, to an end.

That partnership reprised the business-government cooperation during World War II that harnessed American industry to manufacture, on a vast scale, the weaponry that won the war. The final stage of the national response to the pandemic—the distribution of the vaccine—also bore a similarity to the American record in that and other wars: a halting, sometimes fumbling start, but then an increasingly effective performance as mistakes were corrected and bottlenecks overcome. Frustratingly slow when the vaccines were first approved for public use, the countrywide pace of vaccination accelerated until, by the second week in April, four million people received inoculations on a single day.

The pace then slackened, however. Many Americans have proven reluctant to be vaccinated, some of them no doubt motivated by the same libertarian convictions that limited the practice of the NPIs. This means that the country may never have enough of its inhabitants who have either had the disease or been inoculated against it to reach the desirable goal of “herd immunity.” Many of those shunning the vaccine are young and healthy and thus not at high risk from the disease. Some, however, are at risk, and both groups expand the pool of people who could be infected, which increases the chances that new and more dangerous strains of the virus will emerge. Even in the absence of such a development, moreover, those who have received inoculations may have to be re-vaccinated; just how long the vaccines provide immunity has not been definitively established.

Amid multiple uncertainties, one conclusion seems certain: Covid-19 will not be the last pandemic that the world will encounter. In the middle of the last century the idea gained currency that infectious diseases would soon be entirely eliminated. That belief has disappeared. As bad as the combination of communicability and lethality made this particular virus, previous outbreaks of infectious diseases—the several episodes of the bubonic plague, for example—have been far worse. The next one might also inflict greater damage than the world suffered from Covid-19. That is why the continuing assessment of what happened last year is vital. The ultimate failure in responding to Covid-19 would be the failure to do everything possible to learn the lessons from it that are necessary to prepare for the next global pandemic.

Michael Mandelbaum is the Christian A. Herter Professor Emeritus of American Foreign Policy at the Johns Hopkins School of Advanced International Studies, a member of the editorial board of American Purpose, and author of The Rise and Fall of Peace on Earth (2019).