The COVID pandemic in historical memory

When the COVID-19 global pandemic began a little more than two years ago, many people in the USA noted that the Spanish flu pandemic a century earlier had left almost no trace in either our national historical memory or cultural history. This seemed surprising, given that it killed an estimated 675,000 Americans, most of them in their 20s and 30s.

Three and a half years ago, Ron Klain, the former chief of staff to both Joe Biden and Al Gore when they were vice presidents, and the head of the White House response team for Ebola in 2014-15, wrote a remarkably prescient article about the next global pandemic. These paragraphs seem in several ways especially prophetic:

The past two decades have seen a roll call of near-miss catastrophes. The SARS outbreak of 2002. The H1N1 flu of 2009. The MERS outbreak of 2012. And, of course, the Ebola epidemic of 2014, which at one point was forecast to take 1 million lives. They all were horrible, but each could have been significantly worse.

H1N1 offers a telling story. At a time when the world worried about a pandemic flu coming from Asia, H1N1 exploded from Mexico and California across the US. Once it was identified as a pandemic risk, an all-out effort to create a vaccine was launched — but the vaccine wasn’t made widely available to the public until after the epidemic’s peak. Even then, manufacturers were able to produce only a limited supply. Government officials gave conflicting guidance about the danger and the safety of routine actions (like keeping schools opened or air travel with infected people).

In the end, about 60 million Americans contracted H1N1 that year — which, by pure luck, turned out not to be a particularly lethal strain. Had it been even one-tenth as deadly as the Spanish flu (which was estimated to have killed about 10 to 20 percent of those it infected), even our modern medicine could not have prevented hundreds of thousands of Americans from dying in a relatively short period of time, in an event that would be more searing in contemporary consciousness than 9/11.

New political and social trends further increase our risk level. A rising tide of anti-vaccine sentiment in the US and Europe is raising the risk of a resurgence of once-vanquished infectious diseases (like measles), and increasing the likelihood of massive vaccine resistance in the event of an epidemic. The ability of social media to rapidly spread false information — painfully illustrated in the 2016 campaign — is another source of danger: Would the directives of public health officials be followed in a crisis? Would they be undermined by misinformation spread by misguided provocateurs or a hostile foreign power?

The last paragraph in particular is a spooky prophecy of exactly what has happened over the past two years.

Klain didn’t anticipate — no one really could have — how successful contemporary medical science would be in creating astonishingly effective vaccines against the next viral global pandemic over the course of just a few months. That development makes his warnings about “new political and social trends” even more plangent in retrospect.

Something else he didn’t anticipate, however, seems more predictable, given the precedent provided by the Spanish flu pandemic. Klain believed that a viral disease that swept over America and killed hundreds of thousands of people would prove to be an event “more searing in contemporary consciousness than 9/11.”

Two years in, COVID-19 has officially killed almost one million Americans, although the true number is certainly higher than that.

The current CDC stats record 385,000 deaths from the disease in 2020, 462,000 in 2021, and 153,000 in 2022 (The 2022 totals represent an annualized rate of 600,000 deaths from COVID, although of course they are the product of the now-receded Omicron wave).

The CDC also record 1.1 million excess deaths from all causes since February of 2020, with just under 900,000 of those deaths being from COVID — not all COVID deaths are excess deaths statistically speaking — and a little more than 200,000 being from other causes. These numbers are actually pretty conservative, as the excess death totals in 2020 and 2021 alone add up to nearly 1.1 million, if you just extrapolate from the most recent annual mortality data prior to the pandemic.

But has all this epidemiological carnage over the last 24 months seared itself into our contemporary consciousness in a way that will be more powerful and long-lasting than memories of 9/11? (An event 500 times less lethal to Americans than the COVID pandemic, if you want to get technical which I do).

I would say that the answer to that question is complex, but the short version would be “no, not really.” COVID was, no doubt, a traumatic event in the national psyche for several months starting in the spring of 2020, but the trauma faded fairly rapidly, between a combination of the development of effective universally available vaccines, and the inevitable normalization that happens with all pandemics.

Predictions, especially about the future, are inherently dangerous, but I predict that, as a matter of historical consciousness, the COVID-19 pandemic will (not) be remembered much in America, just as the Spanish flu epidemic was almost completely forgotten in fairly short order. This seems especially likely to be true given that, unlike the latter pandemic, COVID-19’s death toll has been overwhelmingly weighted toward the elderly (Nearly 80% of the people who have died were 65 or older, although with the development of the vaccines the deaths in the last year have been somewhat less skewed toward the elderly than they were in the first year of the pandemic).

Here’s a brutal way of expressing this statistically: The age-adjusted mortality rate in America jumped from 715 per 100,000 to 829/100,000 between 2019 and 2020, and seems likely to be just about the same, or perhaps slightly higher, in 2021 (75,000 more Americans died in 2021 than 2020 from all causes, which was almost exactly the same as the increase in COVID deaths between the two years, although again the COVID deaths last year were slightly more skewed toward young people than in 2020, which could bump the age-adjusted mortality rate a bit higher).

To put that in historical context, this means the age-adjusted mortality rate in the USA over the past two years has been the same as it was roughly 15 years prior to the pandemic (it was 844/100 in 2003 and 814/100,000 in 2004). In terms of public health, wiping out 15 years of advances in public health overnight should be a big deal — in fact one that leaves us with 1.1 to 1.2 million more Americans dead over the past two years than would have died otherwise.

In terms of social and historical consciousness, the new situation soon becomes totally normalized.

And once the pandemic has truly ended in epidemiological terms, which of course it hasn’t yet (see the 2022 stats above), it will, it seems likely, fade as quickly from our historical memory as its predecessor did a century earlier.

Until the next time.