The end(s) of the Covid pandemic

One thing I’ve done throughout the Covid pandemic has been to track the number of excess deaths in the US: that is, the number of deaths above and beyond the number that could have been expected but for the pandemic. Note that not all Covid deaths are excess deaths in this sense — someone who died of Covid who would have died from something else during the relevant time frame doesn’t count as an excess death, statistically speaking — and not all excess deaths were caused directly by Covid itself.

The latter point is easy to see if we look at the total deaths in the US between 2020 and 2022. Through 2019, the trend in total deaths in the US would have led us to expect just about 8.7 million total deaths during these three years. Annual deaths are pushed upward by the increasing size and average age of the population, and downward by decreasing age adjusted mortality risk, which until the pandemic had decreased almost every year subsequent to the influenza pandemic a century ago. These two factors nearly cancel each other out, with the result that total deaths in the US tend to rise by about 1% per year. This calculation is what yields the 8.7 million total deaths estimate for 2020-2022.

In fact the total deaths in the US for those three years was 10,148,990, i.e., about 1,450,000 deaths above what otherwise would have been expected. The official Covid death toll for those three years was just about 1.1 million, and when you subtract the Covid deaths that weren’t excess deaths, statistically speaking, we’re looking at somewhere around 425,000-450,000 excess deaths that weren’t attributable, at least officially, to the Covid pandemic (My belief is that the vast majority of these “non-Covid” excess deaths will turn out to have been Covid deaths that weren’t counted as such, but it’s going to take years to sort this out).

So we’ve just been through by far the worst public health catastrophe of the last 100 years — indeed there were probably more excess deaths per capita in the US during the Covid pandemic than there were in the two prime years of the Spanish flu pandemic (A very odd statistical fact is that overall mortality in the US actually fell BELOW pre-pandemic levels during the second year of the Spanish flu pandemic, that is, 1919. This may be attributable to the big decline in overall infectious disease because of pandemic precautions).

All this is important to keep in mind when we learn that, over the last few months, we’ve seen little or no excess mortality in the statistical sense in the US:

During Covid’s worst phases, the total number of Americans dying each day was more than 30 percent higher than normal, a shocking increase. For long stretches of the past three years, the excess was above 10 percent. But during the past few months, excess deaths have fallen almost to zero, according to three different measures.

The Human Mortality Database estimates that slightly fewer Americans than normal have died since March, while The Economist magazine and the C.D.C. both put the excess-death number below 1 percent. . .

The progress stems mostly from three factors:

• First, about three-quarters of U.S. adults have received at least one vaccine shot.
• Second, more than three-quarters of Americans have been infected with Covid, providing natural immunity from future symptoms. (About 97 percent of adults fall into at least one of those first two categories.)
• Third, post-infection treatments like Paxlovid, which can reduce the severity of symptoms, became widely available last year.

“Nearly every death is preventable,” Dr. Ashish Jha, who was until recently President Biden’s top Covid adviser, told me. “We are at a point where almost everybody who’s up to date on their vaccines and gets treated if they have Covid, they rarely end up in the hospital, they almost never die.”

Note that about 80 people per day on average are still dying from Covid in the US, which would be a pretty bad flu year, so it’s not as if the mortality risk from the disease is now negligible. It’s just moved into the ordinary disease category, as opposed to a viral monster that killed, directly and indirectly, close to 1.5 million Americans in less than there years.

And of course there’s still the scourge of long Covid, which remains poorly measured, let alone understood.

But, in an epidemiological sense, the Covid pandemic is, at least for now, over. What changes it will end up having caused in American society, above and beyond all the deaths, will be something that’s studied by historians and sociologists for many years. I suspect the biggest change will end up being that the ultimately successful fight against this terrible disease convinced about 40% of the country that vaccines are either suspicious, or simply malevolent government incursions on their Freedom ™.