The COVID pandemic has been one of the most impactful world events of our lifetime. Aside from the disease itself, the community response to the disease has been intense and unprecedented. We have never before seen such prolonged, mandated restrictions and economic shutdowns in response to a global emergency.
The pandemic has brought out some of the best and worst of humanity. On the best side, we have seen many people working very hard, at great risk to themselves, to help or save others. We have amazing feats of scientific innovation, in particular the vaccines and other medical treatments developed so quickly. We have communities that came together in support. Governments enacted radical measures to support the population economically during periods of reduced employment. On the negative side, we have seen misinformation, propaganda, hatred, the escalation of the anti-vax movement, and violence. These phemenona are expected in pandemics; there are good authors to follow on this subject, such as Christakis (see Apollo's Arrow), or Taylor (The Psychology of Pandemics).
The pandemic and the community response to the pandemic has affected different people in different ways. For some people the disease itself was devastating, either causing death, critical illness in hospital, or similar devastating effects in loved ones. The majority of people have had a case of COVID, followed by full recovery, most of whom with no perceptible damage to their health, but a large minority of people have varying degrees of disability following acute recovery, in the form of so-called "long COVID."
The community response to COVID has had variable effects as well. Many people have suffered loneliness, mental health problems, worsened physical health problems, and economic hardship due to restrictions. Many children have had significant disruptions in social and educational development. Those living in abusive homes were more stuck in these harmful situations. Most of us were not able to visit ailing or dying loved ones. The negative impacts have affected some people much more than others. But there have also been positive effects of public health restrictions. Many of us have found ways to connect, work, and learn remotely. Many introverts have been unaffected by restrictions, or have enjoyed them. Many schoolchildren were spared the bullying and other adversity due to school attendance, and actually experienced a reduction in suicide risk. (see Hansen et al., 2022). Some have had bonding time with loved ones or family, living in the same household, that they would never otherwise have had. And many of us have developed a greater engagement for working together as a community, each doing our part, to solve a major world problem.
I have in the past compared COVID to cigarette exposure, just as an analogy, not as a literal equivalence: a case of COVID, assuming survival and acute recovery, could be compared to the health effects of 10-20 pack years of smoking (that is, a pack a day for 10-20 years), with a full series of vaccinations with boosters reducing this number substantially. Most people in the population are lucky--they can tolerate 10-20 pack years of smoking without any obvious health damage. As a result, a contrarian data scientist could argue that smoking is not very harmful, and should not be restricted (this in fact did happen up until recent decades). But most people with a 10-20 pack year smoking history would have a measurable decrement in many health metrics--they would be less healthy than they would have been had they not smoked. Some of these effects may become more obvious only after decades of time, with higher rates of heart disease, emphysema, reduced exercise tolerance etc. Some people with such smoking history will develop lung cancer, and die, sometimes after a long delay. Children and young adults are even less likely to show acute adverse effects from 10-20 pack years of smoking, since, of course, they are younger and healthier! But of course we can all agree that it would be preposterous to suggest that we should allow children to smoke! Just because children have a much higher survival rate of a harmful agent doesn't mean it is ok for them to be exposed. Similarly, it should never have been assumed that the low COVID death rate in children is a reason to be unconcerned about mass spreading in younger age groups.
The overall mortality rate from COVID has always been in a medium range, initially a much higher mortality rate than most strains of influenza, but much lower than a disease such as Ebola. At this point the mortality rate is more similar to that of influenza, as a result of mass immunization and infection-induced immunity. But of course, these rates are subject to change (up or down) as new variants are developing as we speak. Unlike seasonal influenza, COVID cases and deaths are simmering, with recurrent waves lasting a few months each, throughout the entire year, over years of time, rather than settling down after the season is over. The mortality rate has always been very strongly dependent on age, with elders having very much more severe effects and a much higher death rate than children or young adults.
The restrictions and mandates of the past 3 years helped reduce the total number of COVID deaths. They bought time to allow better treatments to be developed, and to allow a mass vaccination campaign. They also reduced surges of hospitalization and ICU use. Despite the restrictions, critical care usage was often right at the brink of overflow. The restrictions prevented a health care catastrophe that would have been much, much worse.
To this day, I feel that many analysts of this topic don't fully acknowledge or understand how exhausting and frightening it was for workers in critical care medicine in the past 3 years. We were dealing with near overflow situations, especially during the case surges. If we had been more lax about public health restrictions we would have had patients dying in the hallways waiting for ventilators, and other patients without COVID (including heart attack or cancer patients, post-surgical patients, or victims of accidents) dying due to lack of care. The stress, and often trauma, imposed on the exhausted medical staff has not been adequately understood outside this niche community of experts. Critical care experts have been too busy saving lives these past 3 years to busy themselves talking to journalists or trying to engage in public information campaigns.
A curse of successful public health intervention is that it can cause people to question afterward whether any of it was necessary, rather than have some gratitude that a much, much worse disaster did not happen.
A contrarian argument based on analysis of death rates in developed countries is a small and potentially misleading component of understanding this issue. There have definitely been excess deaths -- of course -- due to COVID, but the magnitude of this increase has not been shockingly high compared to rates and changes over the past decades, particularly in areas where there were good public health measures and high vaccination rates. In many ways these data are evidence of the effectiveness of the interventions, rather than a sign that we did too much, unnecessarily. Furthermore, death rates alone are the tip of the iceberg regarding health damage, just as a look at mortality rates does not tell the full story regarding the health dangers of smoking.
Most of us in the medical and public health/epidemiology community have closely followed data on the issue of COVID almost daily over the past 3 years. The epidemiology community in particular has been deeply involved in this analysis.
Rather than share my own analysis of data right now, I think it's preferable to cite some of the many other experts in mathematics, statistics, microbiology, virology, and epidemiology who have devoted much of their professional focus over the past three years to studying the pandemic. I choose the references below because they represent people and groups with years or decades of established expertise, highest levels of educational achievement from top universities, extensive peer-reviewed publications, no significant biases due to financial profit motives etc., and a balanced, moderate point of view:
1) the website "Our World in Data" has been a wonderful source of information, not only about the pandemic, but about a wide variety of other issues going on in the world. I strongly recommend this site, as one to follow regularly. They have curated excellent data about the pandemic. I recommend following all their COVID data, but here is one link in particular, looking at excess deaths:
https://ourworldindata.org/excess-mortality-covid#excess-mortality-during-covid-19
2) for some local BC experts, I encourage following the UBC Covid-19 Modelling Group. Check out the monthly slide presentation from their website; they also have regular video presentations summarizing their findings. Members include Stanford-trained Ph.D. mathematical biologist Dr. Sally Otto, mathematics professor Dr. Eric Cytrynbaum, Stanford-trained Ph.D. physics professor Dr. Dean Karlen, engineer Dr. Jens von Bergmann, mathematics Ph.D. with specialty in infectious disease modeling Dr. Caroline Colijn, computational biologist Dr. Ailene MacPherson, mathematics professor Dr. James Colliander, statistics professor Dr. Daniel McDonald, mathematician and infectious disease modeler Dr. Dan Coombs, and mathematical biologist Dr. Elisha Are. These are people with years of expertise in data analysis and epidemiological statistics. Before doing one's own personal dive into the data, consider whether this group has already done the work at a more sophisticated level.
3) Dr. Isaac Bogoch is a well-known Canadian infectious disease specialist who has worked hard to inform the public about COVID-related issues. Highly recommended. Can follow on Twitter: @BogochIsaac.
4) Dr. Eric Topol has also been a great educator about COVID-related issues. He was the chair of cardiovascular medicine for 13 years at the Cleveland Clinic, and has since become a leader in medical research and education. Can follow on Twitter: @EricTopol.
5) Dr Akiko Iwasaki is a Yale immunobiologist, one of the top specialists in this area in the world. She has done extensive work on the pathophysiology of COVID and long COVID. Amazing scientist and an amazing person. Can follow on Twitter: @VirusesImmunity.
6) Dr. Trevor Bedford is a professor of biostatistics & computational biology at the Fred Hutch Cancer Centre in Seattle. Can follow on Twitter: @trvrb
7) Dr. Zeynep Tufekci is a sociologist, with excellent commentary about many aspects of the pandemic, ranging from epidemiologic analysis, to political factors. Can follow on Twitter: @zeynep
8) Dr. Michael Mina, a Harvard epidemiologist, pathologist & immunologist, has an expertise in mathematical modeling, and during the pandemic has been a leader advocating for better use of rapid testing. Can follow on Twitter: @michaelmina_lab
9) Dr. Linsey Marr is a Harvard-trained environmental engineer and aerosol scientist, who has been a leader in the research concerning ventilation and mask effectiveness in the containment of respiratory pathogens. I have felt that the improvement of ventilation has been a neglected area in pandemic and overall infectious disease management; such improvement would likely be broadly accepted by most people, regardless of their political leanings or other beliefs. Can follow on Twitter: @linseymarr@fediscience.org
10) Dr. Nicholas Christakis is a Yale sociologist and physician with expertise in the mathematics of social networks. He is the author of a good introductory book about pandemics in general, and COVID in particular (but this book is in need of a sequel, since it was published only one year into the pandemic). He has vast wisdom and experience in the analysis of pandemics and associated social behaviour. Highly recommended to follow. Twitter: @NAChristakis
11) Dr. David Boulware is a professor of medicine and infectious disease specialist at University of Minnesota Medical School. He has been an advocate for better randomized-controlled studies of COVID treatments. Such RCTs have been incredibly important, and in my opinion, should have been done on a much larger scale over the past 3 years, to clear up various uncertainties about optimal COVID management. Such good RCT data showed that treatments such as ivermectin and hydroxychloroquine were ineffective, while some other possible alternative treatments such as metformin, are likely to be useful. I feel that many more RCTs should have been done, and should still be done, to replicate and elaborate current findings.
12) Dr. Marc Veldhoen is an immunologist, a professor of immunology in Lisbon, with training in London, working at Cambridge 2010-2016. I appreciate his clear, authoritative, balanced, erudite efforts to educate the public about immunology in general, and COVID in particular. Twitter: @Marc_Veld
I have referred to Twitter links above, but also note that Twitter itself is deteriorating due to serious problems in its leadership, so it may be necessary to find the researchers mentioned above in other ways online or in publications.
The list above is, of course, a tiny slice of the huge, top-notch worldwide COVID research community. The scientists in this area have done excellent work in terms of genomics, pathophysiology, treatment innovation, epidemiology, and data science, as well as looking at social, psychological, and political factors.
I recommend checking out the leading medical, epidemiology, and other relevant scientific journals, such as Nature, Science, the JAMA Network journals, the New England Journal of Medicine, The Lancet, Epidemiology, and The American Journal of Epidemiology . The American Society for Microbiology is an excellent resource for detailed virology research, and also has some public education resources. When you look at these websites, I encourage browsing through the past year or so of issues, pausing to look at the abstracts of interesting or relevant articles, and choosing a few of the best articles to read in depth. You can search the website to look for articles specifically about COVID. If you have access to a university, you can get full articles from these sites, otherwise you can at least read the abstracts. One of the general takeaways from this perusal of journals should be to understand and appreciate, with some degree of gratitude and awe, the depth and sophistication of the research.
I also encourage checking out some of my previous posts about COVID over the past few years (though some of them are a bit outdated or may need some corrections). I consider my major post about polarization & propaganda to be very important: http://garthkroeker.blogspot.com/2021/09/conspiracy-theories-vaccine-hesitancy.html
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