The Covid pandemic: Unanswered and undiscussed questions

Ernest Davis
July 7, 2023, with updates.

At the beginning of his book Awakenings (1973), Oliver Sacks remarked on the surprisingly small place that the 1918-20 influenza pandemic held in our collective memory. In August 2021, at the height of the Covid pandemic, I wrote in an unpublished review of Michael Lewis' The Premonition that, by contrast, "It seems altogether unlikely that the 2020-? Covid pandemic will be soon forgotten. Many histories of the pandemic will be written; no doubt many are already in progress."

As far as I can tell now, barely two years later, I was completely mistaken. We collectively seem to be largely committed to pushing the pandemic out of our minds as quickly and thoroughly as possible; or, rather, much more quickly and thoroughly than I would have dreamed was possible. If any significant histories of the pandemic, either books or popular articles or technical articles, have been published since Lewis' book, I cannot find them.^* In May 2021, Universal Studios started planning to turn Michael Lewis book into a movie; that seems to have been dropped. As things are going, within a decade the Covid pandemic will be as far out of sight as the 1919 flu pandemic was in 1973. Probably the inventors of the mRNA vaccine will get the Nobel Prize that seemed a shoo-in for them two years ago, but I wouldn't bet very long odds even on that.

As far as I can tell, only a few topics still seriously engage writers and journalists. The origin of the disease, though a food market or a lab leak, is hotly debated. So is the wisdom, effectiveness, costs and benefits of governmental responses and advice, which is now a hot-button issue in the Presidential race. There has been some — much less, as far as I have seen — of the current and future state of the disease; in particular, Katherine Wu wrote three articles (linked below) for The Atlantic on these critical subjects in May; and a little about the medical status of long Covid. Certainly these are all important questions, and I applaud the work of those such as Wu, Zeynep Tufekci, and my cousin Katherine Eban, who are involved in investigating the first, pondering the second, and researching the last two. However, there are many other questions that seem to me also important, which seem to be going completely undiscussed. Some of them may be unanswerable, now or forever, but then it would be worthwhile discussing why they are unanswerable.

If you, the reader, know of any good discussions of any of these, or if you want to suggest further questions of this kind, then please do email me, and, if it seems reasonable, I'll add those here with an acknowledgement to you.

The Present

1. Has the US population or the world population attained "herd immunity" or anything close to that?
2. How dangerous is the disease, currently? If you are a person with conditions XYZ (age, medical condition, vaccination status), how much risk are you taking spending two hours unmasked in a indoor setting with 500 other people? How much risk are you taking if you commute to work on public transportation? If you take a four hour plane ride?
3. Who should be getting additional vaccinations?
4. If you contract the disease or are exposed to it, to what extent should you isolate yourself?
5. How effective are the existing vaccines, at preventing the disease or ameliorating its consequences? Is development and improvement of Covid vaccines still ongoing? Has there been any progress in the last six months?
6. How effective are existing treatments? Is the development and improvement of treatments still ongoing? Has there been any progress in the last six months?
7. What are the priorities of the US government, other governments, other institutions, as regard Covid? What is being funded, and to what degree?

The Future

1. If the disease does start to spread rapidly again in some location, how quickly will that be detected? Are we in a position to respond more effectively this time than last time?
2. What are the long term prospects? Will this disease eventually vanish or become extremely rare, will it stay at current levels or better, or is it an ever-present threat for the foreseeable future?

The Past

1. How accurate were the predictions made in March and April 2020 and later? If inaccurate, what did they fail to foresee? Are there any lessons to be learned about our ability to make these kinds of predictions?
2. Mutations. There was alpha, beta, gamma, delta, and omicron. People were making grim jokes about the upside being that they were learning the Greek alphabet and journalists were writing depressing articles about how it looked like Covid would be throwing up new diabolical mutations as far as the eye can seen. And then, pretty much, it stopped, at least in terms of mutations that got a lot of traction. Why? Here, actually, there was an May 2023 article by Sarah Zhang in The Atlantic. But there should be more that can be said.
3. Is there any explanation, in terms of public policy, public behavior, health infrastructure, way of life, genetics, other circumstances, for the very strange and erratic course of the disease over the three years it was virulent in different parts of the world? Or is this just what is to be expected from a random process with strong positive feedback, intricate causal chains, and unsystematic interventions over a network of personal interactions? For instance (these is all based on numbers in WorldOMeters.info, and of course inaccuracies and inconsistencies in those numbers may be part of the explanation): Central Europe was hit particularly hard; Hungary, with a poupalation of 11.4 millon, has had 2.2 million cases and 48,000 deaths. Much of Africa got off comparatively lightly; Nigeria, with a population of 216 million has had 266,000 cases and 3,000 deaths. In Taiwan there were 24,000 cases in the two years between January 2020 and April 1, 2022, and 10 million cases in ten months between April 1 2022 and february 1 2023. In India there have been 44 million cases in total; more than half of those began in two short, intense surges totalling 14 weeks between April 1 and June 7, 2021 and between December 24, 2021 and February 8, 2022. 43% of the deaths in India — 230,000 out of 533,000 — occurred in the 11 weeks between April 3 and June 20 2021. What sense does any of this make? Should we expect it to make sense?

Update: Answers

IMPORTANT UPDATE (July 14, 2023). My dear niece Ruthie Davis has written a long, deeply researched answer to my questions below:

Pandemic Answers by Ruthie Davis, July 14, 2023.

Ruthie strongly recommends the three-part article The Year the Covid Pandemic "Ended" by Artie Vierkant and Beatrice Adler-Bolton, in ]The New Inquiry, December 21, 2022.

My brother Joey points out the following two links, relevant to question Present.6:
"The NIH has poured $1 billion into long Covid research — with little to show for it"
Ventilation improvements in K-12 Schools

Recent articles in The Atlantic

One More COVI Summer? Katherine Wu, July 29, 2023.
Fall’s COVID Shots May Be Different in One Key Way Katherine Wu, May 26, 2023.
Only the Emergency Has Ended Katherine Wu, May 5, 2023
23 Pandemic Decisions That Actually Went Right Rachel Gutman-Wei, Sarah Laskow, Yasmin Tayag, Katherine J. Wu, and Sarah Zhang, May 9, 2023.
Will COVID’s Spring Lull Last? Katherine Wu, May 1, 2023
Long-Haulers Are Trying to Define Themselves, Lindsay Ryan, April 28, 2023
Long COVID Is Being Erased—Again, Ed Yong, April 19, 2023.
Trapped with Covid: Inside the Louisiana State Penitentiary, we faced a new kind of enemy., John Corley, April 10, 2023
No One Really Knows How Much COVID Is Silently Spreading … Again Katherine Wu, February 28, 2023
An ICU Doctor on How This COVID Wave Is Different Caroline Mimbs Nyce, February 17, 2023

Lessons from the Covid Crisis

There is a book Lessons from the Covid Crisis by "The Covid Crisis Group" led by Philip Zelikow, that came out on April 25, 2023. It's mostly an account of the organizational failures of the US government and the US healthcare system in responding to the pandemic, with recommendations for how to do better. It's certainly worth reading. It's well written, though I didn't always put in the effort to keep track of the more obscure government agencies. Argues strongly that the lockdown, particularly of schools, was continued much longer than was at all helpful or sensible. It doesn't address any of the questions I posted the other day. If you liked Michael Lewis' The Pandemic it's worth noting that several of his heroes (Charity Dean, Carter Melcher etc.) are members of "The Covid Crisis Group" that authored this.

The review by Richard Tofel in Stat gives a good summary and I would say is on the mark in its evaluation.