Lane Kenworthy, The Good Society
March 11, 2021

Covid-19 has killed approximately 2.6 million people worldwide and 550,000 in the United States. It has caused the sharpest economic downturn since the 1930s. And it has massively disrupted schooling for many children and young adults. The development of several vaccines means there is now an end in sight, though it isn’t clear exactly when that will happen.

What do we know about the virus and the disease? How has the United States fared, in terms of cases and deaths, compared to other rich democratic nations? Why have some poor countries had fewer deaths than many rich ones? What have governments done to help minimize the economic damage? Can we resume in-person schooling? In what ways will the pandemic change us? How can we be better prepared for the next one?

Skip to:

• Infectiousness and deadliness
• The United States and other rich democratic nations
• Why have many poor countries done better than rich countries?
• Mitigating the economic damage
• Resuming in-person schooling
• When will it end?
• Will the pandemic permanently change us?
• Preparing for future pandemics

INFECTIOUSNESS AND DEADLINESS

Infections

Figure 1 shows the daily number of new confirmed Covid-19 cases per million population. The infection rate worldwide rose slowly but steadily beginning in March 2020. In the United States there was a steep rise from mid-March to mid-April, concentrated in New York City and nearby New Jersey. Infections then fell steadily for two months. From mid-June through July they again rose rapidly, and the case numbers peaked at a higher level before declining once more. A third rise began in September. The second and third increases extended across much of the country. The third rise was by far the largest. Cases peaked in mid-January and have fallen since then.

Many people who are infected display no symptoms and so never get tested. They therefore don’t show up as a confirmed case. The actual infection rate is approximately three times the rate suggested by confirmed cases, which suggests that about 100 million Americans have been infected.¹

Early on, it was thought that transmission occurred mainly by touching surfaces, but scientists now believe most transmission is via airborne particles.² Infection is most likely when multiple people are gathered in the same room indoors without ventilation that can rapidly recirculate and filter the air. There seems to be very little transmission outdoors.³

Adverse health consequences

According to the Centers for Disease Control, as of March 2021 about 1.5 million Americans have needed hospitalization in order to get supplemental oxygen or more advanced care for Covid-19.⁴ If 100 million have been infected, this suggests that about 1-2% of all cases are “serious” in this sense.

Deaths

From March 1, 2020 to March 11, 2021, an estimated 2.6 million people worldwide have died from Covid-19. The average daily toll has been about 7,000. Prior to the pandemic, it was estimated that about 60 million people would die in 2020, which is 164,000 per day. Figure 2 shows the toll added by the pandemic. From this perspective, the impact appears relatively small. But keep in mind that the number is small only because a significant part of the world essentially shut down for some of this period, an enormous economic sacrifice.

How deadly is the disease? The share of people infected with Covid-19 who die is estimated to be approximately 0.5%, or 1 in 200.⁵

Deaths have been most common among people who are old or who have preexisting health problems. In the United States, about 80% of Covid-19 deaths have been among persons aged 65 and over.⁶ About one-third of deaths have been in nursing homes, though this counts not only elderly residents but also employees.⁷ We don’t have hard data on deaths among people with preexisting health conditions, but it is widely agreed that this group is among the most vulnerable if they contract the virus. It also appears that men and members of minority racial and ethnic groups are more likely to die if infected.⁸

THE UNITED STATES AND OTHER RICH DEMOCRATIC NATIONS

Figure 3 shows daily death rates in the United States and 20 other affluent democratic countries. In March and April a number of nations in western Europe — Belgium, France, Ireland, Italy, the Netherlands, Spain, and the United Kingdom — experienced spikes in infections and deaths. By the end of May nearly all of these countries had brought the infection and death rate way down, via partial or full lockdowns. In June they began to reopen businesses, restaurants, and in some cases sports leagues, yet for a while infections and deaths were contained. However, a second wave began in September, with case levels in some countries zooming far above their earlier peaks.⁹ Case levels and deaths began to fall in January and February.

Apart from New York City, the United States didn’t experience the kind of early dramatic spike in Covid-19 cases seen in parts of western Europe, and beginning in late April lockdowns and physical distancing efforts yielded considerable progress. The number of daily deaths in America fell to about 2 per million by mid-June. But then the country went in the wrong direction, as many states moved aggressively to reopen — often before case numbers had fallen sufficiently, without proper distancing, without requirements to wear masks, without sufficient testing, and with little contact tracing.¹⁰ As seen in figure 4, infections began rising rapidly again in mid-June. After declining again in August and early September, a third rise commenced in late September, with case totals much higher than in either of the previous two peaks. Since peaking in mid-January, case numbers have fallen steadily.

Relative to the number of cases, the increase in deaths resulting from the second and third surge wasn’t as large as the rise that occurred in April. For one thing, by summer there was greater awareness of the vulnerability of elderly persons, particularly in nursing homes, so more aggressive efforts were taken to guard against outbreaks. And a larger share of new infections were among people under 30, who are far less likely to die if infected. Also, hospitals got more effective at preventing death among Covid-infected patients.¹¹

The US record in the pandemic perhaps shouldn’t be judged as the worst. As we see in figure 5, the total number of deaths per million people is still higher in Belgium and the UK. Yet America’s performance is very disappointing. It had a good opportunity in the early summer, and then again in early fall, to draw on its experience and that of other countries to squelch transmission of the virus. But it didn’t.¹²

A big part of the reason for this failure is the approach of the Trump administration and its allies. David Leonhardt puts it as follows¹³:

“There is one way — in addition to the scale of the continuing outbreaks and deaths — that the United States stands apart: In no other high-income country have the messages from political leaders been nearly so mixed and confusing.

These messages, in turn, have been amplified by television stations and websites friendly to the Republican Party, especially Fox News and the Sinclair Broadcast Group, which operates almost 200 local stations. To anybody listening to the country’s politicians or watching these television stations, it would have been difficult to know how to respond to the virus.

Mr. Trump’s comments, in particular, have regularly contradicted the views of scientists and medical experts.

The day after the first American case was diagnosed, he said, ‘We have it totally under control.’ In late February, he said: ‘It’s going to disappear. One day — it’s like a miracle — it will disappear.’ Later, he incorrectly stated that any American who wanted a test could get one. On July 28, he falsely proclaimed that ‘large portions of our country’ were ‘corona-free.’

He has also promoted medical misinformation about the virus. In March, Mr. Trump called it ‘very mild’ and suggested it was less deadly than the common flu. He has encouraged Americans to treat it with the antimalarial drug hydroxychloroquine, despite a lack of evidence about its effectiveness and concerns about its safety. At one White House briefing, he mused aloud about injecting people with disinfectant to treat the virus.

These comments have helped create a large partisan divide in the country, with Republican-leaning voters less willing to wear masks or remain socially distant. Some Democratic-leaning voters and less political Americans, in turn, have decided that if everybody is not taking the virus seriously, they will not either.”

Sweden’s approach has differed from that of other rich democracies. The Swedish government chose not to require businesses to close during the peak infections period beginning in March. The government believed Swedish citizens would voluntarily exercise appropriate caution, thereby slowing transmission of the virus while avoiding a devastating economic downturn. At the same time, some of Sweden’s top public health officials hoped that allowing moderate, as opposed to minimal, transmission might enable Sweden to more quickly reach herd immunity.¹⁴

The strategy doesn’t appear to have worked well. Sweden’s death rate has been far higher than in neighboring Denmark, Finland, and Norway (figure 5). And there has been no apparent economic benefit; Sweden’s economic contraction has been very similar in magnitude to those of its neighbors. In addition, attempts to gauge the prevalence of Covid-19 antibodies among the Swedish population suggest the country remains a long way from herd immunity.¹⁵

What countries have been success stories? South Korea is one. It moved early to limit travelers into the country. It encouraged mask wearing. And it very quickly instituted heavy testing and contact tracing, with quarantines for anyone testing positive or identified as having been in contact with an infected person.¹⁶ Daily Covid-19 deaths per million persons in South Korea have never exceeded 0.2 (see figure 3 for comparison).

For most of the past year Germany’s performance also was impressive, given that it is a large nation connected by land to an array of other countries from which there is, in principle, freedom of movement. It was early (February 28) to take precautions to prevent travelers into the country from spreading the virus, it was early to impose a contact ban (March 22), it ramped up testing volume rapidly and offered tests for free, and, perhaps most important, it made a special effort to prevent the spread of the virus in elderly facilities.¹⁷ Until recently, Germany’s number of cases and deaths were relatively low compared to other rich democracies. Still, Germany was hit hard by the third wave beginning in winter 2020.

WHY HAVE MANY POOR COUNTRIES DONE BETTER THAN RICH COUNTRIES?

Many health experts have worried that the world’s poorer nations would suffer the most from Covid-19 due to the limited reach of government services and lack of modern healthcare infrastructure. Yet so far, a number of quite poor countries in Africa and Asia have suffered few Covid deaths.

One hypothesized explanation points to obesity. Obesity accentuates breathing problems caused by Covid, and it increases the likelihood of hospitalization. Figure 6 shows a strong positive association between countries’ obesity rate and Covid deaths.¹⁸

MITIGATING THE ECONOMIC DAMAGE

The pandemic has laid bare the financial precarity of tens of millions of US households. Prior to the crisis, nearly one in ten Americans had no health insurance, one in four workers got zero days of paid sick leave, and 40% of adults didn’t have enough savings to cover a $400 emergency expense.¹⁹ In March and April, more than 20 million jobs disappeared, and even though some have come back, as of early March 2021 there were still 10 million fewer Americans employed than before the pandemic.²⁰

The federal government has responded with extraordinary relief measures, including loans and bailouts for small and large corporations, expanded sick leave, increased unemployment benefits, direct cash transfers to individuals, and a moratorium on evictions for some renters. Most of this came through the CARES Act and the Paycheck Protection Act, enacted in the spring, and a coronavirus relief bill passed in December. The spending amounts to more around 18% of GDP, a historic high.²¹ This money proved effective in preventing a large rise in poverty.²² But when the programs expired, Congress failed to extend them until December. And while the government aid has helped sustain incomes for many needy Americans, surveys have found an increase in the number of people going hungry.²³

In March 2021 a new rescue bill was passed that will inject another 10% of GDP ($1.9 trillion) into the economy, with much of it going to lower- and middle-income households.

One part of the US strategy has been loans to small businesses that encourage them to not lay off employees, and this appears to have helped.²⁴ Many other affluent democratic nations have relied even more heavily on this approach.²⁵ At the extreme end of the spectrum, in Germany, there has been no net loss of jobs during the pandemic. This sort of approach may prove more effective than America’s at getting the economy back up to full speed quickly, though the US approach could have an advantage in facilitating adjustments from declining economic sectors to growing ones.²⁶

RESUMING IN-PERSON SCHOOLING

While it’s sometimes thought that the only value of school lies in the diploma, schooling improves cognitive ability, and perhaps more important, it helps people develop a variety of noncognitive skills — sociability, discipline, punctuality, and much more — that pay off later in life. Schools can operate entirely online. But in-person schooling is better for a significant share of students — particularly those in less affluent families, who tend to have less access to the internet, less supervision and assistance from family members, and more distractions. For children in low-income families, school also can be a critical food provider; about 20 million American children get free school breakfasts and/or lunches. Moreover, many parents can’t afford to pay for childcare, so if their children aren’t in school, they have limited ability to work.²⁷

Children are much less likely than adults to get seriously ill or die from Covid-19. It also appears that children under age 10 may be less likely than adults to spread the virus. It might therefore be possible to return safely to in-person schooling, at least for children in early grades.²⁸

There are three main obstacles: physical space to keep students distanced; money to pay for additional instructors, new classroom space, barriers in common spaces, improved air circulation, increased cleaning, and ramped-up virus testing and contact tracing; and high infection rates in the surrounding community. The space constraint can be dealt with by using cafeterias, gyms, sports fields, and even nearby streets if needed. The money problem too can be overcome, but thus far Republicans in the Senate have blocked federal government financial assistance. The biggest impediment may be the very high infection rate in many parts of the country, which makes teachers, staff, and students’ parents and grandparents hesitant to see a return to onsite classes. K-12 schools in some districts around the United States attempted hybrid schooling in the fall, with classes meeting in person only a few days a week or just part of the day, but as of the end of 2020, most of the country’s largest school districts were teaching remotely.²⁹

WHEN WILL IT END?

“Herd immunity” is achieved when the share of the population that is immune to a disease is large enough that transmission slows to a crawl, because infected persons come into contact with few people who aren’t immune. As a result, the entire community is protected.

Experts estimate that herd immunity for Covid-19 requires that 60% to 70% of the population be immune.³⁰ (For comparison, the share for measles, which is much more contagious, is 94%.) As of mid-March 2021, the total number of confirmed infections in the United States is about 30 million. As noted earlier, the true number of infected persons is likely about three times higher, suggesting that 25-30% of Americans have been infected.

The best path to herd immunity is a vaccine. More than 100 research teams have been working on developing a vaccine for Covid-19, and the first administration of an approved vaccine occurred in mid-December 2020. As of mid-March, three vaccines have been approved for use in the US.

Completing the process from development to administration in less than a year is an unprecedented feat. It usually takes several years, and in some instances decades. (Scientists have yet to find a vaccine for HIV-AIDS.) A prospective vaccine is initially tested on laboratory animals. Then, phase I and II trials on hundreds of people evaluate effectiveness, appropriate dosage, and safety. Phase III trials involve tens of thousands of individuals, including a control group that receives a placebo. Once an effective and safe vaccine is identified, there remains the challenge of manufacturing it in large quantities, distributing it across the globe, and inoculating billions of people.³¹

Figure 7 shows the progress of vaccinations in the United States. As of mid-March, about 30% of Americans had been vaccinated, though some with just the first of two doses.

WILL THE PANDEMIC PERMANENTLY CHANGE US?

The Great Depression of the 1930s led to creation of some of America’s key public insurance programs — Social Security, unemployment insurance, and aid to low-income families with children — along with labor union protections, reformed banking, enhanced public infrastructure, increased public employment, and government support for homeownership. The Great Recession of 2008-09 spawned passage of the Affordable Care Act (ACA). Will the Covid-19 pandemic result in big, lasting advances in social programs?

It’s tempting to presume that the pandemic will boost public support for an expanded social safety net — that with their eyes newly opened to the precarious circumstances of frontline service workers, black Americans, people with preexisting medical conditions, the homeless, small-business owners, and an array of other vulnerable groups, more Americans will demand that policymakers broaden the size and scope of the country’s public social programs. However, 50 years of public opinion data suggest that economic downturns don’t typically produce sustained rises in progressive sentiment.³² The same appears to be true for political and health crises. Polling data from earlier eras are limited, so it is unclear whether the Great Depression produced a meaningful shift in Americans’ attitudes toward government. But if the New Deal was the product of a popular shift to the left, it was the exception, not the rule. The 1918 flu pandemic was followed by the “Roaring Twenties” and a turn away from the progressive reforms of the two previous decades. Likewise, the economic, political, and foreign policy crises of the 1970s and early 1980s — the oil embargoes, stagflation, Watergate, the US withdrawal from Vietnam, the Iranian Revolution, and the Soviet invasion of Afghanistan — ushered in not a new progressive era but rather the age of Ronald Reagan.

Why don’t crises produce a surge in progressive attitudes? Some people quickly forget or turn their attention elsewhere, so their beliefs and preferences snap back to where they were before the crisis. Some respond to economic downturn by worrying about their own financial well-being rather than the welfare of others. And welfare state opponents and deficit hawks invariably warn against new public spending, arguing that the country can’t afford to take on additional debt.

Another way a crisis can produce lasting change is that temporary expansions of the safety net are made permanent. However, this too has rarely happened in the United States. Time and again during downturns, the federal government has intervened to help people who lose their jobs and to rejuvenate the economy — by extending access to unemployment benefits, making stimulus payments, and declaring payroll tax holidays, loan payment delays, and more. Yet these temporary measures nearly always end once the economy recovers.

When public social programs have been enlarged for good, it has tended to happen via the ballot box. Crises help whichever party is out of power, and once in power, Democrats have sometimes passed progressive legislation despite an ambivalent public mood. That was the story of the 1930s, when voters punished the Republican Party for its management of the economy and ushered in a decade of Democratic control of the presidency and Congress. Big Democratic majorities in Congress also made possible the passage of President Lyndon Johnson’s Great Society programs in 1965 and 1966. Similarly, the Great Recession contributed to passage of the Affordable Care Act not by causing a leftward shift in public opinion but by helping to dislodge Republicans from the White House and the Senate in the 2008 elections. So if the Covid-19 pandemic does produce a sustained expansion in government social policy, it is most likely to have done so by helping Democrats win the presidency and the Senate in 2020.³³

Are there other lasting changes the pandemic might induce? Many companies and employees have found that working from home is more productive and convenient than they had anticipated, so work in offices may decline. This in turn could have knock-on effects on commercial real estate, particularly in cities, with the possible result that residential space will increase, making cities more affordable to live in. Schooling, too, may accelerate its already-ongoing shift toward greater use of online courses. Preferences for separating healthcare and childcare from employment may get a boost. Confidence in government might increase, or it might decline.³⁴

Yet as Claude Fischer has noted, it is striking how little impact the 1918-20 pandemic seems to have had on Americans’ attitudes, behaviors, institutions, and government policies.³⁵ It’s conceivable the same will be true of this one.

PREPARING FOR FUTURE PANDEMICS

Pandemics occur fairly frequently. The one in 1918-20 killed an estimated 50 million people worldwide. The 1957 pandemic killed 1.1 million, and the one in 1968 1 million. We don’t yet know Covid-19’s final death toll.

There will be more pandemics. What can we do to reduce their likelihood and minimize damage? Most recommendations center on efforts to anticipate the particularities of future disease outbreaks and to get a head start on preparation of vaccines. For instance, Peter Daszak, a disease ecologist, recommends a three-part approach: (1) identify as many as possible of the hundreds of thousands of pathogens that could threaten humans; (2) monitor blood samples of people in areas where new diseases are most likely to appear; (3) use these data to develop potential vaccines.³⁶