Five Years On: A Covid Retrospective

As we approach the five year mark of the first known case of covid-19, as we contemplate a half decade of watching a novel virus rip through our communities, our countries, our world, I wanted to do a retrospective on the pandemic.

A keeping score of sorts.

Let’s start with the top-line.

The first thing to say on this is that no one is very clear about how many people covid has killed.

The official number (got covid, hospital tested, died) is 7 million globally, but this is a number frozen in time since late 2022/early 2023.

How big could it really be?

The Economist built a model to estimate excess covid death which says the pandemic death toll might be close to four times higher than the official count, somewhere around 27 million.

27 million. More than the population of Australia.

The upper boundary of the model sits at more than 36 million dead.

We’ll never know the true death toll, a toll that increases daily, because hospital testing is patchy and varies wildly from country to country.

Some of this is down to the fact that covid spread is rampant in hospitals and healthcare systems want to avoid liability. So they just don’t test.

Where they do still test, such as in Wales, we know that 70% of all people who require hospital treatment for covid got covid in a hospital.

Covid continues to add thousands to the global death toll every week. In the US one thousand people are dying of covid every week.

Who were these dead? Who are these dead?

Many of them were parents of children.

By May 2022 researchers estimated that 10.5 million children globally had seen one or both parents, or a primary caregiver, killed by covid.

In the US more than 245,000 children lost one or both parents to covid, with far too large a number of these after vaccines were available. (The linked Guardian story is about a fully vaccinated 40-year-old dad who died in summer 2021).

How many fully vaccinated people died after believing the propaganda that they were immune to the worst outcomes and could go back to normal?

Yet there is no restitution for the children of the covid dead. No official acknowledgment. No dedicated programmes, financial or otherwise.

Pandemics, and the questions they ask, often seem just too big for our societies to grapple with.

Perhaps this is because pandemics deliver particularly intimate and unpredictable devastation.

When every single person on the planet becomes a potential vector for a new disease, they unavoidably disrupt the entire fabric of our societies.

It just can’t be any other way.

In the novelty, in the unknown, is where one half of the fear lurks.

What will the virus do to me?

In the unpredictability of sickness lies the other half.

Who will make me sick?

Will it be my child, a friend or a colleague?

Where and when will this happen?

Will it be when I’m having fun? Or will I get sick in the course of mundane events, doing my shopping or visiting the bank?

Will you die, be made chronically ill or not even notice you have the virus?

In that not noticing, in the asymptomatic course, will I inadvertently kill or disable someone?

How can I keep this all in my head wile also having to pay bills, and put food on the table?

No wonder people don’t want to think about it.

Can you honestly blame them?

Some of us are wired, fortunately or unfortunately, to stare at these realities and unpack these questions.

Fortunately or unfortunately. I’ve often wondered which it is.

One of the eeriest flashbacks for me is how early in the pandemic the media was full of articles about how the 1918 flu had been banished from historical memory, only for our societies to go on and do exactly the same.

By the summer of 2021, against all the evidence to the contrary, most people were convinced covid was over. July 19th 2021 was dubbed ‘freedom day’ in Britain with all protections dropped, and while some countries required masks in hospitals and healthcare through that winter, by 2022 even these were jettisoned and covid was, for most people, definitely over.

It was so over that a brutal June/July 2022 wave in Europe was put down, by experts, to heatwaves, despite the fact that a few clicks could have told you what was driving large excess death that summer. For example Spain, where excess summer death was said to be entirely caused by the heat, had its largest ever summer covid wave, exceeding 2021. But the experts just looked at large excess death, said ‘well it has been hot,’ and called it. A frightening covid blind spot.

Some people have since gone on to believe, a belief seeded and nurtured by right-wing libertarian propaganda, there was never anything to particularly worry about in the first place.

Some of the pushers of this line, such as the people behind the so-called Great Barrington Declaration which argued for herd immunity via mass infection pre vaccines, are going to have prominent roles in the new Trump administration.

An administration that was helped into power by the refusal of Biden and the Democrats to use the generational opportunity covid provided to permanently restructure social programmes. By their refusal to articulate the impact of the pandemic and the measures it necessitated in social, communitarian terms.

And now, as the anniversary of the Wuhan index case approaches, the man who was president when covid struck, the man defeated in large part because of his covid failure, will be inaugurated as president again just a few weeks after this five-year marker.

Hard to grapple with.

What else do we forget about the pandemic? We forget how mesmerised we were as nature rebounded, how clean the air was in the absence of industrial scale human activity. We forget that carbon emissions fell at the sort of pace required to avoid cataclysmic climate change. We forget that no-strings cash payments saw child poverty in America plunge to record lows, that the UK slashed homelessness with schemes that found homes for people sleeping on the street.

We forget that there really was a sense of global solidarity, that the reflection demanded by a pandemic opened up spaces for us to consider truly radical and permanent change. Remember build back better? There really was a sense that the coronavirus, as we all knew it then, could be the catalyst for a better word.

It couldn’t last because of capitalism. This isn’t some glib statement, it is literally why such promises could never be fulfilled. Because such promises required redistribution and structural shifts to economies that billionaires don’t want shifting.

So where are we now with covid?

Acute stage deaths are, of course, after vaccines and infections, still far too high but a long way off the early peaks. That phase is over and a new phase has started: the long tail of chronic illness. Population health will now be degraded for decades as chronic illness and immune system dysregulation triggered by repeat Sars-Cov-2 infections pressures health systems, social systems and economies.

In the US it is estimated than one in four people have some form of long covid. In both the US and UK, applications for long-term disability payments have soared to record levels since 2020, an increase so clearly and obviously connected to covid infections. Yet in our media, political and social discourse the increase is usually blamed on everything other than the virus.

The motivated reasoning (if covid was causing this that would be bad) and denial (so therefore covid can’t be causing this) is absolutely astounding.

And while there is good reason for a focus on the long-term sick, even transient sickness, the fabled ‘just a flu/cough' that more people are getting more often, takes an individual and collective toll. And even when the sickness appears transient, when you have cleared the classic virus symptoms, covid can be taking an insidious toll on our health by harming immune systems.

Covid has long been known to hit the immune system by killing off cells which are key to our immunity. These cells, known as CD4 and CD8 cells, are lines of defence against invading pathogens. As they get to work fighting covid, they are also depleted by the virus. They can eventually recover, but the process can take years. Everyone is different, some are genetically lucky, but as a rule of thumb if you are constantly exposed to covid your body is unlikely to have enough time to rebuild strong immune function.

What would we see if immune systems were being degraded at a population level? We would see the rise of opportunistic infections such as walking pneumonia, whooping cough and an increase in other viral infections. And this is exactly what we are seeing.

Whooping cough in England has gone stratospheric, just a massive increase over any other year in recent memory, with more cases in a week in 2024 than were seen in whole years previously. The same thing is happening in Australia and in North America.

Mycoplasma pneumonia, also known as walking pneumonia, caused by a bacteria, is also skyrocketing everywhere, from the US to England and Wales.

A recent study found people who’ve had covid had significantly higher rates of bacterial infections. In Sweden, the land of let it rip covid, the picture is not pretty, with all sorts of infections at record incidence.

And now bird flu stalks this immune dysregulated landscape.

With more cases popping up over the US every day, and the virus seemingly mutating to more easily infect humans, fears of another pandemic are entirely legitimate. If the virus does find the mutations to go pandemic, all bets are off. Covid broke everyone's brains, physically and metaphysically. We really don't want to know what a second pandemic in a decade will do. But with US agencies captured by big agriculture and no appetite for the sorts of measures needed to stop the spread, a flu pandemic now appears the most likely outcome.

If it happens, economic collapse is probable.

The global solidarity which characterised the first few months of covid would be nowhere to be seen. A Trump administration would go for immunity via infection, which, with a virus likely to have a significantly higher case fatality rate than covid, would cause social and economic chaos. (If there is any crumb of comfort it’s that the virus will need to cede virulence for effective human to human transmission so the fatality rate will not be the much quoted 40-50ish percent).

With masks stigmatised, people will walk defiantly into a viral buzzsaw and call it freedom.

The only chance of a half-decent response to the next pandemic is if we can keep the historical memory of covid alive.

If we can remember the devastating toll it took, but also remember the sense of solidarity and the genuine material improvements that were sparked, albeit temporarily, by a collective global crisis.

If we can remember that we live in a society.

If we can remember that, as bad as things get, every crisis is still an opportunity.