When it is finally written, the definitive history of COVID-19 may well prove otherwise, but for now it appears most likely that: (a) COVID-19 was widely dispersed long before anyone knew what “it” was; (b) most people were therefore probably “exposed” and many of them “infected” long before we panicked and shut down much of the world’s economy (a classic case of closing the barn door after all the animals were out); (c) COVID-19’s IFR (infection fatality rate) as a “novel” flu virus will be higher than a “normal” flu virus, but probably still less than half of one percent (e.g., maybe ~0.40% vs. ~0.14%); and (d) the still unquantified but enormous economic and related human costs we have imposed on ourselves (more on this later) were completely unnecessary — probably the biggest and most costly Extraordinary Popular Delusion in human history.
The definitive COVID-19 history awaits good data on overall death rates, which will eventually reveal whether the moving average (say, three-year) death rate for the 2015-2025 period shows a significant increase around the COVID-19 years (2019-20), within what should otherwise be a gradually rising trend in death-rate in most countries as their populations continue to age.*
The “Underbrush Theory,” helps to explain what has happened.
The Underbrush Theory states that there is a natural rate of attrition (a.k.a., deaths) for any population, and reducing deaths for several years below this natural rate (e.g., perhaps because of lucky guesses on the right flu vaccine, more flu vaccinations, improving sanitation, better public health programs, better cardiology care, better cancer care, better kidney care, better autoimmune care, better and more nursing homes, etc.), just means Mother Nature’s bill is inevitably going to be higher in some subsequent year when she throws a novel flu cocktail at us.
It’s like Smokey Bear preventing forest fires for so long that the underbrush accumulates to feed what inevitably becomes a much bigger, more destructive fire in some future year (think California and Australia). We must all remember that old age is still lethal — no one is getting out of here alive. The only question is what the proximate cause of death will be. Flu-related deaths are and always have been the default option for many old people.
Based on the Underbrush Theory, when a novel virus comes along, death rates rise temporarily as more old people die. Thus, flu-related death rates in various countries should be primarily a function of the proportion of “unhealthy old people” (meaning, old people with some kind of serious-but-manageable underlying medical condition, or “comorbidity”) in their populations.
Ironically, this means the more successful a country’s healthcare system is at keeping people alive by preventing death from other causes (including “normal” flu), the higher its death rate will be at some point in the future when a novel flu virus arrives. Also ironically, countries with relatively poor healthcare and public health systems (e.g., hygiene, sanitation, sewerage, pest control) will have proportionately fewer old people with underlying medical conditions, and these countries will not suffer high flu-related death rates.
Differences in flu-related death rates among states or countries with equal proportions of old people are likely to reflect primarily differences in how healthy their senior populations are. Healthier old people could reflect differences in culture (e.g., diet and nutrition, low vs. high body mass indexes, active vs. inactive lifestyles, personal hygiene, alcohol, tobacco and other substance abuse). Different flu-related death rates might also reflect genetic variations among different population groups (providing greater protection to some and greater vulnerability to others), by genetic variations in the novel flu virus itself (i.e., different strains), and by the virus’s own preference for or vulnerability to environmental influences, like climate variations.
Finally, as we all know, there are other and far more scary viruses (e.g., Ebola or the Spanish Flu) and other pathogens that attack otherwise healthy people of all ages rather than primarily unhealthy old people. A pandemic caused by one of these truly scary pathogens would justify the extreme measures we have taken, but for now, it does not appear that COVID-19 is even close to being one of them.
Deaths attributed to COVID-19 (a number that is highly subjective and probably significantly overstated in some places and understated in others), currently total ~50,000 in the U.S. and ~200,000 worldwide, which compares to 12,000-61,000 annual flu-related deaths since 2010 in the U.S. (according to the CDC’s best guess) and 290,000-650,000 annual flu-related deaths worldwide (according to the World Health Organization’s best guess). With the number of daily deaths attributed to COVID-19 now trending flat-to-down in most countries, it is far from clear that the total number of flu-related deaths (including COVID-19) in the current 2019-20 season will be significantly greater than they have been in past years.
Going further back in the history of U.S. flu-related deaths, the 1918-19 Spanish Flu is estimated by the CDC to have killed 675,000, the 1957-58 Asian Flu 116,000, and the 1968-69 Hong Kong Flu 100,000, all of which would presumably have claimed even more lives today because our population has grown.
Meanwhile, on the other side of the rational cost-benefit analysis that should guide our behavior and public policies, according to a recent front page article in the New York Times, the collateral damage of “national lockdowns and social distancing measures” includes: “135 Million Face Starvation,” a number which the article says, “could double.”**
* Note that attempts to measure “excess deaths” while COVID-19 is anywhere near its peak by comparing total current deaths to historical average deaths for the same period (as some publications like The Economist and the NY Times have done) will inevitably create the impression that the death rate has risen. However, it is likely that higher deaths driven by COVID-19, say in early 2020, will have been largely or completely offset in most countries by lower deaths over the balance of the year and/or by lower deaths in the years leading up to the COVID-19 outbreak. In other words, things will probably even out, and when it is all over, there will probably be no apparent increase in the multi-year moving average. Subject as always to the assumption that the data are accurate, one interesting source on overall death rates in Europe is this.