The Pandemic Was a Time Machine

Recently I came across perhaps the most mind-bending chart about the pandemic I’d seen over three-plus years. Originally published two years ago in The British Medical Journal, it shows how Covid affected age-standardized mortality in England and Wales — a statistic that controls for demographic change in measuring death rates, so that a country doesn’t look as if it’s getting sicker just because it’s getting older.

Two things about the chart jumped out. First, at the onset of the pandemic in 2020, there was a dramatic spike in age-standardized mortality. For men, the increase was 14.6 percent, according to the Office for National Statistics; for women, 11.9 percent.

Second, though: In historical context, that jump did not appear all that large. It only brought age-standardized mortality to the level it had been in the year 2008, meaning that, correcting for age, the English and the Welsh were no more likely to die in 2020, in the midst of a once-in-a-lifetime global health crisis, than they were 12 years before, in what did not seem like a particularly deadly year at the time.

Novelty matters, and the sudden arrival of a masterfully infectious and deadly virus was justifiably alarming and galvanizing, adding a large amount of death on top of a mortality baseline we’d all wish was much lower. But progress in improving that baseline matters, too. And from that vantage, the mortality setbacks of 2020 looked smaller than the apparent gains of the previous 20 years — and not just in England and Wales. Across much of Western Europe and North America, even the horrible pandemic peaks only brought age-standardized death rates as high as they were in normal-seeming years around the turn of the millennium.

At first, this seemed hard for me to believe, given that more than 20 million have died worldwide from the disease, with the pandemic experience in every country quite far from normal. But while the two points may seem contradictory, ultimately, they reinforce each other: The better you appreciate the gains of the last several decades, the larger the disaster of Covid appears. Somewhat incredibly, the pattern applies to many pandemic-era phenomena beyond mortality, with Covid-19 playing the role of a statistical time machine, one that returned us not to the era of the Black Death or even the 1918 flu but to a much more recent and less alien-seeming time just a decade or two in the past. Which raises an implicit question: How do we come to terms with 20-year setbacks in a time of pretty rapid, if uneven, progress?

Let’s start with mortality. Across other nations in Europe, the rough pattern appears similar to the English one: an abrupt jump in 2020 mortality that nevertheless did not reach the age-standardized levels experienced around the year 2000. In the United States, the setback was larger, but only slightly. According to the Centers for Disease Control and Prevention, the rate here was around 882 per 100,000 in 1999, and, after falling to 715 per 100,000 in 2019, rose only to 835 per 100,000 in 2020 and 880 per 100,000 in 2021.