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Still not sure how post-Covid, we haven't concluded that improving indoor ventilation should be a massive public health priority.

Seems like there'd be a lot of tension between that goal, and reducing energy use.

It's not 100% solvable, but it's possible to recover a lot of the thermal energy of the air you exhaust and put back into the air you're intaking: https://en.wikipedia.org/wiki/Energy_recovery_ventilation

Because it's difficult. How do you solve for this problem in a house without internal ducting in temperature extremes throughout the year?

I'm curious, how long has ventilation ducting been part of housing codes, in other words how old are houses that have that problem?

Many (most?) houses in the north/north-east do not have ducts. It's very rare for me personally to come across central air in the NY area.