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Comment by btbuildem | Hacker News Reader

> The Antonine plague would continue to rage in the cities and military camps of the Roman Empire for at least another decade. A second wave of an undiagnosed epidemic disease hit Rome in 190 AD; if this too was part of the Antonine plague, then the pandemic lasted at least a quarter-century.

What ended it? Decade or quarter century - how did it subside, and why?

Can't help but draw parallels with the covid-19 pandemic -- most people you'll talk to will refer to it in the past tense, even though folks continue to get sick with it. We've stopped most monitoring and data collection, and it most definitely disappeared from the media. The one remaining reliable source of information is the wastewater analysis, which tends to indicate the virus is more or less as present in the population now as it's been in the past few years.

My conclusion to all this was kind of a sad lightbulb moment -- all the past pandemics, they didn't magically end. People just got tired, it became too expensive or politically inconvenient, we collectively turned away and pretended "it went away". The quarter-century timeframe on the Antonine plague looks starkly realistic in this light.

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> My conclusion to all this was kind of a sad lightbulb moments -- all the past pandemics, they didn't magically end. People just got tired, it became too expensive or politically inconvenient, we collectively turned away and pretended "it went away". The quarter-century timeframe on the Antonine plague looks starkly realistic in this light.

You make it sound like it's just a political decision, but a main reason why attention fades because the virus just becomes less deadly. E.g. the Spanish flu killed >20 M people, and yes you're correct it didn't go away, essentially every current flu virus can be traced back to the Spanish flu. People are just not dying from it to the same degree, so naturally we pay less attention.

Its worth noting that its hard to tell whether a virus became more deadly or whether the most at risk died early.

You can normalize by age groups, that's still possible.

And either way, outcome is the same. Virus is not killing as much as it did.

> You can normalize by age groups

Does that work? If genetically predisposed to dying from something, if it gets most of those predisposed they can’t get it again.

> Virus is not killing as much as it did.

Even that really is impossible to say. Our methods and frequency of testing for CoV-2 infections, both before and after death, have changed dramatically. Previously we were telling everyone to get tested when they feel sick at all, and considering anyone who dies after testing positive to be a Covid death. Now we rarely test and only considering it a Covid death when its as obvious a death from any other cold. We simply can't compare the numbers at all, at best we could say we have drastically reduced how often we mark Covid as the cause of a death.

Noe the excess deaths data has absolutely reverted to pre-pandemic levels, but again we were horrible about collecting unbiased data. Excess deaths actually seem to line up better with the vaccine rollout than with the initial viral outbreak. That could be completely coincidental and a sign that the virus was more deadly in its second year, but again we didn't collect the right data and don't know because during the rollout no one was willing to (or allowed to) consider that the vaccines could be killing people, leaving us with a gap in data that would have been really handy to now be able to definitively show that it was a more deadly virus killing people rather than the vaccine itself.

In 2020 those in power in the media and government told us that left unchecked, the virus would overwhelm hospitals and cause even more people to die, and to some extent that did happen.

The pandemic is over because if you go to the hospital now, on a random day, there are empty beds, and there isn't a COVID ward. There doesn't have to be careful testing and whatnot to know that the pandemic is over. You can just look around. It's either over or so minor that calling it a pandemic seems to be a misuse of the word.

> Excess deaths actually seem to line up better with the vaccine rollout than with the initial viral outbreak.

This seems to be a bizarre statement. I can't speak to other countries, but at least in England the widespread rollout of vaccines (just beginning in January 2021) only started at the end of the final major spike in excess deaths.

It's simply not possible for excess deaths to line up better with vaccine rollout than with the initial outbreak, because both major spikes in excess deaths were before mass vaccination rollout.

https://www.gov.uk/government/statistics/excess-mortality-wi...

That’s kinda the same thing. All nature is a balance, and as the rock shapes the river, the river shapes the rock.

I think the answer is called reversion to the mean.

As in a bunch of factors go into how nasty a virus is based on which and how it infects cells and how it manages to suppress the immune system, etc.

Particular substrains can be more or less nasty but will tend to evolve towards some normalized mean nasty.

Except in the case of Covid the host is contagious before symptoms develop, so there is no evolutionary pressure on it to be less deadly (i.e. give itself more time to spread by not killing the host).

No, not an exception.

It is common for people to become contagious before symptoms. But contagiousness is not a binary on/off switch. As your virus load increases, you get others sick more easily. And the result is that most people continue to become more contagious as they develop symptoms.

But there is also a second factor. We have multiple layers of immune defenses. COVID is very good at getting past our initial defenses and getting us sick. Over and over again. But if you've had it once, you have the ability to ramp up against it quickly in a way that limits how sick you can get from it. So if you've ever had it, it is now much less deadly for you. (Unless you become immunocompromised.)

Evolutionary pressure doesn't factor into this. Imagine the virus doing a random walk over a bell curve of virulence. On average an outlier is going to mutate into a not outlier.

SARS-1 was an outlier, very deadly. SARS-2 s probably not an outlier.

That said I think a virus can evolve to the point where it's arguably a different virus in which case the median virulence can change.

Except that current strains can't be traced back to the 1918 strain - they are separate strains, not descendants. We don't really know why the 1918 strain disappeared.

Fun fact: while the IFR of the seasonal flu is around 0.1%, there's around a 2.5% chance you will die from it.

The thing about endemic diseases is that we get them over and over and over. Eventually it gets you.

I was really hopeful at the beginning of the COVID-19 pandemic that we would start taking the flu more seriously. There was essentially no flu season that year because of the precautions taken for COVID; we are actually removing one of the strains from flu vaccines next year because it went extinct.

Things have changed since 2019. In 2023, only around 1.5% of deaths were from the flu; of course, another 1.5% of deaths were from COVID. So as things stand now, instead of a 2.5% chance that we will eventually be killed by our major endemic respiratory disease, there's a 3% chance we will eventually be killed by one of our two major endemic respiratory diseases.

> The thing about endemic diseases is that we get them over and over and over. Eventually it gets you.

The bigger thing is that the IFR differs dramatically based on age, and eventually you either die from something else or get old.

If it weren't for the IFR going up with age, you'd still have a very low lifetime chance of dying from the flu.

Yes and no; younger people also die less.

The flu death rate in the 0-4 age bracket for the 2022-2023 was 1.2 per 100k, compared to 26.6 per 100k for the 65+ age bracket. Meanwhile, the death rate of the 1-4 age bracket [different sources; different buckets] was only 28 per 100k, compared to 2000 per 100k for ages 65-74 or 15,000 per 100k for ages 85+.

So, flu deaths are a larger percentage of child deaths than than elder deaths, even though most people who die of the flu are old. The answer to "How can we most readily lower child mortality?" is always going to be "Keep infectious diseases under control."

The largest portion BY FAR of everyone's lives (beside infant fatalities) is the portion between 4 and 65.

There is no way the fatality rate of someone with my health profile or the health profile of the average HN user has a 2.5% chance to die from the flu this year. That must be including sick and/or elderly.

Most people don't die every year; 2.5% [well, 1.5% last year] of the people who die, die of the flu.

> Most people don't die every year

I don't think anyone dies every year. Just once. /s

Thanks, apologies for the misunderstanding. I wonder what the number is for pneumonia.

2.5% of deaths caused by flu is not the same as a 2.5% chance of dying of the flu, though.

Unless you do something unusual, that's almost exactly what it means. (Almost exactly because new causes appear, and those chances won't stay constant during your life.)

No.

US population: 330M

Deaths per year (approx): 3.46M (call it 1% of the population)

2.5% of deaths: 86,500 people

Number of flu infections, per year: 9M .. 41M

2.5% chance of dying of flu: 225,000 .. 1,025,000 people

Number of deaths due to flu, per year: 4,900 .. 51,000

Actual chance of dying of flu (2010-2022): 0.01% - 0.5% [0]

[0] min ((4900/41000000), 4900/9000000)) .. max (51000/41000000, 51000/9000000)

The OP didn't say "per year". You added that one gratuitously.

It makes no difference at all. But whatever set of statistics you use has to represent the same period. We could use daily deaths from flu, or decadal deaths from flu, or forthnightly deaths from flu .. as long as the total deaths we're comparing with cover the same period.

Thanks for this breakdown, I was too tired to protest but I completely agree with your interdiction.

I mean, I began by saying:

> the IFR of the seasonal flu is around 0.1%

We're all going to die some day. Based on current causes of death, there's a 20% chance, give or take, that it will be heart disease. A 20% chance it will be cancer. A 2% chance one of us will die from kidney failure. And around a 1.5% chance it will be from the seasonal flu, which has an IFR of 0.1% or less.

Anyway, bringing this back around to the Spanish flu, it's fascinating, to me, that if you were alive in 1918, there was around a 1% chance you would die, that year, of the Spanish flu, and around a 2% chance you would die, years or decades later, of a seasonal flu. Pandemics get you upfront, all at once, epidemics get us eventually, over time.

"x% chance dying of the flu" has two vastly different meanings.

"If you die, then the cause of death is to 2.5% the flu" is one meaning. Likely close to correct.

"With 2.5% you will die this year a death caused by the flu" is another. Unlikely to be correct.

This doesn't seem correct. Deaths per year are around 3.5M; deaths from flu vary between 5k and 50k.

TBH I'm not sure where I'm getting the 2.5% number from; it's the one that stuck in my memory from the last time I dug into this data. It's entirely possible that my memory is wrong or the data I was looking at represented an outlier in flu deaths.

For the 2023 / 1.5%, I referred to the provisional vital statistics for 2023: https://wonder.cdc.gov/controller/datarequest/D176;jsessioni...

Looking at past years (https://www.cdc.gov/nchs/data/databriefs/db355_tables-508.pd...), I get more like 2%, even for bad flu years like 2018. So that 2.5% number is probably either completely misremembered or based on provisional data that has since been revised downward.

Yeah, 1 - 1.5% seems inline with most data. That is: about 1.5% of all deaths are deaths from flu.

However, deaths among those infected by flu are much, much smaller than this (because the number infected is much, much bigger than the total number of deaths)

>Fun fact: while the IFR of the seasonal flu is around 0.1%, there's around a 2.5% chance you will die from it.

That's an incorrect statement unless the age distribution of people on this forum exactly matches the age distribution of the US population, which it doesn't. The overwhelming majority of flu deaths are concentrated in the elderly; someone under sixty is orders of magnitude less likely to die than someone older than eighty.

I don't think this has to be incorrect. Or that your "unless the age distribution...." needs to be true either.

Everyone eventually dies. When that happens, as things currently stand, it will be a 2.5% chance the cause will be the flu.

You might die young or old. Across those possibilities, it is 2.5%

That can be consistent with the idea that if you were to die next year, it probably (i.e., much less than 2.5%) won't be the flu because you are a young person.

> You make it sound like it's just a political decision, but a main reason why attention fades because the virus just becomes less deadly

That's an interesting point, right? I don't know that we have so much control over our attention, living in the age we do. Mass media and advertising, the two pillars of a massive propaganda machine (in a sense of building consensus) continue to pump out opinions, which shape our perception of reality.

In that sense, our attention to the pandemic did not have a chance to develop organically, but it was rather guided and instrumented by the mechanisms in place. The relatively smaller subset of society that controls them (not in a conspiratorial way, but in a practical "business pays for minutes of airtime / ad impressions" way) gets to decide how we perceive world events.

I'd posit (given historical datasets and what we see in wastewater) that the level of infection across communities is roughly comparable to the past few years (why wouldn't it be? nothing's changed after all in our behaviour). It's only in public perception that the pandemic has diminished.

It’s important to note that data during the initial part of the pandemic was grossly inflated.

The statistics and cause of death was attributed to COVID if you simply had presence of the virus in your body regardless how you died.

The virus was especially good at killing the elderly. It’s plausible that once those people in the population died, naturally the kill rate went died.

> we collectively turned away and pretended "it went away".

The most vulnerable population succumbed to it and died. Everyone who could be infected was infected. This pandemic became endemic, like some but not all other pandemics. Once it's endemic, the policy interventions that were apparently controversial are less effective. Survivors become more immune than they were before.

"By the toll of a billion deaths man has bought his birthright of the earth, and it is his against all comers; it would still be his were the Martians ten times as mighty as they are. For neither do men live nor die in vain."

> "By the toll of a billion deaths man has bought his birthright of the earth, and it is his against all comers; it would still be his were the Martians ten times as mighty as they are. For neither do men live nor die in vain."

For anyone wonder, H. G. Wells in The War of the Worlds

* https://www.goodreads.com/quotes/10445439-for-so-it-had-come...

* https://www.goodreads.com/quotes/621562-by-the-toll-of-a-bil...

This applies to diseases which are importantly but not always mortal. And very contagious. Like coronavirus

Very contagious diseases which are rarely mortal never go away. Like chicken pox

Not very contagious diseases which are always mortal don't spread far away. Like ebola and maybe the original pest. They require a reservoir lest they vanish forever.

Very contagious and always mortal diseases are self limited, they kill whole populations. One of the downsides of a global community is that almost the whole humanity is one population.

Self sufficient populations are found in the north pole. And in some island east of India called "Sentry island". I hope there are more

> The most vulnerable population succumbed to it and died. Everyone who could be infected was infected.

This explanation has some extremely obvious flaws. The world is still full of people who meet all the criteria of being particularly vulnerable to coronavirus. I doubt I’d be able to leave my house without seeing somebody who’s extremely obese or old.

"vulnerable" is the combination of medical characteristics and probability. "Everyone who could be infected was infected." is not accurate, but the r value is significantly lower, despite not every at-risk person being dead.

Looking at it in terms of "died"/"didn't die" is such a convenient oversimplification. Lots and lots of people didn't die, but suffered greatly; many of them developed long-term consequences like organ damage (and all the chronic illness that comes with that) or disability.

The claim that "survivors become more immune than they were before" is an outright lie, contradicted by an ever-growing body of research. Covid-19 does not grant you lasting immunity - it weakens the immune system, it causes neurological damage, and affects the cardiovascular system in a dramatic way.

The initial policy interventions were heavy-handed in a time of chaos and relative ignorance -- and there's no place for them now. There's opportunity now to go after the method of transmission in a more systemic way, legislating "clean air" efforts to make indoor spaces less of a breeding/spreading grounds for airborne pathogens.

> The initial policy interventions were heavy-handed in a time of chaos and relative ignorance

While I don't think we should go back to 2020 practices, I do think that what happened was less heavy-handed than we all remember. The US at least never had a real lockdown. You were always allowed to leave your house. The only places that got shut down by the government were bars, restaurants and schools. All other closures and people stopping to go out and socialize was pro-active behavior by citizens. Sure, some places required you to wear a mask, but IMO this was much less inconvenient for most people than the politically motivated outcry would make you think.

I am 100% with you that we should invest in ventilation and IMO far-range UV-C light in public spaces. COVID or not, respiratory diseases suck and cost massive amounts of money each year. If we can reduce them and improve air indoors it's a huge win that we should take.

> The only places that got shut down by the government were bars, restaurants and schools.

At least one SoCal city filled a skate park with sand.

There's a video of harbor cops going after a guy paddle-boarding in the ocean. (There was no one within 50 yards until the water cop on the jet-ski showed up.)

There were also churches where arrests happened.

California closed hair salons/barbers, but personal stylists were okay if you were connected. Then again, neither did the restaurant closing. (See Newsom, French Laundry.)

Do we actually want this, truely? If the species goes long enough in such sterile environs, free from voracious infection and without the constant assault upon the immune system, wouldn't the ultimate end result be far more disastrous? If removed from our protective civilization bubble or should a disease come along that can penetrate it, couldn't this be far more devastating to a population? Isn't a constant assault from the maximum amount of weakened and lesser disease of paramount importance to a robust and healthy immune response?

I don't think we'd accomplish a truly sterile environment. Even the places with good ventilation and far-UVC light won't be truly sterile. If someone coughs right at you, you are sor gonna get exposed. There will also still be plenty of places where we won't do these things. Most people won't have this in private homes for example. I think it would bring urban areas maybe somewhat closer in exposure levels to what you have in more rural areas.

> Everyone who could be infected was infected.

Some of us avoided being infected until we first got vaccinated.

> What ended it? Decade or quarter century - how did it subside, and why?

It probably killed everyone who wasn’t sufficiently resistant to it, leaving a population who were. Natural selection. The disease probably didn’t go away - it just stopped killing people. This is probably just one of many such events throughout European history that led to a population with various resistances - and when that population arrived on the shores of the Americas, it brought those diseases into contact with a population that enjoyed no such resistances.

Also, evolutionary pressure tends to make viruses less deadly. Variants that don't kill or incapacitate the host can spread faster, since the carriers are up and moving around. They'll inoculate the population against more deadly variants in the process. The longer a virus hangs around, the more variants there will be--with the more lethal ones tending to fade away, and the less lethal ones spreading far and wide.

The "Genomic Lineages" graph of Covid variants from the UKHSA gives a good view of how variants follow on from one another, at least with Covid. Flu certainly had three (?) popular variants doing the rounds (one of which was thought to have been eliminated by lockdown) but at the moment, it seems like there's usually one Covid to rule them all at any one time:

https://ukhsa-dashboard.data.gov.uk/topics/covid-19

This is true for flu viruses, not covid, as it spreads before symptoms show, so there is no pressure on it to become less deadly, as the fate of the host is immaterial.

Of course there is still pressure on it to become less deadly. If deadly virus starts spreading, no matter when the symptoms show, people will start washing hands, wearing masks and socialize less. All those acts put pressure on virus to become less deadly.

Not enough people did all that for long enough to make a difference. I'm the only one masking at work and in other enclosed spaces.

Previous poster was implying that such measures will spread with any "sufficiently deadly" virus, and that presumably COVID19 is not perceived as such at this time (rightly or wrongly).

Pandemics burn out eventually. The weak are killed off, those who survive either have natural immunity or are strong enough to recover. The pathogen itself also evolves; it's not really good for a virus to kill its host, as that limits its ability to spread.

This is often mentioned but its true only from statistical or 'strategy' point of view, something viruses on their own simply don't possess. They just multiply via various mechanisms, what happens with their environment is well beyong their capability to care or plan around.

Their mutations are random, but its proverbial throwing gazillion bunch of stuff on the wall and seeing what sticks. Their numbers and short life span give them maybe 100 million? evolution speed advantage compared to humans. Maybe much more. Think how humans would change in say 100,000 generations.

The virus of course does not do this consciously, but simple darwinian logic dictates that the strains that are too deadly will kill its pool of hosts too quickly, and die off together with them.

The person you’re responding to arguing against a straw man is intellectual Darwinism in play, let nature do its thing

I strongly encourage you to use a word other than "weak" in this sort of context. "Susceptible" will do. Ditto for "strong". "Resistant" might suffice.

Plenty of people died of COVID19 who were by no measure "weak" (other than susceptibility to COVID19) and your language suggests that viruses act upon some sort of generically less well-adapted genotype. Viruses kill people who are more susceptible to the effects of the virus (which may also differ from person to person). Those people may have previously been judged "strong".

"Weak" and "strong" are incredibly poorly chosen words to use in discussing susceptibility to disease.

There were 141 deaths attributed to COVID last week. It was 838 in 2023, 1,678 in 2022, 3,694 in 2021, and 11,243 in 2020. This is practically gone away.

https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm

I believe data is now going to be more limited:

https://www.hhs.gov/about/news/2023/05/09/fact-sheet-end-of-...

> CDC COVID-19 data surveillance has been a cornerstone of our response, and during the PHE, HHS had the authority to require lab test reporting for COVID-19. At the end of the COVID-19 PHE, HHS will no longer have this express authority to require this data from labs, which will affect the reporting of negative test results and impact the ability to calculate percent positivity for COVID-19 tests in some jurisdictions. Hospital data reporting will continue as required by the CMS conditions of participation through April 30, 2024, but reporting will be reduced from the current daily reporting to weekly.

You might choose to provide a geographic area with such numbers. I have no idea what you're referring to ...

> This is practically gone away

You mean the collection and reporting of data, right? That's what's gone away?

What would've made the virus itself go away?

I think we as a mankind went through some collective mental trauma re dealing with covid pandemics, and our subconsiousness ain't best equipped to deal with it. Just like with other trauma it blurred it into into some hazy dreamy distant maybe-land.

Fascinating to see it happening in real time and be part of it.

Amen. All the economic and cultural and political upheaval, not to mention war that’s happened since, we seem to assume that the pandemic stressed a bunch of systems and that’s the causality.

I feel like we don’t sufficiently acknowledge that a mass-trauma event also made the entire damn species more irrational and reactive, and that’s going to be our reality for a generation.

We can't get rid of COVID-19, it's not just a decision or apathy.

Yeah it has jumped to too many other species to ever have a chance in hell of eradication. Literal fantasyland to think that it going away is a viable option at our technological level.

Immunity builds up over time, and diseases etiolate (become less virulent) because in the end, Ebola isn't a winning strategy for the DNA inside the virus.

We don't die of the English Sweating disease, which killed people inside 24h (notably Thomas Cromwell's family, in Hilary Mantel's telling of his life)

> they didn't magically end. People just got tired, it became too expensive or politically inconvenient, we collectively turned away and pretended "it went away"

Look, I get why it feels like this, but there is another take on this. The mass immunisation did what it needed to do for us: removed the high risk of mortality and replaced it by background levels of a mostly serious but not fatal disease.

The risk is of a new disease, or a new strain. It can be just as bad. If the peridicity of that happening was 10-20 years, you'd have the long tail of the antonine plague, modulated through RNA vaccine development timeframes and the rise and fall of mass public travel.

If we just become homebodies and stop flying, Plagues will become local again.

Given that we're talking about a plague from over a thousand years ago, once it spread to the populations that people were in frequent contact with it basically halts at that point. Everyone has gotten sick and either died or acquired limited immunity. If there is no trade route to spread it, it can't go anywhere on its own. Also I think we can be reasonably sure that if far away merchant arrives at an area where the bodies are literally piling up out side the gates, they won't enter.

It is a 19th and 20th century innovation that viruses can spread so easily.

However, I'm under the impression that the Roman Empire was a lot more linked than we think when we say "they didn't have cars or airplanes".

Sea/river transport has been available since the first monkey climbed on a floating log and it was already widespread, cheap and convenient even 2k years ago.

Human population was only a tiny fraction of 20th century numbers back then. There were no casual travelers from Constantinpole to Buenos Aires at all.

Not that far, but you could probably carry a virus from Tomis [1] to Gades [2] via several merchant ships.

[1] https://en.wikipedia.org/wiki/Constan%C8%9Ba

[2] https://en.wikipedia.org/wiki/C%C3%A1diz

>Can't help but draw parallels with the covid-19 pandemic

That is very clearly the intent of the article and a fantastic reason to write it off as social media garage and stop reading it.

Can't help but draw parallels with the covid-19 pandemic . . .

I debated responding as there are other responses that get it mostly right . . .

You are correct that the virus is still around and will probably be forever more. But, it ceased being a public health issue 2-2.5 years ago. What happened? Everybody has either been vaccinated or had the virus or most likely, both. So the virus continues to exist and continues to evolve and people continue to get sick, but everyone's immune system has now seen something closely related and is much more able to fight the disease off. It has endemised and become basically like any other cold or flu that exists. There were already 3(?) coronavirus strains widely circulating in the human population before Covid-19 became a thing. Covid-19 has simply become one of ~200 different viruses that cause the common cold.

Covid-19 hasn't become - it is still much the same and not the same as the common cold. But as you point out we have become more tolerant of it (or at least are now able to convince ourselves that we are more tolerant to it).

We all know that wars end pandemics. As soon as the hot phase of the war in the Ukraine restarted, Covid was "gone".

Maybe something similar was the case in the Roman times too.

???

The Spanish Flu became as bad as it was because of a hot war - one of the hottest actually: WWI[1].

[1] https://en.wikipedia.org/wiki/Spanish_flu#Timeline

Maybe. Maybe not. Search for the death rates in e.g. Switzerland and Germany.

There's a really interesting questionvof whether people get tired of past pandemics or over react to new pandemics. Did we get tired of masks and news of how many die from Covid, or did we exaggerate CoV-2 and expect a pandemic with high mortality rate when the data didn't support it?

The thing is, we DID see a high mortality rate. We DID have incinerators running up queues in Italy and mass graves being dug in New York. Those things happened. Millions of people died from COVID, either directly or (more likely) from opportunistic infections enabled by COVID.

However the mortality rate normalized as the total number of infections rose. It mostly killed off people in groups that were high risk. That's almost tautological - the people in those groups may not even have known they were high risk prior to COVID though.

In other words: if the purpose of the response to COVID was to prevent deaths, we largely failed. If the purpose of the response was to contain CoV-2, we definitely failed. In retrospect, the function if not the purpose of the response was to delay the spread and enable immunization from vaccines. I wouldn't call it a success, especially not globally due to the hesitance to waive patent restrictions for poorer countries, but it was less of a failure than the other two possible purposes of the response.

Of course the problem is that while the rightwing meme of "is it FROM COVID or WITH COVID" is already difficult enough to deal with, measuring the impact of COVID on patients who did not die is even more difficult because we not only can't fully know what variables we're looking for but those variables are also likely to be extremely difficult to isolate, especially given the stress of being in a pandemic, news coverage about the pandemic and the measures enacted as a response to the pandemic.

> Of course the problem is that while the rightwing meme of "is it FROM COVID or WITH COVID" is already difficult enough to deal with

I don't actually understand why this is considered a meme or rightwing, its always seemed like a reasonable question to me.

As you pointed out, a large majority of those who died were already at high risk, meaning they already had underlying health conditions. If someone with high blood pressure, diabetes, obesity, etc contracts a novel virus and dies is it really as simple as saying the virus is what killed them?

I don't think people often articulate the question well, that's for sure. Its usually used as a talking point, but it is a reasonable question in my opinion. Saying that Covid killed someone that has been dealing with health issues for years or decades, and likely is on multiple prescription medications, writes off all of their underlying conditions and boils it down to a statistic that reads as though the person was totally fine until they contracted CoV-2.

I think this is unintuitive to me, because “dying with Covid” makes the assumption that the person was actively dying from a completely separate cause and got Covid before they died… which isn’t necessarily true for folks with underlying health conditions. Like if I had uncontrolled diabetes which made me move slowly due to foot rot, and someone struck and killed me with their car, do they get to argue I actually “died with car accident”?

> I don't actually understand why this is considered a meme or rightwing, its always seemed like a reasonable question to me.

I mean, yeah, that's the school of Just Asking Questions. It's standard bad faith participation strategy in discussions, you play the role of an unconvinced fence sitter while actually pushing a narrative. In this case, it was that COVID was killing fewer people than it actually was.

While for a statistician or a medical practitioner looking to better understand the pandemic will find value in the answer to the question, your average laymen doesn't understand how to apply the difference to arrive at an informed opinion. People parroting this weren't concerned how many people were actually dying of COVID; they wanted to go get their hair cuts and eat out again.

A desire for a return to normal is a very... well, normal and human impulse but if it's not time yet, it's not time yet.

It is possible for both dying "from" and dying "with" to be true. (although the medical meaning of each is imprecise IHMO)

I have read that many (most?) of the victims of the 1918 flu pandemic did not die from the virus, rather the virus weakened them to the point where pneumonia bacteria took hold in their lungs. With no recourse to antibiotics many did not survive the bacterial infection.

This sounds like how my great-grandfather died. It was reported that he contracted the flu and was sick for two weeks but began to recover, then relapsed and died. Sounds like a bacterial secondary infection after a viral infection.

That seems unfair to say, covid-19 is causing way less deaths now than then, and the population is more resistant to it now

> Can't help but draw parallels with the covid-19 pandemic -- most people you'll talk to will refer to it in the past tense, even though folks continue to get sick with it. We've stopped most monitoring and data collection, and it most definitely disappeared from the media. The one remaining reliable source of information is the wastewater analysis, which tends to indicate the virus is more or less as present in the population now as it's been in the past few years.

> My conclusion to all this was kind of a sad lightbulb moment -- all the past pandemics, they didn't magically end. People just got tired, it became too expensive or politically inconvenient, we collectively turned away and pretended "it went away". The quarter-century timeframe on the Antonine plague looks starkly realistic in this light.

What exactly did you expect though? The pandemic stage has ended, it's now a novel virus that will continue to circulate among us for many, many years until we find a way to eradicate it. Eradicating requires broad vaccination of the population against it over generations, like smallpox, or the way polio is going (many societies have eradicated it).

There's not much more to talk about on COVID, for now the strains are not the same killing machines from the beginning of the pandemic, a lot of people have been vaccinated while many others refuse to vaccinate themselves. Just like influenza continues to kill (or maim) people year-over-year, COVID will keep killing and maiming people but it's not creating a huge strain in the healthcare system globally.

Also, there's not much more to do, the disease exists and will continue existing, we might get new vaccination schemes (like for influenza) to protect the most vulnerable people, we will continue to catch it and probably suffer side-effects but the emergency part of it is mostly over...

What were your expectations?

I can only speak for myself and I'm not in the US but having been raised on a diet of "end of history" era Hollywood stories about the world coming together to defeat a common threat, I expected something closer to a war economy than just a bunch of temporary subsidies, conflicting mandates and half-assed lockdowns that ultimatel fizzled out before even the lower bound of vaccination for what the scientists said would be required for herd immunity was met.

Instead we saw countries stepping over each other to buy last minute supplies from China because they had eliminated their stockpiles for "efficiency", politicians opportunistically demonstrating defiance in order to make a name for themselves and subsidies being tailored to the specific niche interests of major industries while public services were told to exercise "individual responsibility" instead of receiving additional funds. We clapped for the nurses and then went back to cutting the public health budget because the economy was tanking while a few lucky businesses redistributed societal wealth into their pockets.

Nobody demonstrated leadership. Anyone who did was kneecapped by opportunists. Even the EU couldn't commit to a joint plan without having individual member states decide they're special and allowed to do backroom deals to break the same rules they just agreed to. The only thing any politician could agree on was that the economy had to "keep running" at any cost.

What did I expect? I don't know, to be honest. But I expected something more coherent and closer to the lies we were told about the state and what it is good for. But what shocked me more is how after the mask came off and revealed that it's all always been false advertising, we simply went back to normal. But this already happened before, e.g. after the Wikileaks and Snowden revelations. I shouldn't be surprised that people prefer to forget.

I'd expected something similar to the John Snow pump handle story -- that once we learned that the virus spreads via air, we would invest in clean indoor air, and innovate ways to make it safer to share spaces with large numbers of people over extended time.

The acute phase death rate may have dropped off (and the data collection has most definitely dropped off, stopped entirely, or became obfuscated, so it's hard to know for sure), but we know for a fact that about 15% of those who get sick, get a long-term sickness that ranges from seriously inconvenient to severely debilitating. We know this from collected data [1], not some statistical models.

My inner cynic concludes that in for-profit healthcare systems, having a growing proportion of the population be chronically ill is actually the optimal scenario: you can dole out treatments and medicines at high prices, and as long as your patients don't die or get better, it's a very profitable proposition. I'm not saying we're doing this consciously like some comic-book villain, but the incentives are aligned exactly so.

1: https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article...

I think when people talk about COVID-19 in the past tense they're referring to the period of national lockdowns, which are no longer necessary since the health services are not being overwhelmed in the way before anyone had immunity/vaccinations. I don't think anyone believes the virus was eradicated.

That's because the current variants are fairly mild. The original variant was brutal for the population at risk and we saw a jump in excess mortality. I believe mortality has since come back down. The anomaly was that the media were still making a big deal out of covid when vaccines were available and the variants were mild. Of course until the Ukrainian war started which magically "stopped covid".

It will take time before passion and fear cool down and people look objectively at our reaction to covid. I think it will appear as a gigantic overreaction compared to similar outbreaks like the 1958 flu.

What exactly do you propose we do about covid anyway? None of the mitigations that were forced upon us did anything beyond make things much worse.

Seriously. Covid wasn’t even that bad relative to other pandemics in the past.

Besides I think the real reason nobody really talks about it anymore is because a lot of people woke up to how badly they got scammed and are pretty embarrassed with their reaction. No to mention flushing several years of their life and their children’s life down the toilet for nothing. Not to mention the disastrous economic fallout we will be suffering through for quite some time.

… which again, was all for absolutely nothing.

> None of the mitigations that were forced upon us did anything beyond make things much worse.

> Covid wasn’t even that bad relative to other pandemics in the past.

Do you not see how these two statements contradict each other? What did you expect to see if the mitigations had worked?

For covid in particular (and also the Spanish Flu, to a large extent), number of deaths is the big factor; deaths are _dramatically_ down in most countries. Barring a perfect vaccine, it's likely never going away entirely, but it's also generally not threatening to collapse healthcare systems anymore.

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