Unlike in a hurricane or war zone, much of covid’s toll happened out of public view, inside the crowded hospitals where people died on ventilators, often without families by their side in the early months. Frustration built among millions of Americans who were largely stuck at home and required to wear masks at stores as kids learned via Zoom because of an invisible threat. Glimpses came through in the haunting stream of ambulances in empty New York City streets or images of overflowing morgues.
“These are traumatic experiences, and in many ways the ways we deal with it is to forget and move on,” said Ziyad Al-Aly, a physician-scientist and senior clinical epidemiologist at Washington University in St. Louis who treated covid patients and has been extensively researching the long-term consequences of the virus. “A lot of Americans don’t really remember those days, but we lived each one of them.”
This disconnect has led to misconceptions years later, according to public health experts. Hindsight, the distance of time and the now endemic nature of the virus have allowed certain myths about the pandemic to emerge. But these are some of the truths of covid, which killed more than 1.2 million Americans, that medical professionals and health experts want to remember.
Lockdowns served a purpose
That stretch of spring 2020 when society came grinding to a halt with businesses and schools closed, gatherings banned, and church services suspended has sometimes been dismissed as a fruitless economic disruption, as the virus continued to rage for years.
But these actions were not about eradicating covid. Remember the phrase “flatten the curve”? It meant spreading out the inevitable cases over time, avoiding a massive spike that would overwhelm hospitals — not bringing them down to zero.
“The point of this is, instead of a spike of the curve, to delay and flatten that curve with the hope that you can keep the utilization of resources to be within the health care system’s capacities,” then-Health Secretary Alex Azar said in a March 15, 2020, press briefingthat previewed plans for mitigation.
Doctors, nurses and others who were frontline medical professionals at the time lament that the public does not recall or appreciate what they faced as they confronted a deluge of patients with a disease they had never seen before and with a shortage of personal protective equipment to keep themselves safe.
New York City emerged as early hot spot and a warning sign. At its peak in the week of March 29, more than 1,500 covid patients were hospitalized per day and roughly a third were dying.
“I remember walking into the hospital in March and April 2020 and feeling like I was walking into the apocalypse,” said Craig Spencer, then a physician in the emergency roomat Columbia University Medical Center.
Nationwide, the health care system did not become as overwhelmed as feared in spring 2020, which experts have attributed in part to mitigation, hospitalization rates being lower than expected and measures to increase bed capacity. Hospitals became more strained in the next two winters, including the massive omicron wave of 2021-2022 that caused milder illness but sparked record hospitalizationsand staffing shortages as record numbers of Americans became sick.
There is robust debate on which restrictions were imposed and for how long — especially school closures. The phrase “follow the science” for policymaking was an oversimplification because science cannot offer a clear road map for navigating trade-offs, science communications experts and public health experts have acknowledged. Covid raged around the world, including in China with its draconian “zero covid” strategy, and countries experienced different consequences and benefits from their decision-making.
Covid was not just the flu
These days, the experience of getting covid is far more mundane for most Americans (though still worrisome for the elderly and immunocompromised). But in the early days, the threat to younger Americans was far greater for people not considered high-risk today.
In 2020, SARS-COV-2 was a novel virus unlike other coronaviruses that have long circulated. It was so alarming because people’s bodies were not trained to fight it and doctors were not trained in how to treat it. Symptoms and complications were more unpredictable and far-reaching than with other respiratory viruses.
Seniors were the ones always at highest risk of death, and they are overwhelmingly the ones who still die from the virus. But at least 275,000 who died of covid were under the age of 65, according to Centers for Disease Control and Prevention data. Covid was not as severe as feared in children, but the death toll of more than 1,600 is also higher than fatalities from other diseases that prompted aggressive public health responses to spare children from preventable death.
“Folks who either got it and it was really mild or got it and they were asymptomatic are looking at what happened in 2020 compared with them and their experience and think nothing has changed, it’s always been just a cold,” said Jessica Malaty Rivera, an infectious-diseases epidemiologist. “But we can thank hybrid immunity between vaccines and infection for the reason why mortality rates are lower than they were in 2020.”
Covid has often been dismissed on social media as just the flu or a common cold. It was not true in the first several years of the pandemic when covid proved far more transmissible and virulent. Now covid is becoming more like the influenza as vaccination and prior infection have bolstered immunity. The CDC estimatesthat 45,000 died of flu last respiratory virus season, more than double the covid death toll. But experts don’t know whether it will stay that way or whether more virulent variants will emerge.
Vaccines were sold as preventing infection
People often vent that they were infected with coronavirus despite being vaccinated, and others are quick to retort that the vaccines were never meant to prevent infections and instead were designed to protect against severe disease.
But the early messaging about vaccines did focus on covid vaccines as a way to keep you from getting covid. Officials often stressed the importance of vaccines to achieve “herd immunity” to stop the spread, until it became clear that vaccinated people could still be infected and spread the virus.
The coronavirus vaccines were initially effective at preventing sickness outright. During trials, the Pfizer and Moderna mRNA vaccines were foundto be more than 90 percent effective in preventing disease. A study of 4,000 frontline workers found that in the first three months of the vaccine rollout, two doses reduced the risk of infection by 90 percent.
Then the virus started mutating to bypass the first-line immune defenses, making it easier to infect the vaccinated, who still carried additional immune protection to reduce the severity of illness.
President Joe Biden in July 2021 said“you’re not going to get covid if you have these vaccinations” as the delta variant surged. That wasn’t true: Infections among the vaccinated were no longer rare in the delta surge, which forced CDC officials to acknowledge a need to change vaccine messaging.
Malaty Rivera said the benefits of immunization were oversold to Americans who should have received a clearer message that vaccines are an imperfect tool best combined with other measures to reduce risk, such as masking.
“And so they feel betrayed,” she said. “You made me feel like the vaccine was going to open up my life again. You made me feel the vaccine was going to give me the freedom to not get sick.”
Trump has changed his tune on covid
Supporters and allies of President Donald Trump often assail the public health response to covid as overreaching.
The White House overhauled the covid.gov site that once offered resources for information on testing, treatment and vaccines to criticize the handling of the pandemic — including under Trump’s watch. It says “prolonged lockdowns caused immeasurable harm to not only the American economy, but also to the mental and physical health of Americans, with a particularly negative effect on younger citizens.”
It was under Trump that the federal government recommended social distancing and business closures. The president himself spent months “issuing conflicting messages and dismissing the threat of the virus, even as his health advisers warned him the worst was yet to come,” concluded “Nightmare Scenario: Inside the Trump Administration’s Response to the Pandemic That Changed History,” based on extensive reporting by Washington Post journalists Yasmeen Abutaleb and Damian Paletta.
In a January 2021 report, the Trump White House touted how the administration “implemented strong community mitigation strategies” and “released guidance recommending containment measures critical to slowing the spread of the virus.” The March 16 guidance described as “the president’s coronavirus guidelines for America” called for closures of schools and venues where people congregate once the virus starts transmitting in communities.
“A lot of the strictest things happened when Trump V 1 was in power,” said Malaty Rivera, who also volunteers for the organization Defend Public Health, which advocates against Trump administration health policies.
White House spokesman Kush Desai said in a statement that the Trump administration “issued commonsense guidance” when “everyone was in the dark about the nature of covid” before it adjusted its approach as new evidence emerged.
“After an abundance of evidence made clear that the economic, social, and psychological effects of universal school and other lockdowns far outweighed any possible reductions in covid transmission and mortality, the Trump administration and various GOP-led states accordingly adjusted and called to lift mandates, opting instead for more targeted measures to protect vulnerable populations,” Desai said. “Blue states chose to ignore this evidence, and doubled down on destructive lockdowns as well as blanket vaccine and mask mandates that tanked their economies and sabotaged the development of a generation of children.”
Now scientists and anti-vaccine activists who rose to prominence as covid contrarians hold federal health positions after voters restored Trump to the office they once ousted him from in part because of how he handled the pandemic.
Trump has focused his covid messaging on blaming the pandemic for foiling a good economy under his watch and revisiting the virus’s origins. Covid.gov now promotes the “lab leak” theory that SARS-COV-2 originated from Chinese experiments, even though the assessment of federal agencies and scientists is split.
Kristin Urquiza, who co–founded Marked by Covid to memorialize the victims of the pandemic after losing her father in 2020, said she is frustrated by what she sees as the Trump administration downplaying the consequences of covid.
“Covid was one of the most horrific events that has ever happened to me and to my community,” said Urquiza, who has struggled to gain traction for a national covid memorial in Washington, D.C. “Part of the reason why we are so committed to it is to remember our loved ones but to spare others from the horrific experience we lived through.”
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