For the second anniversary of the pandemic, I wrote a counterfactual history of some of the key early turning points: accepting transmission without symptoms, recognizing airborne spread, the importance of clusters, and the need to increase vaccine supply and distribute it equitably.There is, obviously, more, but it’s already a lengthy article. Plus, early action obviously is crucial, as well as vaccination as fast and as widely as possible.

Why do this exercise and how does this differ from Monday Morning Quarterbacking, so to speak? Also, why not write more about the political and institutional dysfunction that made these outcomes happen?

We cannot step into the same river twice, the Greek philosopher Heraclitus is said to have observed. We’ve changed, the river has changed.

That’s very true, but it doesn’t mean we can’t learn from seeing what other course the river could have flowed. As the pandemic enters its third year, we must consider those moments when the river branched, and nations made choices that affected thousands, millions, of lives.

What if China had been open and honest in December 2019? What if the world had reacted as quickly and aggressively in January 2020 as Taiwan did? What if the United States had put appropriate protective measures in place in February 2020, as South Korea did?

To examine these questions is to uncover a brutal truth: Much suffering was avoidable, again and again, if different choices that were available and plausible had been made at crucial turning points. By looking at them, and understanding what went wrong, we can hope to avoid similar mistakes in the future.

I tried, as best I could, to provide real-time actual examples of countries that did act quickly and correctly based on emerging evidence—countries like Taiwan, South Korea, Japan and such. 

Also, even though epidemics are easier to suppress with early action, it’s silent spread and superspreading that make a timely response even more important, as shown by South Korea’s early response.

South Korea experienced major superspreading events in February 2020, including one in a secretive church that accounted for more than 5,000 infections, with a single person suspected as the source. The country had the highest number of cases outside of China at that point.

South Korean officials sprang into action, rolling out a mass testing program — they had been readying their testing capacity since January — with drive-through options and vigorous contact tracing.

South Korea beat back that potentially catastrophic outbreak, and continued to greatly limit its cases. They had fewer than 1,000 deaths in all of 2020. In the United States, that would translate into fewer than 7,000 deaths from Covid in 2020. Instead, estimates place the number of deaths at more than 375,000.

The value of a counterfactual is that by showing a plausible, possible alternative path, it sets a goal and a path. I encounter a lot of “there isn’t anything else possible”—a limited imagination is a way of ensuring limited change. It fuels despair, understandably, when we should be outraged, but in a productive way. Outraged to change things.

On the political dysfunction: much has been written about it already, by many others. Occasionally, I do too. How to move forward despite it, and also while addressing it, is not an easy question whatsoever—and that is an understatement, obviously, to the depth of the challenge. 

But there are two things to add here. One, Trump’s massive, negative impact on the first year of the pandemic in the United States is obvious. But it wasn’t just the United States that failed in ways, say, South Korea which was quite unlucky with early major superspreading events did not. Many countries, including many in Western Europe not ruled by incompetent wanna-be authoritarians failed in similar ways. 

Plus, even in the United States, it wasn’t just Trump, as terrible as his administration was. It is a difficult truth, but many of our liberal institutions and key public health officials, many of whom did not work for Trump and thus were free to say what they wanted, made pronouncements and gave and promoted advice that turned out to be very wrong, and contrary to evidence. Were they well-meaning? I don’t doubt that part. We still need to do better, though. (Free article idea: tracing the first three-four months of the United States response, but not just Trump.)

Back to the counterfactual: the point is to figure out what was possible so that we can have a broader view of why those roads weren’t taken, exactly so that maybe, just maybe, we can learn and do better next time—not just for a pandemic, but clearly, the broad degradation of how our societies function. It’s so apparent over the past few decades: many things that became even more possible thanks to wealth, technology and science have become worse in their functioning. But that exact wealth, technology and science make it possible to turn this around.

Meanwhile, on a related note to this moment, I’m going to recommend two amazing books for this moment, both by the great historian Barbara Tuchman. 

First is Guns of August: The Outbreak of World War I, tracing the initial month of World War One, setting in place dynamics that would define the first half of the 20th century, arguably also the 1918 pandemic. (Non-affiliate links).

The second one March of Folly: From Troy to Vietnam, a history of societies that failed because the elites did not take actions that were plausible, available, rational and even in their self-interest. 

My most sincere wish is that we stop writing an additional chapter to that book.

(Note: updated with link! Sorry, on the road today!)