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For Christmas one of my kids bought me a book, the art of logic in an illogical world.  I really appreciated the book for two reasons.  First, my kid witnessing books strewn on coffee tables throughout his childhood figured that a book probably would get more use than a tie, in a world that is permanently business casual for dress code.   Second, the book is about logic, but not in a ‘math way’, but in a ‘how do humans include and exclude emotions when making decisions’ way.  I recommend the book.  The key thing the book teaches you is that when you have a disagreement – look backwards to the root of the disagreement such as a difference in values.

Anyhow, it has been five years since much of the world went into lockdown in March 2020 over COVID-19 (Covid), a virus that appears to have originated in Wuhan, China.  At the time, my world was turned upside down – as it was for many – and I found myself reading and writing about Covid to make sense of it all.  I won’t link my past commentaries mostly because like many others I was ‘guessing’ on answers and trying to sort out what research made the most sense.  At least one person urged me to ‘stay in my lane’.

That said, anything that has a material impact on mortality is my lane – and I think this is a worthwhile time to look again to see what we know now.

Hypothesis

When Covid surfaced, it was recognized as a respiratory illness.  Anyone could get the virus but the most vulnerable to death were the elderly and those with compromised immune systems.  While our medical professionals valiantly fought to save lives – lives were lost.  Unfortunately, tracking of causes of death were not precise and as Covid deaths rose – deaths from influenza fell.

My hypothesis at the time was that we were ‘pulling forward’ deaths of our elderly and once the pandemic had passed, we would see a shortfall of deaths in these older age groups.  I remember telling people that this data wouldn’t be available for at least five years.

Mortality Updates

The following chart is from actuary Mary Pat Campbell based upon data from the US Center for Disease Control:

The message?  In almost all age groups, mortality from 2020 to 2023 is higher than pre-covid.  So, thus far, my hypothesis has not proven true, not only have we not gone back to pre-pandemic mortality levels, but we also aren’t seeing the trough that I expected would emerge by now.  Maybe another year of data in 2024 will show more improvement.  That is a trick actuaries like to use – if you don’t like the results, choose a different reference period.

Interested in what this data means in words, I spoke to Mary Pat Campbell this past weekend – she has new data coming soon which I will share in a follow-up.  The key learning is that there are too many factors to support my single axis – mortality pull forward – thesis.  What we might be seeing is higher mortality due to delayed or inadequate medical attention during the pandemic – especially for cancer.

What does seem to be emerging in the more granular data that Mary Pat shared is the growing ‘inequality of longevity’.  People with higher incomes and education (often correlated) are securing themselves longer lives.  This isn’t completely news as the CIA’s mortality update in 2014 started to separate out the income effect.

Here in Canada, a recent Canadian Institute of Actuaries webcast showed similar results for Canada – mortality continues at higher levels that before the pandemic – at least through mid-2024.  The chart below shows weekly experience (black dots) compared to what we expected (yellow curve).  Note that in Canada at least, rates of death are seasonal – higher in the winter / lower in the summer.

There are three possible futures ahead – mortality falls back to pre-pandemic levels (perhaps with a modest improvement that was expected over time), mortality falls even lower (reflecting my original thesis), or mortality stays above pre-pandemic levels permanently.  The last of these three scenarios is the most worrisome and will result in years of speculation on what has caused a permanent downward shift in our collective longevity.  At this stage, I am unwilling to even try to guess at which outcome we will see.

Politics

Before the pandemic, I didn’t pay much attention to politics.  Other than a growing concern about budget deficits and a slight fascination with the US choosing a businessman and reality TV star for President – I tend to ignore politicians as much as I possibly can.

This changed however during the pandemic.  Suddenly it seemed important to understand the policy choices governments were making to save lives.  Lockdowns were common in the early stages – sadly, many small businesses lost it all.  I remember a meme showing the map of North America with the title ‘places in North America where you can golf’.  The entire map was green, except Ontario which was red.  When Ontario’s golf courses finally opened, they were flooded with people, since travel wasn’t easy, people stayed home looking for something to do outside.

Mask mandates didn’t seem controversial to me at the time – it made sense that masks should slow the spread of the virus and although inconvenient and a little uncomfortable, I didn’t see the harm.  However, we now know that masks slowed the development of children’s recognition of emotions.  This is a reminder that any well intended action has the risk of unintended negative consequences.

When we were first locked down, I started getting together with friends virtually.  When we were discussing the search for a vaccine, I still remember Kevin saying that a vaccine would likely take years and what we needed to hope for was the development of effective anti-viral drugs.  Ivermectin was identified as a potential anti-viral for Covid and was made famous by podcaster Joe Rogan who used it in his battle with the virus. 

Unfortunately Mr. Rogan and the minority of doctors that saw Ivermectin as a potential benefit to people who had the virus, the FDA was against its use for that purpose – and still is today.  Those promoting this option were vilified which built mistrust between the ‘experts’ and those willing to experiment for the benefit of their own health.  People on the wrong side of any discussion (lab leak, closing of businesses and schools, benefits of masks, vaccine efficacy and safety, big pharma incentives) were accused of not trusting government and/or promoting misinformation or conspiracy theories.  The divide caused anger and stress – In Canada – this divide manifested in a truck convoy to Ottawa that further deepened the mistrust many felt for our governments, medical community, and media.  It was an unfortunate time in our history.

Amazingly researchers developed Covid vaccines before the end of 2020 which was less than a year after cases first started to appear.  We were all encouraged to get the vaccine which came in two doses and eventually in a string of boosters.  It was a sad time for some that thought that the cure was worse than the disease as mandates from governments took away either the freedom to choose or the ability to work or travel.  The argument of ‘herd immunity’ supported forcing everyone to get vaccinated and most (including me) did.

Post-mortem

In the US, the Select Subcommittee on the Coronavirus Pandemic released its report this past December.  A breezy 500+ page report reaches many conclusions – a few are:

• The possibility that COVID-19 emerged in a lab is not a conspiracy theory.
• Scientific messaging must be clear and concise, backed by evidentiary support, and come from trusted messengers, such as front-line doctors treating patients.
• Operation Warp Speed was a tremendous success and a model to build upon in the future.  The vaccines, which are now probably better characterized as therapeutics, undoubtedly saved millions of lives by diminishing likelihood of severe disease and death.
• Pandemic-era school closures will have an enduring impact on generations of children.
• The prescription cannot be worse than the disease, such as strict and overly broad lockdowns that led to predictable anguish and avoidable consequences.

My take on all this?  Governments panicked – but perhaps justifiably so in the beginning as the projections showed hundreds of millions of deaths worldwide if no action was taken.  However, as the story unfolded, governments pushed too far based on shaky science, likely out of fear of inaction.  When (not if) the next pandemic rolls around hopefully the lessons learned here make for a better response.

In the meantime, we are left as a society to repair the wounds between those that wanted to ‘trust the science and comply with the experts’ and those that ‘wanted to do their own research and have the freedom to make choices best for them’.  We don’t really win as a society if we forever more divide ourselves into any two camps and so hopefully, we can take lessons learned and work together. 

About the book I mentioned at the outset.  When one side argues that the highest value is sacrificing freedoms for the good of the collective and the other side argues that the highest value is personal choice (especially about health choices) – there is no winning the argument.  Both sides are right from their point of view.