What if COVID-19 were 10 times deadlier?

Relatives wearing protective suits lower the body of a man who died from COVID-19 into a grave in New Delhi. Reuters

"I think I've come to believe that even if the COVID death toll was 10 times what it currently is," MSNBC host Chris Hayes wrote a few days ago on Twitter, "the politics of all of it wouldn't be appreciably different."

I like this question because I'm interested in COVID-19 counterfactuals — whether ideology and identity and in-group loyalty determined everything about the pandemic response, or whether there's a world where Donald Trump went all-in for strict disease-fighting measures and liberals turned anti-lockdown in response, or one where Trump won reelection and hesitation over the "Trump vaccine" ended up stronger on the left.

But those are strictly political counterfactuals, whereas Hayes raises a more medical one: How much of our polarised response to COVID-19 is independent of the nature of the disease itself?

Here's a quick case that he's right. At the pandemic's outset, sceptics of a sweeping response argued that public health authorities were overestimating the disease's dangers, and many conservatives were eager to believe them. The Hoover Institution's Richard Epstein famously predicted COVID-19 would claim only 5,000 lives in the United States. Stanford University epidemiologist John Ioannidis speculated that 10,000 deaths could be a reasonable expectation — which absent media hysteria would feel no different from a bad flu year. Over subsequent months sceptics talked about a "casedemic" in which testing would find more cases but deaths would remain relatively low, and in June 2020 Mike Pence famously downplayed predictions of a second wave.

Today it's clear that the public health authorities got all kinds of things wrong, and many bad decisions — especially about closing schools — were made in an atmosphere of panic. Still, on the fundamental question of how bad the disease would be, the authorities were more right than their more optimistic critics. Even with rapidly developed vaccines, we've had 670,000 reported coronavirus deaths and counting. This is less death, yes, than some of the absolute worst-case projections. But it's still more than 50 times more death than the early predictions from people who thought authorities were panicking too quickly.

In that sense we've already run a version of Hayes' counterfactual. COVID-19 has been deadlier than many people on the right hoped or predicted, and yet the partisan divide that took shape last spring hasn't really budged, with Republicans still taking the libertarian side in debate after debate — closures, masks, now vaccine mandates.

But I'm still not sure Hayes is right about the COVID-19 10-times-worse scenario being basically identical to this one in its divisions. As bad as the coronavirus has been, most people who get it still come out OK, children are especially unlikely to be hospitalised or die, and deaths are concentrated in a population, the elderly in nursing homes, that (to our shame) we already keep somewhat out of mind.

Yes, long-haul COVID-19 is a real problem, but America is good at ignoring its chronic illness epidemics. Yes, there does seem to be a notable tendency for right-wing talk radio hosts to die of the disease — but in the big picture of celebrities, the most famous deaths are more obscure than seemed likely when Tom Hanks or for that matter Trump himself fell ill.

And as terrible as it is that 1 in 500 Americans have died of COVID-19, it's still much easier to have gone through the pandemic without having a close friend or family member die of it — as I have not, for instance — than it would be were the toll 1 in 50.

Before the pandemic, I once built a column around psychiatrist-blogger Scott Alexander's concept of "the scissor," which describes a controversy or idea or event perfectly calibrated to divide people while making them think that the other side is bonkers. Arguably COVID-19's death rate makes it a perfect scissor: It's high enough to make the alarmed feel vindicated, but still low enough that many sceptics feel vindicated as well.

Whereas if the fatality figures were 10 times lower, I suspect there would be much more internal liberal debate over the wisdom of the sweeping early response. And if they were 10 times higher, I think there might have been more red-state support for public health restrictions of all kinds.

But that doesn't mean that the country would have been more unified in a "COVID 10-times-worse" world. Instead, there would be more regional fractures, more governors trying to close borders and restrict travel, more vicious interstate fighting over medical resources, more frenzied culture wars over which drugs to try experimentally, more total panic and meltdown around schools.

And since the one thing we don't seem to be doing yet is preparing for the next pandemic, my fear is that within the next 20 years we'll encounter an invisible enemy that puts the Hayes counterfactual to a test.

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