Six Years Ago Today It Began
The Birth of COVID — and the Destruction of Public Health
February 29, 2020.
I woke that morning to learn that a patient in a nursing home just minutes away from me had died from a coronavirus infection. The disease was so new it didn’t have a name. And now it was killing in Seattle.
Seventeen years earlier, I had followed the course of SARS-CoV-1, a coronavirus that caused COVID-like lung infections, as it spread around the world. The original was far more likely to kill those infected than its namesake. Ironically, the lower case-fatality rate of this second virus made it far more deadly overall.
The virulence of SARS meant stringent epidemic control measures were readily accepted. Because cases almost always announced themselves with significant symptoms and transmission without them was rare, those measures worked. SARS killed 774 people before it was eliminated as a human infection.
No one in the United States died.
Over the next weeks, I watched the first deadly act of SARS-CoV-2 unfold at my doorstep.
March 2020 would prove pivotal — not only for how the epidemic unfolded, but for how it would be remembered. Over the course of that month, competing narratives took shape: about risk, about responsibility, about what counted as overreaction and what counted as prudence.
More than 1.2 million Americans have died since.
There will never be a reporting system for deaths prevented.
In the years since, the scale of loss and the effectiveness of interventions have too often been minimized, and strategies that would have produced far greater mortality have been recast as moderation. Institutions that played a central role in understanding pandemic disease have been demonized as their cause.
But this is not an abstract debate about pandemic memory.
Policies grounded in minimization do not remain confined to rhetoric. They shape budgets, staffing, surveillance systems, vaccination programs, research funding, and access to care. When those systems are weakened, disease follows.
Measles outbreaks are expanding. Research programs are being dismantled. Global health infrastructure has been hollowed out. Insurance coverage for millions remains precarious. These are not theoretical concerns about the next crisis. They are present-tense realities.
Public health is not self-sustaining. It requires institutions, expertise, and political will. When those erode, preventable illness and preventable death increase.
Remembering what happened — and what might have happened — is not about relitigating the past. It is about understanding how policy choices translate into mortality.
The story that began with that first death is still being written. And rewritten.
My previous post describes how a study that took shape in March 2020 became a foundation for minimizing the severity of COVID-19. Over the course of this month, I will examine how other narratives — about disease origin, public health interventions, and vaccines — emerged and evolved to reshape public trust and institutional authority, and how those shifts are affecting American health today. I will also explore how the unique nature of the virus, the unprecedented information ecosystem, and the divisive political climate combined to make all of this possible — if not inevitable. There is a through line from COVID to the generational “destruction” of US health and science cited in a recent Lancet editorial.
Six years ago today, it began.