Thought experiment

Please don't get me wrong. I've seen other people try to put our present crisis in context, or discuss the costs vs. the benefits of certain actions, and be widely condemned for insensitivity or even sociopathy. I remember after the 9/11 attack, when people who tried to explain the motivations or sociological origins of Al Qaeda and similar movements faced the same sort of criticism. You weren't allowed to think about the problem, people weren't ready for any sort of moral confusion. In what I am about to say, I am not arguing against saving lives, on the contrary. I'm just trying to explain something about where we are in history.

Suppose this had happened in, say, 1890? In thinking about that it helps to refer to something sorta, kinda like it that did happen in 1918. The 1918 influenza pandemic occurred during WWI, which is important in some ways but doesn't much affect the analysis I'm doing here. Because record keeping in most of the world was not good, estimates of global fatalities range from 17 to 100 million. Either way that's a lot, especially considering the much smaller population than today. Estimating the case fatality rate is even harder because we can only guesstimate how many people were actually infected. Those estimates range from 3.5% to 10%, but it might be higher. (I'm taking this from Dylan Matthews.) The case fatality rate from Covid-19 is also subject to uncertainty, but it's definitely lower, probably at worst 2%.

Another important difference is that the 1918 flu preferentially killed young people, which is quite unusual. That's one reason why it was particularly noticeable. Old people died of respiratory infections all the time. There were no treatments, no ventilators, there was nothing anybody could do about it. And nobody knew what the infectious agent of influenza was. It was widely thought to be a bacterium. People did understand that it was passed from one person to another, and so where the resources to do so were available, infected people were isolated and their close contacts quarantined, but this was done spottily. Some cities also closed schools, at least for a couple of weeks, and banned mass gatherings, but the sorts of more extreme measures we're seeing now, such as closing restaurants and bars, as far as I know were not used. There is evidence that these measures did reduce the fatality rate in cities where they were applied.

Okay. I'm guessing that Covid-19 in 1890 would at least have been noticed. It wouldn't have caused as much severe illness and death as the 1918 flu, and a lot less among young and healthy people, so it wouldn't have seemed as different from a normal flu season. In fact there were far fewer old people around in the first place. However, since flu would also have been happening it would have seemed like maybe a doubly bad flu season. They would have had no way of telling the difference between the two diseases.

Would it have seemed bad enough to close schools and suspend mass gatherings in some places? I'm guessing probably not, but certainly not more so than 1918. Other than that, nobody would or could have done anything about it. Since there weren't any treatments, there would have been no problem about overwhelming the health care system -- which consisted almost entirely of quackery anyway. Life would have gone on pretty much as normal. Nobody expected to live to be 70 or 80 years old anyway.

The deaths that have and will result from Covid-19 are a great tragedy. But even if nothing had been done at all, against the normal background of death the spike would have been less than 1918. Lacking a vaccine, there isn't really any way to greatly reduce the number of people who will  ultimately be infected. So why is this a catastrophic emergency today when, according to my thought experiment, it would have seemed far less distressing in 1890?

Precisely because we can do something about it. We can get most of the most severely ill people through it and out the other side by putting them on machines that breathe for them. And most people believe that if it is possible to do that, it is ethically compelled. But we don't have enough of those machines and we don't have enough doctors or nurses to operate them at the time we predict the prevalence of disease will be highest. This has already happened in Lombardy and Hubei, and the resulting scenes were horrible to behold.

So we're making this terrible sacrifice to try to slow it down to the point where we don't run out of ventilators and health care providers. Some people, such as Boris Johnson, tried to argue that it isn't it and we should just stand back and get it over with. The overwhelming consensus of was that this is ethically unacceptable, indeed monstrous. People don't want to make these sacrifices but they want to see people dying in hospital parking lots even less. That's humanity. And by the way -- even if the global economy contracts by 30%, we'll still be far richer than we were in 1918. Keep that in mind as well. What has really changed is our expectations.

Update: I should have added that an overwhelmed health care system can't take care of other problems either. People still come in with heart attacks, traumatic injuries, other infections, and need cancer care and so on. The number of deaths from Covid-19 directly understates the total number of deaths associated with the crisis in that circumstances, possibly by a factor of two or more.