One thing to remember amidst some of the COVID pandemic revision is the first wave, March to July 2020, really only hit the coasts hard* in the U.S. Much of the U.S. really didn’t get hammered until the summer, and by then, people had already learned how to excuse the horror and their own role in it.

For context, by the week of July 4, 2020, D.C. had lost 603 lives to COVID (out of roughly 694,000), while Iowa had lost 731 and Missouri 1,068, making their death tolls as an unadjusted by age percentage of total population 26% and 20% of D.C.’s respectively (data from here). It’s worth noting that, while D.C.’s elderly population is disproportionately Black (which is a significant risk factor for death from COVID), as a total of the population, D.C. has a low percentage of elderly people.

If we hadn’t taken strict measures nationally, the carnage in the U.S. outside of the I-95 corridor and parts of the West Coast would have been horrific in the first three months–and the mid-summer surges were less lethal, in part, because of the lessons learned about treating critically ill patients in those previously hard hit areas.

What will always haunt me is the near certainty that had Saint Patrick’s Day, which is a huge party/going out weekend in the I-95 corridor, occurred a couple of weeks earlier or later, many thousands of people might still be alive in our region. But local and state officials just didn’t want to close for that weekend (and the dick measuring contest between NYC Mayor DeBlasio and NY Gov. Cuomo over who could keep bars and restaurants open longer played a significant role in the spread).

This is why former NIH Director Francis Collins’ statement about not shutting down unaffected areas was right, but for the absolutely wrong reason: without these broad, significant interventions, the lesser affected areas would have been more amenable to various protective measures because they would have much higher death tolls earlier. But the death toll in the U.S. would have been much higher by July 4, 2020 than the already tragic 131,000 dead from COVID.

If we’re going to revisit history and speculate about alternative responses, we have to be honest about what those alternatives would have meant for the spread of COVID–and the ensuing American Carnage (to use a phrase).

*And the East Coast, especially along the I-95 Corridor, more so than the West Coast.