Covid’s Deadliest Effect Took Five Years to Appear

Opinion|Covid’s Deadliest Effect Took Five Years to Appear

February 2025. A blustery morning. I alight, a little breathless, from the subway at 168th street and walk the oddly deserted blocks toward the hospital where I work. I hear a distant cough. A windblown plastic bag tumbles along the sidewalk and lodges itself in the skeletal branches of a tree. The familiar, insistent whine of an ambulance rises in the distance.

It has been five years since the world was blown into the tumult of a lethal pandemic. Back then, deserted streets and distant coughs, to say nothing of ambulances docking into hospitals, would have carried a very different meaning. But as Proust wrote, the moments of the past do not remain still. We have metabolized a global trauma — millions of deaths, nations brought to their knees, a generation scarred by grief, isolation and loss — so rapidly that it seems, at times, not to have happened at all.

As the pandemic rose, I saw my patients get sick and in some cases die, including a 42-year-old mother of two young children whose loss is seared into my soul. As it receded, I served on then Gov. Andrew Cuomo’s commission to rebuild New York’s health infrastructure. Back then, the overwhelming public sentiment was: never again. Today, it seems: never what?

But Covid didn’t just change billions of individual lives. It changed our country’s basic approach to public health, in fundamental ways that are becoming fully visible only now — and which the Trump administration looks likely to render irreversible.

It was sometime in the thick of the pandemic, in January 2021, that I reread John M. Barry’s superlative book “The Great Influenza,” which tells the story of the 1918 pandemic and the birth of public health as a discipline in the United States. Before that, shielding the population from disease was primarily the domain of either individual heroic doctors such as John Snow (who solved London’s 1854 cholera epidemic by tracking its epicenter to a contaminated water pump — and, so the story goes, breaking off the handle) or civic interventions such as the new sewer system that London installed to address the Great Stink of 1858.

That ad hoc approach changed in October 1918, when William Welch inaugurated a school of public health at Johns Hopkins University in Baltimore. Its trainees would learn to dissect patterns of disease in populations, just as a pathologist might perform an autopsy on an individual patient. They would confront future epidemics and health crises systematically, through public institutions, issuing mandates, dispensing carefully vetted information and managing the surveillance and containment of contagion — tools that, as Mr. Barry notes, lack the drama of individual heroism but have saved countless millions of lives.