Who Decides What Was “Too Much” in the COVID-19 Response?

Five years after the world was upended by COVID-19, a growing number of voices are claiming that measures to control the virus were excessive. Many who lived through business restrictions, school closures, and separation from loved ones argue that the pain outweighed the benefit.

These reassessments often suffer from a flaw common to many retrospectives on health crises: survivor bias. If you’re here to look back, it means you lived through it—and, perhaps, you lived through it without losing a loved one or suffering long-term disability. That experience shapes the story you tell and can reshape how governments respond to epidemics in the future.

CDC epidemiologist interviews a family in Atlanta about COVID-19.

Source: Centers for Disease Control and Prevention

What Is Survivor Bias, and Why Does It Matter for COVID-19?

Survivor bias—or survivorship bias—is a cognitive distortion that occurs when we focus only on those who made it through a difficult experience while ignoring those who did not. In health, this often leads to misleading conclusions about which interventions were effective and necessary.

In the case of COVID-19, this bias plays out when critics of social distancing or vaccine mandates claim that these measures did more harm than good—while overlooking the many people who died or continue to suffer from COVID-19-related complications.

Who Is Missing From the COVID-19 Debate?

The first group that is missing is the millions who died. There are more than 1.1 million people from the United States who cannot join today’s conversation because they died from COVID-19. While many were older or had underlying health conditions, they were also critical members of our community: caregivers, teachers, bus drivers, and nurses. Their absence from the debate is not just tragic—it skews how we remember the stakes of the pandemic.

The second group is the many millions more who are suffering from long COVID or COVID-related cardiovascular complications. The estimated 5 to 10 percent of Americans who developed long COVID experienced prolonged fatigue and brain fog. Often, they are too ill to be writing editorials or appearing on podcasts to tell their perspective.

Similarly, COVID-19 also caused a large increase in heart attacks and strokes that would not have otherwise occurred. Researchers found that people who had COVID-19 were twice as likely to experience a heart attack, stroke, or death compared to those who never had it. For patients who had been hospitalized with severe COVID-19, the risk was nearly four times higher.

The increased risk persisted across each of the three years following infection. In some cases, the likelihood of a major cardiovascular event was comparable to—or even exceeded—that of people with well-established risk factors like type 2 diabetes.

The final group are all of those avoided infections because of the measures that were put in place and, therefore, were not at risk of long COVID or cardiovascular complications. These voices rarely feature in public discussions about what policies were “worth it.” And these voices are often drowned out by those fortunate enough to have returned to normal life.

Have We Seen Survivor Bias in Past Epidemics?

Survivor bias has distorted our memories of past outbreaks, too. After the 2009 H1N1 flu pandemic, some questioned whether mass vaccination was necessary since the overall death toll turned out to be lower than feared. But that overlooks how the United States and other countries aggressively distributed vaccines and antiviral medications, averting many severe illnesses and deaths.

When danger passes, it’s easy to forget how dire the situation felt when decisions had to be made.

How Does Survivor Bias Shape Public Policy?

Survivor bias doesn’t just affect individual attitudes. It shapes public policy. As memories of the pandemic fade and economic hardship lingers, elected officials may feel pressure to avoid using protective measures in future crises. All policy decisions in a health emergency have difficult trade-offs. If decisions about protective measures are based only on the experiences of survivors—and not on a full accounting of lives saved or lost—the next crisis response could be far less effective.

There’s also a troubling moral dimension. When we minimize the seriousness of COVID-19 in hindsight, we risk devaluing the lives of those who died or continue to suffer. I worry people consider their deaths or disabilities as acceptable losses or, even worse, that their vulnerability made their lives less valuable, less worthy of protection.

Coronavirus Disease 2019 Essential Reads

Denial of Airborne Infection: A Review

Lessons Should Have Been Learned From Previous Pandemics

How Do We Evaluate the U.S. Response to COVID-19?

No one wants to live through another period like the peak pandemic years of 2020 and 2021. The virus and our virus control measures damaged our mental health, social relationships, education, economic growth, and, of course, our political system. Many policies were imperfect. Some lasted too long or caused unintended harm.

But if we are to honestly evaluate the U.S. response to COVID-19, we must acknowledge that decisions were made during a time of immense uncertainty, when the stakes included mass death and health system collapse. And we must ensure our reassessment includes the voices of those who died, who were disabled, and who remain at risk today.

How to Think About Future Health Emergencies?

Survivor bias is a natural human tendency, but when it guides public memory and future planning, it can be deadly. Public health isn’t just about those who make it through. It’s about preventing harm to as many people as possible—including the vulnerable and less powerful.

As we look back on COVID-19 and prepare for future health emergencies, we must make sure to listen to more than the loudest voices. We must also listen to the voices of those who are no longer here.