Five Lessons We Should Learn from Fighting the Pandemic

When Austria went into its first lockdown five years ago, much was still unknown about the actual risk posed by the coronavirus—especially how deadly it was. What would have happened if we had done nothing at all, if no measures had been taken? Had we done nothing, nearly everyone in Austria would eventually have been infected at least once—just as ultimately happened, despite all the measures. So, were they all for nothing?

That conclusion seems tempting—at least judging by the persistent calls for a thorough review. Do we need to rewrite the book on the pandemic, now, with the benefit of hindsight?

Today, we can answer that quite precisely. In a major international study, researchers compiled many data sets and studies on the mortality risk of the original strain of the virus from Wuhan, China. If everyone in Austria had been infected back then, 1.3 percent of the population—about 116,000 people—would have died.

In terms of danger, the coronavirus initially occupied an ambiguous middle ground. It wasn’t deadly enough for every outbreak to immediately cause severe illness and death. But it was dangerous enough to overwhelm the healthcare systems of nearly every country—systems often already stretched thin. Due to the high number of severe lung infections, it quickly became clear that intensive care units would be the first to reach their limits.

The virus’s subsequent variants became even more aggressive. First came Alpha in early 2021, which doubled the risk of death in those without immunity from vaccination or prior infection. Then Delta arrived in mid-2021, doubling the risk again compared to Alpha. It wasn’t until the Omicron variant emerged in early 2022 that we finally caught a break, and the mortality risk dropped significantly.

What prevented such high death tolls in the first place was the initial lockdown, which began on March 16, 2020. It swiftly ended the first wave of infections. As is well known, it was by far the most drastic of all the lockdowns. 

Looking back, I have come to five conclusions:

During this period, crucial political decisions were made that seem to have faded from collective memory over the past five years: The political goal was clearly defined as preventing the overload of intensive care units. So when debating the sense or nonsense of Covid-19 measures, the first question in any review should be: Should hospital capacity again serve as the guiding benchmark in the next pandemic?

This is more than a rhetorical question. Other countries, such as China, South Korea, Taiwan, and Australia, pursued zero-Covid-19 policies, aiming to prevent any cases at all until vaccines arrived or Omicron emerged. Countries like Greece and Spain justified early contact-reduction measures in part to protect their economically vital tourist seasons. Denmark and Finland pursued low-incidence strategies, allowing some cases but tightening restrictions well before hospitals were at risk of being overwhelmed. Austria, like many other Central European countries, opted for a “flatten the curve” strategy within hospital capacity limits.

Of course, it would be ideal if such curve-flattening could be achieved through a well-functioning public health system, handwashing, mask-wearing, and voluntary reductions in contacts—without enforced lockdowns. That’s the example Sweden appeared to set. So why didn’t Austria try it that way?

In fact, that was the plan during Austria’s second wave in the fall of 2020. Contact tracing and personal responsibility were the buzzwords meant to get us through the crucial next two weeks. But the “Swedish way” simply didn’t work here. We hurtled toward critical ICU occupancy while department stores lured shoppers with aggressive sales promotions.

However, there’s now broad agreement that schools should have stayed open. Could we have known back then that infection curves could be flattened even with schools in session? Yes, absolutely. From a mathematical-epidemiological perspective, the answer is fairly straightforward. In major waves of infection, it was typically necessary to cut about 30 percent of potentially infectious contacts to flatten the curve. Whether those contacts were reduced at school, work, or in leisure time was secondary. The networks of social contacts are simply too intertwined.

This also leads to perhaps the most important policy consideration once the goal of pandemic response is defined: Who should bear the burden of future measures, and to what extent? In the end, it’s a political decision to determine where measures are most acceptable. And if they are entirely unacceptable in certain areas, then we must reconsider the goals we’ve set for ourselves.

It makes little sense to debate individual measures in isolation from the overall strategy. And if we now agree not to close schools in similar future situations, we should already be creating mechanisms to ensure that pandemic contact reductions happen elsewhere first. For instance, mandatory remote work could be one such tool.

If we don’t draw the right conclusions now, the next pandemic is most likely to disproportionately harm groups that are politically underrepresented during times of crisis. Alongside schoolchildren, this also included socioeconomically disadvantaged groups, for example.

One question that still preoccupies me today is: Why is it so difficult, no matter your perspective, to separate legitimate criticism of pandemic measures from trivialization of Covid-19 itself? In reality, both should be possible at once: to critically assess mandatory restrictions while acknowledging the significant health risks posed by Covid-19—risks that were substantial and remain present, though now manageable. The logical outcome of such insight would be greater individual responsibility.

In contrast, simple answers—like denying the virus’s existence or believing in a miracle cure suppressed for profit—are, of course, more appealing. But here’s something positive: The majority of people understood and still understand that the pandemic was a complex, multifaceted problem that required equally complex, multifaceted solutions. That included political leaders willing to impose such solutions, even amid louder opposition.

The third lesson, then, is that politics often favored the illusion of simple solutions. In the fall of 2020, we supposedly just needed to trace contacts and wash hands. After that, we just needed to test, test, test.

Science, however, had already reached a consensus: while each of these measures could be helpful under specific conditions, effective pandemic control always requires a combination of many imperfect measures. This is the so-called Swiss cheese strategy: stack enough leaky slices together, and eventually, the holes no longer line up.

Then came vaccines. We just needed to get vaccinated, and the pandemic would be over. In most other European countries—not just Scandinavia, but also many Southern European nations, particularly Portugal—vaccination rates were high enough by fall 2021 that national lockdowns were no longer needed to flatten the curve. Austria, as we know, didn’t reach that level of vaccine uptake. In a hasty political move at Lake Achensee, mandatory vaccination and lockdowns for the unvaccinated were imposed. Shortly thereafter, the Omicron variant significantly reduced vaccine protection against infection, rendering those decisions absurd.

Here again, it’s worth looking at Scandinavia. The spotlight on Sweden, where officials were eager to explain the uniqueness and success of their approach, obscured the “hidden champions” of pandemic management—arguably the other Scandinavian countries. They occasionally used lockdowns too, but overall their restrictions were often as mild as Sweden’s, despite aiming for lower case numbers. According to European mortality monitoring, however, their excess mortality rates—unlike Sweden’s—barely rose above normal levels during the pandemic years. The secret of their success? High trust in authorities, better digitalization, and less political polarization.

One particularly impressive example of this was Denmark’s response to the emergence of Omicron. Until that point, the country had successfully pursued a low-incidence strategy. Thanks to its excellent data infrastructure, Denmark was able to correctly assess the altered risk posed by Omicron as early as December 2021. As a result, the country significantly scaled back its measures and essentially let Omicron run its course. Within just a few weeks, Denmark went from a very low infection rate to one of the highest daily per capita infection rates ever recorded worldwide. This strategy represented a remarkable 180-degree shift. However, due to the high vaccination rates, there was no significant excess mortality—while here in Austria, we were just beginning to deal with the fallout from the meeting in Achensee.

There were two key differences between Denmark and Austria: first, an evidence-based and data-driven decision-making culture in the healthcare system; second, a high degree of interpersonal trust. But let’s take it one step at a time.

First, Denmark’s rapid risk assessment was possible because of the outstanding availability of up-to-date research data on the health, social, and economic characteristics of the entire population. In Austria, on the other hand, it was impossible at that time to, for example, link information on occupational groups with infection trends in order to target measures more precisely.

Better data also enable faster decisions. After all, there is always a certain degree of uncertainty—sometimes considerable—about how effective planned interventions or their removal will actually be. The faster you can evaluate whether the desired effects are occurring, the faster you can make adjustments, making pandemic management more tolerable and effective.

The fact that this low-hanging fruit—better linking of existing datasets—still remains unpicked in Austria, even after the past few years, is nothing short of incomprehensible.

Second, the pandemic highlighted the importance of trust within the population. A large-scale study concluded that globally, there could have been 13 percent fewer infections if all other countries had the same level of trust in their governments as the population in Denmark. If there had been the same level of interpersonal trust, global infections could have been 40 percent lower.

This trust is closely linked to the population’s health literacy, which can be improved through long-term information and communication efforts. This also works with dental hygiene. At least I know of far fewer cases where cavities are dismissed as an invention of the industry aimed at selling more toothpaste.

If we want to be more successful in the next pandemic, these should be key levers: better data to implement the most effective measures through rapid evaluation cycles, and a strengthening of health literacy so that more and more people can assess health risks accurately and behave accordingly with personal responsibility.

What did pandemic management in Austria achieve? Austria experienced just over 20,000 deaths due to the pandemic. That’s at least 95,000 fewer deaths than we would have had to accept if we had done nothing back in March 2020.

A frequently heard cynical argument is that many of these deaths affected the elderly or people with pre-existing conditions. By now, we can more precisely estimate how many healthy years of life those individuals would have had without infection. It turns out that in Austria, on average, about seven healthy years of life were lost with each Covid-19 death.

Statistically speaking, we can therefore count more than 600,000 years of life gained in good health. This was made possible by the measures that allowed us to delay a large portion of infections to a point when the population could already be vaccinated, thereby reducing severe illnesses and other long-lasting consequences.

My personal conclusion: Yes, it was worth it. But we could have done it more cheaply. These five insights are a piece of the puzzle so that we can actually do better next time.