‘History Should Judge Us Harshly’

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Amid warnings of a new surge, COVID-19 deaths in the United States topped 1 million today, according to the Johns Hopkins University Coronavirus Resource Center, a chilling and tragic milestone for a still bringing of waves and disrupting pandemic lives into a third year .

President Joe Biden last week ordered flags flown at half-staff at the White House and all public buildings and grounds until sunset Monday, imploring Americans to “not grow numb to such sorrow.”

By other measures, the nation hit the 1 million mark days or months earlier, which speaks to the difficulty in knowing the true toll of the disease.

The US has the world’s highest recorded death toll from the virus and it got there in devastating speed, just 27 months after the first case was confirmed in the US on January 20, 2020.

The US death toll hit 200,000 on September 22, 2020, and gained another 100,000 by December 14. Just a month later the toll hit 400,000 on January 18, 2021, and 500,000 on February 23, 2021.



The current 1 million toll is equivalent to the entire state of Delaware or the population of San Jose, California, the 10th largest city in the nation.



But suffering is widespread.

New estimates from the World Health Organization (WHO), as of May 5, show that the “excess linked mortality” or the full death toll directly or indirectly with COVID-19 between January 1, 2020 and December 31, 2021, was approximately 14.9 million, revised to three times the number reported until that point.

Syra Madad, DHSc, an infectious disease epidemiologist at Harvard’s Belfer Center for Science and International Affairs and the New York City hospital system, told Medscape Medical News the May 5 recalculation by the WHO shows the difficulty in finding a consistent, verifiable number.

The data collection, distribution of information, and communication are all very different by various governmental entities.

She notes there is also much underreporting of COVID mortality in the US. For instance, the death toll doesn’t factor in those who died of other issues related to COVID, such as an inability to access healthcare in the pandemic or delays in seeking care, she said.



Dr Syra Madad

Despite entering a new wave on the cusp of summer, and predictions of a surge later this year that could infect 100 million — with the attendant mortality that could bring — the country is currently in a better place, with the pace of deaths and American hospitalizations reduced from earlier this year during Omicron. And vaccine availability means people have the choice to help protect themselves.

Still, Madad said, the Centers for Disease Control and Prevention (CDC) reports COVID-19 is the third leading cause of death.

“It’s unfathomable that a virus that didn’t exist a couple of years ago is now the third leading cause of death in the United States,” she said.

“History should judge us harshly on the number of people that we could have prevented from getting infected, and from hospitalization and even dying,” Madad said, citing early missteps in use of tools and mitigation measures and often poor communication of health information.

Four Times the Early Worst-Case Projects

One million deaths is a number no one thought possible in the early months of the pandemic, said Chris Beyrer, MD, MPH, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health in Baltimore.



Dr Chris Beyrer

He said it is four times the highest number predicted by Anthony Fauci, MD, and Deborah L. Birx, MD, when leading the COVID response team, in March 2020. “One of the things this tragically underscores is that you can never get back the early phase of a response to a disease outbreak,” he said. “Very quickly the response got politicized into red and to blue.”

“We did not have the kind of mobilization many other countries did,” Beyrer said,

Critical time and lives were lost in the early days with the lack of personal protective equipment, ambivalence around public masking (with a focus on saving the masks for healthcare workers), and poor social distancing protocols.

Testing was one of the biggest disasters, he said.

“People were waiting in line for hours ill. That, it turns out, is a disastrous approach. We really paid for those early mistakes,” Beyrer said.

The “magnificent success” of the pandemic, on the other hand, came in vaccine development.

“The vaccines and the antivirals are the reason we’re not going to have 2 million deaths,” he said.

40% Know Someone Who Has Died from COVID

Beyrer said the most telling statistic is that 4 out of 10 American adults know at least one person who died of COVID, according to recent data from the COVID States Project.



Dr. Cindy Prins

Cindy Prins, PhD, MPH, clinical associate professor of epidemiology at University of Florida College of Public Health & Health Professions in Gainesville, underscored the tragedy.

“I really don’t think it had to be this many. There were points in this pandemic where people’s lives could have been saved,” she told Medscape Medical News.

Vaccines could have prevented so many more deaths, Prins said, but the messages got muddied.

She gave an example that when Omicron raged, the message was, “It’s not so bad. It’s mild.”

Those are 1 million loved ones. Every one of these people has a face and a story and people who cared about them and lost them.
Dr. Cindy Prins

That gave people reluctant to get vaccinated more support for their position, she said,. explaining that comparisons between risk of not getting vaccinated and risk of vaccination were not explicit enough.

The 1 million number can have a numbing effect, Prins said, just as the duration of the pandemic has people saying, “I’m done.”

“It’s a hard number for people to comprehend,” she said. But remembering is critical.

“Those are 1 million loved ones. Every one of these people has a face and a story and people who cared about them and lost them.”

Prins says she remains hopeful the pace of hospitalizations and death will continue to slow.

However, she said, “We still have reason to be concerned about new variants, waning immunity and another wave that could come at the end of summer, beginning of fall.”

Madad, Beyrer, and Prins have disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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