This marks the gravest public health disaster in a century, outstripping all the combat deaths in both world wars, Vietnam and Korea. Largely because of the pandemic, life expectancy in the United States declined 2.39 years, the greatest fall in eight decades. The disease caused by the coronavirus became a leading cause of death all through the pandemic, and as recently as January, more people age 15 and older died of covid than of cancer. In addition, the pandemic is leaving lasting personal scars, including long covid and mental health disorders in years ahead.
The death toll is just one part of a truly catastrophic chapter in American history. The pandemic also tore at the nation’s social fabric, sent shock waves through the economy and caused widespread disruption in schooling and careers. It brought unimaginable sadness: families and loved ones suddenly bereft; the deaths of so many people all alone, without a warm hand to hold; the bewildering arbitrariness of infection. The costs were heavy, the wounds deep and lasting.
Who were the 1 million lost? They were predominantly old: Almost 75 percent were 65 or older; only 4.2 percent were younger than 45. In the first year, 1 in 5 died in a nursing home or long-term-care facility. In about 90 percent of the 1 million deaths, covid was listed as the underlying cause; for the remainder, a contributing cause. The victims were more likely to be blue-collar workers, in food and agriculture, health care, factories and transportation, studies suggest. Those who died were more often living in poorer US counties. African Americans and Hispanic Americans suffered deaths somewhat disproportionate to their share of the population; they also suffered marked drops in life expectancy in the first year of the pandemic, and once again were disadvantaged by long-festering inequity in access to health care.
Vaccines were a life raft in a sea of danger. But an enduring mystery is why so many people refused to climb aboard and left themselves vulnerable. Free, safe and highly effective shots were easily and widely available to adults in the United States after May 2021, and older and high-risk people had access to them earlier. By June 2021, most adults could have been fully vaccinated and thus shielded from severe illness or death. Yet an analysis by the Kaiser Family Foundation showed that about 234,000 deaths between June 2021 and March could have been prevented had people simply been vaccinated with the primary series, the first two shots.
Among eligible Americans, 82.6 percent got at least one dose, meaning that about one-fifth of the population never felt a needle. Some of this hesitancy is explained by suspicion, ignorance or fear. But in many cases, doubts were amplified by a vocal anti-vaccine movement on social media. The vaccination drive might have done better — and saved more lives — if political leaders, celebrities, athletes and others had spoken up forcefully. Vaccine mandates helped, but only to a point. President Biden pleaded repeatedly for people to get vaccinated. A hard core refused, and paid a high price. When the omicron variant reached a peak in February, the unvaccinated had 10 times the risk of death compared with those with at least one shot.
The United States suffered more deaths per capita than the other major Western democracies. It was not supposed to be this way. The October 2019 Global Health Security Index rated the United States as the most prepared nation in the world for a pandemic. Yet when one happened, the US response was abysmal, with patients waiting in ambulances parked outside overflowing hospitals and health-care workers in New York City giving garbage bags for protection. We were not a shining example.
How could this have happened? A major unforeseen factor was not health care, but leadership and public confidence. Mr. Trump’s response during the first year was reckless and impetuous: championing drugs ineffective for covid such as hydroxychloroquine, encouraging Americans to throw off restrictions long before it was prudent and sloughing off responsibility to the states. Over the course of the pandemic, the debates over lifting restrictions, wearing masks and taking vaccines were utterly politicized. Public confidence was also eroded by confusing and shifting communications from politicians and public health authorities. Trust is fragile and, once broken, hard to regain. What would happen today if another threatening variant emerged — perhaps evading vaccines — and the public was urged to put the masks back on? Would we?
To protect future generations, it would be wise to launch a multi-pronged effort to prepare for the next pandemic. A bipartisan inquiry like the 9/11 Commission would help. We need a blueprint for a far-reaching and ambitious program with these major elements: early warning and rapid response to disease outbreaks; advanced biomedical platforms to develop vaccines and therapeutics swiftly; and a rededication to building public faith. No nation stands alone in this battle, and a truly effective program should be global in reach. By many estimates, both the US death toll and the worldwide official figures are undercounts. The true scale of excess mortality — the amount of deaths above what would normally be expected without the pandemic — is probably well over 1 million in the United States and twice or more the official global toll of 6 million so far.
The most important imperative from this suffering is to take action to prevent it from happening again.