A pandemic milestone and what might come next

Der Tod eines Menschen: das ist eine Katastrophe. Hunderttausend Tote: das ist eine Statistik! (The death of one man: that is a catastrophe. A hundred thousand deaths: that is a statistic!)

-Kurt Tucholsky, 1925

It looks like COVID-19 has now killed about 800,000 Americans.

Here’s the latest dashboard result from Johns Hopkins University:

800,945 dead.  I wrote “about” because American COVID data is so varied and unreliable.  On the lower side the CDC currently posts 796,010.  COVID Act Now estimates 797,000.  On the other side Worldometers thinks 821,444 while the World Bank has 800,043.

I also hedged my language because enough sources argue that published stats undercount COVID deaths worldwide, including in America.  The usual way for determining this is to track total deaths over recent, pre-pandemic years, then project them into our COVID time, checking to see how many more deaths occurred than expected. Some researchers see the real number at 20% higher, and higher still in black and Hispanic populations.  IHME calculated that actual world deaths are around double the official number, and that American deaths are more than 50% higher than the CDC’s figures.

And so many of those deaths were preventable.  Stupidly, infuriatingly preventable, because vaccines are safe, provide protection, are free, are widely available, and have been so for a while. According to the Kaiser Family Foundation:

We also estimate that 163,000 COVID-19 deaths could have been prevented by vaccination since June 2021, when safe and effective COVID-19 vaccines were widely available to all adults in the U.S.

Only around 60% of the population is fully vaccinated, according to Mayo, and that includes people whose last shot was long enough ago that its protections have weakened to some degree.  Maybe 20% have received a booster, according to CDC.

So now: at least 800,000 dead in the United States.  COVID-19 has probably killed a million.

It’s a terrifying number to grasp.  I suspect many people shy away from it.  Statistics are unintuitive for some.  Others may avoid the fact for political reasons: Republicans, embarrassed that Trump didn’t scotch the thing during his last year; Democrats, who hoped Biden would bring it under control by now.

The emotional impact isn’t something most people are used to dealing with.  Not at this scale.  The last medical emergency to strike America was AIDS, which we didn’t handle well, and whose deaths COVID already exceeds, and in a far shorter period of time.  The Great Influenza around 1918 is barely a historical presence, absent from the popular imagination.  The closest the United States has suffered in raw numbers and time is the 750,000 dead of the Civil War, although in a smaller population.  The point is, we don’t have much practice in collectively processing massive deaths.

It’s also a hard number to visualize because the deaths are hard to see – literally. There are very few visual depictions of COVID deaths. We see little evidence of people breathing their ragged, terrible last in emergency rooms, or struggling through ECMO – and for good reasons, including privacy and HIPAA.  It’s a kind of medical echo of the military’s push to not share images of dying and dead soldiers.  The result is similar.  For a culture well trained to experience the world visually, these stories of deaths are off the screen.  We’re living through (among other things) a major visual storytelling failure.

COVID deaths are also hard to grasp because they mostly hit senior citizens.  Here’s a New York Times visualization, finding 75% of fatalities among those over 65 years old:

Simple ageism means we can set these deaths aside. Dying elders are less dramatic, even more expected than younger people expiring.  (COVID killed 1 out of every 100 senior in America so far.  1%!)

On top of this is COVID fatigue. It’s something the study of historical precedents caused us to expect. Every plague is exhausting to the survivors for obvious reasons: extra work for precautions, maybe additional labor for some, and the terrible emotional toll.  When I mention this point every audience has nodded, wearily, in recognition. Heading into the pandemic’s third year, we are bone weary of it. Ian Bogost has recently written movingly on the topic, if you’d like a good sample.

I see this in small personal actions when I “travel” – i.e., visit local groceries stores or train into DC and back. There was the young woman on a Metro car who, sitting with friends, fiddled with her mask (getting at jewelry?), then simply let it drop, her mouth and nose bare.  (The Metro requires masking for all passengers.) There are the nearly gas stations where it’s about a 50-50 chance that fellow shoppers – inside the store – will be masked.  There was a cheerful shop owner in his 60s, maybe older, who simply went unmasked.

One more point: while eight hundred thousand is a very round number, it might not be appealing enough.  The first hundred thousand was a major milestone.  Perhaps it’ll take one million to shock us into discussion, or maybe even action.

So what does the death roll and our reaction to it mean? What does this signify for the future?

Extrapolation, always a sketchy tool, suggests we should watch the butcher’s bill continue to build.  There’s no sign of COVID quickly falling below pandemic levels. Nobody’s trying to utterly eliminate the virus.  It’s possible that Omicron and successor variants could be far less fatal *and* rapidly outcompete Delta in the human race, but I think that would take at least a few months.

The next few months: IHME currently forecasts a range of possibilities. For the global total they project six to seven million, depending on public health behavior.

For the United States, a mere 815,000 if we wake up and get serious about vaccination and masking. The worst case blows past one million by March.

As I’ve said elsewhere, Omicron’s arrival can change things up. Early studies find it to be more infectious, spreading more rapidly than prior strains. (one example) (another) It is too early to tell its lethality. It may prove more fatal, in which case the numbers end up approaching the upper bounds of those IHME charts.  The opposite is also possible.

Our collective desire to not look very hard at the death toll should probably continue.  All of the reasons mentioned above – privacy, exhaustion, invisibility, ageism, statistics – seem likely to remain in play.

Now, extrapolation is sketchy, as I’ve said. It misses changes in volume and new developments. It’s possible a rogue storyteller is even now assembling horrifying footage of deaths and editing them into a gripping, viral narrative.  America could suddenly have a reckoning with ageism, perhaps if something happens with our elderly president Biden or, more importantly, a celebrity.  I don’t think these are likely, but I could well be wrong.

Political changes could occur. We can see strong political dimensions in who gets vaccinated, as this Kaiser tracker shows:

Republicans and independents could experience a change of heart, depending on events.  Men, black people, those without college education, and those aged 18-49 could see political shifts that make getting shot more appealing.  I’m not sure this is likely, but American politics famously has the power to confound expectations.

We may also more hatred of the unvaccinated (the vaccine-hesitant, the vaccine-skeptical, the -resistant, etc.) from everyone else. There’s an easy political way to think of this, with Democrats hating Republicans. That leaves out the political complexity of anti-vax behavior, but does contain a chunk of it.  This hatred can take many forms, from seething social relations online and off to driving punitive policies or vigilante action to simple shunning.

Meanwhile, our lousy vaccination and booster rates suggest a nation with plenty of vulnerable people to house the virus.  Unless we change those rates massively Americans will be riddled with COVID.

Further ahead, I wonder if we’ll push hard to consign the past few years to formal memory, especially if the virus drops below pandemic levels. Public statuary in physical or virtual forms (augmented or extended reality) could appear as a way for us to process the events. I’m not sure of this. A century ago American society turned its back on that great influenza very decisively, deliberately trying to not memorialize it, so we have a memory hole precedent.  But perhaps an aging society will try to commemorate the suffering of its elders.

Let’s keep an eye on this.  And what are you seeing for the pandemic’s next phase?

PS: get your vaccines and boosters!