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:

coronavirus US dashboard JHU 2021 Dec 15

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:

coronavirus deaths by age NYTimes 2021 December 15

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.

coronavirus projected deaths world Dec 21-Feb22 IHME 2021 Dec 15

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.

coronavirus projected deaths US Dec 21-Feb22 IHME 2021 Dec 15

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:

coronavirus vaccinated Kaiser 2021 Dec 15

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!

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15 Responses to A pandemic milestone and what might come next

  1. Joe says:

    I’m vaccinated and have my booster, I wear my mask, but the denial around me gets confusing. At one point in a FB comment, I believe you said that this virus will be real to us when we know people who died from it.

    I know one. I know of two more, one the parent of a student. Certainly others know victims of COVID-19. And yet I don’t see nearly enough precautions being taken.

    Finally, I am through chiding the unmasked. Frankly, without mandates it’s their risk to take. I will get any booster shots available and I hope to ride this thing out.

    • Bryan Alexander says:

      I think a lot of people have a similar attitude now, Joe. Hunkering down and planning for the storm surge.

      Good point about deaths. Perhaps I should modify my FB comment to include: “and be moved by them.”

  2. Jeremy Stanton says:

    I suspect we might see more division along vaxxed and unvaxxed lines, a “vaccination war” as some are calling it, resulting from the absence of an honest public discussion about the pros and cons of the vaccines. The lack of open discussion is driving a great deal of mistrust among those with legitimate concerns about adverse effects and waning vaccine effectiveness. At the same time, the public health response seems to be heading toward more and more draconian measures. Both sides are digging in their heels, leading to more polarization and social fragmentation. Recent actions in Austria and Switzerland segregating vaxxed and unvaxxed, the involuntary quarantining of suspected infected people in Australia, the vicious online scapegoating of the unvaxxed, and other trends are giving rise to resistance among those who were formerly on-board with vaccines, or somewhere in the middle. Yet at the same time, we do need an effective public health response, “effective” being one that the super-majority of the public can get on board with. Omicron is appearing in “fully vaccinated” individuals, for example, all four of DC’s first four cases (https://mayor.dc.gov/release/dc-health-confirms-four-covid-19-cases-involving-omicron-variant-district). A legitimate public health question that urgently needs to be (calmly) discussed is: if fully vaccinated individuals are contracting (and spreading) the virus, should we really be investing public resources in trying to achieve total vaccination with the currently available vaccine products? Should we be investing in research into better products, and/or looking at a broader constellation of measures (perhaps even those that might be sourced from outside of the techo-medical-industrial complex)? The vaccines seem to be effective at keeping people out of the hospital, which is incredibly important, but this is a very different thing than preventing the spread of sars-cov-2. And as long as it’s spreading, covid and its attendant social unrest will be with us.

    One (wildly optimistic) hope for 2022 is that we might begin to have a substantive public discussion about what real public health might look like in the future. The CDC’s data show that ~659,000 people in the US died of heart disease in 2019 (https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm), so it’s fair to estimate the expected mortality from heart disease in the US during the nearly two-year timeframe of the pandemic is probably somewhere around 1.3-1.4 million. Which is a shocking number but so normalized in our society it gauges barely a shrug. I can’t remember the last time I saw a public health message suggesting we eat less meat, sugar, and trans-fatty foods. In many ways, the pandemic has revealed that we have an underlying “crisis of comorbidities” deeply ingrained in our population, which are deserving of an equally earnest public health response.

    • Bryan Alexander says:

      Jeremy, I’m all for improved discussion.

      Would you consider boosters to be superior products in this case?

    • S. says:

      Jeremy, I agree with most of your points…. but I do question whether the primary question should be “how do we stop the spread”, or rather, “how do we live with the spread”. We cannot STOP the spread. What we can do is reduce spread especially among the population with co-morbidities, and develop post-infection treatments (good progress is being made in this area). I really appreciated your last paragraph – I think the public would be better served by advising that everyone walk for 45 min a day, than by mandating vaccines and masks.

  3. S. says:

    Yes, I think our American public is in “Covid exhaustion”. We are tired of the continued confused reporting, tired of the doom-and-gloom prognostications, tired of the government over-reach. I believe it is time (past time, actually) to switch from “pandemic” panic porn to “endemic” decision-making, and time for a switch from government protectionism to personal responsibility. In fact, I fear that at least a fair portion of the “anti-vax” entrenchment is in direct opposition to the authoritarian approach of leaders from the campus and local levels all the way up to federal. If leadership would adopt the position “here are the facts, do as you see fit” position, and stop feeding the raging mobs on both the left and the right, people would eventually return to rationality. It reminds me of the clever lyrics in the parents’ song from The Fantasticks: “Why did the kids put beans in their ears? They did it cause we said No!”. When I’m particularly frustrated, I remember that history moves as a pendulum, and the only question is whether we have reached the pendulum’s maximum amplitude. In my opinion, we haven’t yet, but we will within 6-12 months time.

    • Bryan Alexander says:

      S., good Fantasticks quote.
      Do you think a governmental step back would encourage more people to decide to get vaccinated, wear masks, etc?

      • S. says:

        A step back (the switch from law enforcement to personal accountability) by itself will have a calming and rationalizing effect. Case studies probably abound in the anti-smoking campaign, in the motorcycle helmet laws, and in combating fetal alcohol syndrome. In each of these scenarios, trying to legislate healthy behavior was a pitiful failure, but encouraging personal accountability has slowly changed the definition of “socially acceptable behavior” throughout much of our society. It’s not a perfect mechanism, but it is the only sustainable one. Further, it is not enough to simply take your hands off the steering wheel and expect the car to stay between the ditches. Responsible decisions cannot be made in the absence of facts, and the CDC and other govt leaders have almost utterly failed to provide serious, coherent, conversational, multi-faceted, in depth, research-based facts. And this is creating an unfortunate “haves and have-nots” rift in our population; those who had the knowledge and basic research capabilities found the facts they needed and made their personally accountable decisions this past spring and summer; those who lack these skills and resources are left swinging in the wind, buffeted by the most strident and power-grabbing voices, feeling victimized and alienated by the very govt who were supposed to protect them. Bottom line, the first response of govt and leadership needs to be “this is a personal decision, which cannot be legislated by govt or private leaders”. Under that approach, Yes, I think more folks would get vaccinated, and No, I think fewer people would wear masks (because the disadvantages are pronounced, and the benefits are minimal in all but a clinical setting).

        • Bryan Alexander says:

          I appreciate this thoughtful comment, S.

          I agree that the CDC has flubbed things. My assessment might be even more harsh, since I’m thinking of their badly failed testing effort in spring 2020, as well as their persistent challenges in getting, analyzing, and sharing data. To an extent this depends on the broader problem of America’s public health capacity being weak.

          Yet I’m not sure the analogies work for me. None of those were infectious diseases. They also moved much more slowly than COVID. For example, it takes years – decades – of smoking tobacco to create a likelihood for lung damage, while we’ve seen various strains of this coronavirus leap continents in days and bodies in mere hours. Isn’t this an emergency, where emergency measures make sense?

          • S. says:

            I think you’ve highlighted a key element of my thinking, Bryan: Covid should no longer be considered an emergency, it is now a part of normal life. Normal life now needs to include rapid and accurate testing available to all. Normal life now needs to include easy and fast access to effective post-infection treatment. Normal life now needs to include predictive modeling to inform development of vaccines effective against emerging variants. And normal life needs to include societal acceptance of personal accountability for getting vaccinated (or for alternative mitigations against serious illness). That’s what I meant in saying that we are past “pandemic” and should be gearing up for “endemic”.

  4. Glen McGhee says:

    A more accurate portrayal of COVID fatigue, and COVID trauma, from Doctors at War review by Randall Collins. Move over Ian, if you have the stomach for it. Last paragraph.
    So, now you know why we have to rebuild the health care system, right?

  5. Dahn Shaulis says:

    A return to Malthus and Herbert Spencer.

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