Edited by Rafaela Prifti/
The magnitude of the country’s loss is nearly impossible to grasp. More Americans have died of Covid-19 than in two decades of car crashes or on battlefields in all of the country’s wars combined.Experts say deaths were all but inevitable from a new virus of such severity and transmissibility. Yet, one million dead is a stunning toll, even for a country the size of the United States, and the true number is almost certainly higher because of undercounting.It is the result of many factors, including elected officials who played down the threat posed by the coronavirus and resisted safety measures; a decentralized, overburdened health care system that struggled with testing, tracing and treatment; and lower vaccination and booster rates than other rich countries, partly the result of widespread mistrust and resistance fanned by right-wing media and politicians.The virus did not claim lives evenly, or randomly. A NYT study of 25 months of data on deaths during the pandemic found that some demographic groups, occupations and communities were far more vulnerable than others. A significant proportion of the nation’s oldest residents died, making up about three-quarters of the total deaths. And among younger adults across the nation, Black and Hispanic people died at much higher rates than white people.Understanding the toll is essential as the pandemic continues. At latest count, more than 300 people are still dying of Covid every day. It is a moment for all of us to reflect on our society.The first wave of deaths was concentrated in the Northeast, especially New York City and its suburbs. In the early months, doctors were not sure how best to treat the disease. Hospitals were overwhelmed. Deaths climbed sharply.In March and April 2020 New York City was hit harder than any other city in the country has been during the pandemic. At the height of this outbreak, a New Yorker was dying of Covid almost every two minutes — nearly 800 people per day, a rate five times as high as the city’s normal pace of death.About 60 percent of all deaths at the beginning of the pandemic happened in the Northeast, as the virus tore through cities and suburbs on the Eastern Seaboard. New York City alone saw 20 percent of the nation’s deaths in the first wave, despite making up just 3 percent of the U.S. population. This period would prove to be the region’s worst by far. The rest of the country would bear the bulk of the 900,000 deaths to come.Epidemiologists have pointed to the density rate and New York’s role as an international hub of commerce and tourism to explain the early spike in cases and deaths. Still, the earliest surge also took an acute toll in cities including Detroit, New Orleans etc.A spike in emergency room visits to New York City hospitals by people who had “flu-like symptoms” in early March suggested that thousands of city residents were infected.On March 15, Mayor Bill de Blasio shuttered bars and restaurants and announced that public schools closures the next day. Gov. Andrew M. Cuomo imposed broad restrictions on nonessential businesses on March 22. A Columbia University study found that the near-lockdown measures were most likely responsible for a more than 50 percent reduction in transmission of the virus.By summer 2020, New York was garnering praise as a model of infection control. Death rates in New York City would never rise as high as they did in the early wave.Still some health officials estimate that more than half of the New Yorkers who died in the earliest days might have lived had officials put the lockdown measures in place even a week or two earlier, since the cases were doubling every two days.New York’s political leaders cited lack of direction from the federal government, inconsistent messages from public health experts and the daunting task of getting the public on board with a massive disruption of everyday life for the timing of restrictions.Among wealthy countries, the United States has been notably unsuccessful at persuading residents to get fully vaccinated and boosted. Today, about a third of people across the United States have not been fully vaccinated, and some 70 percent of the population has not received a booster.Nearly half of the deaths from Covid in the United States occurred after vaccines were made widely available. The failure to vaccinate, epidemiologists say, contributed to hundreds of thousands of deaths. During the Omicron wave in December 2021 and January 2022, for instance, the Covid death rate in the United States was higher than in Germany, France, Britain or Canada, which had each fully vaccinated and boosted larger shares of their populations.More than 429,000 people have died of Covid since all adults in the United States became eligible for vaccination in April 2021. A majority of them were unvaccinated, but as the virus has continued to spread, it has killed thousands of vaccinated people, too.Public health experts say the government failed to do enough to help the public understand how effective the vaccines are, or to combat misinformation and conspiracy theories by some right-wing media and politicians.The vaccines have been shown to be largely effective at preventing severe disease and death. But Debra Furr-Holden, an epidemiologist at Michigan State University and the incoming dean of New York University’s school of global public health, said that deaths among vaccinated people had not been explained well and had exacerbated fears surrounding the vaccine and distrust of the government.The C.D.C. has received data on deaths by vaccination status from only about half of the states, so it is impossible to know exactly how many vaccinated people are among the million who have died. But at least 50,000 vaccinated people, many of them older or without booster shots, were among the deaths reported since late April 2021, when vaccines became widely available.Still, vaccinated people have had a much lower death rate — unvaccinated people have been at least nine times as likely to die since April 2021.In recent months, states have scaled back on vaccination campaigns and incentives, and also dropped masking requirements and other mitigation measures that help protect the unvaccinated and other vulnerable people. Some health experts express concern that efforts to persuade people who were unsure were tramples by the rush to return to a pre-pandemic normal and the government-ordered employer vaccine mandate drove some people away from the vaccines.Staggering Losses of Older AmericansThe pandemic has been especially deadly for the oldest. Covid has killed more than 3 percent of the entire U.S. population 85 and older. Older Americans have endured extreme loneliness and isolation while having to listen to the idea that ‘we’re going to die anyway”. Home bound some found solace in an online community of older adults who share stories and take fitness classes.Older people tend to have weaker organ function and immune systems, leaving them more vulnerable to disease and less likely to respond to vaccines. Indeed, age has sometimes been a bigger risk factor than vaccine status during the pandemic. People 80 and older who had gotten shots were almost twice as likely to die at the height of the Omicron wave as those in their 50s or early 60s who had not, according to C.D.C. data.But public health experts said the reluctance of others to adapt their behavior was a contributing factor to the large number of deaths among older people over the course of the pandemic.Covid-19 Death Rates by Age and RaceA common refrain is that older Americans might have died of something else — cancer, heart disease or old age — had Covid not hit them. But that does not mean that their final years were not cut short. In the two years before the pandemic, an average of 877,000 people over 85 died each year. In 2020 and 2021, the same age group saw 100,000 more deaths than that each year.Comparisons to the impact of the flu, which overwhelmingly kills older people, do not hold up either. Covid has killed at least eight times as many people as the flu and pneumonia do in a comparable timespan, according to Andrew Noymer, an associate professor of public health at the University of California, Irvine.By March 2021, Black and Hispanic people in every age group have died at higher rates than white people. The racial disparity in deaths was especially extreme at the beginning of the pandemic, but the gaps remain today.Hispanic people ages 25 to 54 died at a rate more than four times as high as white people of the same age group before vaccines became widely available. Black people of the same age group died at more than three times the rate during that period.Covid-19 Death Rates Among Ages 25-54Disparity in part is because a disproportionate share of essential workers are people of color, public health experts said. Another reason for persistent disparities in deaths was lower vaccination rates. White people were significantly more likely to be vaccinated than Black and Hispanic people in the first months of the vaccine rollout.The gap between Black and white people has since narrowed to about six percentage points, while Hispanic people now have a slightly higher rate of vaccination than white people, according to recent study by the Kaiser Family Foundation.Workers Without Other Options but WorkMeat-packing workers had been dying of Covid. Transit workers had been dying of Covid. Farm workers had been dying of Covid. Many workers who came to be known as “essential” because their jobs required in-person work had no other option.Nearly 80 percent of workers ages 20 to 64 who died of Covid in 2020 worked in industries designated as essential, according to data obtained by a team of researchers at the University of San Francisco, California. Workers in 11 sectors that were exempt from stay-at-home orders — including food services, health care, construction, transportation, agriculture and manufacturing — were almost twice as likely to die of Covid than others the same age, the researchers found. About two-thirds of workers in the United States are employed in industries that fall within the classification.Income is also a predictor of a person’s risk of dying of Covid in this country. People without a college degree and those who live in poorer neighborhoods have been more likely to die of Covid than those with a college degree and people who live in wealthier ZIP codes.Data from the country’s three largest cities shows that the highest-income neighborhoods have generally seen the least death over the course of the pandemic, while the poorest neighborhoods have seen the most.Covid-19 Deaths by Income in Major CitiesLower incomes also correlate with a lower likelihood of vaccination, which is in turn associated with Covid deaths. For example, while Republicans have been far more likely to go unvaccinated than Democrats, a divide also exists between high-earning Republicans and poorer ones: According to one survey of self-identified Republican voters in June 2021 conducted by Abram Wagner, a University of Michigan epidemiologist, Republicans with monthly incomes of under $2,000 were twice as likely to be unvaccinated as those with monthly incomes of $5,000 or above.The United States is far from the only country that has suffered a staggering death toll. The World Health Organization estimates that 4.7 million more people died in India during the pandemic than would have in normal times, and that one million more died in both Russia and Indonesia. Several smaller countries also have experienced higher death rates than the United States.But there is little doubt that America fared worse than almost all wealthy nations, with one of the highest rates of infection, according to an analysis in The Lancet.Nursing Homes BatteredThe virus swept through places like prisons, colleges and group homes, where people live together, but the toll was especially high in long-term care facilities, like nursing homes.The nursing homes did not allow family members visitations during the pandemic.Residents of long-term care facilities continued to die long after the early months of the pandemic, and long after lockdowns that were criticized later for isolating seniors in dangerous, damaging ways.Early on, a shocking 43 percent of all Covid deaths were among residents and staff members at long-term care facilities. The proportion would shrink, but the deaths continued to rise. In total, more than 200,000 deaths — about one in five of all who have died — have been associated with these facilities. Deaths in nursing homes slowed sharply in January 2021, weeks after vaccines were introduced. But they did not vanish entirely. As Delta and then Omicron swept the country months later, deaths in nursing homes rose again, though never to the levels seen before vaccinations. Some experts blamed relatively low vaccination rates among nursing home workers before shots were mandated by the federal government. But experts also pointed to problems that existed before the pandemic, like crowding, underfunding and staffing shortages.Industry leaders have called on the federal government to make a major investment to protect nursing homes by improving staffing and care. While public health and government officials point out that there was a large proportion of the deaths from nursing homes, they are resistant to provide resources. Covid had exposed failings in the country’s system of long-term care centers that had yet to be widely addressed, which raises a lot of questions for the next pandemic.Relentless Blows to the South of the CountryBy early 2021, the South’s death rate spiked again. Then came the Delta variant, and the Omicron wave, and it just got worse.As hospitals overflowed, many residents died in their homes. The ripple effect of the pandemic was evident, too, as people with heart or kidney disease for whom there were no hospital beds were dying. While other regions endured several waves of the virus, the South has suffered more frequent and extreme waves of infection and death.The South has also experienced the highest death rates from Covid of any region. In part, that is because it is home to some of the lowest vaccination rates in the country. Since vaccines became available, the average death rate fell everywhere but the South, where it rose by about 4 percent.Epidemiologists also pointed to less stringent responses — lockdowns that ended sooner and masking restrictions that were not enforced as strictly, even when they were in place.The South has also suffered because the share of adults with three or more chronic health conditions is higher on average than in any other region. Many chronic health problems are risk factors for the coronavirus, and several studies have suggested that 30 percent to 40 percent of all Covid deaths in the United States involved people with diabetes.Mississippi has the highest Covid death rate of any state, and one of the lowest vaccination rates. The State’s health official said that it has been tough to compete with misinformation, especially on social media, and with people who tried to downplay the seriousness of the pandemic as the polarization around the virus and vaccines have been devastating the South.The original was a NYT analysis of 25 months of data on deaths during the pandemic including demographic groups, occupations, communities, income, age, race and location.