500,000 US COVID-19 deaths and counting—a shameful public health failure: Derrick Z. Jackson

A century since the 1918 flu claimed an estimated 675,000 lives in the United States, COVID-19 is about to claim its 500,000th life in the nation.

According to February 12 projections from the University of Washington’s Institute of Health Metrics and Evaluation (IHME), we’re on track for 614,000 deaths by June. With no drastic action, we will surely surpass the 1918 toll before returning to anything resembling normal life. We also will have created the most shameful episode in US public health history.

Our nation’s failed response to COVID-19 should long perforate our pomposity about being the greatest nation on earth. We’ve been the greatest of fools, and we have the planet’s greatest death toll to show for it. We’ve collectively turned our back on our own victories in public health that have saved millions of lives and added 30 years to average life expectancies in the United States during the 20th century.

We have so rejected the lessons of the past that the coronavirus is on track to wipe out more than a year of average life expectancy in the United States. We have so ignored systemic racism that COVID-19 will take three years off the life expectancy for Latinx people, and two years for African Americans. Researchers at the University of Southern California and the University of Princeton estimate that the pandemic may result in the greatest decline in US life expectancy since the 1918 pandemic, and the biggest decline among developed nations, further cementing us in last place among wealthy nations.

Worse, we cannot say we were blindsided. Early in the pandemic, scientists warned of a rapid spread. Experts in systemic racism and environmental justice warned that COVID-19 could particularly devastate Black and Latinx communities because of a host of pre-existing health disparities, more congested and polluted living conditions, less access to quality health care and disproportionate representation in essential health and commerce service work with high risk of exposure to the coronavirus.

Yet, the inaction of the nation invited the virus to bury us. The gap between lower Black life expectancy and higher White life expectancy will grow by nearly 40 percent from 3.6 years to 5, destroying progress made on this gap over the last 15 years. Latinx people, who actually live three years longer on average than White people, are likely to lose 70 percent of that difference because of COVID-19. “No cohort may ever experience a reduction in life expectancy of the magnitude attributed to COVID-19 in 2020,” the study said.

For us to have allowed that level of death makes it seem as if our eradication of polio and smallpox and near-eradication of measles and mumps were a mere aberration. It is as if we erased from our memory the benefits of government action to protect public safety, such as cutting smoking with tobacco taxes, saving lives with seat-belt laws and speed limits, and blunting the spread of infectious disease with testing, screening, and promoting simple physical barriers to viruses, such as condoms to prevent the spread of HIV.

COVID-19 triggered a dispiriting race to the bottom. Early proclamations that “we’re all in this together,” quickly gave way to a dystopian spectacle of every state, every city, and every human for themselves. Too many federal and state leaders chose to reopen economies last spring, often ignoring pleas from mayors of cities who saw what COVID-19 was doing to communities of color. A mid-June 2020 Washington Post poll found that at that point in the pandemic, Black and Latinx people were respectively three and two times more likely to know someone who died from COVID-19 than a White person. Black people were consequently far more likely than White people to say in multiple polls that controlling the pandemic was a major priority.

The result was a segregated response to the pandemic, encouraged by a racist president who refused to model social distancing and the use of face coverings. Too many White Americans took his cue at mass gatherings from campaign rallies to church services. White privilege helped the virus worm its way from the cities to deep into more rural heartlands of the nation. The selfishness and small-mindedness of the response made a mockery of the resources that could have been brought to bear against the pandemic. We became Lilliputians bereft of common good.

1918 redux

1918 flu

It is easy to lay immense blame on former President Trump and his administration for setting the tragedy of the US response in motion. He knew very early about the lethality of the coronavirus yet chose to purposely “play it down” to the American people because he didn’t “want to create a panic.”

In doing so, Trump replicated one of the worst mistakes made by leaders in 1918. Back then, in the last year of World War I, the nation’s political leaders were in no mood for additional bad news. Congress passed the Sedition Act that year, making it illegal to “willfully utter, print, write or publish any disloyal, profane, scurrilous, or abusive language,” about the government. The act’s passage inspired hundreds of thousands of private citizens around the nation to intimidate and even beat people they presumed to be unpatriotic.

As historian John Barry recounted for a 2006 Centers for Disease Control and Prevention workshop on the lessons learned from the 1918 flu pandemic, at that time, “patriotism was more important than truth.” When the flu began appearing, a Chicago public health official said, “Worry kills more people than the disease itself.” The federal government did so little that the Public Health Service returned most of the $1 million it was given to fight the pandemic.

Many cities took matters into their own hands and, a century later, the lessons are clear. As multiple studies of the 1918 pandemic have found, those municipalities that more firmly banned public gatherings, closed schools, or otherwise employed measures of social distancing, experienced fewer deaths. A study last year by Federal Reserve and MIT researchers found that cities with stronger public health protections also tended to have stronger economic recoveries. Co-author Emil Verner, an MIT economist, explained to the New York Times that stronger public health measures, “actually make it safer for economic activity to resume, and they mitigate the negative impact of the pandemic itself on mortality.”

Those insights, though, were completely lost on the ahistorical Trump, for whom the stock market was more important than science or public health. Many governors allied with Trump followed his lead, insisting, to the point of intimidation, on keeping their economies open. Almost as if the Sedition Act, repealed after the conclusion of World War l, was still in force, some governors threatened to punish workers who did not return to work after last spring’s lockdowns.

In many states, this was akin to pouring kerosene on systemic racism in the world of essential work, as White workers disproportionately stayed safe telecommuting from home. In many states in the early months of the current pandemic, African Americans and Latinx and Indigenous Americans died at grossly higher rates than their White counterparts, with multiple studies tying death to essential work.

Systemic racism rolls on in vaccine rollout

puerto rico vaccine covid

The Biden administration was elected with many promises to correct the previous administration’s mistakes. Biden’s quest is to somehow rally a divided nation around possible solutions, especially with new variants of the coronavirus threatening to lengthen the misery. For individuals, the top thing we can do is to wear face coverings and continue to maintain social distance. The IMHE estimates that 34,000 lives could be saved between now and June with universal use of face coverings.

For state governments, part of the solution is walking the talk of racial equity. So far, despite the promising start of the Biden administration of returning scientists to the podium to deliver authoritative coronavirus updates to the public, systemic racism remains aflame in our pandemic response. The most current wildfire is that the communities most impacted by COVID-19 are consistently last to get vaccinated against it, regardless of the political leanings of a state.

For instance, Massachusetts, stereotyped as liberal, was severely embarrassed by overwhelmingly White lines at the opening of a vaccination center in the heart of Boston’s Black community. The state also was criticized for establishing its first mass vaccination centers in large sports venues and suburban malls, either physically or culturally light years away from communities of color hardest hit by COVID-19. Whether due to lack of access to the Internet, time needed to book an appointment, transportation difficulties or failure by officials to engage local community centers, Black people have been getting vaccinated at rates less than half their share of state populations in Delaware, Florida, Indiana, Louisiana, Mississippi, Missouri, New Jersey, Ohio, Pennsylvania and Tennessee.

For Latinx populations, vaccination efforts to date have accounted for less than half their share of the population in Alaska, Colorado, Delaware, Florida, Indiana, Maryland, Massachusetts, Mississippi, Nebraska, New Jersey, North Carolina, Oregon, Pennsylvania, Rhode Island, Tennessee, and Texas.

The racial vaccination gap is likely even more widespread but the Kaiser Family Foundation, which is doing the tracking above, has sufficient data to list only half of all US states. With Black and Latinx populations at the leading edge of death in this crisis, it is unconscionable that states did not proactively prioritize vaccination efforts for those communities.

It represents another lie to people of color about “being in all this together,” especially now as White people collectively realize we’re all in the casket together. The disproportionate distribution of the vaccine to White people coincides with national share of White deaths, according to February 10 CDC data, rising steadily in recent months to 62.5 percent, edging past the 60.1 percent White share of the population.

We all have a hand in this failure

COVID-19 travel

It is hopeful that the Biden administration has ended Trump’s full-scale war on science that chased out scientists from many federal agencies and culminated in turning a deaf ear during the pandemic to the nation’s top infectious disease experts. The question now is: can we use science to our best advantage to protect people, especially the essential workers that are keeping us fed at grocery stores and with take-out meals, the farm laborers and those on the line butchering meat, the sanitation workers picking up our garbage, the delivery folks bringing us the goods from our online purchases, and the frontline health care workers dealing with the ill?

The question now is: can we use common sense to our best advantage? If we are honest with ourselves, we surely know that, given 103 years to learn from the last-worst pandemic, our current collective behavior is not even close to the best we can do.

The surges in holiday travel and gatherings, from last Memorial Day to this past Christmas, the desperation of so many colleges to hold in-person classes and play sports, the self-important need of some churches and temples to hold services and the temptation, family by family, to think they could get away with a birthday party, a wedding, or a funeral, are all reminders that a collective response to COVID-19 remains far from reality. The Supreme Court, shaped into almost a conservative super majority by Trump, has compounded the problem by recently striking down state temporary restrictions on in-person services, choosing in-person religious service over public health.

A last major question is whether COVID-19, which was so weaponized by the Trump administration that his supporters saw face coverings as the theft of freedom, can be turned in to a rallying cry to fuse a divided government. This milestone of a half million dead, the specter of bodies piling up in makeshift morgues, is thus far a headstone for decades of faltering public health funding.

In a 2020 report, “The Impact of Chronic Underfunding on America’s Public Health System,” the Trust for America’s Health noted that the nation’s public health emergency preparedness programs have been cut from $940 million in 2002 to $675 million in 2020. Hospital preparedness programs have been slashed from $515 million in 2004 to $275 million in 2020. That makes the $8.3 billion in Congressional COVID-19 emergency funding last March an exercise in expensive catch-up.

Add to that our lack of economic safety net stemming from our ragged ethos of rugged individualism. While a wealthy nation like Germany has compensated businesses during its lockdowns for 75 percent of pre-COVID sales and workers for about two-thirds of their lost wages, our Congress argues bitterly over limited stimulus checks and a few hundred dollars of monthly unemployment relief.

President Biden has said, “I am not going to shut down the economy, period. I am going to shut down the virus.” Biden’s ability to say that, within the bounds of science and public health safety, would be immensely bolstered if Congress was more agile in providing more robust funding to help businesses and workers survive science-based shutdowns and capacity restrictions.

Not time to drop the mask

COVD-19 vaccine

A resuscitation of the federal government from its 1918 coma is critical as desperate states and cities make pandemic choices that lie either on the bare edges of public health or in utter disregard of it. With the hospitality and indoor recreation industries on their knees, liberal governors in states such as California, New York and Michigan are lifting stay-at-home orders and restaurant capacity restrictions. More conservative states have begun lifting mask orders, raising the number of states without such orders back to 15.

Virologist Angela Rasmussen of Georgetown University’s Center for Global Health Science Security recently told ProPublica that, with dangerous variants of the coronavirus working their way through the United States, the expansion of indoor dining is “completely reckless.” Epidemic expert Sam Scarpino of Northeastern University said that while vaccines give us the chance to bring the pandemic under control, easing up prematurely on social distancing restrictions “may end up wasting all the effort we put in.”

On NBC’s “Meet the Press,” last Sunday, CDC Director Rochelle Walensky bluntly said it was “absolutely” too soon for states to lift mask orders. On CBS’s “Face the Nation,” she pleaded with the nation not to be as numb to the pandemic, saying its trajectory in the coming months “depends on how we as a country behave.” Noting that the current level of death of between 1,500 and 3,500 deaths a day is still more than twice the daily level of last summer, Walensky said:

“We are nowhere near out of the woods. And as you know, if we relax these mitigation strategies with increasing transmissible variants out there, we could be in a much more difficult spot. So what I would say is now is the time to not let up our guard. Now is the time to double down.”

That thought of doubling down is almost inconceivable given the nation’s half-effort to stop the original spread of the virus, the continued defiance of common-sense public health measures such as masking in conservative regions, and the desperation of more liberal states to keep people employed in the absence of sufficient federal support. What Walensky was really calling for, at heart, is for us to summon a shared sense of common good to quell the virus. She called for us to place public health over individual privilege and misguided notions of freedom.

Her call is likely our last chance to avoid surpassing the 675,000-death toll of 1918. We should not waste it.

Derrick Z. Jackson is on the advisory board of Environmental Health Sciences, publisher of Environmental Health News and The Daily Climate. He’s also a Union of Concerned Scientist Fellow in climate and energy. His views do not necessarily represent those of Environmental Health News, The Daily Climate or publisher, Environmental Health Sciences.

This post originally ran on The Union of Concerned Scientists blog and is republished here with permission.

Banner photo credit: U.S. Army photo by Luis A. Deya