1 million COVID deaths—"Normal" is what got us here, there is no going back
Two frontline doctors reflect on a grim milestone
by Drs. Elisabeth Poorman and Dharushana Muthulingam
5/20/22
We have arrived at a somber milestone — 1 million dead in the US of COVID-19. What have we learned from such a steep price? We know more about COVID-19 and how pandemics spread, but we have not done enough to prevent the next wave-–possibly already be on its way with rising hospitalizations and deaths. Nor are we prepared for the next inevitable pandemic.
When COVID-19 first emerged in the US, we were on the front lines–and in the dark. As physicians in internal medicine and infectious disease, our patients arrived in our offices and hospital floors with fever and shortness of breath, but we had no access to tests. Colleagues around the country didn’t have enough masks. When they asked for help, they were reprimanded or even fired. Nurses came to work in trash bags. States outbid each other for ventilators, a largely preventable coordination catastrophe. As this brand new disease emerged, we desperately searched for answers in a sea of largely unchecked misinformation and institutional silence.
This spring, we emerged from another brutal winter COVID surge. It is a relief to collectively catch our breath. We are understandably tired of COVID — but COVID is not done. Instead of using this time to prevent another surge, we have resigned ourselves to not only stop preparing for the future, but to actively undo the safety measures we had in place. Congress has ceased funding a response, including for testing, treatment and vaccination. Economic life lines like the expanded child tax credit were allowed to expire. Masking requirements on transportation, where social distancing is impossible, have been arbitrarily ended by court mandate.
Schools are struggling to upgrade ventilation; few have created safe places to eat outside, or decreased classroom size. Workplaces continue to force workers to eat in cramped rooms together, in spite of clear evidence that this spreads disease. In the most expensive healthcare system in the world, out of pocket costs continued to rise, posing a major barrier to getting prompt care, with no major party calling for meaningful reform. Meanwhile, 1 in 5 healthcare workers have left their jobs since the pandemic began.
Pundits who have been demanding we “return to normal,” that we forget and move on, prioritize the convenience of people like themselves over our collective safety. They ask us to forget and to learn nothing.
But we remember too much. We remember a young woman gasping for breath in our office, telling us she could not quarantine, because her work did not allow employees to take so many sick days. We remember patients canceling urgent appointments because they lost their jobs and therefore their health insurance. We remember hospital rooms filling with COVID patients, scared and hungry for air, using their last breath sometimes to beg us to help them, or sometimes to insist that COVID-19 was not real. We remember new medical residents who did not know how to discharge patients home after months working in the hospital, because until then, none of their patients had survived.
COVID-19 revealed an entire health infrastructure that had been steadily defunded over decades, including public health, mental health care and rural hospitals. In a country that charges people without insurance for flu shots, we have relinquished much of our healthcare, including the vaccine rollout, to private interests who do not have incentive to reach the underserved. It is unsurprising then that vaccination access replicated long-standing health disparities and with lower vaccination rates for poor, uninsured, and Black and Latino Americans until recently, even as they reported less vaccine hesitancy. While the common refrain was that those who wanted to get vaccinated could, private pharmacies required online signups that excluded millions. With the end of Congressional funding for COVID-19, this threatens our ongoing progress even now, to reach people who have limited computer access, no access to a doctor, or are blind.
COVID has also revealed the fragile and underfunded systems of childcare, housing, and worker protection. As physicians, we witness the consequences of this regularly: patients who still cannot access testing or vaccines, cannot take time off work, and live in crowded apartments, nursing homes, or jails.
Globally, inequity in vaccine access means that we are not addressing the emergence of new variants. There is yet another new variant of concern rapidly spreading. Calls to move on dismiss these ongoing dangers, and instead, prioritize the comfort of those lucky Americans who have been safer all along.
Our country has lost more lives to COVID than any other wealthy nation. COVID has revealed a country that treats healthcare as a luxury good. It has revealed a country where race remains a strong predictor of who lives, and who dies. This is what “normal” gave us.
We have all suffered over the last 2 years. The grim landmark of 1 million dead does not begin to capture this. It is understandable to want to leave the pandemic behind. But we cannot surrender to willful ignorance or denial. We cannot keep accepting preventable deaths. We must build a country that protects the vulnerable and does not keep accepting systemic failure. We need to make healthcare accessible to all. We need to be a country that invests in lessons learned, or we will never get out of this.
Normal is what got here. We cannot go back.
Dr. Poorman is an internal medicine physician and faculty in Chicago. She has published in New England Journal, the lay press, as well as discussed physician mental health NBC news. You can find her on twitter and her website. Dr. Muthulingam is an infectious disease physician and clinical researcher in St. Louis who has contributed pandemic news to Vogue and NPR. You can find her on twitter, ig, and her website.