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On May 12 the White House acknowledged that more than a million Americans have died of COVID-19. Since infectious disease modelers began forecasting the course of the pandemic in early 2020, the US has exceeded worst-case predictions over and over. In the first year, 500,000 people died; and by spring of 2022, a million deaths had become a horrific inevitability. Currently, the national COVID toll hovers around 300 lives a day—three times more than the people who die from car crashes daily in the US.

Despite the historic weight of one million deaths, it can be impossible to wrap one’s head around the figure. “There was one human that put us over the edge of that number,” Maitely Weisman, a cofounder of the Essential Caregivers Coalition, puts it. To focus on the total can mean moving “too far from the Earth to see the individuals inside of it.”

Thousands of those deaths have taken place in the lull between COVID surges. When waves of infection are high, headlines: overwhelmed hospitals, thousands of mourners, and a steady drumbeat of updates from public officials. But right now, a third of Americans say the pandemic is over, and in spite of pleas from the White House, Congress has slashed pandemic funding. Yet the country is, in many ways, even more fragile than it was two years ago. Dwindling federal dollars threatens to cut off testing, antivirals, and possibly even vaccines for 31 million uninsured Americans, while the health care system itself has been eroded by a wave of hospital closures and nursing burnout

[Related: Meet the nurse who’s running a Texas COVID-19 clinic all on her own]

Popular Science reached out to people close to the pandemic response, hoping to open a series of windows on the country as it remembers, rebuilds, and rethinks public health and safety for the future.

These are excerpts from conversations.

Jennifer Avegno, director of the New Orleans Health Department

How has the news of a million COVID deaths in the US changed your perspective or actions?

As humans, we’re pretty bad at putting big numbers into context. I tend to say, a million people is basically the metro population of New Orleans completely wiped off the map. But that still makes it a lot more abstract—some city got wiped off the map, but I’m still here. I come back to those early days when we were hit so hard, and knew very little, and had almost no tools to stop the deaths. Those deaths were very personal, because everybody was reporting on every single one. It was the nursing home outbreak at Lambeth House, Zulu Social Aid and Pleasure Club, an Uber driver. So I try to reflect on who these individuals might be, and what they leave behind—I know people who died. You’d be hard pressed to find someone who didn’t know someone who died of COVID. I think that’s what makes it real.

It also makes me renew my focus: We cannot go back to those early days, nor can we continue on a trajectory where a million people is acceptable. In New Orleans, like most of the rest of the country, COVID is in the top three causes of deaths two years in a row. That can’t continue unless we want to live in a very different world.

What aspects of the pandemic are no longer getting the attention they deserve?

I think we have not done a great job historically paying attention to those who are disabled or are always going to be at risk. Those folks feel forgotten. Everyone else has moved on with their life, but if you’re immunocompromised in whatever way, you’re still in the same boat you were in March 2020. If we fail to take care of those who have the least protection, then we can’t move on as a society.

I’m an ER doctor, so it’s really important to me to make sure that your doctors feel comfortable prescribing paxlovid. At the city we are working really hard with the local partners to set up a hotline, so you don’t even if you tested positive at home, you don’t even have to go anywhere. Because again, that’s going to keep people from having to stay in the hospital.

Where are you finding hope as the country moves forward?

The good news is we do have a lot of tools at our disposal. We have widespread availability of tests. The next hurdle will be providing access to the additional layers of protection in oral treatments and antibodies that we have.

Ed Rupert, cofounder of First Responder Trauma Counselors

How has the news of a million COVID deaths in the US changed your perspective or actions?

We work with emergency room physicians and staff and EMS workers—they were kind of canaries in cages. While everybody else was locked down, these people were leaning into the problem. 

[Related: Who helps first responders in a crisis?]

Our work is a treadmill of trauma. We’re constantly working on this churn of trying to manage it. We’re at a more tenuous point. It’s bigger than COVID—that was just a stress test of the system, and we saw the inconsistencies where the weaknesses and the strengths were. The strengths were the people, and the inconsistencies were the support.

Where are you finding hope as the country moves forward?

We look at the pandemic and say, okay, how can we build capacity for mental health services for the people on the frontlines? We’re looking at groundbreaking technologies like eye-movement desensitization and reprocessing therapy, ketamine-assisted therapy, and sensory deprivation tanks, among other options. But there’s also the model of the response. We spend a lot of time normalizing help. It’s like when a fire department is overwhelmed and they call another department and say, “I need mutual aid”—it’s no big deal. We’re just the backup.

Maitely Weisman, cofounder of the Essential Caregivers Coalition

How has the news of a million COVID deaths in the US changed your perspective or actions?

We have never felt differently from the rest of the public—it’s not over until everyone can be treated quickly and successfully.

When I see a million deaths, it’s because it’s still a pandemic. It drives us crazy when we see people being very cavalier about it. Now that we’re allowed back into facilities, we have to stay safe. We’re masking everywhere we go. Members of our coalition and of other advocacy groups who go into long-term care homes need to work a job in an exposed place like grocery stores or restaurants. Some of them also take mass transit. The point is that they’re worried about accidentally contracting the virus every day.

When you’re out in the community, you don’t know who’s a family caregiver, who is a nurse, or a doctor. You don’t know the links, they’re invisible to you. You don’t know where they go and who they touch, who’s in their world.

What aspects of the pandemic are no longer getting the attention they deserve?

I imagine that we’ll be seeing more outbreaks. We’ve already heard of a couple, but they’re not reporting them as vividly as they did before. So you’re not seeing the struggle that nursing home residents are still experiencing, and that feeling of having their rights stripped as if they’re nonpersons.

Mary Owen, director of the Center of American Indian and Minority Health at the University of Minnesota

How has the news of a million COVID deaths in the US changed your perspective or actions?

I’m not reacting. We’ve watched as [the US] climbed steadily toward this number. My perspective of dismay over the lack of public health infrastructure and profit driven health care remains the same. 

What aspects of the pandemic are no longer getting the attention they deserve?

I’m anxiously watching what’s happening to our K-12 educational systems and the impact of COVID on a system that, pre-pandemic, faced chronic underfunding resulting in overcrowded classrooms, overworked teachers and support staff, and underserved youth. I’m watching what is happening in our healthcare system that, pre-pandemic, had physician burnout rates nearing 50 percent. I’m watching the impact on both systems of increased rates of early retirement and job flight because of the demands of COVID on top of already stressed systems. 

Where are you finding hope as the country moves forward?

I’m feeling hopeful that young people are aware, active, and fighting for change.

Govind Persad, bioethicist at the University of Denver Sturm College of Law

How has the news of a million COVID deaths in the US changed your perspective or actions?

It puts into perspective the extent to which our focus has been—in some ways—narrow: A million people at home have officially died of COVID, but many more people have died worldwide, and many others have died due to the pandemic (for instance, from delays in obtaining health care). Could emphasizing the broad harms of the pandemic rather than focusing on direct COVID deaths still lead to a better response?

What aspects of the pandemic are no longer getting the attention they deserve?

Despite having highly effective vaccines, we have invested insufficiently in research on which strategies for COVID-19 response achieve the most public health benefit with lowest burden. What dosing schedule for vaccines and boosters is optimal? Rigorous trials of non-medical interventions and efforts at program evaluation could help us move from policy based on hunches, precautionary reasoning, or repeated zigzags toward an mature, evidence-informed response. 

Where are you finding hope as the country moves forward?

The Food and Drug Administration appears to have the needed information to act quickly on authorizing a vaccine for children under 5. It has been frustrating to see repeated delays coupled with inappropriate rationales (e.g. that authorizing one vaccine candidate before others would be “confusing” to parents or that authorization decisions should aim to reassure “anti-vaccine communities”). Extending eligibility to these children will benefit them directly, provide relief for their families, and nudge our population protection further upward.

Cari Levy, palliative medicine chief and co-director of the Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care, Rocky Mountain Regional VA Medical Center

How has the news of a million COVID deaths in the US changed your perspective or actions?

It’s very distressing, obviously. I think all of us at this point have friends or colleagues or family who are in some phase or denial—whether it’s “this isn’t real,” or “the vaccine doesn’t work.” I remember a family member saying [early in the pandemic], “Look, they all panicked and said a million people will die, but here we have 1,000 people.” I think about that two years later. We have a million dead, and yet people are still pretty flippant about things.

What aspects of the pandemic are no longer getting the attention they deserve?

A couple of things. One is that we had some early data that people who have had COVID are at a higher likelihood of developing dementia, and we are seeing that now in nursing homes. What we’re seeing is, where somebody might have taken three years to have a decline in their cognition, now it’s months.

The other is that nursing homes before the pandemic, half of them were not making a profit. Currently, we’re seeing a fair number go out of business, and none of them are properly staffed. There’s a really interesting thing happening: Nobody wants to go to a nursing home on a good day, and as soon as they get there and see how poor the staffing is, they want to get out. I think we’re going to see a big shift to home care, as there’s not enough beds available, or the beds available aren’t desired.

[Related: Finding a therapist can be overwhelming, but these tips can help]

The third is that a lot of people are emerging now 100 pounds overweight, or with a wound on their leg that is now basically going to kill them—all the things that people haven’t tended to because they were scared to go into a doctor’s office. We only had maybe one COVID patient last week, but the hospital is super busy.

Where are you finding hope as the country moves forward?

We initially thought, “Oh, suddenly people are going to appreciate how integral nursing homes are to society.” But they just got blamed for the problems. Now I guess the thing that I am hopeful about is home care models. I do think there will be a huge shift. It’s not necessarily a bad thing, because nursing homes are not doing well, and haven’t been doing well for a long time. And this will force the industry to turn upside down and reconfigure. So it’s going to be painful; it’s going to be clunky. A lot of people will be caught in the crosshairs of that, but I think ultimately, we will get better at caring for people at home.

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