Thursday, July 09, 2020

The U.S. death toll has reached 100,000. The pandemic has exposed the nation's vulnerabilities and dangerous divide.

May 28. 2020
Sandy Brown, 60, of Flint, Mich., lost her husband, Freddie Brown Jr., 59, left, and her son, Freddie Brown III, 20, right,to covid-19,. MUST CREDIT: Photo for The Washington Post by Brittany Greeson
Sandy Brown, 60, of Flint, Mich., lost her husband, Freddie Brown Jr., 59, left, and her son, Freddie Brown III, 20, right,to covid-19,. MUST CREDIT: Photo for The Washington Post by Brittany Greeson
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By The Washington Post · Marc Fisher · NATIONAL, HEALTH, POLITICS 

One hundred thousand Americans dead in less than four months. It's as if every person in Edison, New Jersey, or Kenosha, Wisconsin, died. It's half the population of Salt Lake City or Grand Rapids, Michigan. It's about 20 times the number of people killed in homicides in that length of time, about twice the number who die of strokes.

The death toll from the coronavirus passed that hard-to-fathom marker on Wednesday, which slipped by like so many other days in this dark spring, one more spin of the Earth, one more headline in a numbing cascade of grim news.

Nearly three months into the brunt of the epidemic, 14 percent of Americans say they know someone who has succumbed to the virus.

These 100,000 are not nameless numbers, nor are they mostly famous people. They are, overwhelmingly, elderly - in some states, nearly two-thirds of the dead were 80 or older. They are disproportionately poor and black and Latino. Among the younger victims, many did work that allowed others to stay at home, out of the virus's reach.

For the most part, they have died alone, leaving parents and siblings and lovers and friends with final memories not of hugs and whispered devotion, but of miniature images on a computer screen, tinny voices on the phone, hands pressed against a window.

The dead are not equally dispersed across the land. They perish mostly in pockets - in huge, frightening outbreaks such as the one in New York City, and in smaller ones, flares of disaster around meatpacking plants, in immigrant neighborhoods and at facilities for the elderly.

The demise of these 100,000 people has had strangely little public impact in a country with a long history of honoring its fallen and committing to common cause in their memory.

Americans have responded to the coronavirus pandemic with outpourings of gratitude - New Yorkers' nightly chorus of cheers for health-care workers, for example - and widespread cooperation, including extraordinary, quick pivots to staying at home and wearing masks.

But there have been few expressions of public grief - no gold stars in the windows of homes where people died, no outcry for national unity or memorials, as happened after the Sept. 11, 2001, terrorist attacks. In this trauma, the enemy is unseen; there is no one against whom to mobilize the nation's energy, anger and frustration.

"We're living in a moment when national sentimentality and displays of compassion are muted because the government doesn't conceive itself as a first responder," said Lauren Berlant, a University of Chicago professor whose work focuses on compassion. "There is empathy, but it's been localized - it's in the states and cities and neighborhoods."

Despite a death toll that has overwhelmed hospitals and funeral homes, it remains early in the course of the epidemic. There has been as yet no national requiem, no moment that captured the collective sense of loss, no president standing atop the ruins, rallying the nation through a bullhorn.

"Maybe," Berlant said, "it's hard to mourn when you're busy trying to sustain life."

The virus does not seek out the elderly. In Maryland, where the Ocean City boardwalk teemed with beachgoers over the Memorial Day weekend, fully half of coronavirus cases involve people between the ages of 20 and 49.

But the roster of deaths tells a different story: The vast majority of the dead have been over 50, according to The Washington Post's analysis of data from across the country.

The places where America tucks away its elderly - nursing homes, assisted-living facilities, age-restricted developments - are where the virus hits with lethal efficiency.

In Page County, a rural swath of Virginia about 100 miles west of Washington, there have been 19 coronavirus hospitalizations and 19 deaths. Eighteen of the dead lived at Skyview Springs Rehab and Nursing Center in Luray, Virginia, where 94 residents and staffers at the 120-bed facility have tested positive for the virus.

These are disproportionately cruel deaths, especially in facilities where many died in isolation, apart from loved ones.

Sherry Dean Rovelo's mother, Betty Lou Jason, was in a nursing home in Bluffton, Ohio, after suffering a stroke at age 80. She contracted the coronavirus and was sent to a hospital, where Rovelo was not allowed to visit her.

For four days and four nights, Rovelo and her brother watched their mother via an iPad that a nurse had propped up next to her. Rovelo read and sang and played her mother's favorite music, watching as Jason struggled for air. She "could only moan when spoken to," her daughter said. Jason, a pastor's wife, died on Good Friday.

"The grief and guilt of not being there physically with Mom during her last hours are not likely to leave us anytime soon," Rovelo said.

Raymond Bullus was 75 and suffering from dementia at a Trenton, New Jersey, nursing home when he contracted the virus last month. His sister, Melanie Branon, who lives in California, received an email. She opened it to find "a horrible picture of death, which I received without warning," she said. The email asked her to identify the body, remotely.

"I was never able to communicate with him directly during his five days" in the hospital, Branon said, "not to offer the comfort of a familiar voice, and tragically, not to even say goodbye."

The virus has canceled the rites that human beings have created to usher the people they love into the nevermore. Funerals, wakes, shivas, burial services - all reduced to a thin, video-transmitted replica or erased entirely. On New York's Hart Island, where the city's paupers and prisoners have long been buried, workers dug deep trenches and filled them with stacks of wooden coffins - producing images so painful that police confiscated the drones photographers used to view the horrific scene.

Coronavirus deaths have come in serial waves of clusters among certain groups in certain places. They hit first in densely populated settings. Death has come in high concentrations among people whose jobs require them to work side by side with others - transit workers, prison guards and inmates, factory workers and meatpackers.

Doctors, nurses and other medical personnel who stepped up to battle an intensely contagious and poorly understood disease are disproportionately represented among the dead.

Paul Cary got behind the wheel of an ambulance and drove 27 hours from Colorado Springs to the Bronx because he saw that his skills as a paramedic were needed. For three weeks, he answered 911 calls and ferried coronavirus patients from overloaded hospitals to slightly less besieged facilities, caring for oxygen-starved victims as his ambulance rumbled through eerily empty streets.

Then Cary fell ill and entered one of those hospitals himself. He died on April 30 of covid-19, the disease caused by the coronavirus. He was 66 years old and left behind two children and four grandchildren. New York's mayor, Bill de Blasio, promised that the city Cary had come to help would build a proper memorial to him, someday.

As millions worked from home and millions more lost their work, many Americans' jobs still put them in close quarters with other people - sharply increasing their risk of catching the virus.

Jason Hargrove lost his life driving the bus, taking people to work. One day in March, a woman got on Hargrove's city bus in Detroit and repeatedly coughed without covering her mouth, the driver said in a Facebook video that he posted to express his outrage.

"We're out here as public workers doing our job, trying to make an honest living to take care of our families," he said. "For us to get through this and get over this, man, y'all need to take this s--- serious. Folks dying from this."

Four days later, Hargrove, 50, fell ill with the virus. A week after that, he was dead.

The coronavirus likes a crowd. Superspreading events have been perhaps the most efficient infection hot spots - sports events, street festivals, weddings. And the lethal danger spikes indoors, where air is stagnant and people interact at close distances.

Anywhere large groups gather and stay together for a while is problematic, especially if people are talking loudly, yelling or singing, propelling potentially infected droplets into the air for others to breathe in. Some of the deadliest clusters of cases can be traced to richly social events: Mardi Gras in Louisiana, chorus practices, corporate meetings.

Patricia Frieson and Wanda Bailey, sisters who lived near each other in the Chicago area, attended a funeral together in early March. Within days, Frieson, a 61-year-old retired nurse, fell ill. By mid-month, she was in the hospital, struggling to breathe. Before a test confirmed that she had the coronavirus, her family gathered with her, hugging.

As Frieson neared death, Bailey, a 63-year-old former medical coder, developed a wicked cough, a common symptom of the coronavirus. She, too, ended up in the hospital. The sisters died 10 days apart.

Covid-19 likes a crowd. Superspreading events have been perhaps the most efficient killing fields - sports events, street festivals, weddings. And the lethal danger spikes indoors, where air is stagnant and people interact at close distances.

Anywhere large groups gather and stay together for a while is problematic, especially if people are talking loudly, yelling or singing, propelling potentially infected droplets into the air for others to breathe in. Some of the deadliest clusters of cases trace back to richly social events: Mardi Gras in Louisiana, chorus practices, corporate meetings.

Patricia Frieson and Wanda Bailey, sisters who lived near each other in the Chicago area, attended a funeral together in early March. Within days, Frieson, a 61-year-old retired nurse, fell ill. By mid-month, she was in the hospital, struggling to breathe. Before a test confirmed that she had the coronavirus, her family gathered with her, hugging.

As Frieson neared death, Bailey, a 63-year-old former medical coder, developed a wicked cough, a frequent symptom of covid-19. She too ended up in the hospital. The sisters died 10 days apart.

The Post's analysis of state and city data shows that in some places where the virus has hit hard - including New York City, the District of Columbia and Illinois - African-Americans died at disproportionately high rates. For example, in the District, where 46 percent of residents are black, 76 percent of those who have died of covid-19 were black. In contrast, although the city's population is 37 percent white, whites account for only 11 percent of deaths.

Elsewhere, the disparity is even greater. In Michigan, African-Americans have accounted for 40 percent of the deaths, though they make up 14 percent of the population.

Some of the most ferocious outbreaks have burned through majority-black locales, where the social safety net was already frayed and health care shortages are common amid high levels of underlying medical conditions. A predominantly black section of southwest Georgia, for example, has suffered a higher death rate than even the hardest-hit New York City boroughs.

The coronavirus has struck Latinos in a similarly devastating way, in part because many live in multigenerational households and work in service industries in close contact with other people. Latinos are more than twice as likely as whites - 26 percent compared with 10 percent - to know someone who has died of the virus, according to an ABC News-Ipsos poll released last week.

The virus has accentuated differences between people who have good health care and those who cannot afford it. In two Queens neighborhoods along one bus line, there's an 800 percent difference in the death rate from covid-19. It's low where the affluent live and sky-high among the poor, many of whom are immigrants who are afraid to seek medical attention because they are in the country illegally or because they lack health insurance.

The coronavirus has struck Latinos in a similarly devastating way, in part because many live in multigenerational households and work in service industries in close contact with other people. Latinos are more than twice as likely as whites - 26 percent vs. 10 percent - to know someone who has died from the virus, according to an ABC News-Ipsos poll released last week.

The virus has accentuated differences between people who have good health care and those who cannot afford it. In New York, about 90 percent of the dead had suffered from preexisting conditions, hypertension foremost among them. In two Queens neighborhoods along one bus line, there's an 800 percent difference in the death rate from covid-19. It's low where affluent people live, and sky-high among poor people, many of them immigrants who are afraid to seek medical attention, because they are in the country illegally or because they lack health insurance.

In Mississippi, the county that has lost the most people is far from densely populated. But more than a quarter of the 74,125 people in Lauderdale County, along the Mississippi-Alabama border, live below the poverty line, according to census figures. The county was home to 47 of the 580 Mississippians who have died from covid-19.

The virus ravages families. Joseph Vo Van Ngo and Bay Thi Huynh, husband and wife, escaped from poverty in communist Vietnam in 1981, slipping away in a boat Ngo built in secret.

They settled in Worcester, Massachusetts, where, on May 14, they died of covid-19, minutes apart, in the same hospital, in the same room, one month after they celebrated the 60th anniversary of their arranged marriage. Ngo was 85 and Huynh was 82.

On the same day, their oldest daughter, who had been taking care of her parents at their house, entered the hospital; she too had the virus. Five days later, Kim Chi Nguyen-Ngo, who was 50, also died.

Death usually brings people together, in mourning, in sadness, but also in the succor of family and the ministrations of faith and remembrance. Coronavirus deaths steal much of that support.

"We've literally lost touch," Berlant said. "The heartbreaking pictures of people standing outside nursing homes reaching toward their loved ones embody the frustration we feel, and point to the urge to invent ways to show up for each other."

If the kind of public grieving that followed 9/11 is missing now, that's partly because of the nature of the virus, which hits different communities at different times, and partly because President Trump has put the onus for fighting the epidemic on states and governors rather than on the federal government, which traditionally has led the response to national emergencies, she said.

Denial has always been part of how people cope with death, and the early spread of the virus was accompanied by Trump's persistent assurances that the coronavirus wouldn't amount to much. As late as mid-April, he said that the country's coronavirus deaths would end up "substantially below the 100,000" level, maybe as little as half that number.

More recently, he has questioned the death tallies being reported by federal, state and local governments, academic sources and news organizations. Most health officials agree that 100,000 is likely an undercount. Many deaths officially attributed to other causes stemmed from disorders sparked or complicated by covid-19.

Yet as the number of Americans who know someone who has been infected has jumped from 10 percent at the end of March to 33 percent last week, according to the Axios-Ipsos poll, a national consensus has developed across partisan lines that averting deaths is a good reason to stay home and minimize contact with other people.

But it has also become clear that there are no guaranteed fortresses against this virus, which burst forth in densely populated places but recently has spread, unimpeded by the tools of modern medicine, especially in rural locales.

Each death ripples through a family, to co-workers and friends and neighbors.

Shelby, Montana, is a small town of 3,200 people where six of Montana's 16 coronavirus deaths have occurred. All six were connected to an assisted-living facility, Marias Heritage Center.

Marguerite Horgus had entered the home earlier this year after she broke her pelvis. When she fell ill in March, she went to the hospital. "Her lungs were filling, and they called and said she's taken a turn for the worse," said the oldest of her five children, Nancy Horgus Whitt.

All five of Horgus' adult children got to see her, but then, soon after their visit, a test confirmed that she had contracted the virus. As their mother suffered, some of the siblings tried to stay with her.

"They put my brother in a hazmat suit and he sat there all day, waiting, and then they said no, you can't see her at all," Whitt said. "It was just a mess."

For two days, Horgus was by herself. She struggled with every breath. She was 86 when she died.

A couple of days later, Whitt was also diagnosed with the coronavirus. She spent the next month alone at home in Missoula, Mont.

"I ate only cans of peaches and cans of pears," she said. "I could not cook for myself. My chest felt like I had an elephant sitting on it. Two weeks of incredible headaches and fatigue and pressure on your chest."

Now the family has put off any memorial service until at least late summer. They still want a gathering where it will be safe for their mother's friends in Shelby and relatives in Canada to attend. For now, their mother's ashes remain at the funeral home, and they wait.

"Our family motto is 'How tough are you? Tough enough,' " said Whitt, 69, an artist and postal worker. "Well, after hearing my mother try to breathe and her dying alone, and then I had it all alone, it's hard to get out of your head.

"You always hope she'll have a quiet death, a death in your sleep. She didn't. It was not a good death."

 

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