By The Washington Post · Reis Thebault, Alyssa Fowers · NATIONAL, HEALTH
First, there were the reassurances: "Like a miracle, it will disappear," the president promised months ago. And then came the shutdowns, with calls for a coherent national strategy and optimistic projected death tolls.
But the divine has not intervened. The shutdowns were lifted, the warnings ignored and the predictions surpassed. And now, the novel coronavirus has officially killed more than 150,000 people in the United States, according to data gathered by The Washington Post. While the disease continues to kill the oldest with impunity, other disturbing trends have emerged.
Among them: Hispanics make up an increasing proportion of covid-19 deaths. More than 25,800 have been struck down by the merciless pathogen, which now accounts for 1 out of every 5 deaths among Hispanics, according to data from the Centers for Disease Control and Prevention analyzed by The Post.
America's death count reached six figures just after Memorial Day. In the summer weeks that followed, leaders who triumphantly reopened their states reversed course as coronavirus infections soared among their residents. Instead of jump-starting the economy, the restart fueled the virus's spread.
The national fatality rate, on the decline for most of June, began rising steadily in July, and scenes from the pandemic's darkest days - the overwhelmed hospitals and overflowing morgues of New York City - were reenacted in states across the South and West.
The contours of the crisis have not changed much: The virus has continued to deepen the country's divides and exploit its systemic inequities. The willingness to wear a mask, perhaps the most basic precaution, varies widely by political affiliation. And those hurt most by the rampant spread are still overwhelmingly elderly and disproportionately people of color.
New numbers published recently by the CDC present one of the most complete pictures yet of the pandemic's evolving impact and shifting burden.
When the virus first swept across the country, it devastated Black communities, killing African Americans at a disproportionately high rate in nearly every jurisdiction that published race data. In recent weeks, Hispanics and Native Americans have made up an increasing proportion of covid-19 deaths. The disease now accounts for nearly 20% of all deaths among those groups, higher than any other race or ethnicity in recent weeks, according to a Post analysis of the CDC data.
Both in hot-spot states, and in states where the total number of deaths has decreased, Hispanics make up an increasing share of those deaths - a signal that the pandemic's shifting demographics are not due to its shifting geography.
The death rate among Native Americans, meanwhile, has stayed somewhat consistent, even as it declines for other groups.
States have reported an average of more than 1,000 virus-related deaths per day this week, the highest rate since late May, and experts say the toll is likely to increase rapidly.
"We're playing with fire and gasoline and pine needles, and it could very well explode in our face, and I'm very concerned it will without serious and concerted action," said Howard Markel, a historian and physician at the University of Michigan. "I fear that we are headed, given the way it's being handled, to the worst contagious crisis in human history."
Official government tallies tell only part of the story. The true toll probably exceeded 150,000 weeks ago. Epidemiologists say the country's shoddy testing infrastructure has allowed virus fatalities to go undiagnosed. Also, the pandemic's far-reaching effect on the health-care system has almost certainly contributed indirectly to many more deaths - in people afraid to seek medical care for other maladies, for example.
Some fear the growing toll will have a numbing effect on Americans' psyches.
"At some point, the numbers get so big that they lose their impact," said Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security. "I worry as we continue to mark these milestones that they just become numbers, and they stop really resonating with us as deaths."
In the pandemic's first few months, deadly outbreaks in New York, along with surges in other cities in the Northeast and Midwest, fueled the country's toll. In mid-April, New York state reported more than 1,000 deaths in a single day three times, accounting for nearly half of all deaths nationally.
But now the virus is entrenched in the Sun Belt. Texas, Florida, California, Arizona and South Carolina have recorded the most average daily deaths in the past week. Mississippi and Louisiana have also seen sharp upticks in their numbers of fatalities per capita.
And in many of these places, where the Hispanic share of the population is far higher than the national average, the coronavirus's shifting demographic impact is most acute.
In Florida, California and Arizona, Hispanics consistently made up a disproportionate share of covid-19 deaths in June and early July. The disparity may be persisting, but CDC data lags state statistics, and the agency's most recent numbers were not complete enough to include in the analysis. (The federal data about age and gender among covid-19 deaths were not broken down at the state level over time, so those demographic factors were not included in the analysis.)
In California, Hispanics account for 39% of the state population, but 46% of all virus deaths and 57% of virus deaths reported in the last week of June. In Texas, where Hispanics are 40% of the population, they account for an approximately proportional share of all virus deaths. In the last week of June, however, they made up 57% of the deaths.
Poor data reporting, which initially masked the disease's disproportionate burden on Black communities, has continued to hinder researchers trying to study consequences for Hispanics. A recent report, however, links long-standing inequality to the surges in Hispanic infections and deaths.
Crowded housing, exposure to air pollution and jobs in the meatpacking industry, which President Donald Trump declared were "essential," put Latinos at a particularly high risk for coronavirus infection and death, said Carlos Rodriguez-Diaz, a George Washington University professor who is the lead author of a recent paper published by the journal Annals of Epidemiology.
Rodriguez-Diaz and his team found that, in most parts of the country, counties where more Latinos live saw more cases and deaths - especially in the Midwest, home to most of the nation's meat-processing plants, many of which hire large numbers of Latino migrants.
The researchers called for Medicaid expansion to address disparate access to health care and for better outreach, testing and infectious-disease surveillance to serve the diverse experiences of the country's Latino communities.
In Arizona's Maricopa County, where almost a third of residents are Hispanic, the virus has killed more than 2,000 people. Bertha Esteban Diego, a 25-year-old from Mesa, was one of them. She died June 2 while giving birth to her second son, about two weeks after she was diagnosed with the virus. She and Gaspar Santiago were planning their church wedding. Instead, the couple's friends raised money for a funeral.
Santiago told a local TV station that his family's story is an example of the danger the virus poses to Latino communities.
"We say, 'This is not real, it won't happen to me,'" Santiago said in an interview with ABC15. "But you say that because you haven't lived it. This is a difficult disease. I wouldn't wish it upon anyone."
Arizona and neighboring New Mexico also have seen alarmingly disproportionate deaths among Native Americans. In Arizona, Native Americans account for just 4% of the population, but triple that share of virus deaths. And in New Mexico, where Native Americans are 9% of the population, they make up 75%, of the state's deaths.
The Navajo Nation, which straddles both states, has reported 453 covid-19 fatalities. Adjusted for population, Navajo Nation has seen more virus deaths than any U.S. state.
Experts disagree about exactly how the pandemic will end, but most are united on at least one point: The country and its leaders can still influence whether - or when - another milestone is reached.
"I don't want people to lose sight of the fact that this is preventable and we can change course," said Rivers, the epidemiologist. "This month counts, and the next month and the month after. I do see a lot of missed opportunities behind us that I mourn, but there is always time to make a change and chart a better course."
One influential and oft-cited mathematical model has projected some such scenarios. At its current pace, the United States will surpass 219,000 deaths by November, says the forecast from the University of Washington's Institute for Health Metrics and Evaluation. The model assumes that most schools will reopen in the fall and that state leaders will resume social distancing mandates once their local death tolls reach a certain threshold.
But the model also predicts an alternate future, one in which at least 95% of people wear masks in public. In that scenario, more than 33,000 lives could be saved in the next three months.
"A lot of things in our control," said Christopher Murray, the institute's director. "It's clear the two big drivers here are what people do and what governments do to encourage peoples' behavior change."
Another forecast, from the University of Texas at Austin, projects an escalating death toll through Aug. 20, at which point it predicts the number of daily fatalities will top 3,000, a mark that would be record-setting.
"We didn't have to go from 100,000 to 150,000 as fast as this has happened. I think it's been a real learning experience and maybe a wake-up call for the United States," said Lauren Ancel Meyers, a biology professor at the university and an architect of its U.S. covid-19 model. "I am hopeful that more of the American public have become amateur epidemiologists and really understand the impact of their individual choices on how many people die of this virus."
The group's model, Meyers said, is based on past behaviors. It doesn't project further than three weeks because researchers cannot predict how the public will act.
"The question is not so much what can we do about the number of people who will die in three weeks, but what we can do about the people who will die in four weeks," she said. "That's who our behavior today impacts."
In interviews, leading public health experts were baffled that, after 150,000 lives lost, there is still seemingly no national plan.
"These numbers will continue to accelerate. Our nation is in free fall right now with no federal plan," said Peter Hotez, dean of the National School of Tropical Medicine at Baylor University.
"The plan is for states to be in the lead. That was a failed strategy from the beginning. States never had epidemiological horsepower to understand how severe the problem could get and what the interventions needed to be. This was all predicted and predictable."
The pandemic is so destabilizing, Hotez argued, that the best way to think about it is as a homeland security threat. He recently published an editorial in the journal Microbes and Infection urging a simple approach: The country should set a containment goal - one new case daily per 1 million residents, say - and impose stay-at-home orders until it's reached. At that point, he wrote, contact tracing would be possible and officials could stamp out any remaining infections.
But Hotez sees an unwillingness to advance such a plan from both political parties, and he worries that Democrats are more focused on defeating Trump and inaugurating a President Joe Biden in the new year.
"That won't work," he said. "If we wait until January 2021, we're not going to have a country by then at this rate of acceleration."
Many experts fear the situation will only get worse in the fall, and they said three factors could influence the severity: colder weather driving more people indoors, where the virus has shown special vigor, a possible flu outbreak that could put even more strain on hospitals and, most pressing, the new school year.
Schools are a vital part of every community in the country, the experts said, and they will play a crucial role in students' development and states' economic restarts, but some are worried the facilities will become virus hubs when in-person learning resumes.
The coronavirus has spread with brutal efficiency in close, congregate settings, such as nursing homes, prisons and cruise ships. Schools, especially those with cramped classrooms, share some of the same risk factors.
"There's no scenario here where everyone wins and everyone is protected," said Tara Smith, a professor of public health at Kent State University. "It's the elephant in the room right now, and unfortunately we have no good guidance at the federal level. It's every school for themselves."
The prospect of an effective vaccine remains the biggest cause for hope, but one is unlikely to make it to market in the next year - despite the Trump administration's aspirations, said Hotez, who as director of the Center for Vaccine Development at Texas Children's Hospital is researching coronavirus vaccines.
"We're not going to vaccinate our way out of this mess - at least not any time soon," he said. "Waiting around for a vaccine is a false hope and one guaranteed to fail."
When the pandemic finally does subside, Smith said, it's likely to be "with a whimper." There'll be no clear-cut end, she said, like the conclusion of a recent Ebola outbreak in the Democratic Republic of the Congo. Instead, the coronavirus will eventually become endemic, she predicted - more nuisance than nightmare, thanks to vaccines, other treatments and enough immunity in the population.
But that could take years.
"I fear we're going to hit a lot more of these milestones," Smith said. "I don't see this burning out any time soon."
- - -
Data on deaths by region comes from The Washington Post's coronavirus tracker. Death data by jurisdiction, race and Hispanic origin comes from the Centers for Disease Control and Prevention's National Center for Health Statistics.
The analysis using the Post's tracking data includes Feb. 29 to July 25. NCHS data are collected at a lag and recent weeks are likely to be incomplete, so The Post's analysis only used deaths recorded through July 4. The analysis used provisional counts, which weight results to account for potential underreporting.