It’s the national record no one is celebrating: The American COVID-19 death toll has crossed the 500,000 mark.

The novel coronavirus is now the third leading cause of death in the U.S. — behind heart disease and cancer, but ahead of accidents, respiratory diseases, stroke, Alzheimer’s, and the flu, according to annualized federal health statistics.

COVID-19 deaths have also surpassed the number of Americans killed during the Civil War (498,332); World Wars I and II (116,516 and 405,399, respectively); and all American wars since 1945 combined, — Korea (54,246), Vietnam (90,220); and Desert Storm/Desert Shield (1,948) — Department of Veterans Affairs records show.

“For sure it’s an incredibly sobering milestone,” says William Schaffner, MD, a professor of infectious diseases at Vanderbilt University School of Medicine. “It’s an awful lot of human beings. They all have relatives; they all have families. It’s not just numbers; it’s a vast number of people and all their social networks that are in mourning.”

For Leana Wen, MD, an emergency medicine doctor, the most troubling part of the death toll is that many of those cases could have been prevented with a more aggressive federal response to the pandemic.

“Reaching 500,000 is yet another grim milestone, one of so many we’ve had thus far,” says Wen, a former Baltimore health commissioner and a visiting professor at George Washington University. “It reflects the tragedy of the U.S.’s lack of a coordinated, national response.”

Amesh Adalja, MD, an emerging infectious diseases specialist with the Johns Hopkins University Center for Health Security, says the milestone prompts a thorny question for public health officials:

“You have to look at that number and say: How low could it have possibly been? You look at a country like Taiwan — eight people died there.

“It didn’t have to be this high. If there was decisive action taken in the early months of the pandemic — if we would have fortified nursing homes, gotten testing straightened out, assured our hospitals had capacity and warned the public [better]…just imagine how much lower that number could have been.”

According to Johns Hopkins University’s coronavirus tracker, COVID-19 claimed its 500,000th American victim Monday. 

By far, the United States has had the greatest number of deaths from virus in the world, followed by Brazil (246,504), Mexico (180,107), India (156,385) and the United Kingdom (120,810).

Hours before the 500,000th death was recorded, President Joe Biden issued a proclamation to lower flags at all federal properties until midnight Thursday.

“We, as a nation, must remember them so we can begin to heal, to unite, and find purpose as one Nation to defeat this pandemic,” Biden said in a statement.

Variants a Threat, but Optimism Remains

Another concern: COVID-19 variants are emerging that could bring new challenges in confronting the pandemic and reverse some of the progress being made in vaccinations and reductions in infections and hospitalizations.

That’s why it’s more important than ever to follow CDC recommendations to wear well-fitting masks, avoid crowds and poorly ventilated spaces, wash your hands often, and stay at least 6 feet away from people outside the home.

“We should be cautious, with variants on the horizon that are more contagious,” Wen says. “The gains we’ve made could quickly be reversed. Now is not the time to let down our guard.”

Despite these concerns, and the federal missteps on COVID-19 spotlighted by the 500,000-death milestone, health experts say they are optimistic about the future.

They cite better COVID-19 testing, new treatments, the rollout of the vaccines, the Biden administration’s more aggressive response to the pandemic, and how the public is now better at following advice to prevent the disease that didn’t exist earlier in the crisis.

“It’s much better to have COVID now in February of 2021 than it was to get COVID in February of 2020 or March of 2020,” Adalja notes.

“There’s still a large number of deaths that are occurring because of the sheer number of infections, but we are much better at treating a COVID patients now than we were, and we’re getting better at it every day, and I think that reflects decreased deaths in people who are hospitalized with COVID.”

Schaffner agrees, saying: “There are really any number of lights at the end of the tunnel.” But he warns against “magical thinking” that COVID-19 “is just going to disappear” with all the progress being made on testing, treatments, and vaccinations.

“By ending the pandemic at least in the United States, that doesn’t mean the virus is gone,” he says. “We will have to learn how to live with this virus going forward for years, just as we live with influenza.”

CDC Director Rochelle Walensky, MD, said while cases are trending in the right direction, any good news is “counterbalanced by the stark reality that this week we will surpass one half million covid 19 deaths in the U.S., a truly tragic reminder of the enormity of this pandemic and the loss it has afflicted on our personal lives and our communities.”

Schaffner also worries that there are still critical hard lessons that have yet to be learned from the deaths of 500,000 Americans from COVID-19.

The biggest lesson, in his view, is this: “It did not have to be so. Those of us in public health think a very substantial number of these deaths could have been prevented, if we had had a definitive national coherent science- and public health-based response from the beginning.”

Signs of Improvement

In addition to reporting the new U.S. death toll, the CDC this week released a report card of sorts on the status of COVID-19’s impact on the U.S. as the nation crossed the 1-year mark in the pandemic. It is a mix of optimism tinged with a reminder of how far we have to go. As of Feb. 19:

Death rate falling: Nationally, the number of daily COVID-19 deaths is fluctuating, with 2,601 new deaths reported on Feb. 17. But the 7-day average number of new deaths decreased by 9% — to 2,708 per day — compared to the prior week.

Despite this encouraging news, the daily numbers of new deaths are still much higher today than during the first two peaks of the pandemic in the spring and summer of last year.

Cases declining: More than 28.13 million cases have been reported since the first COVID-19 patient was identified in the United States on Jan. 20, 2020. But the number of cases has been trending downward over the past 5 weeks.

The highest 7-day average occurred the week of January 11, 2021, and was 249,048. The current 7-day average is 77,385 cases, which is a 68.9% decline from the all-time high and a 24.5% decrease from the prior week.

Even so, the 69,165 cases reported on Feb. 17 are higher than during either of the first two peaks in the pandemic.

Hospital admissions down 62%: Hospital admissions of new patients with COVID-19 have plummeted 62% — from the national peak of 18,006 on Jan. 5, to 6,841 on Feb. 16. The average number of daily admissions also fell by 21.8%, compared to the previous week.

Vaccinations rising: Since the COVID-19 vaccination program began in December, 63.1 million shots had been administered as of Feb. 21. Overall, about 43 million people have received at least one vaccine dose, which is about 13% of the U.S. population, and almost 19 million people have received two vaccine doses, which is 5.7% of the U.S. population.

As of Feb. 18, the U.S. was vaccinating about 1.6 million Americans a day, a 1.4% rise from the previous week.

Wen says the latest news from the CDC on the dip in new cases and hospitalizations is encouraging. But she says those declines are probably not the result of the vaccine, but because the nation is recovering from the huge rise in cases and hospitalizations tied to holiday travel and family gatherings in November and December.

“The decline in case counts is probably due to the fact that we had a massive surge from the holidays, and we’re coming down from that,” she explains. “Vaccine rollout has not covered many people and is probably not a significant contributor to decreasing case counts.”

Adalja says he believes the drop in cases also has to do with Americans being more likely to cover their faces in recent months. In addition, a growing number of Americans have also had COVID and are getting vaccinated, which can knock down transmission.

“So many people in the population have been infected — 30% maybe or more — and also some percentage have been vaccinated, so a population that has some level of community immunity is going to be harder for the virus to spread in than one that has less community immunity,” he explains.

A Lagging Statistic

So, why have COVID-19 deaths continued to rise, as the case rates and hospitalizations have fallen in recent weeks?

“The reason why deaths haven’t fallen is because deaths always lag behind cases,” Adjalja says. “But death [rates] are starting to fall now, and I suspect they will continue to fall on a lag basis, versus cases.”

Despite the progress in vaccination, case rate reductions, and fewer hospitalizations, Adalja and Wen are concerned that the virus is continuing to hit certain vulnerable populations particularly hard. That includes seniors and minorities, who have suffered disproportionately higher infection and death rates, largely because of social and economic reasons, they say.

“Those who already face the greatest burden of health disparities have been disproportionately affected by COVID-19,” Wen notes. “It’s not the virus that’s doing the discriminating — it’s our systems.”

The CDC’s National Center for Health Statistics and figures compiled by the independent COVID Tracking Project make clear that the pandemic has hit Americans over 65 harder than younger people and ravaged Black, Hispanic, and Native American communities.

For instance:

Seniors, aged 65 and over, account for about 16.5% of all Americans. But 81.1% of Americans who have died from COVID-19 were 65 or over. (About 21% died in nursing homes or long-term care facilities.) By comparison, 16.4% were 45-64, and 2.5% were under 45.

• Black people account for 12.3% of the U.S. population, according to the U.S. Census Bureau, but nearly 18% of COVID deaths.

• Hispanics make up 17.8% of the population, but 16% of COVID deaths.

Adalja explains that access to quality health care is a factor for lower-income Americans and people of color. But minorities are also more likely to work in essential services that don’t allow them to telecommute, which can increase their exposure to others infected with COVID-19.

“They could be working in hospitals, they could be working in nursing homes,” he notes, “they could work in grocery stores, they could be transportation workers, they could be food service workers.”

For this reason, Juanita Mora, MD, says people of color have been the “unsung heroes” of the pandemic, putting themselves at risk in such essential roles.

“They have placed food on our tables this whole time and exposed themselves to the public while being more at risk of contagion to the virus and bringing it home,” says Mora, an allergist and national spokesperson on minority health issues for the American Lung Association.

“Only 1 in 6 Latinos and only 1 in 5 African Americans were able to telework from home this whole pandemic. Minorities also live in multi-generational homes where isolation, if infected, is hard to do…and are also higher risk for COVID-19 infection because their level of poverty is often high as well — which means whether they are scared or not to go to work, they have to go because they need the paycheck.”

In addition, minorities face barriers to vaccination for a variety of reasons, Mora says. “There is a lot of mistrust in the vaccines in minority communities,” she notes. “Our numbers in vaccination rollout have been low all throughout the country. I attribute part of this reason to barriers in access to the vaccine such as technological and language barriers. There is also little access to the vaccine right into the minority communities.”

Lindsay Kalter contributed to this report. 

Sources:

William Schaffner, MD, professor of infectious diseases, Vanderbilt University School of Medicine.

Leana Wen, MD, emergency medicine doctor; visiting professor of health policy and management, George Washington University School of Public Health.

Amesh Adalja, MD, emerging infectious diseases specialist, Johns Hopkins University Center for Health Security.

Juanita Mora, MD, allergist; national spokesperson on minority health issues, American Lung Association.

Department of Veterans Affairs: “America’s Wars.”

Statistica: “Number of novel coronavirus (COVID-19) deaths worldwide as of February 19, 2021, by country,” “Share of old age population (65 years and older) in the total U.S. population from 1950 to 2050.”

CDC: “COVID Data Tracker Weekly Review,” “Heart Disease Facts,” “Prevent Getting Sick.”

CDC National Center for Health Statistics: “Weekly Summary on COVID-19 Deaths.”

COVID Tracking Project: “The COVID Racial Data Tracker.”

CDC National Center for Health Statistics: “Weekly Summary on COVID-19 Deaths.”

American Cancer Society: “Cancer Facts & Figures 2020.”

NPR: “As Pandemic Deaths Add Up, Racial Disparities Persist — And In Some Cases Worsen.”

Clinical Infectious Diseases: “Racial Disparities in Coronavirus Disease 2019 (COVID-19) Mortality Are Driven by Unequal Infection Risks.”

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