997,083.

That’s the number of Americans killed by COVID-19 so far, according to the CDC.

We think of it as a million, if we think of it at all. That’s not just because large statistics are often hard to parse, but also because nobody trusts anybody’s numbers now. COVID-19 testing has fallen off the map, thanks to the success of personal tests, which usually go unreported to public health systems; the lack of interest at local, state, and federal levels to coordinate on data; the utter failure to get things together for wastewater testing (which is really useful!).  In the pandemic’s third year, the richest and most technologically advanced country in the world knows less about COVID than it used to.

Before all of that, or in addition to it, we have the problems of politics causing people to mess with data. The CDC published a new community transmission system which effectively downplays infection rates. Donald Trump clearly told us to test less, in order to have fewer “cases.”  Some families demand of hospitals that their dead don’t get “COVID” as cause of death.

The CDC’s sunny view of things.

Then we have the knock-on deaths. Those are the people who couldn’t, or wouldn’t, go into hospitals for the care they needed for non-COVID problems.  Sometimes the facilities were overrun with pandemic patients. How many people have died as a result?

Some of you know I track this stuff, and that includes looking at excess deaths. Such counts and analyses have seen the US blowing past 1 million months ago. We’re probably in the 1.2 million zone now. Worldwide, the number may be as high as 15 or 18 million.

Back to America: most aren’t mourning these terrifying numbers now, it seems. Instead, we accept the butcher’s bill, if we think of it at all, like we accept so many other death tolls: car deaths, deaths of despair, death by congestive heart failures. We’ve moved COVID deaths from the “important, even sexy” column to the “shrug, it’s part of modern life” one.

Generally, we also want to get on with our lives.  “I want to live without fear,” some tell me.  “It’s over,” others insist, citing the vaccine’s success and lower weekly death tolls this month.  Many people seem to have forgotten that SARS-CoV-2 is a contagious disease, and prefer instead to think about it as something which only happens to them.  They view it like the question of wearing a bicycle helmet, a matter solely of personal risk. So if I think I’ll probably be fine when the virus comes close to my nose, I’ll junk the mask, hit the bar, and embrace my hairdresser.

The extraordinary vaccine plays a role in this cultural transition.  Or rather, the vaccines, since it’s been a long time (in COVID time) since we thought one shot would do it, and the “vaccine” is more of a platform, really. We need multiple shots, and then new ones as the virus throws off new mutations. Perhaps we’ll get used to the need for regular new doses, like flu shots. Every year or every six months will come the call from governments, counties, drugstores, your family physician (if you have one), and clinics to get your new COVID shot. Like flu shots, not everyone will get them for various reasons – we’re too busy, we are antivax for a wide range of reasons, or we don’t think it’s serious – and the virus will continue its work.

Beyond the vaccinated and/or confident, what about the people who are at serious risk of being sickened or killed by the virus? The immunocompromised, those with serious comorbidities? Ah, remember what I said about our moving the disease to the “shrug, it’s part of modern life” column. We are starting to think of these very vulnerable people as ordinary casualties to be, like people killed by cars, which is to say we barely think of them at all. Besides, we’re not seeing compelling stories about those people. Some are them older, and their dying from the virus is apparently fine with a disturbing number of Americans. Moreover, the older, the already sick, the immunocompromised, all are invisible in the stories we tell, for various reasons.  (One of the stories of COVID in America is how badly our storytelling has been.)

What about long COVID and the tens of millions of Americans suffering from a range of illnesses, tissue damage, and disabilities therefrom? Well, many Americans can dismiss some cases as hysteria or hypochondria or simple weakness, it seems. Especially if women, black people, Latinos, or poor people are those suffering. There’s a long tradition of that. Then we can just… accept long COVID as part of our social world. For years to come we’ll know some people who cough a lot, because they have “COVID lung.” Some will get winded easily, and we diagnose it as the same, or because of COVID heart. Some will not be as mentally sharp, and we’ll forgive them, or tease them, because they have COVID brain fog. Others will disappear from sight or just die, and that’s ok, because we moved them to the forgettable column.  The enormous suffering of the victims, the huge strain on our health care systems: ditto.

I write this and I know some of you think I’m being too bitter or too unfair. Perhaps I’m too morbid because I just lost two friends in the past two weeks (one to an unrelated cause, the other unknown). I’m also spending time in person and at a distance with my fragile, badly ill, 90 year old father, who lives on the very edge of death, riddled with COVID possibilities, and maybe that has made me unduly sentimental. Maybe all of that’s true.

But I had these thoughts in April, and March, and before. Some of you know I wrote about breaking the one million barrier when excess deaths pointed in that direction.

This is one way a pandemic ends, not with a bang nor with a whimper. Instead the pandemic becomes endemic in shambling stages, and we gradually weave it into everyday life. There’s nothing dramatic like a sudden cure. Nothing so ambitious as eradication is even on the table.  We just extend a warm, intimate, and invisible embrace to the virus and turn, minus some of us, to the next day.

What does this tell you about how America will handle the next pandemic?

(thanks to my wife, who works in public health, for conversations; thanks to my Facebook friends for their responses to an earlier draft of this)