Brittany Trang at Stat News:

This Wednesday will mark two years since nurse Sandra Lindsay became the first person in the U.S. to receive a Covid-19 vaccine outside of a clinical trial. A study released Tuesday by the Commonwealth Fund shows that in those two years, the Covid vaccines have averted over 3 million deaths in the U.S.

The Centers for Disease Control and Prevention estimates that more than 1 million Americans have died from Covid-19 since the onset of the pandemic. But the study results show the toll would have been even worse had the U.S. had relied upon so-called natural immunity acquired through infection as the only immunological defense against the virus. Without vaccines, the country would have experienced four times as many deaths, 1.5 times more infections, and 3.8 times more hospitalizations in the time since December of 2020. The vaccines also saved the U.S. $1 trillion in additional medical costs.

The study’s key message is that vaccines are “worth our money as taxpayers,” said Isaac Chun-Hai Fung, an associate professor of epidemiology at Georgia Southern University, who was not involved in the study. “We pay for the vaccination campaign and it works. It saves us money and it saves lives.”

Rather than modeling population-level effects, the team of researchers from the University of Maryland, York University, and the Yale School of Public Health used a computational model that allowed them to incorporate factors like waning immunity or different age groups’ eligibility for vaccines and boosters into their calculations. Fung noted that adding all of these parameters together creates more statistical uncertainty in the data, meaning that there’s a larger margin for error in the study’s final results. The authors acknowledge this uncertainty by providing “credible intervals” for their calculations — ranges that show, for example, that their estimates for the number of averted deaths would be between 3.1 million and 3.4 million.

[...]

A previous version of the study was released in April 2022 and subsequently published in the Journal of Global Health. The December 2022 update added the prevalence of comorbidities in the U.S. population to the model. Other factors the model accounted for included the waning of infection-acquired or vaccine-acquired immunity; boosters characteristics of several variants; the rollout of vaccines to different age groups; and changes in pandemic restrictions and mobility patterns.

Jessica Glenza at The Guardian:

More than one million people have died in the Covid-19 pandemic in the US, according to Johns Hopkins, far and away the most deaths of any country.

While the sheer number of deaths from the coronavirus sets the US apart, the country’s large population of 332.5 million people does not explain the staggering mortality rate, which is among the highest in the world.

For every 100,000 residents, 291 people have died from Covid-19, according to the Johns Hopkins University Coronavirus Resource Center. Among the 20 worst affected nations, only two other countries – Brazil and Poland – have higher mortality rates per 100,000 people.

Deaths directly attributable to Covid-19 are only one measure of the pandemic’s toll. Deaths from drug overdoses hit a record high in 2021, killing at least 100,000 Americans. Chronic conditions such as heart disease, hypertension and dementia have contributed to the number of “excess deaths” – a number which includes other ailments exacerbated by the pandemic, as well as those deaths caused directly by Covid-19. This number crossed the one million threshold in mid-February.

The extraordinary toll has set the US apart among wealthy, peer nations, exposing inequality, a unique and fragmented health system, and polarized politics – all of which likely made the crisis worse, researchers said.

“In terms of understanding why we had such a bad experience from the pandemic, we have to think about the systemic issues that already were in place when the pandemic arrived,” said Steven Woolf, a social epidemiologist and population health researcher at Virginia Commonwealth University. “And, on top of that, mishandling of the pandemic by the government and by the public, frankly.”

The pandemic shone a light on longstanding racial and ethnic health disparities, as Black, Latino and Native American people were infected, hospitalized and died of Covid-19 at rates that were, at times, double those of white Americans.

The drivers of those outcomes – the disproportionate likelihood for people of color to lack the same quality housing, employment and healthcare access as white Americans – are well known and documented. Such disparities are the “intended or unintended consequences of policy decisions”, a recent commentary in the Journal of the American Medical Association said.

The US has nonetheless had difficulty correcting course. Vaccines were at first slow to reach minority, low-income and rural areas. One recent study has shown how at least one advanced Covid-19 therapy, monoclonal antibodies, were the least likely to reach the highest risk patients for whom they are recommended.

[...]

The all-consuming nature of the pandemic has also allowed preventable and treatable infectious diseases to flourish. Thousands of young children, particularly in low-income households, have fallen behind on routine vaccinations. Rates of sexually transmitted diseases have reached the “highest numbers in American history”, as overwhelmed and underfunded local health agencies reallocated resources to Covid-19.

Meanwhile, the mental health of adolescents in particular has suffered, as millions were cut off from the mental health services provided by schools. Pediatricians, children’s hospitals and psychiatrists declared a mental health crisis among the nation’s youth, and a recent CDC study has shown how emergency room visits for eating disorders has increased dramatically among adolescent girls.

Millions of children were also thrust into food insecurity, as the numbers of children receiving school meals plummeted. Missed academic time appears to have caused the educational achievement gap to widen.

[...]

Concepts fundamental to US governance also proved problematic in the pandemic. In just one example, the US Constitution makes public health the responsibility of individual states, creating a patchwork of different pandemic responses.

Culture and environment also appear played a role. Americans are more likely than citizens of other countries to engage in what public health researchers consider risky behavior, such as gun ownership, smoking, consuming more calories and exercising less. Polarized politics make it more difficult to implement guardrails on these behaviors.

Floundering responses by federal, state and local governments compounded existing issues, and eventually allowed pandemic-related public health guidance to become political and cultural footballs.

Dylan Scott at Vox: 

Rising coronavirus cases aren’t going to stop much of the country from continuing to move on from the pandemic, leaving many Americans to fend for themselves on the road to a new normal.

Even as cases nationwide have jumped 47 percent over the last two weeks, on Monday a federal judge lifted the mask requirement for air travel and it doesn’t sound as if the Biden administration is putting up a big fight to reinstate it. When people who were literally on a plane heard the news, their response reflected this chaotic new moment in the pandemic, a mixture of cheers and fresh fears.

But if you look at people’s attitudes broadly, Americans have been drifting toward normalcy. According to the Kaiser Family Foundation’s March poll, 27 percent of Americans say they have basically returned to doing what they normally did before the pandemic. Another 14 percent said that they never changed their behavior — meaning nearly half of the country is living as if Covid-19 had never happened. On the other end of the spectrum, 17 percent of Americans say they are still not doing most of the activities they did before the pandemic.

The largest group, 42 percent of the US, is somewhere in the middle. These Americans say they are doing some — but not all — of their pre-pandemic activities. If you combine this group with the people who have returned to normal, more than half of the country is now taking it less seriously, as the government and businesses continue to encourage a return to economic and social activity.

For so many people, that makes this a disorienting period of the pandemic. We’ve moved away from a sharp focus on cases as the most important metric and away from using broad mitigation measures — like mask mandates — to drive down case numbers. But it’s not clear what should replace the old pandemic mindset.

There are obviously still many good reasons to avoid being exposed to Covid-19. Some people, particularly the elderly and immunocompromised, face a higher risk of developing serious symptoms if they get infected. For others, there is an economic and social cost of getting sick, especially if their workplace or school mandates a lengthy isolation period following a positive test.

But it’s hard to avoid exposure when the combined policy response from federal, state, and local authorities is no longer based on helping people do that. In general, the government is now focused almost entirely on limiting hospitalizations and deaths and otherwise allowing a return to pre-pandemic activities. Hospitalizations are currently plateauing nationally after a long decline. Deaths are still dropping from their peak during the winter omicron wave.

With so many vaccinated or previously infected with the virus, we would expect to see fewer severe cases. But the virus is still spreading. The difference now is, the government and businesses are tacitly and overtly acknowledging they can only do so much about that. Delta Air Lines, in its response to the court ruling lifting the mask mandate, initially referred to Covid-19 as an ordinary seasonal disease — before backtracking.

Instead of one cohesive Covid-19 response, people are left making millions of individual decisions that also ultimately limit other people’s ability to steer clear of the virus.

As President Joe Biden said on Tuesday, when asked whether Americans should continue to mask on planes despite the mandate being rescinded: “That’s up to them.”

The uncomfortable truth is there is only so much one person can do now. Wearing masks, avoiding crowded indoor spaces, and staying up to date on vaccinations are still the playbook for reducing your risks from Covid-19. But with so many people moving on, there is not a foolproof plan for avoiding infection.

[...]

At previous points in the pandemic, it seemed clear what would need to happen next to start loosening our pandemic rules: cases needed to fall. New tools were arriving all the time to help that happen. First, we were waiting for the vaccines to be approved and then for people to get vaccinated. A few months later, we were waiting for news on booster shots, and the looming omicron wave promised to spread immunity throughout much of the population, albeit at a high cost.

But at this point, few if any new interventions are coming even as cases keep climbing. The toolbox has been stocked — vaccines, therapeutics, tests — and it’s now left to each person to decide how they’ll use the tools.

Society is making a difficult pivot, asking people who have lived through the most extreme social and economic disruption of their lives, all because of the novel coronavirus, to regard it now as part of the milieu. We are transitioning from a world of stay-at-home orders, business closures, and universal masking requirements to a choose-your-own-pandemic experience.

[...]

The US is going through a difficult pandemic transition

Not everybody is facing this new normal on equal footing. Elderly Americans and the immunocompromised continue to have good reason to be vigilant about avoiding Covid-19 because it could still pose a serious risk to their health.

But for others, there may be a tug of war between the pull toward normalcy and wanting to be conscientious about a virus that, even in this relative lull, still kills around 500 Americans every day.

Figuring out a new approach can be a challenge when the government, businesses, and many of the people around you act like Covid-19 is no longer an active concern. People are also making this transition back to more normal activities while contending with ever-changing public health guidance and an increasing lack of real-time information about the actual state of the outbreak.

You see the disorder everywhere. While there was always some variance in how public health experts thought about the pandemic, the divisions feel starker than ever now. When Philadelphia recently decided to put its mask mandate back in effect because local cases were starting to rise, former Baltimore city health commissioner and Washington Post contributor Leana Wen was baffled. She cited the CDC’s own assessment, which classified Philly as an area with low risk. But some of her public health peers quickly pushed back on Wen for doubting the city’s decision to be more proactive about slowing Covid-19’s spread.

You’d be forgiven for being confused. But this kind of dissonance is increasingly common. Newspapers are canceling their White House Correspondent Dinner receptions because of a local increase in Covid-19 cases — but the dinner will go on. Even as local cases are rising, the DC Metro system is ending its masking requirement.

AP, via The Guardian: 

Propelled in part by the wildly contagious Omicron variant, the US death toll from Covid-19 hit 900,000 on Friday, less than two months after eclipsing 800,000.

The two-year total, as compiled by Johns Hopkins University, is greater than the population of Indianapolis, San Francisco, or Charlotte, North Carolina.

The milestone comes more than 13 months into a vaccination drive that has been beset by misinformation and political and legal strife, though the shots have proved safe and highly effective at preventing serious illness and death.

Despite its wealth and world-class medical institutions, the US has the highest reported toll of any country and even then, the real number of lives lost directly or indirectly to the coronavirus is thought to be significantly higher.

Melody Schreiber at The Guardian: 

The true number of deaths from the Covid pandemic in the US is probably being undercounted, due to the long-lasting and little-understood effects of Covid infection and other deadly complications that surged during the past two years.

“We are seeing right now the highest death rates we have ever seen in the history of this business,” J Scott Davison, CEO of insurance company OneAmerica, told journalists on 30 December.

“Death rates are up 40% over what they were pre-pandemic,” he said, among working-age people between 18 and 64. Deaths among older Americans have also increased, with one in 100 Americans over the age of 65 dying.

There have been an estimated 942,431 excess deaths in the US since February 2020, according to the US Centers for Disease Control and Prevention. Hispanic, Black and Native American and Alaska Native populations have been disproportionately affected with high death rates, research shows.

Previous crises pale in comparison to the pandemic, Davison said. “A one-in-200-year catastrophe would be a 10% increase over pre-pandemic [levels]. So 40% is just unheard of.”

Many of the deaths aren’t counted in the official Covid tally, he said, because they happen months after Covid infections. “The deaths that are being reported as Covid deaths greatly understate the actual death losses among working-age people from the pandemic. It may not all be Covid on their death certificates, but deaths are up in just huge, huge numbers.”

In addition to deaths from Covid-19, drug overdoses – already one of the leading causes of death for working-age adults – and homicides have also risen during the pandemic.

Insurers are also seeing a rise in disability claims – at first for short-term disability and now for long-term disability, because of both long Covid and delayed care for other illnesses, “because people haven’t been able to get the healthcare that they need because the hospitals are overrun”, Davison said. It’s a trend “consistent across every player in the business” of insurance.

Deaths from long Covid have been particularly difficult to track, because the virus may no longer be present at the time of death, but it weakened organs or created fatal new ailments.

Kathleen Foody at AP, via NewsNation Now:

CHICAGO (AP) — More than a year after the vaccine was rolled out, new cases of COVID-19 in the U.S. have soared to the highest level on record at over 265,000 per day on average, a surge driven largely by the highly contagious omicron variant.

The previous mark was 250,000 cases per day, set in mid-January, according to data kept by Johns Hopkins University.

The fast-spreading mutant version of the virus has cast a pall over Christmas and New Year’s, forcing communities to scale back or call off their festivities just weeks after it seemed as if Americans were about to enjoy an almost normal holiday season. Thousands of flights have been canceled amid staffing shortages blamed on the virus.

Dr. Anthony Fauci, the top U.S. infectious-disease expert, said Wednesday that there is no need to cancel small home gatherings among vaccinated and boosted family and friends.

But “if your plans are to go to a 40- to 50-person New Year’s Eve party with all the bells and whistles and everybody hugging and kissing and wishing each other a happy new year, I would strongly recommend that this year we not do that,” Fauci said.

The number of Americans now in the hospital with COVID-19 is running at around 60,000, or about half the figure seen in January, the Centers for Disease Control and Prevention reported.

While hospitalizations sometimes lag behind case numbers, the figures may reflect not only the protection conferred by the vaccine, but also the possibility that omicron is not making people as severely ill as previous versions.

COVID-19 deaths in the U.S. have climbed over the past two weeks from an average of 1,200 per day to around 1,500.

The USA is seeing the highest level of COVID cases per day, even higher than the late 2020/early 2021 period where the vaccine rollout was limited to certain age groups or occupations, thanks to the Omicron variant.