Here’s what you need to know:A memorial in Washington in January for the 400,000 lives lost to the coronavirus in the United States. President Biden has said that the memorial will not be the country’s last.Credit…Todd Heisler/The New York Times
The United States reached a staggering milestone on Monday, surpassing 500,000 known coronavirus-related deaths in a pandemic that has lasted almost a year. The nation’s total virus toll is higher than in any other country in the world. It has far surpassed early predictions of loss by some federal experts. And it means that more Americans have died from Covid-19 than did on the battlefields of World War I, World War II and the Vietnam War combined.
“The magnitude of it is just horrifying,” said Jeffrey Shaman, a professor of environmental health sciences at Columbia University who has modeled the virus’s spread and says that the scale of loss was not inevitable, but a result of the failure to control the virus’s spread in the United States.
The United States accounts for about 20 percent of the world’s known coronavirus-related deaths, but makes up just 4.25 percent of the global population.
About one in 670 Americans has died of Covid-19, which has become a leading cause of death in the country, along with heart disease and cancer, and has driven down life expectancy more sharply than in decades. The losses have been searingly personal for the relatives and friends of the 500,000.
“It never goes away,” the Rev. Ezra Jones of Chicago said of his grief for his uncle, Moses Jones, who died of the coronavirus in April.
The harrowing milestone comes amid hopeful news: New virus cases and deaths have slowed dramatically, and vaccine distribution has gradually picked up pace. But uncertainty remains about emerging virus variants, some more contagious and possibly more lethal, so it may be months before the pandemic is contained. Scientists say the trajectory of the U.S. death toll will depend on the speed of vaccinations, the effects of the variants and how closely people stick to guidelines like mask-wearing and social distancing.
Last March, in the early days of the pandemic, Dr. Anthony S. Fauci, the nation’s top infectious disease expert, and Dr. Deborah L. Birx, the official coordinating the coronavirus response at the time, projected that even with strict stay-at-home orders, the virus might kill as many as 240,000 Americans — a number that seemed unimaginable at the time.
“As sobering a number as that is, we should be prepared for it,” Dr. Fauci said at the time.
Less than a year later, the virus has killed more than twice that number.
U.S. deaths from Covid-19 came faster as the pandemic wore on. The country’s first known Covid-19 death occurred in Santa Clara County, Calif., on Feb. 6, 2020, and by the end of May, 100,000 people had died. It took four months for the nation to log another 100,000 deaths; the next, about three months; the next, just five weeks.
The virus has reached every corner of America, devastating dense cities and rural counties alike through surges that barreled through one region and then another.
In New York City, more than 28,000 people have died of the virus — or roughly one in 295 people. In Los Angeles County, the toll is about one in 500 people. In Lamb County, Texas, where 13,000 people live scattered on a sprawling expanse of 1,000 square miles, the loss is one in 163 people.
The virus has torn through nursing homes and other long-term care facilities, spreading easily among vulnerable residents: They account for more than 163,000 deaths, about one-third of the country’s total.
Virus deaths also have disproportionately affected Americans along racial lines. Over all, the death rate for Black Americans with Covid-19 has been almost two times higher than for white Americans, according to the Centers for Disease Control and Prevention; the death rate for Hispanics was 2.3 times higher than for white Americans. And for Native Americans, it was 2.4 times higher.
By Monday, about 1,900 Covid deaths were being reported, on average, most days — down from more than 3,300 at peak points in January. The slowing came as a relief, but scientists said variants made it difficult to project the future of the pandemic, and historians cautioned against turning away from the scale of the country’s losses.
“There will be a real drive to say, ‘Look how well we’re doing,’” said Nancy Bristow, chair of the history department at the University of Puget Sound in Tacoma, Wash., and author of “American Pandemic: The Lost Worlds of the 1918 Influenza Epidemic.” But she warned against inclinations now to “rewrite this story into another story of American triumph.”
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Assisting a coronavirus patient in Galicia, Spain, last week. New cases have declined to half their peak globally, but in Spain, hospitalizations are higher than ever.Credit…Brais Lorenzo/EPA, via Shutterstock
A month ago, the pandemic looked especially bleak. More than 750,000 coronavirus cases were tallied worldwide in a single day. Infections surged across the entire United States. New variants identified in Brazil, Britain and South Africa threatened the rest of the world.
But the past month has brought a surprisingly fast, if partial, turnaround. New cases have declined to half their peak globally, driven largely by steady improvements in some of the same places that weathered devastating outbreaks this winter.
Cases are an imperfect measure, and uneven records and testing mask the scope of outbreaks, especially in parts of Africa, Latin America and South Asia. But fewer patients are showing up at hospitals in many countries with the highest rates of infection, giving experts confidence that the decline is real.
The lull in many of the world’s worst outbreaks creates a critical opportunity to keep the virus in retreat as vaccinations begin to take effect. Experts believe vaccines have done little to slow most outbreaks so far, but a small group of countries, primarily wealthy ones, plan to vaccinate vulnerable groups by the spring.
The positive signs come with a number of caveats and risks.
Many countries are still struggling. Brazil has a serious resurgence in the face of a new variant discovered in the country. Hospitalizations in Spain are higher than they have ever been, even though official tallies show a decline in new cases. And in a number of European countries — the Czech Republic, Estonia and Slovakia — the infection rate is worsening.
More contagious variants — or lapses in social distancing and other control measures — could still bring new spikes in infections. A variant first identified in Britain is spreading rapidly in the United States, and it has been implicated in surges in Ireland, Portugal and Jordan.
And while most countries have seen declines in cases over the past month, the total global reduction has been driven largely by just six countries with enormous epidemics.
A subway train in Manhattan on Monday. New York and New Jersey are adding cases at rates higher than every state except South Carolina.Credit…Jeenah Moon for The New York Times
As coronavirus cases decline across the United States, the East Coast has emerged as a lingering hot spot — at least in relative terms.
Eight of the 10 states with the highest rates of recent cases border the Atlantic Ocean. New York and New Jersey are adding cases at rates higher than every state except South Carolina, with Rhode Island close behind. Massachusetts, Connecticut and New Hampshire are all in the top 15.
“It’s whack-a-mole,” said Leana Wen, an emergency physician and public health professor at George Washington University. “One part of the country sees a surge, and then another, and then it declines.” Several months ago, the Upper Midwest was outpacing other regions in new infections. Before that, the Sunbelt surged.
Those waves of regional outbreaks could help explain why the East Coast is struggling compared with other parts of the country, said Ashish K. Jha, the dean of the Brown University School of Public Health. Although the Upper Midwest has similarly frosty winters — keeping people indoors, where the virus can spread more easily — that region’s previous outbreak meant it achieved “not quite herd immunity but pretty close,” said Dr. Jha, “unfortunately in all the wrong ways.”
Even the states seeing the most new cases are seeing steady improvement, however. Over the last two weeks, New York has seen a 14 percent decline in new cases and a 24 percent decline in coronavirus-related deaths. South Carolina’s declines are even more dramatic.
The number of Americans hospitalized for Covid-19 is at its lowest since early November, according to data from the Covid Tracking Project. Globally, new cases have plummeted to half their peak.
“We’re moving in the right direction, just not as fast as other places,” said Simone Wildes, an infectious disease expert at South Short Health in Weymouth, Mass., referring to the East Coast. She wondered if the regional lag could be attributed in part to lower vaccination rates among Black Americans, with high populations in East Coast urban centers. “As more vaccines become available, we want to make sure this particular group gets all the information they need,” she said.
A Trump rally in Freeland, Mich., in September.Credit…Doug Mills/The New York Times
State lawmakers across the country, most of them Republicans, are moving aggressively to strip the powers of governors, often Democrats, who have taken on extraordinary authority to limit the spread of the coronavirus for nearly a year.
In a kind of rear-guard action, legislatures in more than 30 states are trying to restrict the power of governors to act unilaterally under extended emergencies that have traditionally been declared in brief bursts after floods, tornadoes or similar disasters. Republicans are seeking to harness the widespread fatigue of many Americans toward closed schools, limits on gatherings and mask mandates as a political cudgel to wield against Democrats.
Lawmakers frame the issue as one of checks and balances, arguing that governors gained too much authority over too many aspects of people’s lives. These legislators are demanding a say in how long an emergency can last, and insisting that they be consulted on far-reaching orders like closing schools and businesses.
But governors respond that a pandemic cannot be fought by committee. They say that the same Republicans who politicized the science of the pandemic last year, following former President Donald J. Trump in waging a new battle in the culture wars, should not be trusted with public health.
Last April, when governors in all 50 states declared disaster emergencies for the first time in the country’s history, support for their initial stay-at-home orders to slow the virus’s spread was generally bipartisan.
But that soon evaporated as Mr. Trump, obsessed about the economy in an election year, played down the virus. Supporters echoed his dismissal of health experts and defied governors who filled the federal leadership vacuum to manage the pandemic — especially Democratic governors whom the president took to insulting, issuing cries to “liberate” states like Michigan.
Across the country, lawmakers in 37 states have introduced more than 200 bills or resolutions this year to clip the emergency powers of governors, according to the lobbying firm Stateside, which focuses on state governments.
Rhesus macaques are the primary species of monkey that are bred at the Tulane University National Primate Research Center in Covington, La.Credit…Bryan Tarnowski for The New York Times
The world needs monkeys, whose DNA closely resembles that of humans, to develop Covid-19 vaccines. But a global shortage, resulting from the unexpected demand caused by the pandemic, has been exacerbated by a recent ban on the sale of wildlife from China, the leading supplier of the lab animals.
The latest shortage has revived talk about creating a strategic monkey reserve in the United States, an emergency stockpile similar to those maintained by the government for oil and grain.
As new variants of the coronavirus threaten to make the current batch of vaccines obsolete, scientists are racing to find new sources of monkeys, and the United States is reassessing its reliance on China, a rival with its own biotech ambitions.
The pandemic has underscored how much China controls the supply of lifesaving goods, including masks and drugs, that the United States needs in a crisis.
American scientists have searched private and government-funded facilities in Southeast Asia as well as Mauritius, a tiny island nation off southeast Africa, for stocks of their preferred test subjects, rhesus macaques and cynomolgus macaques, also known as long-tailed macaques.
But no country can make up for what China previously supplied. Before the pandemic, China provided over 60 percent of the 33,818 primates, mostly cynomolgus macaques, imported into the United States in 2019, according to analyst estimates based on data from the Centers for Disease Control and Prevention.
The United States has about 22,000 lab monkeys — predominantly pink-faced rhesus macaques — at its seven primate centers. About 600 to 800 of those animals have been subject to coronavirus research since the pandemic began.
Scientists say monkeys are the ideal specimens for researching coronavirus vaccines before they are tested on humans. The primates share more than 90 percent of our DNA, and their similar biology means they can be tested with nasal swabs and have their lungs scanned. Scientists say it is almost impossible to find a substitute to test Covid-19 vaccines in, although drugs such as dexamethasone, the steroid that was used to treat former President Donald J. Trump, have been tested in hamsters.
The United States once relied on India to supply rhesus macaques. But in 1978, India halted its exports after Indian news outlets reported that the monkeys were being used in military testing in the United States. Pharmaceutical companies searched for an alternative, and eventually landed on China.
But the pandemic upset what had been a decades-long relationship between American scientists and Chinese suppliers.
The I.C.U. at Marian Regional Medical Center in Santa Maria, Calif., this month. Almost three-quarters of the nation’s I.C.U. beds were occupied over the week ending Feb. 18.Credit…Daniel Dreifuss for The New York Times
Over the past year, hospital intensive care units have been overrun with critically ill Covid-19 patients, who develop severe pneumonia and other organ dysfunction. At times, the influx of coronavirus cases overwhelmed the resources in the units and the complexity of the care these patients required.
An interactive graphic by The New York Times explores how coronavirus surges affected I.C.U.s and their specialty medical staff.
New cases in the United States have fallen since their peak in early January, but almost three-quarters of the nation’s I.C.U. beds were occupied over the week ending Feb. 18.
The national average for adult I.C.U. occupancy was 67 percent in 2010, according to the Society of Critical Care Medicine, though this number and all hospitalization figures vary depending on the place, time of year and size of hospital.
When the coronavirus rips through a community, I.C.U.s fill up. Hospitals have been forced to improvise, expanding capacity by creating I.C.U.s in areas normally used for other purposes, like cardiac or neurological care, and even hallways or spare rooms.
Elective surgeries often get put on hold to keep beds available, and early in the pandemic, hospitals saw huge drops in people admitted for any reason other than Covid-19. I.C.U. staff members, regardless of specialty, often spent most or all of their time on Covid patients.
“We’re all exhausted,” said Dr. Nida Qadir, the co-director of the medical intensive care unit at Ronald Reagan UCLA Medical Center. “We’ve had to flex up quite a bit.”
A memorial for victims of the coronavirus in Casalpusterlengo, Italy.Credit…Isabella de Maddalena for The New York Times
On Sunday afternoon, several hundred people gathered in the small town of Codogno, about 35 miles south of Milan.
The group, including local dignitaries, army veterans and hospital workers, was meeting for the unveiling of a small garden, featuring a quince tree and a sculpture with three steel columns. Inscribed on a platform below the columns were the words “Resilience,” “Community” and “Restart.”
The garden is one of Italy’s first memorials to those who have died after contracting the coronavirus, and it was dedicated on the anniversary of the day news broke that a 38-year-old resident of Codogno, who became known as Patient One, had the virus. That man was Italy’s first known case of local transmission. The next day, the police sealed the town, and no one could enter or leave.
“It was horrific, absurd and unimaginable that this nightmare could unfold in Codogno,” Francesco Passerini, the town’s mayor and the driving force behind the memorial, said in a telephone interview before the ceremony. “Nearly everyone has lost someone,” he added.
For some, it may seem too early to create a memorial to a pandemic that is still raging. More than 200 people were reported to have died from Covid-19 in Italy on Sunday, and the country is in a state of emergency until at least the end of April, with strict travel restrictions in place.
But the memorial in Codogno and others planned elsewhere in Europe are not intended as sweeping monuments to the historical moment, but simple places to grieve and reflect.
Tokyo’s business district in September. About one in five women in the city live alone.Credit…Noriko Hayashi for The New York Times
While the pandemic has been difficult for many in Japan, the pressures have been compounded for women. As in many countries, more women have lost their jobs. In Tokyo, the country’s largest metropolis, about one in five women live alone, and the exhortations to stay home and avoid visiting relatives have exacerbated feelings of isolation.
Other women have struggled with the deep disparities in the division of housework and child care during the work-from-home era, or suffered from increases in domestic violence and sexual assault.
The rising psychological and physical toll of the pandemic has been accompanied by a worrisome spike in suicide among women. In Japan, 6,976 women died by suicide last year, nearly 15 percent more than in 2019. It was the first year-over-year increase in more than a decade.
Each suicide — and suicide attempt — represents an individual tragedy rooted in a complex constellation of reasons. But the increase among women, which extended across seven straight months last year, has concerned government officials and mental health experts who have worked to reduce what had been among the highest rates of suicide in the world. (While more men than women died by suicide last year, fewer men did so than in 2019. Over all, suicides increased slightly less than 4 percent.)
The situation has reinforced longstanding challenges for Japan. Talking about mental health issues, or seeking help, is still difficult in a society that emphasizes stoicism.
The pandemic has also amplified the stresses in a culture that is grounded in social cohesion and relies on peer pressure to drive compliance with government requests to wear masks and practice good hygiene. Women, who are often designated as primary caregivers, at times fear public humiliation if they somehow fail to uphold these measures or get infected with the coronavirus.
In one widely publicized account, a 30-something woman who had been recuperating from the coronavirus at home died by suicide. The Japanese news media seized on her note expressing anguish over the possibility that she had infected others and caused them trouble, while experts questioned whether shame may have driven her to despair.
Lucia DeClerck tested positive for the virus on her 105th birthday, one day after her second vaccine shot.Credit…Michael Neiman
Lucia DeClerck, the oldest resident of a New Jersey nursing home, learned that she had contracted the coronavirus on her 105th birthday, Jan. 25, the day after she had gotten her second dose of the Pfizer-BioNTech vaccine, according to Michael Neiman, the home’s administrator.
At first, she said she was scared. She did not like being isolated, and she missed the daily chatter from the parade of caregivers at Mystic Meadows Rehabilitation and Nursing, a 120-bed facility in Little Egg Harbor.
She showed few symptoms. And within two weeks she was back in her room, holding her rosary beads and wearing her trademark sunglasses and knit hat.
To her two surviving sons, five grandchildren, 12 great-grandchildren and 11 great-great grandchildren, who call her Grandma Lucia, she has a new moniker: “The 105-year-old badass who kicked Covid.”
On Monday, she got a shout-out from Gov. Philip D. Murphy, who described a phone call with her during a coronavirus news briefing. “What an uplifting conversation,” the governor said.
Ms. DeClerck’s family gathered in January 2020 at Mystic Meadows to celebrate her 104th birthday before the onset of the pandemic. When they learned that she had contracted the virus, they braced for the worst.
Ms. DeClerck is one of 62 residents of Mystic Meadows to have contracted the virus; four patients died, including three who were receiving hospice care.
In January, residents were being tested twice a week, and a rapid test in the last week of the month showed that Ms. DeClerck had contracted the virus.
She had also been vaccinated, which most likely contributed to her recovery. The first studies of Britain’s mass inoculation program showed strong evidence on Monday that even one dose of vaccine can help slash coronavirus-related hospitalizations.
Ms. DeClerck is not the oldest person to beat the virus.
Europe’s oldest known resident, Sister André, contracted the virus at 116. She celebrated her 117th birthday with a glass of Champagne this month at a nursing home in Toulon, France.