The US will top 200,000 deaths from the novel coronavirus in the coming days, a devastating milestone that comes eight months after the pathogen was first confirmed on American soil.

The US, with 4 per cent of the world’s population, accounts for about 21 per cent of global coronavirus deaths. The disparity underscores America’s failure to contain a virus that blazed through populous states such as Texas, Florida and California this summer despite predictions that warmer weather could bring a respite.

With a population of 330 million, the US reached 100,000 Covid-19 deaths on May 27, four months after the first recorded case. It has taken another four months to near 200,000, a number roughly equal to the population of Yonkers, New York, or Huntsville, Alabama. Brazil ranks second in deaths, with more than 134,000 in a nation of 210 million.

As the presidential election on November 3 nears, the US virus response has become a key issue for voters, along with the economy, which the pandemic has scarred. US President Donald Trump has said that the worst is now past, and claimed that a vaccine will be available within weeks. Democratic presidential nominee Joseph Biden has criticised Trump for his handling of the pandemic and tying scientists’ hunt for an inoculation to the election calendar.

Data show US virus deaths have occurred disproportionately among people in at-risk categories, including individuals age 65 and older, people of colour and those with other health conditions. Deaths have also been concentrated in certain parts of the country, with more than 70 per cent reported in only 12 states, including New York, New Jersey, Texas, California and Florida, according to a Bloomberg analysis of Johns Hopkins University data.

“Reaching 200,000 fatalities is a reflection of just how extensive the transmission of this virus has been in this country and how ineffective our public health approach has been to containing and stopping the spread,” said Josh Michaud, associate director for global health policy at the Kaiser Family Foundation, an independent non-profit.

“Without enough testing and contact tracing and rigorous quarantine and isolation policies, we’re just kind of collectively limping along with this response, hoping it’ll get better in many cases when we haven’t done the work to make sure it will get better,” he said.

It is also almost certainly a significant undercount of the true human toll of the pandemic, since not all virus cases are likely captured in official counts. The US Centers for Disease Control and Prevention figures show that 201,917 to 262,877 more people have died in the US since February than historical trends would predict, although not all are attributable to Covid-19.

State Trends

The US virus trajectory is at an inflection point. While new cases appear to be stabilising nationally, declines in former hot spots are obscuring increases in Midwestern states like North Dakota, South Dakota, Wisconsin and Iowa. They number among 33 current hot-spot states, according to the Kaiser Family Foundation, which considers rising cases, test-positivity rates and new daily cases per million population in its analysis.

Experts warn that conditions are ripe for further spread, with schools, universities and more workplaces reopening and cooling temperatures likely to push more socialising indoors. One prediction, from the Institute for Health Metrics and Evaluation at the University of Washington, expects there could be 415,090 Covid-19 deaths by year-end.

Health officials have also been closely monitoring the effects of last week’s Labor Day holiday, as long weekends have traditionally been a time of surging cases. But it still remains to be seen whether new cases increase, decrease or continue to plateau, they said.

“I worry we’re at the calm before the storm,” said Justin Lessler, an associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. “We’re about to have a really big question answered, and that is: What’s going to happen when the weather turns cold again, when we enter the fall and winter months?

“We don’t have a great sense of exactly how that’s going to influence the transmission of the virus itself, but we do know for sure its going to change human behaviour,” Lessler said.

Complicating the picture is a decline in testing. The US was performing about 5.6 million screenings a week in late July, but in the seven days through September 12 did only about 4.6 million, according to data from the Covid Tracking Project. Unevenness in testing has dogged efforts to make sense of the virus’s path.

“Deaths, by contrast, are the most stable indicator we have in how things are going, but lag several weeks behind on-the-ground conditions,” Lessler said.

Shift in Sickness

A decline in weekly deaths from a high of about 8,000 in early August to 5,100 last week is a promising, if early, sign. Over time, the US has made strides in protecting elderly people and treating Covid-19. There’s also been a shift toward younger individuals falling ill, and they are more likely to have mild cases, said the Kaiser Family Foundations Michaud. The trend is likely to continue as case numbers also decrease, he said.

But as long as the new coronavirus is spreading in the US, with no vaccine available, there’s no guarantee it won’t keep killing residents or filling up hospitals.

A spate of cases on college campuses has proved the latest test, though the outbreaks don’t currently appear to have spread significantly into the wider community or be straining local health systems.

“We just cant let our guards down, even in a county that had high caseloads and successfully drove them down,” said Brian Fisher, a Children’s Hospital of Philadelphia researcher working on PolicyLabs Covid-19 modeling project. “There are still plenty of vulnerable people in those communities we need to work to protect.”

“Two hundred thousand deaths is definitely not a number that we wanted to reach,” Fisher said. “And I hope we’re not talking about a number of 300,000 in the future.”

Copyright2020 Bloomberg L.P.

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