scorecardresearch Skip to main content

A quarter million Americans could die from the coronavirus. Maybe more. How do we absorb that much death?

The United States is about to endure a collective trauma unlike anything in recent memory.

adimas -

President Trump, long a coronavirus skeptic, stood before a room of White House reporters Tuesday afternoon and offered a sobering new message.

“I want every American to be prepared for the hard days that lie ahead,” he said. “We’re going to go through a very tough two weeks.”

The United States government was projecting that the new coronavirus will kill 100,000 to 240,000 Americans. Many of them, it seems, could die in the coming month. And epidemiologists warn that the eventual total could be substantially higher — maybe 400,000 or 500,000; it’s impossible to say with any precision.

But if even the most conservative forecasts turn out to be correct, they are hard to fathom. How do we absorb death on that scale? How do we mourn it?


These questions, unthinkable just a few weeks ago, now feel like some of the most pressing we have.

WHEN KARESTAN KOENEN, a psychiatric epidemiologist at Harvard’s T.H. Chan School of Public Health, heard the death toll projections, she started searching for something comparable in our recent history.

About 90,000 American service members perished in the Vietnam War era. And every year, some 650,000 people in this country die of heart disease.

Those numbers were helpful. They provided a certain context. But they didn’t feel entirely relevant.

This pandemic is different, she says. It summons the special panic of the inability to breathe. And because of the demands of social distancing, it has separated us from each other and ruptured our rituals.

“Many of the ways we as individuals, and communities and societies, cope with grief, we will not be permitted to do,” she says. “And that seems more important than the numbers.”

Years ago, Koenen’s father died unexpectedly at the age of 56 — alone in China, where he was living and working at the time.


Koenen, then 29, was shocked and deeply saddened. But she took real comfort in her father’s funeral. Some of it was the sheer size of the gathering. More than 1,000 people attended. “But more than that, it was the number of people who came up to me and told me things my father did for them that I never knew about,” she says. “That was incredibly meaningful to me. And I’m not sure that ever would have happened if we hadn’t had the funeral.”

Hundreds of thousands of people who lose friends and relatives in the coming weeks may not be able to attend funerals, or drop off meals at loved ones’ homes, or sit shiva.

The pain, Koenen adds, will be particularly acute in certain families and certain communities. Death from the coronavirus, as we’ve already seen, arrives in clusters: a nursing home in Kirkland, Wash., a veterans hospital in Holyoke. In late February, someone with the virus attended a funeral for a retired janitor in Albany, Ga., and days later, the local coroner told the New York Times, infection hit the town “like a bomb.”

Koenen says a big enough cluster in a small enough place will make it difficult to properly mourn the dead. “People’s resources — to help each other — are going to be tapped,” she says. “When we’re all under stress, then it’s harder for us to come together.”

Baruch Fischhoff, a psychologist at Carnegie Mellon University, says coming to grips with mortality on this scale will require “dual processing” — that is, a reckoning with both heart and mind.


We’ll need to stay focused on the big numbers, he says, so we can intelligently allocate resources and hold our leaders accountable. But we’ll also need to linger on the individual cases, so that death is not just a number.

For some, he says, the human connection will come by way of celebrity. He points to a recent piece in his hometown paper, the Pittsburgh Post-Gazette, about the gravely ill John Prine, a country-folk singer who, in the words of columnist Tony Norman, wrote songs of “fleshy, insistent humanity and humor.”

For others trying to grapple with COVID-19, Fischhoff says, the first real premonition of death may be “a nurse giving an emotional appeal about the risk she’s facing because we don’t have enough personal protective equipment” or deep-seated worry about a far-away child or parent.

When the disease crests, many will know someone who dies or will be two or three steps removed. And then our simmering, communal grief will rise to a new level.

THE ONE THING we know about large-scale trauma is that a sense of social support — within a family, or an apartment building, or a neighborhood — can protect the psyche.

Koenen, the psychiatric epidemiologist, lived in New York at the time of the 9/11 attacks, and she remembers being buoyed by rotating dinners at friends’ houses.


“If you look at the mental health effects, across the broader population, they were actually quite minimal,” she says, even if they were significant for first responders and families of victims.

There were much higher rates of persistent post-traumatic stress disorder, she says, after Hurricane Katrina, which so heavily affected poor Black people and left so many feeling betrayed by local and national leaders.

There is a chance that feelings of betrayal will surface during this crisis, too — especially if health care workers and grocery store workers on the front lines feel like they aren’t being properly protected from the virus. Some of the anger may be directed at President Trump, who has come under sharp criticism for his handling of the pandemic.

But in the short term at least, much of the emotional response will turn on how local authorities handle the outbreak, Koenen says, “and that’s, in some ways, good news, because we all have more influence on that.”

Just after 9/11, in her role as a psychiatrist, Koenen took family members of the missing down to Ground Zero, where an engineer and firefighter would explain just how hot it was below the rubble — and family members could come to some acceptance that their loved ones were gone.

They “had a place . . . to say goodbye,” she says. “There was that process of giving people a sense of — I mean, I hate the word 'closure,’ in a way — but closure.”

That sort of tactile experience won’t be possible for some time, now. But we’ll have to find alternatives, Koenen says, if we’re going to move ahead.


And if we can, we may be better positioned to move ahead than we can imagine.

JACK MITCHELL IS the president of the Mitchell-Wiedefeld Funeral Home just outside Baltimore. His family has been in the business for six generations now. They’ve buried politicians and writers and business leaders. And years ago, their funeral home was one of the first in the country to move from horse-drawn to motorized hearses.

Mitchell, who serves on the board of the National Funeral Directors Association, says it’s a difficult time for families to mourn. Wakes have been canceled, services delayed.

Recently, Mitchell spoke to a man who had lost his wife to Alzheimer’s disease and wanted to leave her ashes at the funeral home for a while. He was going home to an empty house; his two sons were out of state and would have to keep their distance for the foreseeable future. He wasn’t sure if he could bear to look at the remains, alone, every day.

“As he left, it was just this feeling that everything is on hold,” Mitchell says. “It’s difficult.”

But he’s confident that, when life returns to normal, people will turn up for all the delayed services. They will make a point of comforting the afflicted.

And as someone who confronts mortality every day, he’s able to put the federal government’s projected death toll in perspective. One hundred thousand to 240,000 is a lot of deaths, he says. But some 3 million Americans were expected to die this year before the coronavirus arrived.

Andrew Noymer, a demographer and epidemiologist at the University of California, Irvine who has spent a lot of time examining death certificates, offers a similar circumspection.

We are in the midst of a serious public health crisis, he says. And we are sure to see some disturbing photographs of overrun hospitals in the coming days. “But there’s not going to be bodies piled up in the streets like some Medieval re-enactment or dystopian sci-fi,” he says.

And it’s remarkable, Noymer says, how quickly we can leave catastrophic events behind.

The late historian Alfred Crosby wrote a book on the Spanish Flu of 1918, which killed some 670,000 Americans, that was originally titled, “Epidemic and Peace, 1918” — “epidemic” referencing the flu and “peace” the end of World War I.

“But when it was reprinted in 1989,” Noymer says, “the book was called ‘America’s Forgotten Pandemic.’ And that’s really a better title, because the 1918 flu — which was, so far, much worse than anything we’re going to get — was kind of wiped off the memory banks. It really didn’t persist in the collective consciousness of the United States.

“Americans,” he says, “sort of moved on.”

And perhaps we will again.

FOR NOW, THOUGH, we’re a nation on the brink. We’re entering the “hard days” that President Trump warned about.

And even if the numbers are not quite as daunting as they seem — even if the projected dead are a tiny sliver of 1 percent of the population — the threat still weighs heavily.

Fischhoff, the Carnegie Mellon psychologist, says the pandemic has some of the properties of terrorism. The individual risk of death may be quite low for many. But the worry is ever-present.

“You’re worried for yourself, and you’re worried for everybody else you know, and even people that you don’t know,” he says. “And you know there’s only a limited number of things you can do to reduce that risk.”

Shelter in place. Wash your hands. And wait for the terror to subside.

Clarification: An earlier version of this story said 90,000 American service members died in the Vietnam War, but the figure includes non-theater deaths from that era.

David Scharfenberg can be reached at Follow him @dscharfGlobe.