As US surpasses 500,000 COVID deaths, experts reflect on what could have been

President Joe Biden, First Lady Jill Biden, Vice President Kamala Harris, and her husband, Doug Emhoff, attended a candlelit ceremony Monday outside the White House to honor the 500,000 Americans who have died in the coronavirus pandemic.SAUL LOEB/AFP via Getty Images

Early last February, a Californian became the first American to die from COVID-19. At the time, testing was barely available, and it would take months for authorities to determine why the person had died. Global health authorities had not yet settled on a name for the disease or the novel coronavirus that caused it.

What they did know was that the disease was deadly. As they soon came to learn, it claimed lives at a horrific rate even as entire countries imposed strict lockdowns. It preyed on the elderly, ripping through nursing homes and pushing the most distinguished hospitals past their limits. The disease spread fairly easily, transmitted even by people who had no idea they were sick. No one was immune.

Just over a year later, after months of tragedy around the world, the country’s daily case and death counts are falling, the pace of administering highly effective vaccines is accelerating, and the pandemic’s gradual end seems to be within sight. In Massachusetts, more than 1 million people have received at least one vaccine dose. Day by day, we know more about the coronavirus and how to stop its spread.

Yet the progress has emerged from a toll of staggering proportions. The United States has now reached a calamitous milestone that crystallizes a year of grief and anguish: 500,000 lives lost to COVID-19.

The somber moment was observed in the nation’s capital on Monday. At the White House, President Biden, Vice President Kamala Harris, and their spouses lit candles to memorialize the dead and led the country in a national moment of silence. Bells at the Washington National Cathedral rang 500 times.

Early models of the pandemic offered a wide range of possible outcomes, depending on how the country responded. Some models projected that as many as 2 million Americans would die without public health intervention, and others that as few as 100,000 would die if the United States imposed serious mitigation strategies. The country’s actual death count, falling firmly in the middle of these estimates, may not represent a worst-case scenario. But the scale of human loss stands as an indictment of a series of fatal policy missteps, experts said.

“Did I know the virus was capable of taking this many lives? Yes,” said Dr. Jennifer Nuzzo, a Johns Hopkins University epidemiologist who has led a team tracking COVID-19 data since last spring. “Did I expect, at the beginning of this, that the US would allow half a million people to die? No.”

Despite significant advances in treating the disease, January marked the outbreak’s deadliest month so far in the United States, with more than 95,000 lives lost. Nuzzo and other experts said that while the pandemic has not been as deadly as it might have been, the US’s toll — the highest in the world — is far greater than it had to be. This level of devastation — equal to the entire population of a major city — was far from inevitable, they said.

“We spent much of the last year not really seriously trying to tackle the virus. So, if you just allow the virus to spread and are half-hearted in your measures of responding to it, it’s not surprising that we’ve suffered nearly incalculable losses,” Nuzzo said. “There’s no other way to frame [500,000 deaths] than as a devastating loss.”

When experts sought to predict how deadly the pandemic might become, they relied on models that analyze a range of variables, including policy interventions, population-level behavior, and characteristics of the virus itself.

In March, White House officials presented forecasts based on a number of national and international models. A worst-case scenario, with no intervention, would mean between 1.5 and 2.2 million deaths in the United States, they said. On the other hand, with mitigating steps such as social distancing and targeted lockdowns, officials said, deaths could range from 100,000 to 240,000.

Thousands of white flags were planted in the nation’s capital in memory of Americans who have died of COVID-19.Patrick Semansky/Associated Press

But despite widespread restrictions, in many areas the pandemic has been far worse than many imagined. In Massachusetts, where officials once questioned a University of Washington prediction that 8,200 would die from COVID-19, more than 15,000 people have lost their lives.

And the nation’s outbreak, while currently slowing, is ongoing, with more than 1,000 Americans still dying each day. That’s down from highs of more than 4,000 a day in January.

“It’s really tragic that this is not surprising,” said Samuel Scarpino, a Northeastern University epidemiologist. “The risk that we would mismanage this, especially federally,” was clear early last spring, he said.

Scarpino said 500,000 likely undercounts the deaths caused by COVID-19. It took months for testing to become widely available, and several studies have shown that the virus was circulating globally much earlier than originally thought.

States and the federal government were slow to act when cases rose last spring and again this fall and winter, an error Scarpino said cost countless lives.

“That [delayed action] meant something that would not have been inevitable if we’d actually had taken action and coordination becomes to a certain extent inevitable,” he said. “Once it actually takes hold and starts spreading, there’s very little you can do, as we’ve seen.”

Beyond modeling, Scarpino and Nuzzo both pointed to one concrete, clear indication that the United States could have avoided this level of loss: Other countries did.

“There are a lot of other countries that have much more complicated border situations and much larger populations that were able to prevent what happened in the US from happening,” Scarpino said.

Globally, nearly 2.5 million have died, data from Johns Hopkins shows. The country with the second-highest death toll, Brazil, has recorded just under 250,000 deaths, with a slightly smaller population than the United States. India, home to 1.4 billion people compared to the US’s 328 million, has recorded just over 156,000 deaths.

A Maryland cremation worker brought the body of a COVID-19 victim to a van in Baltimore in December.ANDREW CABALLERO-REYNOLDS/AFP via Getty Images

Despite the rollout of vaccines since mid-December, a closely watched model from the University of Washington projects more than 589,000 dead by June 1.

The pandemic is not over, and it is too early to know its final toll, experts said, but they also expressed something rare in recent months: hope. Although the exact reasons behind slowed transmission are difficult to pinpoint, and the fear of fast-spreading variants persists, experts said they are optimistic that with vaccine distribution picking up across the country, these encouraging trends will continue.

“We were given a tremendous gift from science with these vaccines,” Nuzzo said. “So I do expect to see the death numbers continue to decline, which is really welcome news.”

Still, Nuzzo said she remains devastated by the enormity of loss and haunted by what might have been.

“I mean you have to stop and wonder. . . . What would we have done, where would we be, if we didn’t have these vaccines?” she said. “But we do, and I’m very glad that we do.”