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In a painful reminder of the devastation wrought by the pandemic, COVID-19 deaths nationally crossed the 675,000 threshold on Monday, surpassing the toll of the 1918 influenza pandemic.

Given the widespread availability of COVID-19 vaccines, which were developed in record time in a display of the extraordinary advances in medical science in the past century, the total should never have climbed so high, specialists said.

“I think it reflects the fact that the US was very, very slow in 2020 to step up and take COVID-19 seriously,” said Dr. Philip Landrigan, director of Boston College’s global public health program. “I think we made an enormous mistake in the beginning by minimizing the epidemic.”


“The Trump administration, in my opinion, is culpable in not having taken this thing seriously, not having paid attention to their doctors and public health professionals, and not having mandated masking and social distancing and other common-sense protections right from the beginning,” he said.

If the Trump administration had shown the kind of leadership that the Biden administration is now showing, “many hundreds of thousands of people who have passed away would still be with us,” he said.

Dr. Howard Markel, professor of the history of medicine and director of the Center for the History of Medicine at the University of Michigan, said the death toll was an avoidable tragedy.

“As a doctor, I’m saddened that we’re reaching this point because, unlike in 1918, since January we have had several wonderful vaccines that are both safe and effective in preventing cases and deaths of COVID,” he said.

“As a historian of medicine and a historian of epidemics and pandemics, in particular, I’ve been utterly gobsmacked by the level of politicization that’s been going on” that has resulted in fierce opposition to vaccination and mask-wearing, he said.

Dr. Howard Koh, a former high-ranking state and federal public health official who is currently a professor at the Harvard T.H. Chan School of Public Health, said few, if any, projections early in the pandemic foresaw such a high death toll.


“Despite a century of historic advances in medical care involving hospitals, ICUs, ventilators, treatments, vaccines and technology, our nation has still been woefully ineffective in mounting a robust public health response,” he said by e-mail.

“Skepticism about lifesaving guidance from public health officials has made a bad situation worse,” he added.

He called for increased public health funding, saying, “our paltry national investments in public health remain shameful.”

“We continue to underappreciate the power of prevention,” he said.

One key caveat on the milestone: the United States has about three times as many residents as it had a century ago, meaning the implied death rate now is about a third as high.

As of Monday afternoon, there had been 675,446 deaths in the United States since the start of the pandemic, according to Johns Hopkins University data. The toll has increased by an average of 1,970 a day over the past week.

“To have so many people who have died with modern medicine is distressing,” said Eric Topol, director of the Scripps Research Translational Institute. “The number we are at represents a number that is far worse than it should be.”

The milestone comes as the fast-spreading Delta variant has pushed the country into a dangerous new phase, upending hopes that the pandemic had passed and setting the stage for an uncertain fall and winter.


The closely watched model from the University of Washington’s Institute for Health Metrics and Evaluation model is predicting COVID-19 deaths will exceed 776,000 by Jan. 1.

Vaccinations first rolled out in the United States in December, and have been widely available for months. Since then, the vast majority of deaths have been among the unvaccinated.

"There is so much misinformation out there that some people cannot be convinced" of the benefits of vaccines, said Bertha Hidalgo, an epidemiologist at the University of Alabama. "Those are absolutely the deaths that can be prevented."

A recent CDC study found that people who were not fully vaccinated this spring and summer were more than 10 times more likely to be hospitalized, and 11 times more likely to die of COVID-19, than those who were fully vaccinated. While Delta’s spread has resulted in more cases among the vaccinated than many anticipated, the vaccine still provides strong protection against severe illness.

Topol, the Scripps director, said the United States has failed in other ways. Mask use has declined significantly, and most people are still using cloth masks, which are much less effective than surgical and N95 masks. He recommended widespread distribution of medical-grade masks and rapid at-home COVID-19 tests that can help detect infections early on.

“Vaccines are a paramount part of the strategy, but we have failed on other measures as well,” Topol said. “We’re fighting this war with two hands behind our back.”


The 1918 flu killed an estimated 50 million people worldwide. The Massachusetts toll has been estimated at 45,000.

The flu came in several waves, including one that arrived in August 1918 among sailors on a ship in Boston Harbor. By year’s end, more than 4,000 Bostonians had died of the flu, compared with 51 deaths from the year before. Even more died from illnesses related to the flu, such as pneumonia.

COVID-19 has killed about 4.7 million people worldwide, according to Johns Hopkins University. In Massachusetts, it has killed more than 18,000 people.

Jeremiah Manion of the Globe staff contributed to this report. Material from Globe wire services was used in this report.

Martin Finucane can be reached at martin.finucane@globe.com.