When Johns Hopkins University announced that the United States had surpassed 1 million deaths from Covid-19, I was just recovering from my first (and hopefully last) bout of the disease. I had prepared as much as possible – kudos to Pfizer – so the infection would pass like a nasty flu. Earlier in the crisis, an immunocompromised man in his late 50s like me might have ended up in the hospital, on a ventilator, just a coin toss from eternity.
In a way, I now feel more connected to people whose lives have been touched by Covid. But of course, many lives were not only touched by the disease, but destroyed. The cost of 1 million friends and relatives lost in the last 27 months defies summary and comparison. There is no adequate standard to measure this mass of grief.
But trying is better than living in denial—pretending the hurricane never passed or the earthquake never happened. At worst, Covid-19 became the third leading cause of death in the United States, behind heart disease and cancer. The country experienced the largest decline in life expectancy since World War II. More than 200,000 children have lost a parent or significant other.
People try to process this experience in different ways. My interpretation construct is global health in other countries. The United States is pretty good at saving people from infectious diseases elsewhere. The President’s Contingency Plan for AIDS Relief has saved more than 20 million lives since 2003. The President’s Malaria Initiative has reduced mortality rates from malaria by about 50 percent in countries where it operates. It has saved the lives of around 2 million children.
When I’ve attended these programs abroad, I’ve seen the importance of health technology—things like antiretroviral drugs and long-lasting insecticide-treated bed nets. But the progress made depends on the human factor of compliance: take the pills every day even if you don’t feel sick, and be sure to put up the bed net every night. Adherence to AIDS medication was initially patchy because Africans sometimes distrusted Western medicine and turned to traditional healers. But over time, people saw the immediate, almost miraculous healing power of AIDS drugs in their friends and neighbors. Soon the stigma was reduced, and AIDS patients reached Western levels of adherence in most places.
Now imagine that you are part of a country trying to help the United States with its Covid-19 crisis. They are trying to administer a wonderful vaccine that will ward off most infections and provide near freedom from serious illnesses. The key, as always, is compliance. But there is a powerful Red faction – dominant in much of the country – that favors quack treatments, distrusts modern medicine and is resistant to vaccines (and mask-wearing) out of political pride.
Surely, over time, the Red Faction would see the health benefits of three or four pinpricks. Surely it would refuse to take health advice from mad politicians and unreliable community healers. Surely the stigma would fade when the vaccine proved safe and effective.
But no. After more than two years, California achieved more than 70 percent complete immunization coverage. But a large number of states – including Missouri, Georgia, Arkansas, Alabama, Wyoming, Indiana – barely reached 50 percent. While about half of the residents in these states are well protected, little has been done to build a kind of herd immunity that protects an entire community.
In any normal vaccination campaign – aiming for 80 to 90 percent uptake – this would be counted as a failure. A donor country would be forced to reconsider its methods. And of course questions would arise: why would a country with a relatively advanced healthcare system have the highest number of Covid deaths in the world? Why have health outcomes been so dramatically affected by class and race? Why didn’t the effectiveness overcome the stigma? Does this Red Faction have contempt for their elders, as evidenced by who bore the brunt of the sacrifices? Is this country prepared for any crisis that requires joint action?
There is another question that seems the most unexpected, at least for me. Since mortality rates for vaccinated people are 20 times lower than for unvaccinated people, what force, what belief, what ideology drove a large part of the country to live so recklessly? We are dealing with a form of polarization that is stronger than self-preservation – a kind of populism that lets populists die.
Yet most Americans are still adrift down the Covid river, living in denial of the rocks ahead: new variants, long Covid, ongoing deaths. Who would have thought that so many people’s response to an existential crisis would be folk remedies and complacency.
