Diminished: Collective Cost and Collective Action in the COVID-19 Pandemic
By C. R. L. Moore
By Claude Monet (French, 1840–1926) (https://collections.mfa.org/advancedsearch/Objects/peopleSearch%3AClaude%20Monet)
In a seventeenth-century plague season, church bells tolled around the clock, marking each death. The poet-priest John Donne, listening, wrote:
“No man is an island, entire of itself; every man is a piece of the continent.... any man’s death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee” (“Meditation XVII”, John Donne, Devotions).
The ongoing COVID-19 pandemic has diminished and is diminishing the American peninsula on the human continent at a devastating and unsustainable rate.
As of January 30, 2023, the New York Times reports at least 1,114,413 Americans have died as a result of COVID-19. For the last several months of 2022 in the United States, COVID-19 took lives comparable to a 9/11 attack every week. The excess death toll, as of January 14, 2023, is even greater: 1,269,813. The lower number omits increased deaths of despair and deaths downstream of COVID infection, like previously healthy people dying of cardiovascular events soon after even mild COVID infection. Even so, if we were to ring church bells once per minute to memorialize each official COVID-19 death in only the United States, they would ring every minute for more than 2 years. More Americans have died of COVID-19 than have died in combat in every war since 1775.
Though none of my loved ones has yet died of COVID, this staggering number of deaths diminishes me.
I am diminished by the friends I will never meet, the doctors who will not be available in my old age, the "essential workers” no longer able to serve essentially.
I am diminished by the 10.5 million children globally who have lost a caregiver to COVID-19, and the 7.5 million who have been orphaned by it.
I am diminished by the loss of the wisdom capital in my elders and the generational capital of the younger souls lost or impaired in body and brain by relentless repeated infections.
We are collectively diminished in the reversal of decades of life expectancy gains, the largest increase in mortality in 100 years, according to Census.gov . COVID-19 was a top-5 cause of U.S. deaths across all age groups in 2020 and 2021.Although final data are not yet available, it appears to have been the fourth-leading cause of death, behind heart disease, cancer, and pneumonia, for 2022. It was the number-one cause of death among 40-59 year olds for January to October 2021. Federal Reserve chair Jerome Powell estimates that, because of COVID-19, nearly half a million working Americans have died in excess of pre-pandemic expectations.
We are diminished by the 33% increase in maternal mortality in the U.S. since March 2020, compared to previous years.This increase has disproportionately affected Hispanic and Black Americans. COVID-19 infection during pregnancy increases the likelihood of death sevenfold, in addition to increasing the probability of other bad outcomes to mother and child.
We are diminished by the thousands of children who have died of COVID-19. A new paper in the Journal of the American Medical Association found that from August 2021 to July 2022, COVID-19 was the top infectious-disease cause of death for ages 0 to 19 and the eighth most common cause of childhood death as a whole. During that period, despite vaccine availability for some young people, COVID-19 was the most deadly childhood infection, past or present; COVID-19 has so far proven even more deadly than measles was prior to vaccines. The most vulnerable age group was infants from age one month to one year. The second-highest number of pediatric deaths occurred from age 15 to 19 years.
We are diminished also by the 2 to 4 million sufferers with long COVID completely disabled from paid employment in the United States alone, and tens of millions more long-COVID patients working at diminished capacity. Separate studies by the Brookings Institute, Harvard University, the New York Federal Reserve, and the Government Accountability Office independently arrived at similar numbers. We are diminished by adding thousands more Americans to their ranks every day, given a conservative estimate of 10% probability per infection and an average daily infection count of more than 45,000 in the United States at the end of January 2023. No area of social infrastructure is immune to damage from this tsunami of disability: the ripple effect of unintended consequences harms GDP and the labor force, worsens staffing challenges in transportation, supply chain, healthcare, and education, and strains marriages and families. In addition, the risk of long COVID increases with each reinfection. COVID infections are like Russian roulette, except that each reinfection adds a bullet to the chamber.[i]
As an immunocompromised cancer survivor, I am diminished by the inaccessibility of safe worship, social, and cultural events, due to discarded precautions and CDC guidance for immunocompromised people to avoid crowds, especially indoors. The even bigger obstacle is the increasing and severe difficulty obtaining COVID-aware medical/dental, veterinary, and elder care and safely accessing basic civic functions like jury duty, driver’s license renewal, voting, and K-12 public education. It has even become more difficult to complete repairs to homes and cars as service providers decline requested safety accommodations. Gradually, through social media and other online spaces, we are finding each other, banding together (separately) in a separate and suffering shadow society, exchanging prayers, referrals, practical tips, and sometimes even material assistance.
Able readers are diminished by the absence of invisible millions like me who feel trapped between the rock of COVID risk and the hard place of isolation.
We are all diminished by the degradation to our healthcare infrastructure when surging or chronically elevated COVID-19 drives healthcare workers out of the medical field due to burnout, PTSD, disability, or death. Instead of “flattening the curve,” we are flattening the spirits of our doctors and nurses. We are diminished as the autumn surge in multiple respiratory infections fills hospital beds to the exclusion of patients suffering other medical emergencies, as White House COVID-19 response coordinator Dr. Ashish Jha told the Washington Post recently. Dr. Jha predicts the dysfunction from our chronically overloaded healthcare infrastructure will last years.
We are diminished by the erosion of our educational infrastructure, with teachers in Texas, for example, retiring and quitting in record numbers. In the 2022-2023 school year, 20% of teachers have no type of certification underway or completed.
We are diminished in the cost to community safety when COVID is the leading cause of death among law enforcement officers for three consecutive years.
This diminishment of our society will continue and increase if we continue our present practices. For whom does the bell toll? It tolls for all of us in some form or fashion. Some are at especially high risk of severe short-term disease from COVID-19, but all of us bear the cost of continued unmitigated community spread. As Dr. Daniel Griffin says on his weekly clinical updates for the podcast This Week in Virology, “No one is safe until everyone is safe.”
However, the power to prevent much suffering is in our hands: we can choose to wear high-quality (K)N95 masks when we share air with those outside our households. We can choose to keep remote work, worship, and learning optionsavailable as disability accommodations. The pandemic increase in remote work opportunities has actually enabled some people with disabilities to reenter the work force. We can encourage and enable sick people to stay home unless seeking care. We can plan social events and life milestones for uncrowded outside spaces or virtually, or both. We can improve air quality in indoor public spaces like schools and hospitals. Billions of dollars of pandemic aid to schools remains unspent. Applying some to improved air quality would benefit all learners and teachers beyond the current pandemic.
We can stop much of the diminishment. We can protect each other with kindness and compassion, but it will take all of us, together, as part of the same human continent. In protecting our neighbors, the lives we save may be our own.
[i] This helpful graphic from @wikisteff on Twitter captures the Nature reinfection data from Veterans Affairs patients clearly and vividly:
The starting point on the left of the graph represents one’s individual risk for the various symptoms prior to any COVID-19 infection at all. The lines show how many times more probable a specific longterm effect becomes with each repeat infection. It is still unknown what additional reinfections beyond the scope of the study do to a person’s hazard ratio.
This study concludes that vaccination does not significantly reduce the risk of the above long-term outcomes of even a mild initial infection. The best prevention is to reduce infection risk in the first place.
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