The magnitude of the country’s loss is nearly impossible to grasp.
More Americans have died of COVID-19 than in two decades of car crashes or on battlefields in all of the country’s wars combined.
Experts say deaths were all but inevitable from a new virus of such severity and transmissibility. Yet, 1 million dead is a stunning toll, even for a country the size of the United States, and the true number is almost certainly higher because of undercounting.
It is the result of many factors, including elected officials who played down the threat posed by the coronavirus and resisted safety measures; a decentralized, overburdened health care system that struggled with testing, tracing and treatment; and lower vaccination and booster rates than other rich countries, partly the result of widespread mistrust and resistance fanned by right-wing media and politicians.
The virus did not claim lives evenly, or randomly. The New York Times analyzed 25 months of data on deaths during the pandemic and found that some demographic groups, occupations and communities were far more vulnerable than others. A significant proportion of the nation’s oldest residents died, making up about three-quarters of the total deaths. And among younger adults across the nation, Black and Hispanic people died at much higher rates than white people.
Understanding the toll — who makes up the 1 million and how the country failed them — is essential as the pandemic continues. More than 300 people are still dying of COVID every day.
“We are a country with the best doctors in the world, we got a vaccine in an astoundingly short period of time, and yet we’ve had so many deaths,” said Mary T. Bassett, the health commissioner for New York state.
“It really should be a moment for us all to reflect on what sort of society we want to have,” she added.
The coronavirus arrived in the United States by early 2020, setting off wave after wave of infection and death in the months that followed. An alarming peak that first spring was followed by an even deadlier wave that winter.
More Americans died then than in any other period of the pandemic, just as vaccines were arriving and offering hope that it might soon be over. But new variants emerged: delta in the summer of 2021, followed by omicron, which spread so widely that deaths surged again.
What began as a crisis in cities spread to rural areas and back again, until the path of the virus traced the full geography of the country.
The chaotic beginning
The first wave of deaths was concentrated in the Northeast, especially New York City and its suburbs. No one knew much in those early months. Doctors were not sure how best to treat the disease. Hospitals were overwhelmed. Deaths climbed sharply.
New York City was hit harder in March and April 2020 than any other city in the country has been during the pandemic. At the height of this outbreak, a New Yorker was dying of COVID almost every two minutes — nearly 800 people per day, a rate five times as high as the city’s normal pace of death.
About 60% of all deaths at the beginning of the pandemic happened in the Northeast, as the virus tore through cities and suburbs on the Eastern Seaboard.
New York City alone saw 20% of the nation’s deaths in the first wave, despite making up just 3% of the U.S. population.
A spike in emergency room visits to New York City hospitals by people who had “flu-like symptoms” in early March suggested that thousands of city residents were infected.
On March 15, Mayor Bill de Blasio shuttered bars and restaurants and announced that public schools would close the next day. Gov. Andrew Cuomo imposed broad restrictions on nonessential businesses on March 22. Those near-lockdown measures were most likely responsible for a more than 50% reduction in transmission of the virus, a Columbia University study found.
By summer, New York was garnering praise as a model of infection control.
But Dr. Thomas Frieden, a former head of the Centers for Disease Control and Prevention and a former commissioner of New York City’s Health Department, said he believed that restrictions came too late. More than half of the New Yorkers who died in the earliest days might have lived, he estimated, had officials put the lockdown measures in place even a week or two earlier. “Cases were doubling every two days, and every two days you were doubling the impact,” he said.
Toll on unvaccinated
Among wealthy countries, the United States has been notably unsuccessful at persuading residents to get fully vaccinated and boosted. Today, about one-third of people across the United States have not been fully vaccinated, and some 70% of the population has not received a booster. (By contrast, 17% of people in Canada have not been fully vaccinated, and 46% have not had boosters.)
Nearly half of the deaths from COVID in the United States occurred after vaccines were made widely available. The failure to vaccinate, public health researchers say, contributed to hundreds of thousands of deaths. During the omicron wave in December 2021 and January 2022, for instance, the COVID death rate in the United States was higher than in Germany, France, Britain or Canada, which had each fully vaccinated and boosted larger shares of their populations.
More than 429,000 people have died of COVID since all adults in the United States became eligible for vaccination in April 2021.
A majority of them were unvaccinated, but as the virus has continued to spread, it has killed thousands of vaccinated people, too.
“It’s just sobering that in a country with remarkable resources like ours that we are seeing deaths like this,” said Dr. Lisa Cooper, director of the Johns Hopkins Center for Health Equity. “And we’re seeing a lack of benefit from therapy that we know is accessible.”
Public health experts say the government failed to do enough to help the public understand how effective the vaccines are, or to combat misinformation and conspiracy theories by some right-wing media and politicians.
Huge cost for seniors
Like many in her age group, Germaine St. John, 87, of Laramie, Wyoming, counts several friends lost to COVID.
In her 82 years as a Laramie resident, she has raised a son, started a senior community theater group, enjoyed a career at the local bank, found common cause with fellow political conservatives and, in the early 1980s, served as mayor. But well before the pandemic, she said, she had begun to feel sidelined because of her age. And the way some younger neighbors have declined to wear masks or refrain from large gatherings when cases were on the rise seemed to diminish the lives of those most vulnerable.
“This idea of ‘we’re going to die anyway,’” she said. “That is awful to say about any age group.”
Three-quarters of those who have died of COVID have been 65 or older — 1% of all people in this age group. And the pandemic has been especially deadly for the oldest. COVID has killed more than 3% of the entire U.S. population 85 and older.
Public health experts said the reluctance of others to adapt their behavior was a contributing factor to the large number of deaths among older people over the course of the pandemic.
“A lot of what has effectively been a slaughter has been the product of policies and public health failings, and just not caring,” said Dr. Louise Aronson, a geriatrician at the University of California, San Francisco.
A lasting racial disparity
Black and Hispanic people in every age group have died at higher rates than white people. The racial disparity in deaths was especially extreme at the beginning of the pandemic, but the gaps remain today.
Hispanic people ages 25 to 54 died at a rate more than four times as high as white people of the same age group before vaccines became widely available. Black people of the same age group died at more than three times the rate during that period.
In part, that is because a disproportionate share of essential workers are people of color, public health experts said.
Another reason for persistent disparities in deaths was lower vaccination rates. White people were significantly more likely to be vaccinated than Black and Hispanic people in the first months of the vaccine rollout.
Workers without options
Meatpacking workers had been dying of COVID. Transit workers had been dying of COVID. Farmworkers had been dying of COVID.
Nearly 80% of workers ages 20 to 64 who died of COVID in 2020 worked in industries designated as essential, according to data obtained by a team of researchers led by Yea-Hung Chen, a public health researcher at the University of California, San Francisco. Workers in 11 sectors that were exempt from stay-at-home orders — including food services, health care, construction, transportation, agriculture and manufacturing — were almost twice as likely to die from COVID as others the same age, the researchers found. About two-thirds of workers in the United States are employed in industries that fall within the classification.
“These workers were by definition more exposed, but the extent of the disparities was striking,” Chen said.
Nursing homes battered
The virus swept through places like prisons, colleges and group homes, where people live together, but the toll was especially high in long-term care facilities, like nursing homes.
Residents of long-term care facilities continued to die long after the early months of the pandemic, and long after lockdowns that were criticized later for isolating seniors in dangerous, damaging ways.
Early on, a shocking 43% of all COVID deaths were among residents and staff members at long-term care facilities. The proportion would shrink, but the deaths continued to rise. In total, more than 200,000 deaths — about 1 in 5 of all who have died — have been associated with these facilities.
Deaths in nursing homes slowed sharply in January 2021, weeks after vaccines were introduced. But they did not vanish entirely. As delta and then omicron swept the country months later, deaths in nursing homes rose again, though never to the levels seen before vaccinations.
Surges in the South
While other regions endured several waves of the virus, the South has suffered more frequent and extreme waves of infection and death. More than 378,000 people in the region have died, many of them younger.
The South has also experienced the highest death rates from COVID of any region. In part, that is because it is home to some of the lowest vaccination rates in the country. Since vaccines became available, the average death rate fell everywhere but the South, where it rose by about 4%.
Public health researchers also pointed to less stringent responses — lockdowns that ended sooner and masking restrictions that were not enforced as strictly, even when they were in place.
The South has also suffered because the share of adults with three or more chronic health conditions is higher on average than in any other region.
Mississippi has the highest COVID death rate of any state, and one of the lowest vaccination rates. Dr. Thomas Dobbs, the state’s health officer, said that even given the catastrophic problems with underlying illnesses in Mississippi, persuading more people to get vaccinated would have helped prevent many deaths.
It has been an uphill battle, Dobbs said, to compete with misinformation, especially on social media, and with people who tried to downplay the seriousness of the pandemic. Polarization around the virus and vaccines, he said, was devastating.
“Either you were fully on board or you did absolutely nothing and ran headlong into the buzz saw that was COVID,” he said.