Minutes before a crowd of lawmakers gathered on the steps of the Capitol last week to mark the impending U.S. death toll of 1 million from Covid, it began to rain.
The shower ended by the time that House Speaker Nancy Pelosi and other members of Congress walked down from the building, but the slate gray sky — and an American flag waving at half-staff above them — set the somber tone of the event.
“Behind each number is a name of a person, beloved,” Bishop Mariann Edgar Budde, the leader of Washington’s Episcopal diocese, said in prayer. “Far too many taken, much too soon, and sometimes alone.”
Minutes later, after a musical performance by the Air Force chorus and a moment of silence for Covid victims, the lawmakers began filtering back into the Capitol. There were no other prepared remarks. The moment had passed.
Over the course of the pandemic, there have been a number of vigils, moments of silence and temporary installations in the United States honoring the victims of the coronavirus. But as the country crossed the million-death-milestone on Thursday, there was no national, permanent memorial to America’s loss. Some of the survivors have called for more to be done.
Kristin Urquiza, who turned to activism after her father died from Covid in June 2020, said recently that a permanent national memorial to the pandemic is essential, and that there is a “need for us as a country to have our president set the tone, bring us together as a nation to really commemorate this moment.”
“A million people is quite profound,” Ms. Urquiza, a co-founder of the advocacy group Marked by Covid, said, adding that “the gestures are not fitting to scale.”
Perhaps the most prominent effort to date has been a vast sea of white flags planted on the National Mall for two weeks in September, easily visible from the White House, symbolizing the more than 670,000 people in the United States who had died of Covid by then — roughly the same as the entire toll of the 1918 flu pandemic, which also has no national memorial.
The Biden administration and members of Congress have said that with the pandemic far from over, their focus is on preventing more deaths, but even accomplishing that has its own challenges. The administration’s request for a $22.5 billion aid package to fund vaccines, therapeutics and other treatments has been whittled down to less than half its original size because of a Republican demand that it is paid for by clawing back previously approved funds. And that $10 billion package remains stalled over a push to include language in the bill that maintains immigration restrictions at the country’s land borders.
“We’re still in a fight against Covid and a battle against Covid,” Jen Psaki, the White House press secretary at the time, said at a news conference last week. “There are still far too many people getting sick, getting hospitalized and dying. And this is not the last time we will commemorate or the last step that the president will take to commemorate.”
That day Mr. Biden had issued a proclamation ordering U.S. flags at the White House and all public buildings to be flown at half-staff for multiple days to commemorate one million Americans dying of Covid.
“As a nation, we must not grow numb to such sorrow. To heal, we must remember,” he said. “We must remain vigilant against this pandemic and do everything we can to save as many lives as possible.”
Asked after the vigil whether Congress would establish a permanent national memorial to victims of Covid, Ms. Pelosi said only: “Right now, we’re just trying to save lives.”
“We need to be able to respond to the situation that we’re in and not the situation that we wish we were in, and be able to walk and chew gum at the same time,” Ms. Urquiza said referring to the Biden administration’s Covid response. “We need to hold space for people who are experiencing grief and loss as well.”
Biden has made previous efforts to pay tribute to Covid victims. The night before his inauguration, he led a national mourning at Washington’s Reflecting Pool for the 400,000 Americans who had been killed by the virus. A month later, when the toll had reached half a million, he held a moment of silence on the South Lawn of the White House.
Although Marked By Covid has identified more than 70 local memorials, vigils and art installations marking the pandemic in the United States, all but a few have been temporary.
The Baltimore County government in Maryland has planned a permanent public art memorial, scheduled to be installed in the fall. Delaware unveiled a memorial tree and plaque earlier this month for families to fill in the names of loved ones who have died. New York City established a permanent memorial last year honoring the first known city sanitation worker who died of Covid in April 2020. Hundreds of New Yorkers died a day that spring during the first devastating wave.
Joshua Collier, a 42-year-old community health care worker, said the threat of Covid made going to work in Austin, Texas, scary for him and other health clinic employees in the first half of the pandemic.
“I was afraid of getting Covid in the clinic,” he said.
But vaccines — he’s had three shots — and easing restrictions have freed him to embark on a 16-day bicycle journey to Monterrey, Mexico, as part of a charitable organization whose members travel south of the border to distribute used bikes to laborers and Indigenous people.
Mr. Collier and Mario Porras, a fellow cyclist, started their travels from an Austin park on Thursday and hoped to reach their destination by June 4.
Their trip was part of an annual trip for Bikes Across the Border, but the group was forced to scrap the trips the two previous years because of Covid. This year, Mr. Collier and Mr. Porras are the only two participating. They have had as many as 30 people join the trip, but it was hard to convince people to return after the past two years.
Still, as Mr. Collier reported his progress on Friday after making 32 miles on the first leg of the trip, he was obviously able to find reasons for optimism, even as the nation recorded a million deaths from Covid.
“Happy and free,” he said, describing his mood.
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Reporting from New Orleans
Maurice Amaechi, a bouncer at Tropical Isle on Bourbon Street in New Orleans, stood masked at the door as patrons entered on Thursday evening. “I worry about it, but I know nothing is going to change,” he said. “Everyone knows about it, but no one cares. I go with the flow because I can’t go anywhere else.” He said his girlfriend’s aunt died of Covid, which made it real for him. He said he wears a mask both to protect others and because he has asthma.
Reporting from Everett, Wa.
Linda Marsh, 57, works in escrow in Everett, Wash., and was considered an essential worker. “We’ve had to work from Day 1,” she said. “It has really impacted me. I don’t go out as much. Pretty much stay home, go to work, go home.” She added that: "You would have thought we would have had it under control by now. It’s really scary. People I know have been really sick, and I know people whose family members have died. It’s a horrible thing. I can’t believe we don’t have it under control yet.”
Reporting from New York City
In the Tottenville neighborhood of Staten Island, Louie Loguirato absorbed news of America’s millionth Covid death with sadness — and suspicion. He said that while he is certain that multitudes of Americans have died needlessly over the past two years and that he mourns for them, he questions whether the numbers were overstated. Like many of his friends, Mr. Loguirato, a 61-year-old owner of an office cleaning business, caught and beat Covid. “I think it’s just going to fade away,” he said of the virus. “And when it does, hopefully we’re stronger.”
Reporting from New Orleans
Herbert Johnson, owner of Professional Funeral Services in New Orleans, says that throughout the pandemic, the funeral home held two services every weekday and five a day on weekends. “Some people still think it’s not real,” Johnson said. “If I could take a few of them through here, they could see the numbers. There’s nothing fake about that.”
In March 2020, in the wake of the first confirmed coronavirus death in New Orleans, Mayor LaToya Cantrell canceled the annual St. Patrick’s Day parades and celebration with only four days’ notice. The city had become an early national hot spot for the virus after its Mardi Gras celebration in February turned into a superspreader event.
Soon, the virus’s ferocity would become clear, as the city’s hospitals filled up. But that Saturday, a crowd gathered at Tracey’s Original Irish Channel Bar on lower Magazine Street, in defiance of the mayor’s orders. At one point, as a loudspeaker blared “Kiss My Irish Ass,” a group wearing plaid kilts danced and slapped their backsides to the lyrics, some shouting the mayor’s name as they twirled.
“Nobody knew about Covid,” said Jeffrey Carreras, 51, the owner of Tracey’s. “Was it real or not real? Was it only the flu? A scam by the government? We didn’t know.” He said he sent security-camera photos of the growing crowd to the superintendent of the New Orleans Police Department. As evening set in, he asked the police to break it up. “They’re starting to swarm,” Mr. Carreras told the superintendent.
Looking back, Mr. Carreras said, he understands the initial coronavirus scare but believes that the new variants of the virus do not require the same vigilance. “They keep prolonging it,” he said, referring to pandemic policies. “First we were closed down for six weeks. That turned into two years,” he said, adding, “I’m not wearing a mask anymore. I’m just over that. I’m done with Covid.”
Over the past two years, New Orleans has lost 1,110 people to the virus, according to a New York Times database. A vast majority of the Covid victims in New Orleans have been Black, according to the county’s health department.
Many grieving Black families turned to Professional Funeral Services on North Claiborne Avenue, where, for months, undertakers held funerals at 9 a.m. and at noon every weekday, with five funerals a day on weekends. The funeral home’s owner, Herbert Johnson, and its manager, Markeith Tero, worked from dawn until midnight on many of those days, picking up the bodies of people who had died at home and preparing the bodies in a way that would not infect mourners or staff.
This week, Mr. Johnson, 55, described a family that had lost a mother, a father and two adult children to the virus. A surviving daughter buried her entire family, he said, recalling two calls he received from the household after the father, a pastor, died at midnight and his wife died at 4 a.m.
Just weeks after the Centers for Disease Control and Prevention began a comprehensive internal review with an eye toward restructuring, the agency’s director announced on Friday that the team that coordinated the national response to the Covid-19 pandemic would return some of its functions to other departments.
But the so-called Incident Management Structure, initially brought together to respond to the public health emergency, is not being dissolved and will continue to meet “the demands of this evolving pandemic,” according to a letter sent to employees on Friday by the agency’s director, Dr. Rochelle Walensky.
The move signals the beginning of efforts to put in place comprehensive changes at the agency, whose public standing and reputation have suffered in recent years. Some 60 percent of Americans, for example, say they are confused by changes in official pandemic recommendations, according to a recent Pew Research Center survey.
But Dr. Walensky’s letter was short on details regarding the changes. A statement in response to questions from The New York Times said only that the review’s “initial data collection phase is complete, and now the director will synthesize the information, identify themes, and prioritize next steps to formalize approaches and find new ways to adapt the agency to the changing environment.”
Dr. Walensky told employees last month that the C.D.C., which has faced an onslaught of criticism over its recent handling of the pandemic, would undergo a review and evaluation by Jim Macrae, a federal official who has held several senior positions within the Department of Health and Human Services. That review started on April 11.
The review is also looking at how to modernize ways in which the agency develops scientific research and deploys it, and what other strategic improvements can be made to better serve public health, like better surveillance systems.
To those ends, the reviewers have conducted more than 100 interviews and held nearly 50 one-on-one conversations with public health leaders both inside and outside the agency, Dr. Walensky said.
The C.D.C. has long been admired for its scientific approach to improving public health. Many scientists from around the world were trained by its experts and have emulated the agency’s standards and methods.
But the C.D.C.’s infrastructure was neglected for decades, along with the public health system generally. Agency scientists stumbled early in the pandemic with the flawed design of a diagnostic test, and went on to make some recommendations about masking, isolation and quarantine that critics charged were based on insufficient evidence.
On Friday, Dr. Walensky indicated that health equity would be a priority for the agency in the future. The pandemic laid bare the stark racial and ethnic health disparities in the United States. Black, Hispanic and American Indian/Alaska Native adults were hospitalized with Covid and died at higher rates than white Americans.
The roots of the inequities are myriad, and include difficulties gaining access to care, mistrust in the medical system, higher rates of existing health problems like obesity and diabetes, and socioeconomic circumstances, like crowded housing and consumer-facing jobs, that increased the odds of exposure to the virus.
Dr. Walensky said that lessons learned from the pandemic and feedback she has received made clear “that it is time to take a step back and strategically position C.D.C. to facilitate and support the future of public health with a keen focus on health equity and the agency’s core capabilities.”
Reporting from New Rochelle, N.Y.
Nick Triscari, the owner of Wooden Spoon restaurant in New Rochelle, N.Y., said the virus’s toll hit him hard. “Two years ago, I didn’t think anything like this would be possible,” he said. “We have friends and family members who passed away. I am also a firefighter, and one of our captains died of Covid.”
Reporting from New Orleans
Savannah Peoples, 4, dances in front of her grandfather, Dan Gillison, of Centreville, Va., and her mother, Summer Peoples, of Atlanta, at Cafe Du Monde in New Orleans, where the family was on vacation. “We're trying to be safe. I've got my mask, I've been immunized,” Gillison said. “For me, this is healing,” he said of the family trip after the isolation of the pandemic. He added: “I haven't had this opportunity for fellowship. That's what human beings need: They need community, they need fellowship, they need each other. There is no physical health without mental health.”
After more than two years, the death toll from Covid-19 has reached one million in the United States. Hear loved ones recount memories of the lives lost.
In the confounding days of April 2020, Laura Jackson's husband, Charlie, developed a cough and fever. Jackson heard that private hospitals were so full that they were turning away Covid patients and convinced Charlie to go to the closest V.A. hospital. That afternoon, she parked in the hospital lot, barred from entering the emergency department. A nurse came to the car and handed over her husband’s belongings: cellphone, wallet, watch. Charlie died three weeks later. The separation from her husband in his last days haunts her. Read my story on those left behind.
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, one 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 one 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.
A federal judge on Friday blocked the Biden administration from lifting a pandemic-related health order whose scheduled expiration on Monday would have thrown open the doors of the United States to asylum seekers at the border for the first time in more than two years.
The ruling means further delays for thousands of people waiting for a chance to seek refuge in the United States, but it averts a potential crisis on the border by giving the administration more time to roll out its plan to handle the large numbers that are expected. Department of Homeland Security officials have said they were preparing for as many as 18,000 migrants a day, compared with 8,000 currently, if the order were lifted.
“The Biden administration is probably breathing a sigh of relief because they weren’t ready for the rule to be lifted,” said Wayne Cornelius, director emeritus of the Center for Comparative Immigration Studies at the University of California, San Diego.
The sweeping public health measure, known as Title 42, was put into place in March 2020 to control the transmission of the coronavirus across the border. Under its authority, thousands of migrants arriving at land borders have been swiftly expelled, without an opportunity for those fleeing danger and persecution to request humanitarian protection in the United States.
But since the Centers for Disease Control and Prevention said in April that it would suspend the order, citing the availability of effective vaccines to combat the coronavirus, concern has shifted to the potential for overcrowding and turmoil at the border should Title 42 expulsions no longer be enforced.
Judge Robert R. Summerhays of the U.S. District Court for the Western District of Louisiana issued a nationwide preliminary injunction directing the administration to keep the rule in place for now, effectively postponing what would almost certainly be tens of thousands of new migrant admissions.
Even with the public health order in place, U.S. Border Patrol agents are encountering near-record numbers of people who either crossed on their own or were allowed to enter under various Title 42 exemptions. A total of 234,088 migrants crossed the southern border in April.
Twenty-four states, led by Arizona, Louisiana and Missouri, sued on April 3, two days after the C.D.C. announcement lifting the public health order, arguing that Title 42’s continued enforcement was needed to avert the threat of a “wave of illegal migration and drug trafficking” and that returning to normal enforcement practices would cause irreparable harm.
In a 47-page decision, Judge Summerhays, an appointee of President Donald J. Trump, whose administration initially adopted the public health order, found that lifting the order would cause irreparable harm by increasing the health care and education costs that the states would have to bear as a result of the arrival of a large number of new migrants. And the judge ruled that the states were likely to succeed in their argument that the C.D.C. had not followed proper rule-making procedures under federal law.
“The court concludes that the public interest would be served by a preliminary injunction preventing the termination of the C.D.C.’s Title 42 orders,” the judge wrote.
Republican state leaders praised the decision. “The federal court stepped in to protect our nation when the Biden administration failed to do so,” Gov. Doug Ducey of Arizona said in a statement on Twitter.
But some legal analysts said the ruling left the federal government unable to comply with its legal obligations under both U.S. and international law to offer asylum to migrants who meet the standards under the law.
The injunction “will continue to imperil lives and block access to the asylum system,” said Monika Y. Langarica, a staff attorney at the Center for Immigration Law and Policy at the University of California, Los Angeles.
The Justice Department said it would appeal the ruling, and the Biden administration said it would continue to enforce the expulsions pending the outcome. “The authority to set public health policy nationally should rest with the Centers for Disease Control, not with a single District Court,” Karine Jean-Pierre, the White House press secretary, said in a statement.
Government lawyers had argued in court that the C.D.C. had determined that Title 42 authority was no longer warranted, and that forcing the government to enforce the policy amounted to an intrusion on the agency’s handling of the pandemic.
But the court ruled that the order had become about more than public health during the pandemic. “Title 42 is certainly a public health measure” the judge wrote. “But, as defendants acknowledge, it protects public health by regulating immigration.”
A team of lawyers had sought to persuade the judge to limit his injunction only to those states asking for it, a move that would have allowed Title 42 to be lifted in states such as California and New Mexico, and some along the northern border with Canada. But the judge rejected that request this month, and his ruling applies to the entire country.
There have been about two million expulsions since March 2020 under the order, affecting many people who would have otherwise been admitted to the United States for an assessment of their asylum claims or placed into deportation proceedings. Those processes often take months or years.
The public health order initially was used to swiftly turn back migrants from Mexico and Central America by busing them back to Mexico. But under the Biden administration, large numbers of migrants from Haiti and other countries have also been swiftly deported, typically on planes, without hearings.
As the pandemic subsided, human rights advocates and progressive lawmakers raised intensifying concerns that Title 42 was being used as a tool to curb immigration, in violation of international law, rather than to stop the spread of Covid-19.
The announcement on April 1 by the C.D.C. that the measure was no longer warranted drew swift, loud rebukes from Republicans who predicted that the United States would be overwhelmed with border crossers, including several thousand already waiting in Mexico and thousands more likely to move north from their home countries.
Scenes of chaos at the border, even if short-lived, could be damaging for Democrats heading into a hotly contested midterm election, even though many of them, including the Senate majority leader, Chuck Schumer of New York, pushed for lifting Title 42 earlier this year. Republicans have made border security a core campaign issue, and have demanded a vote on a Senate amendment that would ensure the public health order remains in place before voting on a package that allocates funds toward vaccines, therapeutics and other coronavirus treatment. Some Senate Democrats have also expressed concerns about the administration’s plans to lift the order, making the amendment likely to pass.
The Justice Department could seek an emergency stay of Judge Summerhays’s injunction from the U.S. Court of Appeals for the Fifth Circuit, which would almost certainly turn it down, and then the case could land in the Supreme Court. Alternatively, the administration could wait until Congress votes on the amendment, and if it passes, ask the judge to set aside the case as irrelevant.
In April, the Department of Homeland Security said that it was not possible to predict the number of migrants who would show up at the border after Title 42 expires, and that it could vary widely from one section of the border to another.
Homeland Security officials have said they were preparing for as many as 18,000 migrants a day, while most predictions hover around 12,000.
The Biden administration unveiled a plan in April to handle the influx by increasing border personnel, streamlining migrant processing to prevent overcrowding and imposing strict penalties on border crossers who cannot establish a legal basis to remain in the United States.
The plan, a 20-page memo, also targets migrant smugglers for criminal prosecution, outlines a new collaboration with nonprofits that shelter migrants after they are released from immigration custody and coordinates more widely with countries through which migrants pass en route to the United States
Alejandro N. Mayorkas, the homeland security secretary, has defended the strategy while conceding that the border could come under more strain and asserting that the broken immigration system requires an overhaul, which Congress has failed to deliver for decades.
Immigration has bedeviled Mr. Biden since he entered office promising to undo the harsh border policies of his predecessor. But the prospect of an abrupt end to Title 42, along with a large wave of border crossings that has occurred despite the public health order, turned the issue into an urgent matter of national debate. Polls have shown that more than half of Americans oppose lifting it.
“The court’s decision to block the C.D.C. from ending Title 42 will permit the Biden administration to shore up its post-Title 42 plan and seek additional resources from Congress if necessary,” said Aaron Reichlin-Melnick, senior policy counsel at the American Immigration Council, a pro-immigration group.
“But as the last two years of Title 42 have shown us,” he said, “a failed policy isn’t going to get any better with time, and the longer Title 42 is kept in place the harder it will be for any administration to manage the border.”
In the first six months of the fiscal year that started in October, border officials have encountered more than one million migrants at the southern border, about half of whom were removed under the policy.
The public health order has always been applied unevenly, with the government allowing some migrants in under humanitarian exemptions and a variety of other factors that have limited its options.
Along many stretches of the border, for example, Mexican states have refused to accept the return of migrants with young children; along others, states have refused to take back people from far-flung countries, such as Brazil, India and Senegal, compelling the United States to release them inside the country with court hearings for deportation.
While challenging in the short term, lifting Title 42 could result in a decrease in unauthorized crossings in the long term if unauthorized crossers are once again prosecuted for illegal entry instead of being simply expelled, with the possibility of detention and a permanent bar of admission to the country.
The public health order has had the unintended effect of encouraging repeated illegal entries, especially by single adults, because migrants are being quickly processed and returned to Mexico — sometimes within minutes of being intercepted by agents — only to try to cross again. About three out of 10 adults are recidivists, and some of them have tried as many as 10 times.
From April through September 2020, 47 percent of single adults apprehended by agents had been encountered in the previous 12 months, more than double the share between 2014 and March 2020, before Title 42 was put into place, according to an analysis by the nonpartisan Migration Policy Institute.
Eileen Sullivan and Emily Cochrane contributed reporting. Susan C. Beachy contributed research.
WASHINGTON — In a sign of growing concern among federal health officials about the spread of new coronavirus infections, the Centers for Disease Control and Prevention is now saying that all people 50 or older should get a second booster shot if at least four months have passed since their first booster dose.
Previously, the agency said those 50 and older had the option of the additional shot, but only encouraged people over 65 or with underlying medical conditions to get it. The new guidance, issued in a statement on the C.D.C.’s website on Thursday, also extends to anyone 12 and older with certain immune deficiencies.
The C.D.C. said it was changing its advice because of a steady rise in infections over the past month, coupled with “a steep and substantial increase in hospitalizations for older Americans.” New confirmed cases surpassed an average of 100,000 a day again this week, according to a New York Times database — a number considered an undercount. And nationally, hospitalizations of people with Covid-19 were averaging more than 23,800 a day as of Thursday, 31 percent more than two weeks ago.
Most Americans 50 or older received their last dose of Covid vaccine more than six months ago. That has left “many who are vulnerable without the protection they may need to prevent severe disease, hospitalization and death,” the C.D.C. said.
In another warning of growing Covid risks, Dr. Rochelle P. Walensky, the agency’s director, said Friday that more that 45 percent of Americans now live in areas where transmission rates are high enough that they should at least consider wearing a mask in indoor public settings.
That was a substantial jump from the data she cited just two days earlier at a White House briefing. She said then that about one-third of Americans lived in counties with medium to high levels of virus transmission. That itself was a big increase; only about one-fourth of the population fell into risk zones the previous week, she said.
In a message posted Friday on Twitter, Dr. Walensky said those in high-risk areas — largely in the Northeast — should wear masks indoors in public. Those in medium-risk areas, which include counties in nearly every state, should consider masks based on their assessment of their personal risks, she said.
Hospital admissions of patients with Covid are a major factor in the C.D.C.’s assessments of a community’s risk. But other experts cautioned that hospitalization data could be misleading because patients might have been admitted for unrelated illnesses, and merely tested positive during routine Covid checks.
“We have 11 people in our hospital right now with Covid,” said Dr. Monica Gandhi, an infectious disease doctor at San Francisco General Hospital. “Three of them were hospitalized for Covid and the other eight have Covid in their noses and are there for other reasons.”
She said that in Massachusetts, a state with a high rate of vaccination, officials estimate that as many as 70 percent of hospital patients who test positive for the virus were admitted primarily for unrelated illnesses. However, coronavirus infections can also exacerbate underlying medical conditions, which many Americans have.
The death rate from Covid, although a lagging indicator, may be a more reliable gauge of the degree of the disease’s impact, because physicians must note the cause of death on the death certificate, according to Dr. Gandhi and other experts.
Recently, deaths have remained low. About 275 deaths have been recorded each day on a seven-day average, Dr. Walensky said on Thursday. The number of new deaths has actually dipped slightly in recent weeks. According to the Times database, the overall toll of U.S. deaths surpassed one million on Thursday, the highest confirmed total of any nation.
Those age 50 or older have been eligible for a second booster since late March, but federal health officials have said too few people are taking advantage of it. Only one-fourth of those 65 and older who have gotten one booster dose, for instance, have gotten a second, the C.D.C.’s data show.
Dr. Walensky also said this week that the C.D.C. and the Food and Drug Administration were now discussing whether to broaden eligibility to those younger than 50.
This week, the agencies cleared a booster shot of the Pfizer-BioNTech vaccine for 5- to 11-year-olds, expanding eligibility for a first booster dose to a younger age group. Among other factors cited in its decision memo, the F.D.A. cited “the continued relaxation” of preventive measures, including mask mandates, social distancing and isolation of infected individuals.
The agency also noted the risk of long Covid, which it said “can cause significant morbidity after initially mild infection.”
We asked listeners to share memories about loved ones they have lost — and about what it’s like to grieve when it seems like the rest of the world is trying to move on.
Reporting from Detroit
The pandemic started when Elizabeth Parks, 17, was a freshman in high school in Portland, Mich. “I went to high school just expecting more of an experience. I just never got to do most of the high school things because of Covid,” she said on Thursday in Detroit. “I remember hearing about it before it ever came to America and I just thought, ‘Oh, it won’t come here.’ I remember when it did come to America, thinking I’d never get it. But I did get it, twice.”
As I photographed the effects of Covid in New York during the spring of 2020, I tried to focus on the Black and Latino neighborhoods that were hit hardest by the pandemic because of health care inequities and structural racism. Day after day, I witnessed relentless suffering accentuated by economic circumstance. It was a great relief to photograph a happy occasion: a celebration honoring the health care workers of Harlem Hospital. On April 28, 2020, community members gathered outside the hospital and women from the Healing Drum Collective played African rhythms. The nurses and doctors broke into dance and, for a moment, there was joy. After the celebration, the workers filed back into the hospital to face another night of death.
Reporting from Jacksonville, Fla.
Lamonte Earnest, a clinician administering vaccines inside the Jacksonville community center, said nobody knew what the virus would ultimately cost. “We haven’t had a pandemic for over 100 years.” He said he hopes that his work has helped prevent more deaths. People are still coming in to the center, seeking their first vaccine dose, he added.
Reporting from Jacksonville, Fla.
For the last two years, Julia Angolli has welcomed those looking for a rapid test at the Clanzel T. Brown Community Center and Park in Jacksonville, Fla. “Nobody knew it was going to be for so long,” Angolli said Thursday.
Graphics editor who worked on the coronavirus case tracker
I remember a time I was wrong: I’ve worked on The Times’s coronavirus tracker since March 2020, designing and building the charts and tables that I depend on to understand the pandemic, just like our readers do. In March 2021, I was invited to give a talk to Times subscribers and explain to them how we had built and maintained the virus tracker. At the end of the talk, the moderator asked me about the future of our tracking efforts. That was a hopeful time: Vaccines were rolling out, and cases had decreased significantly from the awful winter wave. I remember saying that, given the increases in vaccinations, we were thinking about how to design for the “endgame” of the pandemic. If only. Covering the virus has humbled me — and made me realize how little I can really predict.
Reporting from Austin, Texas
“I almost feel desensitized to the growing number that you see on the news,” said James Varan, who was fishing at Lady Bird Lake in Austin, Texas, on Thursday. One million. “It’s almost like you can’t even make sense of it or comprehend it,” said Varan, who works in information technology for a law firm. “It almost has to not mean something to you, just so that you can go on with your day and not think about how many people that is and how much it has affected everybody.”
Reporting from Detroit
Carla Wright reflected on one million Covid deaths while out walking on the riverwalk with her boyfriend, Tony Stone, in Detroit. “It took my cousin, his mom and his sister. It took out a whole generation,” she said. “I ain’t dead yet," her boyfriend replied.
Reporting from New York City
Helena Begum woke up at her home across the street from Elmhurst Hospital Center feeling ill. A home coronavirus test said she was positive. Face wrapped in a mask, hand sanitizer dangling from her handbag, she took the day off work to take a P.C.R. test at the hospital. As she worried over her own health, she also remembered her beloved co-worker who had died at Elmhurst early in the pandemic. His name was Bijit Shah, and he was a barista at La Guardia Airport, where Begum, 50, is a wheelchair attendant. Shah, only 35 years old, died a month after the birth of his first child. “I can’t sleep. I see his face. My heart is broken for his child,” she said, shaking her head. “This is so sad, one million people already — God save us.”
The inside of Matt Emory’s engagement ring reads “I love you” in Luis Celaya’s handwriting. Emory vividly remembers his last visit in a Tucson hospital with his fiancé. He told him what he would have said during their wedding vows: that Celaya changed his life. That he was perfect. And that Emory loved him. Read my story on those left behind.
For the first six months of the pandemic, in the spring and summer of 2020, Dr. Sara Cody had nothing resembling a day off.
She spent weekends and evenings at her office in Santa Clara County, south of San Francisco. As the head of the county’s public health department, which is responsible for a large portion of Silicon Valley, Dr. Cody would become the face of an aggressive response to the pandemic, a calm and deliberate voice and the driving force behind the United States’ first lockdowns.
Now, as the nation marks one million deaths from the coronavirus, Dr. Cody reflected on the impact in the Bay Area, which has been starkly less deadly than in other parts of the country. If the United States had the Bay Area’s coronavirus death rate, more than 600,000 lives would have been spared.
“By and large, there is a trust in government in the Bay Area, and by and large, a trust in public health and science. That culture saved lives,” Dr. Cody said in an interview this week. “You couldn’t have done what we did here in many other places. It just wouldn’t have taken.”
Yet there was still resistance. From the earliest days of the Bay Area lockdowns in March 2020, she was tailed by two sheriff’s deputies. They waited all night outside her house, drove her to work and even accompanied her when she tried to unwind on hikes in a nearby park. Of the death threats she received, one was considered credible enough that a college math teacher was arrested and charged with threatening her.
Those were certainly not things she had signed up for as a public health officer. Nor were her appearances in front of television cameras, or the protesters who gathered outside her home. “I’m a public health physician,” Dr. Cody said. “I’m generally a quiet, reserved, private, behind-the-scenes person. I’m not an adrenaline junkie.”
The pandemic took a toll on her and her family, she said. But she doesn’t dwell on her own difficulties.
“I don’t think anybody escaped this unscathed,” she said.
Reporting from New Rochelle, N.Y.
Anthony Husbands, a pharmacist at the New Rochelle Prescription Center in New Rochelle, N.Y., said he remembers thinking that deaths from the coronavirus in the United States would be measured, at worst, in the tens of thousands. “In the beginning, the previous president had mentioned we will keep it under 50,000. But scientists and doctors said we are going to hit 60,000. I was shocked,” he said of the current death tally.
Graphics editor who worked on coronavirus data collection
At the beginning of the pandemic, when we started tracking cases and deaths, we were working every day, nonstop, including weekends, to maintain and publish accurate Covid case counts, since no official source was doing so. At some point, about eight months in, next to a line of code listing the years “2021, 2022,” a co-worker had written this note: “I pray we never have to add to this array.” Well, of course we did have to update the list. I would frequently think about this note and how we’ve changed from covering this pandemic as a breaking news story to covering it as a dominant story, to now covering it as one story among many that will never truly end.
Reporting from Detroit
Jeremiah Campbell, a bus driver at the Rosa Parks Transit Center in downtown Detroit, stopped to consider the many people lost to the virus — and the toll on people's daily lives. “We have to wear a mask. The things we can do are limited. I just want it to be over, soon,” he said.
Reporting from New York City
Suzette Burgess, 79, was handing out masks to people passing by the River Park Towers in the Bronx, one of the hardest hit housing complexes in the borough. She said actively fighting the virus’s spread was something positive she could do as America surpassed one million Covid deaths. “Just when you think it’s behind you, here it comes again,” she said. “It makes me sad.”
Broadway theaters will continue to require ticketholders to wear masks at least through June 30, industry leaders said Friday.
The Broadway League, a trade association representing theater owners and producers, said the owners and operators of all 41 theaters had agreed to the extension of the mask policy. The decision comes at a time when New York City has declared a “high Covid alert.”
Earlier this week, city officials strongly recommended medical-grade masks in public indoor settings, but Mayor Eric Adams has rejected reimposing mask mandates. But a number of performing arts venues have opted to stick with more restrictive policies in an effort to limit the spread of the virus.
“The safety and security of our cast, crew, and audience has been our top priority,” the League’s president, Charlotte St. Martin, said in a statement. “By maintaining our audience masking requirement through at least the month of June, we intend to continue that track record of safety for all, despite the Omicron subvariants.”
Most Broadway theaters this month stopped checking whether patrons are vaccinated; only a handful of Broadway theaters operated by nonprofits are continuing to enforce a vaccine requirement for patrons.
But mask requirements have been in place in Broadway theaters since they reopened last summer, and the industry has been renewing that requirement on a month-by-month basis. There have been occasional confrontations over the policy — earlier this month the actress Patti LuPone, who is starring in a revival of the musical “Company,” rebuked an attendee at a post-show talkback for the patron’s refusal to fully cover her mouth and nose with a mask. But for the most part, compliance has been high.
There are 35 shows running on Broadway, and last week 246,003 people attended a performance. And if this year follows prepandemic patterns, attendance will pick up over the next few weeks with an increase in tourism after Memorial Day.
When a 35-year-old resident of Snohomish County, Wash., became the first confirmed Covid-19 patient in the United States on Jan. 20, 2020, the county’s public health officer, Dr. Chris Spitters, braced for more.
More came about a month later, with an explosion of Seattle-area cases and the first two reported U.S. deaths. Then, within the next month, hundreds of deaths.
Still, Dr. Spitters recalled in a recent interview, “I honestly figured, ‘Well, a few months, and, you know, we’ll wrap this up.’”
It was hard to imagine then that the number of deaths would cross the current threshold in less than two and a half years. “Who would have thunk, a million?” he said. “That is an overwhelming number. Yet here we are.”
As the United States passes the soul-searing mark of a million Covid-19 deaths, Dr. Spitters, like many local public health officers across the country, is still spending more than half of his time managing the impact of the disease on his county. It is time siphoned away from other pressing public health needs, he said: Only half of Snohomish County’s children ages four to six have had all their recommended vaccinations. Opioid overdoses continue to climb.
His greatest moment of hope, Dr. Spitters said, came about a year ago, when new vaccines became widely available that were highly protective against severe disease and death from Covid. He took pride in the county’s mass vaccination clinics, which sometimes gave shots to as many as 6,000 people a day.
“I thought, well, here we go, we’ll get 80 percent done, we’ll reach herd immunity, and then this thing will recede into a low-level problem that doesn’t grip society,” he said.
He recalled feeling relief that, in part because of the vaccination campaign, the Omicron wave early this year fell short of breaking the local health care system.
Still, he would like to see the 20 percent of residents who are still not vaccinated against Covid get the vaccine. And he would like to see the roughly 40 percent of vaccinated residents who have not received a booster shot get one. Nearly half of Covid deaths across the nation have occurred after vaccines became widely available, mostly among people who were unvaccinated.
As Covid hospitalizations climb once again in Snohomish, Dr. Spitters finds himself still bracing for a Covid variant to emerge that could cause more severe disease.
“Looking back on it, I wonder if there’s something deep in our psyche that sort of protects us from incorporating the full picture, so that we keep trying and don’t get overwhelmed,” he said. “It’s humbling to still be here, struggling with this pandemic. A lot of people have suffered, a lot of people have died.”
I called a woman I had interviewed in March of 2020 whose 65-year-old sister, a resident of the Life Care Center nursing home in Kirkland, Wash., had just died after testing positive for the coronavirus — making her one of the first U.S. victims of what would become a pandemic. In my interview with her this week, Carolyn Lockley shared how she dealt with her grief at a tragic and frightening time when she couldn’t be by her sister’s side in her final days or even hold a memorial for her after she died.
I first interviewed Dr. Chris Spitters, the Snohomish County, Wash., public health officer, when he was handling the first confirmed Covid case in the nation in late January 2020. The Snohomish resident, whose identity was not publicly disclosed, had recovered, his close contacts were being traced and monitored, and Dr. Spitters allowed himself to believe for a brief moment that the spark of the then-novel virus had been extinguished. But ever since that February, managing cases, hospitalizations and deaths in the county from Covid-19 has dominated his work. This week, he said, is “a time to pause’’ to acknowledge the magnitude of a million U.S. Covid deaths.
Carolyn Lockley found some solace that morning in a bird that had landed on the skylight of her bathroom.
Ms. Lockley was washing her face and soothing her eyes, which were swollen from crying. Just moments earlier, she had learned by phone that her younger sister, Renee Gibbs, 65, a longtime resident of the Life Care Center nursing home in Kirkland, Wash., had died of complications from Covid-19.
In early 2020, Life Care was the site of the first big and devastating outbreak of the coronavirus in the United States. And at the beginning of March of that year, Ms. Gibbs became one of the first people in the country to die from it. She had been transferred to a hospital after running a high fever, and there tested positive for the coronavirus before her death.
Ms. Lockley was raw with grief. But as she stood in the bathroom of her home outside Philadelphia, she felt a soothing presence, and her attention was drawn to the visiting bird.
“‘Oh my God, Renee, is that you?’” she recalled saying. “The bird was fussing and fussing. I thought it was my sister’s spirit telling me everything was going to be all right.”
Ms. Gibbs, who was paralyzed because of multiple sclerosis, had been living at Life Care for more than 20 years. She was among 44 people who died as a result of the outbreak at the nursing facility.
It was a time when people were just starting to grasp how Covid-19 spread. They were also learning how precautions like widespread lockdowns could prove cruelly isolating as cases surged around the world.
Ms. Lockley, 69, said that her grief was exacerbated by the fact that she could not be by her sister’s side in the final days of her life.
“It was very painful being that far away and feeling so helpless,” Ms. Lockley said, adding, “She was too sick and not coherent enough to talk on the phone while she was in the hospital.”
Ms. Gibbs’s family could not hold even a memorial service for her, given the risks of gathering. The family opted to have her cremated, but that took months because of a backlog caused by Covid-related deaths.
As she grieved, Ms. Lockley spent time going through cards and photos her sister had sent her over the years, including ones from before she was diagnosed with multiple sclerosis. There were pictures of the two of them together, and one of Ms. Gibbs on a ship. “She loved going on cruises,” her sister said.
Today, more than two years after Ms. Gibbs died, Ms. Lockley said she still feels a void in her life. She misses the phone conversations they had several times a week that could easily last half an hour.
“Renee was my confidante about personal things or anything that might be bothering me,” she said. “Everybody needs somebody to turn to, and she was the one for me.”
Throughout the pandemic, thousands of readers have written into the Coronavirus Briefing newsletter with intimate stories of illness and loss. Many have stuck with me, including a note from Amanda Marie in Atlanta. In December 2020, she wrote in with a provocative headline: “Covid is my friend.” Her 90-year-old husband was in hospice care, and the pandemic allowed her time “at home, just the two of us, for whatever time we have left together and we are grateful.” Four months later, Amanda sent me an update: Her husband had died the previous week. “Now, I have no shoulder to cry on, no hand to hold, no hugs. Flowers and food are left on the doorstep,” she wrote. “Covid is cruel in bereavement. No, Covid, you are no longer my friend.”
They add up to more than 1 million people.
They were Lolita and Louis from New York, a mother and son. They were Ella, a stickler for proper punctuation.
They were Tommy, who loved to rebuild vintage muscle cars. And Leona, who loved to play the Wheel of Fortune slots. Jeanne, who loved being quiet at the beach. Mary, who loved dancing to Mexican music. Johnny, who loved John Wayne movies. Danny, who loved watching hippos at the zoo. Anne-Marie, who loved sparkly things. Thomas, who loved long, scenic car rides. Barry, who loved a good joke. Carolyn, who loved life.
And they were loved. Each left a crater of grief in their wake when they died of Covid. The New York Times examined the listing of survivors in nearly 3,600 obituaries for people all across the United States who have died of Covid since March 2020. Each left behind an average of 15 loved ones.
About 20 percent of those who died left surviving parents and stepparents. About 40 percent left spouses, partners or fiancés. More than 65 percent left siblings. About 75 percent left sons or daughters. More than 60 percent left grandchildren. And many left grandparents, cousins, uncles and aunts, nieces and nephews, and best friends. The analysis did not measure how many young children and teenagers lost loved ones, but a recent study estimated that as many as 200,000 American children under 18 had lost a parent to Covid-19.
“The ripple effects of what we’ve been through, we are only beginning to see,” said Dr. Rebecca Brendel, the incoming president of the American Psychiatric Association.
Dr. Brendel noted that grief from a death affects a wide range of people beyond those who might be mentioned in an obituary. For example, many coronavirus patients have died without family by their side because of social distancing, she said, so already overburdened health workers have often stepped in almost as surrogates in their last moments.
Ashton Verdery, an associate professor of sociology and demography at Pennsylvania State University, said that in early 2020, he was surprised by a persistent narrative that those who were dying from the virus were older, isolated people without close relationships. So he and other professors set out to measure the impact of each death.
They published a peer-reviewed study in July 2020 estimating that for every coronavirus death, approximately nine Americans would be left behind as survivors.
Dr. Verdery said in an interview that the true impact would be greater, because the study did not account for some important kinds of relatives, like in-laws and stepchildren.
“The central point is that these were not socially isolated people,” he said.
Several experts said there was evidence that grief during the pandemic, particularly stemming from the death of a loved one with Covid, has been uniquely terrible.
“We traditionally think about people having a good death where they are in a setting where they are free of pain, their loved ones are surrounding them and their loved ones can tell them how much they meant to them.” said Camille Wortman, a professor emerita at Stony Brook University who has developed a guide of free online resources on grief and Covid.
She said that those characteristics of a good death have often been “incompatible” with a death from Covid, when even holding a simple funeral, an important ritual for dealing with loss, has frequently been impossible.
Prolonged grief disorder, a syndrome in which people feel trapped in a never-ending loop of mourning that lasts for a year or more, was recently added to the Diagnostic and Statistical Manual of Mental Disorders. Some researchers have suggested grief from a Covid death may put people at risk for the disorder. Dr. Wortman said she is concerned that it may.
Dr. Verdery and some colleagues presented research at the annual meeting of the Population Association of America, a nonprofit scientific and professional organization, comparing the health risks of people widowed by Covid with those of people who were widowed before the pandemic. In their research, which has not yet been peer-reviewed, the team found that losing a spouse to Covid was associated with higher levels of depression and loneliness — perhaps in part because losing someone to the virus can be especially fraught.
And negative mental health outcomes, several experts said, may in turn leave people more vulnerable to physical health problems and chronic conditions, like high blood pressure.
For Irene Glasse, the circumstances surrounding her father’s death from Covid still torment her.
In early 2020, Ms. Glasse helped her father, John Grastorf, move into a long-term care facility in Maryland. He was deteriorating from pulmonary fibrosis, an incurable buildup of hard tissue in his lungs, and could no longer live alone. Ms. Glasse liked the facility in part because it was near her home, so she could visit often, and because it encouraged communal activities.
Around St. Patrick’s Day, 2020, the facility locked down as a pandemic precaution. Mr. Grastorf was largely confined to his room, and Ms. Glasse could not visit him for months. But she was grateful when the facility began allowing masked visits on the porch that summer.
Then there was an outbreak at the facility and Mr. Grastorf, 80, caught Covid in December 2020, just as vaccines were starting to be administered at long-term care facilities.
At the hospital, Ms. Glasse was allowed to “moonsuit up” and see her father briefly, but she was not allowed to spend more than a few moments with him — and she was not by his side when he died, something that still haunts her. Ms. Glasse said she went back to therapy and restarted a regimen of mood stabilizers.
“To lose him in this way was very hard,” she said.
One of the most indelible memories I have from covering the pandemic was a rainy day in April 2020. People waited — many for their first time — in a food bank line that stretched for blocks down Coney Island Avenue in Brooklyn. The queue was punctuated by workers wheeling simple wooden coffins from a Muslim funeral home. At the end of April, it would tend to as many as 15 funerals in a day. Nearby on the street, a refrigerated truck used as a makeshift morgue stood just steps away from the huge pallets of food outside the food bank. It was a solemn scene, a collision of all the burdens we would bear in those dark days. But there was also something life-affirming in watching the workers and volunteers persevering to help their fellow New Yorkers through such a dark time.
Health officials in several parts of the United States are seeing worrisome signals in wastewater surveillance data that the coronavirus may be spreading more widely than recent tallies of new cases would indicate, and that a steeper wave may be coming.
Wastewater surveillance provides only a broad-brush picture of virus prevalence in a particular community, but the readings it gives are close to real-time and do not depend on people seeking tests and reporting results. So health officials are looking to wastewater data for early warning of trends. And in some places, those warnings are flashing red.
The data has been like a “canary in a coal mine” for New Orleans, said Dr. Jennifer Avegno, the head of the city’s health department.
Case counts are a “gross underrepresentation,” as many people are opting to take at-home tests instead of going to hospitals or doctors’ offices. Dr. Avegno said the rising prevalence of virus seen in wastewater testing has prompted the city to begin mobilizing resources to prepare for another spike.
Although the city is not considering reinstating mandates, it is preparing in other ways. City officials have begun planning mask giveaways and are stepping up their campaign to encourage residents to get vaccinated and boosted.
New-case counts in the city are averaging 155 a day, five times the rate of a month ago, and wastewater tests show increased coronavirus concentrations in both residential and tourist areas.
“It looks like a surge in slow motion,” Dr. Avegno said. “It’s not the sharp increase we saw with Delta and definitely not with Omicron,” she added.
Houston is another city where wastewater data has been showing ominous signs of increasing infections.
“I don’t know if it’s going to be the magnitude that we saw in the previous surge, but I definitely think we’re starting to see more community infections,” Lauren Stadler, who manages wastewater collection and analysis at Rice University, said in an interview on Thursday.
Harris County, where the city of Houston is, has seen a 175 percent increases in cases in the last two weeks, according to a New York Times database.
Dr. Stadler said that health officials in the city are trying to use the wastewater data to decide what a surge looks like these days.
“I definitely think the wastewater is telling us it’s spreading in the community. But does that mean we’re going to see a surge in hospitals? What does that mean in terms of, like, severity of disease,” Dr. Stadler said. She added that wastewater collection also makes it hard to know who exactly is getting infected, since the data is less individualized.
Scott W. Long, medical director of diagnostic microbiology at Houston Methodist Hospital, said he hoped that people would begin to take more precautions to lessen the severity of the surge in Houston.
“In my personal day-to-day, I know I’ll be masking more outside of work and while traveling,” he said.
In Maine, state health officials have been seeing a surge “for a while,” Mike Abbott, a lead analysts on wastewater screening for the Maine Center for Disease Control and Prevention, said on Thursday. He noted that the increase in cases began in mid-April, with the incline getting steeper in May.
A New York Times database shows that the Maine recorded a sharp upward trend in cases the last week of April and into May that reached levels the state saw during the Delta surge at the end of August.
“We’ve been riding that surge,” Mr. Abbott said. “Now, as far as what’s going to happen next and what we’re worried about, I mean, certainly we’re hoping this isn’t the beginning of a surge similar to what we saw in January with the original variant.”
Experts maintain that the best way to combat surges and protect yourself against the virus is to to be vaccinated.
“My take home advice for people is vaccines are still our best defense. Get boosted if you’re due for one,” Dr. Long said.
An earlier version of this article misspelled the surname of the head of the New Orleans health department. She is Jennifer Avegno, not Avengo. Also, an earlier version of a picture caption with the article misstated the year the picture was taken. It was May 2021, not May 2022.
Covers science and global health
In December 2020, flush with hope that the newly authorized Covid vaccines would defang the coronavirus, I went to visit my in-laws in Rhode Island. Two days later, my editor called: Britain was being walloped by a highly contagious new variant — later known as Alpha — forcing the country to impose its most stringent lockdown since the start of the pandemic. Another variant, later named Beta, was spreading in South Africa. I’ll never forget how somber the experts I called that day sounded. That’s when I realized that the virus would be with us much longer than we had hoped — and perhaps forever.
MELBOURNE, Australia — If the United States had the same Covid death rate as Australia, about 900,000 lives would have been saved.
For many Americans, imagining what might have been will be painful. But especially now, at the milestone of one million deaths in the United States, the nations that did a better job of keeping people alive show what Americans could have done differently and what might still need to change.
Many places provide insight. Japan. Kenya. Norway. But Australia offers perhaps the sharpest comparisons with the American experience. Both countries are English-speaking democracies with similar demographic profiles. In Australia and in the United States, the median age is 38. Roughly 86 percent of Australians live in urban areas, compared with 83 percent of Americans.
Yet Australia’s Covid death rate sits at one-tenth of America’s, putting the nation of 25 million people (with around 7,500 deaths) near the top of global rankings in the protection of life.