COVID, Two Years Later: Too Much To Grieve?

Two years ago, life changed: the pandemic had started taking roots in the United States, people were scared, communities were impacted and life as we knew it started to shut down. Little did we realize how long-lasting and deep the impact would be.

I looked at the New York Times data this morning and realized (again) that we have lost close to 1 million souls in this country. One can debate whether we could have mitigated that number through various measures over these past two years, but one cannot debate the deep emotional scars and losses that have resulted from that carnage.

And deaths don’t begin to tell the full story: lost jobs, people facing incredible risks daily while performing their jobs, lost moments of joy, lives upended. Then there is the toll of “long Covid” –whose entrails remain to be dissected–preventing some from engaging in meaningful activities of daily living for how long no one really knows.

Although Covid cases are declining in most of the country, we still don’t know the end of this saga. That hangs over us like a sword ready to be unleashed at a moment of unsuspecting notice, throwing us back into a whirlpool of potentially even deeper risk and uncertainty.

I think back to those early days of the pandemic, to a time when we didn’t even know if the word “pandemic” was appropriate, waiting for some authority to declare its moment of truth. I had started a series of conversations with a close friend sometime during February 2020, where we would talk for long conversations contemplating what could happen and how it could be mitigated. At the time, I was a senior physician executive with the American Cancer Society, and in part because of my interest in COVID I was asked to help run the organization’s response to the events that were unfolding rapidly nationwide.

My colleague and I had been doing some back of the envelope calculations as to how many people could die as a result of the virus. At the time we had some early numbers coming out of China, and we would contemplate that close to 2 million deaths could occur in the Unites States. We weren’t far off some of the other numbers being offered by more esteemed experts. We thought that the virus could result in a disaster of massive proportions: that would mean that about 1 out of every 100 adults in the United States could die from COVID, a seemingly impossible number.

Fortunately, we were wrong. It was “only” 1 million—a number that is hard to grasp when you think about it. In comparison, we lose close to 650,000 people a year in this country from cancer—and that is a disease where we aren’t starting from zero at a point in time. In March 2020 we were very close to zero Covid deaths. Getting to 1 million in two years is astonishing—and represents a rate that at times far exceeded the cancer death rate, a disease where we are keenly focused on in efforts to reduce the burden.

And talking about cancer: cancer is a reasonable starting point to consider how Covid will impact outcomes and deaths from other diseases going forward. We already know that deaths from other diseases have increased during the pandemic, likely because people failed to seek necessary care as a result of their fear of getting the virus if, for example, they went to the emergency department for urgent evaluation of chest pain, weakness of an arm or leg, or other tell-tale symptoms of an acute medical event.

Some of the cancer impact will be as a result of similar acute delays, however the cancer outcomes will be affected over a longer time period because diagnoses and treatments have been delayed. Screening for cancer suffered because of fear, resulting in what appears to be later-stage disease in more cases than pre-pandemic. Treatments may be more difficult, and outcomes may suffer.

I attended a meeting in November where a radiologist stood at a microphone and castigated those who advised patients early in the pandemic to delay screening. Since I was one of those he castigated, I stood up and responded, reminding him and others that in the early stages of the pandemic we had no idea what we were dealing with. There was fear of contagion (legitimate fear, I might add), resources were being diverted from less-acute to more-acute care, communities were being advised to lock down in the hope of containing the disease, and the reality that for most cancers where screening is effective there were alternative approaches: mammograms don’t have to be done every year for most women at average risk; alternative stool tests could be used in place of colonoscopy for many folks; the annual pap smear has been fading into oblivion for many women, PSA tests are of dubious value in saving men’s’ lives.

Moreover, we thought that there was a “containment date” in sight a couple of months down the road if we followed the suggested rules. In fact, those containment dates were published routinely on one data set from a reputable institution. All we had to do was get to that date and we could go back to normal, while maintaining careful infection surveillance with tools such as contact tracing and isolation/quarantine of suspected and actual Covid cases and contacts.

Alas, that was not to be: governors opened their states prematurely, people got tired of the rules, we tried to move on with life. We can ask the question whether we were naïve in our thinking, but we should not ignore the need to take the actions we took at the time we took them based on the information and reality that existed at the moment. Lives were being lost in rapid succession, and it was not time for business as usual.

Two years later, one million lives lost, and although the numbers of infections are down, they aren’t down everywhere, and people continue to die at astounding rates here in the United States and throughout the world. And truth be told, even as we “open up” and celebrate a return to pseudo-normal, our joy could be short lived if one virus mutates in one place in one way that gives it the power to evade our immunity, our vaccines and our treatments. If Omicron taught us anything, it taught us that fear and heartbreak can rage once again at a moment’s notice—and there is little we can do to prevent it.

One million lost. Mostly adult. Almost as many deaths as cancer. Sometimes at a much higher rate. Arguments abound. Hostility reigns. Politics subsumes the public’s health. Ignorance triumphs over science. Money is more important than lives.

After two years of dissonance, I wonder: Can we still mourn? Can we truly understand the devastation that has occurred? Can we grasp the totality of the impact? Or is it so overwhelming that we must block it off in a corner of our minds and our souls where it is stashed away, since dealing with the reality would be so overwhelming that it would render us emotionally paralyzed?

Or perhaps we are already emotionally paralyzed, inured to a fact set that is too great to contemplate within the limits of our humanity. Two years that have left us powerless to understand and powerless to grieve much more than we already have. Life as we knew it will never be the same.