The vaccines are here – but what has America already lost?

On 14 December, a nurse in New York was the first person in the US outside of a clinical trial to receive a dose of vaccine for Covid-19.

The arrival and potential promise and success of a widely available vaccine marked a turning point in the public health crisis, a glimmer of hope to stem the overwhelming tides of death and suffering as a polarised government – led by Donald Trump’s administration that has all but ignored the surging infections and deaths in the final weeks of his term in office – struggles to combat the disease.

Three days later, health officials reported a record-high number of US coronavirus deaths in a single day – some 3,400 people, more than American lives lost on 9/11. The US also reported a record-high number of patients that day, more than 113,000, who are currently hospitalised for the disease, 10 months into an outbreak that does not reveal any signs of slowing. That record was broken several more times in the days that followed.

Within the final weeks of 2020, Covid-19 has become the leading cause of death in the US. More than 330,000 Americans have died, or one in every 1,000 Americans – a death toll that could reach 400,000 early next year, eclipsing American lives lost during World War II, based on projections from the Institute for Health Metrics and Evaluation at the University of Washington, or a 9/11 roughly every day for more than 100 days.

The arrival of a vaccine is too late for some, a grim irony that while many Americans will receive the first doses, thousands of others who have only recently been infected will die.

How does America grieve at a scale of death unlike any other in modern US history?

The first doses of Pfizer’s vaccine are being distributed to high-risk health workers and long-term care residents and staff. More than 3 million doses have been slated for delivery within the first week of the vaccine’s availability, and another 3 million are on hold for distribution for second doses – the vaccine requires two shots, a few weeks apart.

On 17 December, the Food and Drug Administration gave Moderna’s vaccine an emergency use authorisation, bringing thousands more doses to the US.

While vaccines for long-term care residents and staff are readied, the nationwide surge in cases in those facilities is increasing. For many patients, the double dose of vaccine will arrive too late.

The final weeks of 2020 saw the highest infections and deaths at long-term care centres like nursing homes since The COVID Tracking project began reporting long-term care data in May.

More than 5,000 people in long-term care died within the second week of December, a 26 per cent increase from the previous week. That week is “the worst one we’ve seen,” said COVID Tracking Project’s Artis Curiskis.

“The vaccine offers the promise of an eventual end to the wrenching losses we’ve seen in nursing homes and other [facilities],” the group reported. “But complete immunisation for every vulnerable resident and staff member may take months to achieve. In the time between initial vaccinations and growing outbreaks, we are all but certain to see tens of thousands more Americans die of Covid-19 in [long-term care centres].”

Nearly 20 million confirmed infections have been reported in 2020, with an average number of daily new cases remaining above 200,000 within the year’s final days, according to Johns Hopkins University – more than three times higher than the outbreak’s summer peak in July.

Lawmakers, health officials, physicians, epidemiologists and critics of the administration have echoed a similar phrase: it did not have to be this bad.

No other country has come near the scale of coronavirus death in the US, and Covid-19’s devastating impact among Black and Latino Americans has exposed the chronic neglect and deep inequities within the nation’s health systems.

More than 22 million Americans lost their jobs at the pandemic’s first peak in the spring, and while many returned to work in the months that followed, the president’s promised recovery never arrived. Moody’s Analytics forecast the nation’s economy will return to pre-pandemic levels at the end of 2023. Millions of people have also lost their employer-provided health insurance.

In the wake of the pandemic’s economic fallout, congressional Republicans have been reluctant to provide meaningful economic relief, including extending life-changing unemployment benefits and placing moratoriums on evictions and student loan payments.

After those extended benefits expired, personal incomes decreased in every state compared to the second quarter, by nearly -30 per cent in West Virginia and roughly -25 per cent in Kentucky, according to the Bureau of Economic Analysis.

Following the initial CARES Act payments, a deadlocked Congress has been stalled for months, unable to reach an agreement on a second legislative package, as states continued to open up for business without lawmakers agreeing on a plan to “pay people to stay home”.

After weeks of negotiations in Congress, the president has refused to sign a broad economic package that includes extending federal unemployment benefits as well as a moratorium on evictions, throwing millions of lives into jeopardy.

But even after a return to “normal”, if the vaccines are effective and there are encouraging signs of employment returning to pre-pandemic levels, the nation’s upended economy and the way the US lives and works will have irrevocably changed, from surges in online shopping and streaming services replacing in-person theatres, to ongoing physical distancing guidelines and businesses mining productivity from an increasingly at-home workforce.

Following a deadly spring and a simmering summer, the US entered its next “surge” in the fall, after federal benefits expired and people returned to work – more than 3 million new confirmed infections were reported in November alone, representing a quarter of all US cases since the beginning of the outbreak.

The administration has argued that its increased testing availability caused the spikes in cases – if that were true, the tests would keep pace with the rate of infections. Cases continued to increase week over week.

Mr Trump’s insistence that testing increased cases was one of dozens of fabrications from the White House, from repeated claims that Covid-19 was “going away” despite his own admission that he “downplayed” its impact, to claims that a “cure” was available and shifting blame to Democrats and China, without recognising the crisis at home.

Meanwhile, he was hospitalised for the disease for three days and a likely source of transmission for an outbreak at the White House that impacted more than 100 staffers, while he hosted campaign rallies bringing thousands of unmasked people into crowds, spawning other infections across the US.

Absent a coherent federal response to the outbreak, leaving states to adopt an inadequate patchwork of start-stop “lockdowns” and other measures to prevent the disease from spreading, the federal government has hinged its success on the efficacy of a vaccine – which won’t be widely available to all Americans until mid-2021.

Its distribution – heralded by the administration as part of its Operation Warp Speed to ramp up the creation and production of vaccine candidates and other potentially life-saving drugs – will not ensure the lives of thousands more Americans in the meantime but it has given the government a reason to pursue its aggressive return to normal.

That patchwork response among states – struggling under their own crippled budgets and resistance among Republican officials to adopt effective coronavirus protocols – has left the lives of millions of Americans hanging in the balance.