segunda-feira, 21 de setembro de 2020
O que significa 200 mil mortes nos Estados Unidos?
Two Hundred Thousand Americans Are Dead What have we learned during the coronavirus pandemic—and what have we refused to learn? By Dhruv Khullar September 20, 2020 The novel coronavirus is about to claim its two-hundred-thousandth American life. (It may already have done so; statistics lag.) Less than eight months have passed since the start of the pandemic At some point in 1993, the two-hundred-thousandth American died of AIDS. By that time, a decade had passed since the Centers for Disease Control and Prevention first described the emergence of a mysterious new syndrome. Freddie Mercury and Arthur Ashe had died of the virus, and Magic Johnson had announced his retirement from the N.B.A. Tom Hanks was soon to win an Oscar for his role as an H.I.V.-positive gay man, in “Philadelphia.” Still, the tragic milestone passed without much notice. H.I.V. had become the leading cause of death among young American men, but researchers and activists were still fighting to raise awareness about the virus, and acceptance for the people who were suffering from it. Two years earlier, the hundred-thousandth American had died of AIDS. That death was announced in a short article on page eighteen of the Times, which dispassionately reviewed statistics and projections. The novel coronavirus is about to claim its two-hundred-thousandth American life. (It may already have done so; statistics lag.) Less than eight months have passed since the start of the pandemic. There hasn’t been time to make a movie about it, and there’s been no need to raise awareness; the toll of the virus is tracked daily, even hourly, across the country and across the world. But that doesn’t make the extraordinary loss of life any easier to fathom. In less than a year, COVID-19 has killed four times as many Americans as died from the opioid crisis during its deadliest year. It has killed more Americans than those who perished in every armed conflict combined since the Second World War. Globally, it has killed nearly a million people. Reckoning with such a number, we might try to imagine the dead as individuals. Though the virus is worse for those who are older, people of all ages have died, and of all races, backgrounds, trades, and political persuasions. Each life lost was embedded in a web of relations. According to one estimate, each person who dies of COVID-19 leaves behind an average of nine surviving family members. If this is right, then there are now at least 1.8 million Americans mourning the loss of kin—parents, husbands, wives, children, siblings, grandparents—and millions more who are mourning with them. Meanwhile, as a doctor, when I think of two hundred thousand lost lives, I think of the ones I wasn’t able to save while caring for patients in the early days of the outbreak in New York. I think of the couples transferred hand in hand to the hospice unit; of a parent comforting young children through FaceTime; of an elderly man worrying about using a ventilator that might be needed by someone younger. Moments of national tragedy are usually met with elevating Presidential rhetoric. The country looks to its leaders to offer hope and give meaning to its collective suffering. Three days after the September 11th attacks, in a speech at Ground Zero, George W. Bush told the nation, “I can hear you. The rest of the world hears you. And the people who knocked these buildings down will hear all of us soon.” Later, at a prayer service, Bush said that “grief and tragedy and hatred are only for a time. But goodness, remembrance, and love have no end.” After President John F. Kennedy’s assassination, Lyndon B. Johnson called on the country to “put an end to the teaching and the preaching of hate and evil and violence”; he urged Americans to turn away from “the apostles of bitterness and bigotry.” No such messages will be coming from this President. Donald Trump has abdicated both managerial and moral leadership. (“I don’t take responsibility at all,” he has said, and, “It is what it is.”) Instead of helping the nation heal, he uses his bully pulpit to sow confusion, division, and distrust. He freely admits to misleading the public about the lethality of the virus; he disrupts the efforts of public-health agencies, tarring them with his own brand of partisanship and misinformation; he argues that talk of the virus is designed to damage his reëlection prospects. Meanwhile, his surrogates describe the pandemic, which sickens or kills thousands more Americans each day, in the past tense. There are those, including the President, who question the veracity of the U.S. coronavirus death estimates. That skepticism doesn’t cohere with reality. Across the United States, excess mortality—the difference in the total number of deaths, from any cause, compared with a historical average—far exceeds official tallies of COVID-19 fatalities. In all likelihood, there are more, not fewer, COVID-19 deaths than we have confirmed. And the pandemic, in addition to devastating the economy, has caused enormous collateral health damage. Thousands of Americans have had their medical care postponed or cancelled, or have chosen to avoid health care altogether for fear of contracting the virus. Many have died. In the United States, peaks of panic have given way to plateaus of resignation. The country continues to record tens of thousands of new coronavirus cases each day but remains without a coherent plan to alter that trajectory. Because we never truly subdued the virus, we’re experiencing our newest waves on rising seas. In May, after strict lockdowns, the number of newly diagnosed cases levelled off at around twenty thousand per day. But September’s number is closer to forty thousand. We’re performing more tests, and that helps explain the higher number of new confirmed cases. But it’s also true that the virus is circulating in more places than before. Early in the pandemic, it became clear that a coherent and unified national response would not be coming. States were left to procure supplies and equipment on their own. Individuals and families waded through mixed messages about how contagious and lethal the virus was—and about how they might keep themselves and their loved ones safe. At the end of February, Jerome Adams, the Surgeon General, tweeted that masks are “NOT effective in preventing general public from catching #Coronavirus,” and Robert Redfield, the director of the C.D.C., said that there was “no role” in the pandemic for masks worn by ordinary Americans. Those messages may have been intended to preserve mask supplies for health-care workers, but they seriously damaged the public’s trust in the information that was being provided by the country’s top health officials. It wasn’t until early April—after New York had logged tens of thousands of cases, and after the virus had seeded every state in the country—that the C.D.C. advised the public to begin wearing masks. (Redfield has since said that “cloth face coverings are one of the most powerful weapons we have to slow and stop the spread of the virus.”) It’s easy to focus on national numbers. But the story of the American pandemic is really that of a virus bobbing across the country, searching for oxygen as it’s tamped down in one region or another. A pandemic that began in dense metropolitan areas has now made its way to every part of the United States. In the Northeast, states that once stored dead bodies in refrigerated trucks are now among the safest in the country. Other states, including California and Ohio, took early and decisive action but have seen cases and deaths rise over time. At the beginning of June, new COVID-19 hot spots were more likely to be rural counties than urban ones. By then, the virus had crept into small towns and ski resorts, the Navajo Nation and the rural South, and into prisons, retirement communities, and meatpacking plants, leaving a trail of destruction in its wake. By staying home and flattening the curve, Americans succeeded in buying time for many health-care systems to adjust. The likelihood of dying of COVID-19 has declined substantially since the pandemic began, in large part because we’ve gotten better at preparing for and treating the disease. A statistic called the case-fatality rate (C.F.R.) measures the percentage of people who go on to die after being diagnosed with a disease. States where the pandemic hit early—New York, New Jersey, Massachusetts—ended up with C.F.R.s above seven per cent; the national average is now about three per cent, thanks to lower death rates in states where the virus spread later. In recent months, therefore, the apocalyptic elements of the pandemic have receded from view. There are fewer places where endless streams of patients confront dwindling I.C.U. capacity; there are fewer bidding wars for ventilators and N95s. We’ve settled, instead, into a grinding battle, in which lives are lost incrementally but no less tragically. Six thousand dead in Georgia; two thousand in Minnesota; fifteen hundred in Nevada. It’s these small yet significant numbers, adding up month after month, that have gotten us to two hundred thousand. The coronavirus has assailed America’s image of itself. How does one reconcile the deaths of two hundred thousand people—a fifth of all the COVID-19 deaths in the world—with the idea of an exceptional America, a compassionate America, a scientifically advanced America? The most piercing question has come to be whether we live in a just America. Inequalities in income, housing, employment, and medical care have resulted in Black and brown Americans dying of COVID-19 at higher rates than whites. The pandemic has especially hurt low-income Americans, many of whom are now out of work, but Congress remains locked in a stalemate over whether and how to deliver relief. Meanwhile, in some states, more than half of all COVID-19 deaths are linked to nursing homes, where many older Americans have died without being able to say goodbye to their loved ones. We tolerate these deaths because of a communal ageism. Our inability to protect the most vulnerable Americans has become both a public-health failure and a moral stain.