Within the next two weeks, the United States is projected to hit a total of 1 million Covid-19 deaths since the start of the pandemic. Writing for STAT News, J. Emory Parker dives into the data and outlines the "five pandemics" that led the United States to this grim milestone.

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The 5 pandemics leading to 1M Covid-19 deaths

1. People infected earlier vs. those infected later

At the start of the pandemic, New York City was hit hard, with a death rate peaking around 63 per 100,000 people in one week in April 2020, the highest Covid-19 death rate of any area in the country throughout the pandemic.

But as the pandemic went on, progress was made in how health care providers treat Covid-19 patients, Parker writes. More knowledge about the disease, the availability of new treatments, and the introduction of effective vaccines made it so the ratio of deaths to cases started to drop.

That ratio even stayed low as more Americans were infected by the omicron variant. However, Parker notes that despite the deaths-to-cases ratio remaining low, the absolute number of people contracting Covid-19 from omicron was very high, meaning the omicron wave led to some of the deadliest weeks throughout the entire pandemic.

2. Older patients vs. younger patients

The vast majority of Covid-19 deaths have been among those ages 65 and older.

However, that doesn't mean the disease hasn't had a significant effect on younger people, Parker writes.

According to CDC data, Covid-19 was the fourth-leading cause of death among those ages 15-24 in the United States in 2021, below suicide and above malignant cancers. Meanwhile, Covid-19 was the second-leading cause of death among those ages 25-44 and the leading cause of death among those ages 45-54.

3. Unvaccinated patients vs. vaccinated patients

Since Covid-19 vaccines became available in 2021, it has become clear the death rate among the unvaccinated was significantly higher than the vaccinated, Parker writes.

During the omicron wave in the United States, the Covid-19 death rate among unvaccinated Americans peaked at roughly 26 per 100,000, compared with 2 per 100,000 among the vaccinated and half that among those who had received a booster shot.

4. Rural patients vs. urban patients

Covid-19 hit major American cities hard at the start of the pandemic, but gradually moved its way to more rural areas, Parker writes.

In August 2020, Covid-19 death rates were higher in non-metropolitan areas than in metropolitan areas, and in December 2020, more people per capita had died of Covid-19 in rural counties than urban ones.

There are several reasons for this gap, Parker writes, including access to hospitals being more challenging in rural regions than in metropolitan areas, and higher vaccination rates in cities compared with rural parts of the United States.

5. Poorer patients vs. wealthier patients

According to CDC data, those most affected by Covid-19 were the economically and socially vulnerable, Parker writes.

Data shows that counties with a higher rate of uninsured people—defined by CDC as greater than 11.4%—had higher average Covid-19 death rates than those with lower rates of uninsured people, as did counties with higher proportions of people in poverty.

Similarly, counties that had higher social vulnerability indexes—which combine a variety of factors like socioeconomic status among residents, household composition, and minority status—had higher Covid-19 death rates than those with lower scores.

What happens going forward

CDC's data shows how the United States ended up approaching one million Covid-19 deaths, but it's "clear that we have entered a new phase of pandemic response characterized by a greater tolerance of risk and a greater desire to return to a sense of normalcy," Parker writes.

Going forward, the pandemic "will settle into new patterns of harm, with inequities cast into even sharper relief," Parker writes. "People with existing health complications, older people, and people who already face the challenges of economic and social vulnerability are poised to bear the brunt of society's increased risk tolerance. Whether or not we are done with the virus, it seems the virus will do its best to stay with us." (Parker, STAT News, 5/10)