Covid is devastating US, leaving uneven toll, more questions than answers

The United States saw the most new coronavirus cases of the pandemic on Thursday, with deaths and hospitalizations also rising. Underlying conditions largely determine who survives.

The United States is winding up a particularly devastating week, one of the very worst since the coronavirus pandemic began nine months ago.

On Thursday, a national single-day record was set, with more than 217,000 new cases. It was one of many data points that illustrated the depth and spread of a virus that has killed more than 278,000 people in this country, more than the entire population of Lubbock, Texas, or Modesto, Calif., or Jersey City, N.J.

“It’s just an astonishing number,” said Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. “We’re in the middle of this really severe wave and I think as we go through the day to day of this pandemic, it can be easy to lose sight of how massive and deep the tragedy is.”

In California, where daily case reports have tripled in the last month, Gov. Gavin Newsom announced a new round of regional stay-at-home orders to address a mounting crisis over intensive-care beds. Some counties in the Bay Area said they were enacting tough new restrictions this weekend, before the state rules come into effect. And in South Florida, which is in the early stages of a new surge, physicians and politicians alike worried that there might not be enough resources to treat the sick.

As the virus has spread, infectious-disease experts have gained a better understanding of who among the nation’s nearly 330 million residents is the most vulnerable.

Nursing home deaths have consistently represented about 40 percent of the country’s Covid-19 deaths since midsummer, even as facilities kept visitors away and took other precautions and as the share of infections related to long-term care facilities fell substantially.

Underlying conditions have played a pivotal role in determining who survives the virus. Americans who have conditions like diabetes, hypertension and obesity — about 45 percent of the population — are more vulnerable.

And new evidence has emerged that people in lower-income neighborhoods experienced higher exposure risk to the virus because of their need to work outside the home.

“The pandemic is us,” said Andrew Noymer, an associate professor of public health at the University of California, Irvine, who added that part of the word “pandemic” derives from “demos,” ancient Greek for “people.” “It’s the same word that gives us ‘demography’ or ‘epidemic.’ The pandemic is collectively all of our actions.”

Upticks on both coasts have more than offset the progress in the Upper Midwest, where new case numbers have started to fall. Some places in the Northeast are now reporting more cases each day than they were in the spring, in part because testing was limited then. Rhode Island is averaging more than 1,000 cases a day for the first time. In New York State, cases have reached record levels around Buffalo and Rochester, with no signs of slowing.

More questions than answers remain about the virus and which people it kills, and why. There has been no modern pandemic of this scale and sort for infectious-disease experts and public health officials to draw from. As with cancer or even the common cold, no one has solved all of Covid-19’s many mysteries.

“You may be a person with cancer who gets exposed to very little virus and you’re going to get a severe presentation,” said Dr. Luis Ostrosky, an expert in infectious diseases at McGovern Medical School at the University of Texas Health Science Center at Houston. “But you may be a young person without comorbidities who gets a massive exposure and you may get a severe presentation as well.”

Months ago, there was a notion that the virus was a big-city phenomenon, as New York, Detroit, New Orleans and other urban centers were hard hit. It has become clear that is no longer true, if it ever was.

The virus has torn through places on the southwestern border with Mexico, where cases are spiking around Nogales, Ariz., and up on the northern border with Canada, too, where the Roseau, Minn., area has set records. Los Angeles and Miami are current hot spots, but so are Ziebach County, S.D., and Deaf Smith County, Texas.

The poor, in particular, have been more at risk than the rich, according to analyses of those who have been sickened by the virus or succumbed to it.

And new studies have suggested that the reason the virus has affected Black and Latino communities more than white neighborhoods is tied to social and environmental factors, not any innate vulnerability.

According to one recent study of cellphone data, people in lower-income neighborhoods experienced significantly higher exposure risk to the virus because they were compelled to go to jobs outside their homes.

Through early May, the number of people in the most affluent neighborhoods who stayed home all day increased by 27 percentage points, while the number in the lowest-income areas increased by 11 percentage points, according to an analysis by social epidemiologists at the Boston University School of Public Health.

“Neighborhoods matter,” said Molly Scannell Bryan, a research assistant professor at the Institute for Minority Health Research at the University of Illinois at Chicago. “In Chicago, both your race and the race of your neighborhood affected where high death rates were.”

Men are dying from the coronavirus at higher rates than women, data has shown. Some researchers suggest that one explanation is that men are generally in poorer health than women, more likely to smoke or have heart disease. By early December, at least 135,000 men had died from the virus in the United States, compared with at least 114,000 women, according to federal data.

There are differences by state and by city, however. Women are more likely than men to die of the virus in Connecticut, but men are more likely than women to die in Arizona, New Jersey and the District of Columbia, according to research from the GenderSci Lab at Harvard, which created a tracker on gender disparities related to Covid-19.

One of the key at-risk demographics is older Americans who live in nursing homes and similar facilities.

More than 787,000 residents and employees of at least 28,000 nursing homes and long-term care centers for older people in the United States have contracted the coronavirus, according to a New York Times analysis based on federal, state, local and facility-level data. Of those infected, more than 106,000 have perished.

The virus is known to be particularly lethal to those in their 60s and older who have underlying health conditions. And it can spread easily through congregate facilities, where many people live in a confined environment and workers move from room to room.

After her husband’s nursing home in Boone, N.C., stopped allowing family members to enter the facility because of coronavirus risks, Doris Greer stood outside his window three or four times a week. They had a routine.

Richard H. Greer, 79, who had heart problems and could not walk after a stroke, would call and ask his wife to bring their dogs, a Rat Terrier and “Boston Weiner” named Macy and Teton. Ms. Greer would drive over and a nursing home employee would slide Mr. Greer’s window open just a little bit, and the two would talk through the screen.

Since March, Ms. Greer had prayed that the coronavirus would not make its way into her husband’s facility, but she thought her husband was well protected because he rarely, if ever, left his room.

Then one day in the fall, she arrived at the window and a worker told her that her husband had tested positive and that they could not talk. His condition soon deteriorated.

She was permitted to go into the facility briefly in September in protective gear. Mr. Greer was on oxygen and unconscious. Joined by her sister, she then went back outside and sat by his window and talked to him. She stayed until it was very late and then came back to the window the next morning.

“I don’t know if he could hear me,” Ms. Greer said. “I just told him he was OK and that I loved him.”

She was still there at the window when he died later that day.