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In wave after deadly wave, COVID has claimed 1 million lives in the U.S.

Nurse educator Katie Demelis and nurse manager Nydia White wrap the the body of a patient who died of COVID-19 at Mount Sinai South Nassau hospital in Oceanside, N.Y., on April 15, 2020.
Jeffrey Basinger
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Newsday via Getty Images
Nurse educator Katie Demelis and nurse manager Nydia White wrap the the body of a patient who died of COVID-19 at Mount Sinai South Nassau hospital in Oceanside, N.Y., on April 15, 2020.

One million.

That's how many people have now died from COVID-19 in the U.S. since the pandemic began, according to Johns Hopkins University. It's a toll once thought unimaginable.

Even though passing 1 million deaths has been widely expected for some time, the reality is still devastating.

"It is terrible — horrible," Dr. Anthony Fauci, the White House's chief medical adviser, told NPR in an interview. "To have that many people die of a transmissible disease in a two-year period — it is very sobering, and very sad and tragic."

One million deaths is far more than the number of people who have died from AIDS in the U.S. since that pandemic began decades ago, and more than died from the 1918-1919 flu pandemic. It's about the population of San Jose, Calif., the nation's 10th largest city.

A health care worker tends to a COVID-19 patient who is using a continuous positive airway pressure machine to aid her breathing at Providence St. Mary Medical Center in Apple Valley, Calif., in January 2021.
Ariana Drehsler / AFP via Getty Images
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AFP via Getty Images
A health care worker tends to a COVID-19 patient who is using a continuous positive airway pressure machine to aid her breathing at Providence St. Mary Medical Center in Apple Valley, Calif., in January 2021.

"It's one of these things where the numbers are just so large, it's hard to even wrap your head around it," says Jennifer Nuzzo, a Brown University epidemiologist. "It's just unfathomable to think that those are people — loved ones — who are now missing from this earth. It's really, really hard to comprehend."

So many people died from COVID-19 that a disease that didn't exist three years ago became the third leading cause of death in this country, after heart disease and cancer.

So many died in the prime of their lives that the U.S. experienced the biggest drop in life expectancy since World War II, dropping to the lowest in more than a quarter-century.

"It just boggles the mind, as if our minds needed any more boggling from this pandemic," says Dr. Howard Markel, a University of Michigan medical historian. "It makes me very sad."

A "Yellow Heart Memorial" on the National Mall in Washington, D.C. in May 2021 displays names of people who died from COVID-19.
Drew Angerer / Getty Images
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A "Yellow Heart Memorial" on the National Mall in Washington, D.C. in May 2021 displays names of people who died from COVID-19.

To compound the tragedy, experts agree that 1 million underestimates how many people have actually died from COVID-19 — many deaths went unrecorded or were attributed to other causes.

The toll also doesn't include those who died for other reasons because of the pandemic because, for example, they couldn't get the care they needed for diseases like heart attacks, diabetes and cancer.

Nor does it take into account all of the additional suffering and ruined lives the pandemic has caused. People have lost their jobs or businesses, become addicted to drugs or alcohol out of despair, suffered abuse, fallen behind on their education and experienced intense grief from losing loved ones.

"It's like this giant snowball that is going to take this cumulative toll on the nation's health, in addition to what it's already done in terms of COVID death," says Debra Umberson, a University of Texas, Austin, sociologist.

Nurses and health care workers outside Mount Sinai Hospital in New York City remember their colleagues who died during the first wave of the coronavirus outbreak in April 2020.
Johannes Eisele / AFP via Getty Images
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AFP via Getty Images
Nurses and health care workers outside Mount Sinai Hospital in New York City remember their colleagues who died during the first wave of the coronavirus outbreak in April 2020.

Despite all this, the nation seems intent on putting the pandemic behind it, even as infections are rising again, new variants are looming, and hundreds are still dying every day.

"It's shocking to me that so many people have accepted a million dead. This is not a trivial number. That's a million human beings," says William Hanage, a Harvard T.H. Chan School of Public Health epidemiologist. "And the fact that we have taken this appalling toll, and folks are so keen to move on from there --and not examine how we got there — is deeply depressing."

Experts say there are many reasons for this. A big part of it is that people are just exhausted, utterly depleted from two very long years of hiding from the virus, living in fear and watching so many parts of their lives get devastated.

But part of it is who has died. Many were older people.

A cleaning crew wearing protective clothing enters the Life Care Center in Kirkland, Wash., in March 2020. The nursing home had some of the earliest deaths in the U.S. due to COVID.
John Moore / Getty Images
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A cleaning crew wearing protective clothing enters the Life Care Center in Kirkland, Wash., in March 2020. The nursing home had some of the earliest deaths in the U.S. due to COVID.

"There's a narrative out there that's incorrect that: 'These old people were probably going to die anyhow,'" says Deborah Carr, a professor of sociology at Boston University. "And that's not necessarily true. People in their 70s and 80s may indeed have had many more years left. And COVID took those years away from them."

The pandemic also hit poor people and people of color harder, which means large parts of society haven't been hit directly or nearly as profoundly.

"There's been incredible inequality in who's died of COVID in terms of race and ethnicity," says Umberson.

At the same time, many deaths occurred out of public view. Many died alone in nursing homes or intensive care units, which compounds the tragedy but makes it seem remote.

Friends and family mourn the death of Conrad Coleman Jr. following his funeral service in July of 2020 in New Rochelle, N.Y. Coleman, 39, died of COVID just over two months after his father also died of the disease.
John Moore / Getty Images
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Friends and family mourn the death of Conrad Coleman Jr. following his funeral service in July of 2020 in New Rochelle, N.Y. Coleman, 39, died of COVID just over two months after his father also died of the disease.

"People sort of died off-stage," says Dr. Nicholas Christakis, who studies social networks at Yale. "And obviously people who have seen death up close from COVID-19 have a very different perspective than those who have not."

Another factor is that while many people may know some directly who died, or even know someone who lost someone, most people don't.

One estimate is that every person who died left nine close relatives behind. While that means millions of people are mourning, only about 9 million people out of a country of almost 330 million are immediately affected.

"You probably heard of someone — a co-worker maybe, or a friend of a friend, or someone down the street, or in your building, or something like that, who died," Christakis says. "But the probability that you are intimately connected to someone who died is low."

A COVID-positive woman, 25, grieves after her mother, 54, died at home of COVID-19 in September 2021 in Houston. She says they had planned to be vaccinated the following week.
John Moore / Getty Images
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Getty Images
A COVID-positive woman, 25, grieves after her mother, 54, died at home of COVID-19 in September 2021 in Houston. She says they had planned to be vaccinated the following week.

What most people have seen up close is how the pandemic has disrupted their lives by, for example, preventing them from visiting elderly parents, going to college, seeing friends, traveling or keeping a job.

The massive omicron surge has receded, and vaccines and better treatments are now keeping most people from getting seriously ill and dying. But millions of people are still unvaccinated or under-vaccinated, infections have started creeping up again, and another, even more dangerous variant could erupt at any time.

In the meantime, tens of thousands more will die over the next year even if another variant doesn't emerge, according to the latest estimates.

"People are going to continue to die," says Justin Lessler, a University of North Carolina, Chapel Hill, epidemiologist who helps advise the Centers for Disease Control and Prevention. "Even though we don't expect to see anything like we've seen in the last two years over the coming year — absent a new variant — a significant number of people will still die."

A candlelight vigil in Washington, D.C., in January 2022 honors nurses who died during the COVID-19 pandemic.
Brendan Smialowski / AFP via Getty Images
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AFP via Getty Images
A candlelight vigil in Washington, D.C., in January 2022 honors nurses who died during the COVID-19 pandemic.

And while it's impossible to know exactly when the pandemic will finally end, and what the long-term impact will be, experts say it's likely to be profound.

"It's been a seismic event in the history of the world. It's been a catastrophic event in the history of the United States," says Allan Brandt, a Harvard University medical historian.

"I think that we will be living in the age of COVID-19 long after we have greater control over the pandemic. And I do think historians and anthropologists, sociologists and economists will be evaluating the impact of this pandemic for the rest of the twenty-first century," Brandt says.

Copyright 2022 NPR. To see more, visit https://www.npr.org.

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Rob Stein is a correspondent and senior editor on NPR's science desk.