An art installation on the National Mall in Washington DC in the US honouring victims of the pandemic. Each white flag represents an American death from COVID-19

It’s a strangely odd number. One in three hundred as a decimal is 0.0033 which is largely meaningless to most people. As a percentage it’s represented as 0.33% – a little more familiar to the average layperson. In a format that’s simpler for most people to grasp, it represents 3.3 out of 1,000.

It is also the cumulative number of people in the United States of America who have died from COVID-19 since March 2020.

One out of every 300 people who was alive in March 2020 in the US is dead.

At that time, we knew so little about COVID-19 and when we reflect on the epidemiological modelling predictions, there is a strange disembodiment and other-worldliness to them that is haunting. The world slowly began to grasp the scale and scope of this pandemic as evidenced by the canary-in-the-coal-mine carnage seen in China, Italy and other parts of Europe. On 14 March 2020, The New York Times reported that ‘between 160 million and 214 million people in the United States could be infected over the course of the epidemic, according to a projection that encompasses a range of four scenarios’. The article went on to report that modellers predicted that the pandemic ‘could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities. As many as 200,000 to 1.7 million people could die’.1

Looking back, the numbers were astonishingly accurate.

But it didn’t have to be this way.
Almost half of the one million Americans who have died as a result of COVID-19 succumbed to this disease after vaccines became available. Some of the early deaths in 2020 were unavoidable – we lacked knowledge, therapeutics, testing capabilities, PPE and vaccines.

We didn’t know what we were dealing with and, as a result, we didn’t know how to deal with it.
These are different times, however. Almost every COVID-19 death is avoidable today. It is beyond debate at this stage that the vaccines we have available are incredibly efficacious at preventing hospitalisation and death.

And these one million lives have not been spread equally across America. There are more deaths in those over 65 years of age than any other age group by far. When we stratify by race, COVID-19 has disproportionately affected those from communities of colour (Hispanic and African American). The impact of socioeconomic status has been shown to be significantly associated with COVID-19 incidence and mortality. And educational attainment has also proven to be a differentiator in the total aggregate lives lost to COVID-19. And then, of course, there are those lives lost by political affiliation, geography and vaccine status.

Let me put ‘one in three hundred’ in some disease perspective for you. Four out of 1,000 fifty-year-old women will die in the next ten years from breast cancer. In the next ten years, three out of every 1,000 men aged 55 who are smokers will die from colon cancer. And the same number of men aged 60 or older who are smokers will die from prostate cancer in the same ten-year period. But we have already lost 3.3 out of 1,000 American to COVID-19 in the last two years. I can go on. I can present you with all manner of probabilities and odds of contracting some rare disease or dying of some illness. But you get the point.

When we think about the potential loss of life from everyday diseases like breast, colon and prostate cancer over a ten-year period juxtaposed against the deaths from COVID-19 in a two-year period, it is truly both stupefying and breathtaking.
And to add further insult to injury, the number of one million is probably an underestimate. By how much? Maybe 10%. Or 20%. Who knows?

Numbers are funny. We use them every day but we rarely stop and think about them. Phone numbers. Stock prices. Academic test scores. Once in a while, though, there is a number that resonates. It sticks. Because it reminds us of a morning more than two decades ago, 9/11. Or because it is a pop culture reference that everyone knows, like 007. Or because we are forced to learn it in school, like 3.14.

The final death count in America from COVID-19 will never be truly known. And the question of when we will actually stop counting is really impossible to answer – likely, never. But one day, we will reach two million and five million and our hearts will ache as much then as they do now. Soberingly, we will think then about when it was just one in three hundred.

1https://www.nytimes.com/2020/03/13/us/coronavirus-deaths-estimate.html; NY Times, March 14th, 2020