The COVID-19 Pandemic: Memorial Day—remembering the uncounted deadJun 1, 2021
May 31, Memorial Day, “…is dedicated to the memory of all U.S. Armed Forces who have died while serving their country.” The total of those who have died directly is enormous, but there is another uncounted, and also enormous, toll of those who died after wars from the sequelae of wounds to their bodies and minds. On Memorial Day, I always reflect on my childhood friend Lewis Puller who died by suicide in 1994. We were high school classmates at Christchurch School, a small boarding school in rural Virginia. Lewis’s father was the legendary Marine Chesty Puller, whose career spanned from the “Banana Wars” (Haiti and Nicaragua) to leading the retreat of the Marines from the Chosin Reservoir during the Korean War.
Perhaps inescapably, Lewis became a Marine Lieutenant and was deployed to Vietnam. He was tragically and gravely wounded, losing his legs and suffering other injuries. We had stayed in touch from high school on. I will not forget visiting him in the Philadelphia Naval Hospital where he resided for a year. Our first meeting was tough, seeing my basketball and tennis partner in a wheelchair, one leg lost at the knee and the other at the hip. Lewis became a lawyer and went on to serve on the Presidential Clemency Board after the Vietnam War. Over the years, he was frank with me about his ongoing alcoholism and painkiller addiction. In the end, he decided no more and ended his life. He is among the uncounted; his name will not be found engraved on the wall of the Vietnam Memorial. He left a legacy in his Pulitzer Prize-winning autobiography, Fortunate Son. Recall the lyrics to the Creedence Clearwater Revival song: “It ain’t me, it ain’t me; I ain’t no military son. It ain’t me, it ain’t me; I ain’t no fortunate one.”
Mirroring war, the COVID-19 pandemic is leaving an enormous uncounted toll. A few weeks ago, I recorded a talk for the Tanta School of Medicine in Egypt. At the time, Egypt (population about 100 million) had a reported death count from COVID-19 of 14,140 while Colorado (population about 6 million) had 6,610 deaths. A simple comparison between Colorado and Egypt implies substantial undercounting in Egypt. The May 15-21 issue of The Economist headlines: “Our new model of the true death toll from covid-19.” The WHO count of COVID-19 deaths is 3.5 million. The Economist estimate is 7 to 13 million based on a reasonable modeling approach. The analysis for Egypt points to a large undercount. Like my friend Lewis Puller and the Vietnam War, there will be a delayed toll from “long COVID” and more. How will we mark and commemorate the deaths from the COVID-19 pandemic?
Without even looking to the long term, Colorado’s mortality figures for 2020 show the sweeping and immediate reach of the pandemic on health. COVID-19’s impact on mortality in Colorado far exceeds the 6,718 deaths due to COVID-19 listed yesterday (May 31) by CDPHE. Sunday’s Denver Post summarizes the mortality picture for 2020: more than 9,000 deaths beyond expected, constituting a 23.5% increase. The increase reflects the broad consequences of the pandemic as it affected well-being and mental health, use of health services, and more. For example, deaths were up from chronic liver disease and cirrhosis (likely from increased drinking), suicide, Alzheimer’s Disease, and Parkinson’s Disease. Tragically, fatal drug overdoses increased by 59%. For mortality during the pandemic, disparities across racial and ethnic groups mirrored those of COVID-19 with greater increases among persons of color, including Asian-Americans and Pacific Islanders.
Memorial Day 2021 was also a time to remember the murder of George Floyd as its first anniversary was reached. The editorials flowed; one impactful consequence of this senseless murder awaits—the potential passage of the George Floyd Justice in Policing Act of 2020. The death of George Floyd and other powerful reminders of structural racism have led to far-reaching activities and assessments at the Colorado School of Public Health. Beyond our posted statements and positions, Cerise Hunt has implemented a broad agenda as Associate Dean for Equity, Diversity, and Inclusion. We will speak with the school about this agenda in a July town hall.
As far as Colorado’s epidemic curve, a drop since last week to about 460 people in the hospital with COVID-19. And the weather—cold and raining for the Memorial Day weekend.
Jonathan Samet, MD, MS
Dean, Colorado School of Public Health