More than 300,000 people have died from COVID-19 in the United States.
It is the latest sign of a generational tragedy — one still unfolding in every corner of the country — that leaves in its wake an expanse of grief that cannot be captured in a string of statistics.
"The numbers do not reflect that these were people," says Brian Walter, whose 80-year-old father, John, died from COVID-19. "Everyone lost was a father or a mother, they had kids, they had family, they left people behind."
There is no analogue in recent U.S history to the scale of death brought on by the coronavirus, which now runs unchecked in countless towns, cities and states.
It's equivalent to Sept. 11 happening nearly 100 times. One person now dies every 36 seconds from COVID-19.
"We're seeing some of the most deadly days in American history," says Dr. Craig Spencer, director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center.
During the last two weeks, COVID-19 was the leading cause of death in the U.S., outpacing even heart disease and cancer.
"That should be absolutely stunning," Spencer says. "At what point do we wake up and say, this can't be normalized?"
And yet the most deadly days of the pandemic are still to come.
By the end of January, the U.S. is expected to have lost more people to COVID-19 than service members in World War II, according to projections from the Institute for Health Metrics and Evaluation at the University of Washington.
Even with a rapid rollout of vaccines, the U.S. may reach a total of more than half a million deaths by the spring, says Ali Mokdad of the Institute for Health Metrics and Evaluation.
Some of those deaths could still be averted. If everyone simply began wearing face masks, more than 50,000 lives could be saved, the institute's model shows. And social distancing could make a difference, too.
No other country has come close to the calamitous death toll in the United States. And the disease has amplified entrenched inequalities. Black and Hispanic/Latinos are nearly three times more likely to die from COVID-19 than whites.
"I'm really amazed at how we have this sense of apathy," says Dr. Gbenga Ogedegbe, a professor of medicine and population health at New York University Grossman School of Medicine. He says there's evidence that socioeconomic factors, not underlying health problems, explain the disproportionate share of deaths.
The disease, he says, reveals "the chronic neglect of Black and brown communities" in this country.
Though the numbers are numbing, for bereaved families and for front-line workers who care for people to their dying moment, every life is precious.
Here are reflections from people who've witnessed this loss — how they are processing the grief and what they wish the rest of America understood:
"There are things that we can do to still make a difference"
Darrell Owens, a doctor of nursing practice in Seattle, was startled to learn recently he had signed more death certificates for COVID-19 than anyone else in Washington state.
Owens runs the palliative care program at the University of Washington Medical Center-Northwest, where he's treated COVID-19 patients since early spring.
"I'm feeling much more anger and frustration than I did before because much of what we're dealing with now was preventable," Owens says.
"We're all in this great big storm, but some people are in a yacht and some people are on a cruise ship and some people are on a raft," he adds. "We're not all in this together."
Owens still finds moments of grace and meaning as he cares for the dying.
"The other day, there was a lady I was taking care of who'd come from a local nursing home, and it was very clear that she was nearing the end; her breathing patterns had changed," Owens says. "I just picked up her hand. I sat there. I held her hand for about 25 minutes until she took her last breath."
He stepped out and called the patient's daughter.
"It made such a difference for her that her mom was not alone," he says. "What an incredible gift that she gave me and that I was able to give her daughter. So there are things that we can do to still make a difference."
''It's not a hoax, and you will not understand how horrible this is until it enters your family"
Since his father died of COVID-19 in the spring, Brian Walter of New York City has helped run a support group on Facebook for people who've lost family and friends to COVID-19.
It's helped him grieve his father, John, whom he described as a loving man dedicated to his autistic grandson and to running a youth program for teenagers.
"It's been lifesaving in a lot of ways," Walter says. "Together, we face a lot of issues since we are grieving in isolation. But at the same time, we're also dealing with people that openly tell us that this is not a real condition, that this is not a real issue."
Some in their group admit that they denied the severity of the virus and shunned precautions until it was too late.
"It's not a joke, it's not a hoax, and you will not understand how horrible this is until it enters your family and takes away someone," he says.
All of this complicates the grief, but it has also led Walter and others in his group to speak out and share their stories, so that numbers don't obscure the actual people who were leading full lives before dying from COVID-19.
"I know what it's like to have to say goodbye to somebody over a Zoom call and to not have a funeral," Walter says. "You look at these things and say: 'There are hundreds of thousands of people that are going to be experiencing this before it's over.' "
"300,000 stories that got shut down too quickly"
Martha Phillips, an emergency room nurse who took assignments in New York and Texas in the spring and summer, says there is one patient who has become almost a stand-in for the grief of the many whose deaths she has witnessed.
It was the last COVID-19 patient she cared for in Houston.
"I reached down to just adjust her oxygen tubing just a little bit," Phillips recalls. "And she looks up at me and she sees me through my goggles and my mask and my shield and meets my eyes and she goes, 'Do you think I'm going to get better?' "
"What do you say to someone who's not ready to die? Who has so much to live for, but got this and now they're trapped?"
Phillips remembered her name. Two months later, she discovered the woman's obituary online.
"That one was the hardest," she says. "But there's 300,000 people who had time left that was stolen from them, 300,000 stories that got shut down too quickly."
"Often what is most healing is ... to not be alone with it"
Katherine Evering-Rowe, a therapist in Philadelphia, helps run the COVID Grief Network, which provides free counseling for people in their 20s and 30s who've lost someone to the disease.
"We're hearing that it just feels like there aren't so many people in their lives that really get what losses to COVID are like for them," she says. "These are so often preventable losses."
People have a range of feelings when they're grieving, but Evering-Rowe says there is more anger and isolation with COVID-19.
"Often what is most healing is ... to not be alone with it, being able to talk to other people, being able to congregate, to feel supported," she says. "And one of the big tragedies of COVID is that's not something available to people in the same way."
Many young adults are enduring the loss of a parent — in some cases it's both parents or an entire household, she says.
These deaths have come when they still expected to have ample time left with their parents. And she says typically there are not spaces in American society for younger adults to process this kind of loss together — let alone hundreds of thousands of them all at once.
"I think people are grieving one life at a time, and that's a lot of grief," she says.
"This is worse than being in war"
ER doctor Cleavon Gilman, a veteran of the Iraq War, says it's still hard to communicate the brutality of a disease that kills people in the privacy of a hospital wing, not on the streets.
"I get up, have a cup of coffee, tell my family goodbye and go into the hospital, where there are tens of patients who are critically ill, gasping for breath and getting intubated and dying," he says.
When Gilman was in New York City during the spring surge, he never imagined the U.S. would be losing thousands of people each day to COVID-19 so many months later.
"That 300,000 Americans would be dead and life would go on and people would not have empathy for their fellow Americans," he says. "I can tell you this is worse than being in war."
The enemy is invisible, he says, the war zone is everywhere, and many refuse to take the most simple actions to combat the virus, even as morgues fill up in their own community.
"I call this a crime against humanity, because that's exactly what this is."
Throughout the pandemic, Gilman has shared photos and stories of people who've died from COVID-19 each day on social media. He wishes someone in every city or town of America would do the same.
"All the people that you're not going to see a big article about and you're not going to hear about them anywhere else," he says. "It's really important to honor them."
''Nobody wants to hear sad stories like these"
Nurse Jessica Scarlett saw more death in three months of caring for COVID-19 patients in McAllen, Texas, than she did in her previous 15 years as a nurse.
"It was just extremely difficult to see so much death," she says. "We'd see families praying in front of the hospital, praying for us and for their family on our way into work."
It was unlike any nursing she'd ever done before. Almost the entire hospital was on oxygen. Nurses would sit at the foot of the bed because there wasn't any other space.
She became intimately familiar with the progression of the disease, with patients needing more and more help breathing until eventually being placed on life support.
"And there's nothing you could do," she says. "There was one guy, he would always say, 'Please sit with me — I'm really scared.' And the day before I left, he was intubated."
After that, Scarlett says she needed a break from such a "tremendous amount of death."
She's still trying to grasp all the tragedy, seeing daughters and mothers ending up in the hospital after a family reunion.
What happened inside that hospital felt like its own separate reality. She hasn't talked about her time there with almost anyone else, except other nurses.
"Nobody wants to hear sad stories like these, people don't want to," she says.
This story comes from NPR's reporting partnership with KHN (Kaiser Health News).