'Cannot believe we are here': US hits 700,000 COVID-19 deaths, a milestone we never expected to reach

When the clock ticked down to zero on 2020, the nation watched the ball drop in Times Square – on TV, from home – and said good riddance to a year marked by a brutal pandemic that forced lockdowns, crushed many businesses and killed 350,000 Americans.

So far 2021 has brought little relief. And on Friday evening, the United States passed the dark threshold of 700,000 coronavirus deaths, including another 350,000 this year.

The U.S. reached 600,000 deaths in June, when daily deaths had dropped to under 400 and many were optimistic the end was near for the ruthless world crisis, at least at home. Vaccines were widely available to all American adults and teens. For free.

Three-plus months and 100,000 deaths later, 2,000 Americans are dying per day. And millions have lost interest in the fight. Football stadiums are packed with maskless fans, some in states that ban vaccination and mask requirements.

Soon it will be winter, indoor venues will draw crowds, and people will go inside to socialize. All that increases transmission risk, said Ogbonnaya Omenka, an associate professor and public health specialist at Butler University in Indianapolis.

Reaching 800,000 deaths isn't a longshot, and the specter of even 1 million deaths looms.

"Given the current rates and expectations, the possibility of reaching 800,000 by the end of 2021 is not unreasonable," Omenka said. And beyond that, "because the ending depends mainly on human preferences, we can hit that (1 million) number."

Why do some resist COVID vaccines but embrace monoclonal antibodies?

Dr. Eric Cioe-Peña, director of Global Health at Northwell Health in New Hyde Park, New York, agrees.

"I think it’s realistic that we will see more surges, especially in counties with low vaccination rates, and that we will hit 1 million dead," he said. "I hope we don’t, and I think we still have the ability to end this pandemic in the U.S. and the world."

Vaccinations were a game changer, but many Americans balked. And vaccinated people can spread the virus and get sick themselves, we've learned. "Breakthrough" infections among those who took the jabs are troubling. Now booster shots are the go-to fix.

"I honestly thought we would come together as a nation and defeat this," Cioe-Peña said. "There is a large part of me that cannot believe we are here."

So how did we get here?

The numbers just kept going up

The pandemic started with little global fanfare in Wuhan, China, late in 2019, and soon swept around the world. In the U.S., a wave of defenses ranging from lockdowns, social distancing and masks to vaccines and now boosters have thus far failed to end it.

The first known COVID-19 death in the United States was reported in early 2020. In March of that year, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, warned that 100,000 to 200,000 people could succumb to the disease.

By the end of May 2020, the U.S. death toll was 100,000 – an average of more than 1,000 deaths each day. Four months later we reached 200,000, and Fauci was somberly suggesting that U.S. deaths could reach 300,000 to 400,000.

Three months after that we reached 300,000, and in five more weeks – in the last days of Donald Trump's presidency – COVID-19 had taken 400,000 U.S. lives.

'This is our generation’s D-Day': As US surpasses 500,000 COVID-19 deaths

In February, the death toll reached 500,000. Marty Makary, a professor at the Johns Hopkins School of Medicine and Bloomberg School of Public Health, suggested in a Wall Street Journal opinion piece then that herd immunity was near.

"At the current trajectory, I expect COVID will be mostly gone by April, allowing Americans to resume normal life," Makary wrote.

That was then, this is now. Melissa Nolan, an assistant professor of epidemiology and biostatistics at the University of South Carolina Arnold School of Public Health, said early models indicated a 1-year transmission cycle for the coronavirus, which "unfortunately is not what came to reality."

Noah Greenspan is a specialist in cardiovascular physical therapy who has been treating COVID-19 "long haulers" for more than a year. When his Manhattan-based Pulmonary Wellness & Rehabilitation Center closed in March 2020, he expected to reopen a few weeks later.

"Never did I think it would be permanent," he said.

Greenspan says lack of preparation and resources overwhelmed every aspect of the health care system.

"I also think because of misinformation, poor messaging and political posturing, it was very difficult to get reliable guidance on what we should and shouldn’t do, from masks to social distancing to vaccines," Greenspan said.

Cioe-Peña blames the lack of a coordinated response across the nation and around the world.

"A lack of clear communication and vaccine rollout," he said. "A lack of the fundamental responsibility of government at its core in support of public health and clear, common-sense policies that both support people through the pandemic as well as break transmission."

Why transmission rates saw a resurgence

The development of more easily transmissible variants, such as the delta variant, has fueled the resurgence of transmission. The loss of natural immunity over time among unvaccinated people who previously were infected continued the transmission cycle, Nolan said.

The variants seem to be getting some help: No state governments contemplated lockdowns, even as case and death records were set. State leaders in some of the hardest-hit states barred local governments and schools from requiring masks.

Perhaps most critically, the promise of safe, potent and free vaccinations has failed to crush the pandemic as millions of Americans refuse to get the shots. America now gives fewer first-dose vaccination shots in a week, about 1.5 million, than it once gave on a typical day, about 2 million.

Even some health care workers are passing on the vaccine. Thousands of them face losing their jobs in New York state, where vaccines just days ago became mandatory for them.

'Like toilet paper and hand sanitizer': At-home COVID-19 tests hard to find as Biden mandate looms

Human behaviors, international travel outcomes, vaccination success rates and new variants are among the keys that will determine where the pandemic goes from here, experts say.

"I stand by all Americans when I say that I hope we never see 1 million deaths," Nolan said, adding that current models predict a decline in COVID-19 cases and fatalities. But that assumes no additional variants become an important factor in global transmission, she said.

Three new variants are emerging in South America: mu, iota and gamma. Nolan said the majority of the world is seeing delta as the dominant variant, which will eventually fade out. But if one of the new variants takes hold and starts racing through populations and geographic regions "we might see a resurgence."

Greenspan says that as long as there is strong resistance to vaccines, masking, social distancing "and pretty much any other recommendations made by almost anyone, I see no reason why anything would change."

So what is safe?

Major League Baseball games have been playing before big crowds all summer. The National Football League has played before packed houses. But Cioe-Peña says it's time to pump the brakes on mass gatherings. Mandating vaccination for all is "the only way out of this," and the only way to make mass activities safe, he said.

"Then we can start to move toward normalcy like filling stadiums," he said. "Without a vaccine requirement, filling stadiums is definitely not a good idea."

Smaller gatherings, such as restaurants and movie theaters, also involve risk. New York City requires proof of vaccination for indoor dining and Broadway shows. But some states prohibit such mandates. Omenka says public policy decisions are challenging because of the inseparable relationship between the pursuit of public health and money and socialization.

"It is left for individuals to take charge of their health ... by making informed decisions about their health and safety," Omenka said.

Will the pandemic ever end?

The pandemic's end has been a moving target since it began. Masks and social distancing were the world's first remedy, but every time the curve of infections – then deaths – headed down, a "surge" pushed it back up. The delta variant was the fourth or fifth surge, depending on who is counting, and no one can say with certainty it will be the last.

Omenka said it's difficult to anticipate what comes next because of the "myriad uncertainties" surrounding the virus and American reaction to it.

"But if we don't get things under control, that is tantamount to allowing all the numbers to keep rising," Omenka warned.

Experts say COVID-19 may never fully disappear, but they almost universally agree on how to end the pandemic. Cioe-Peña said that means a concerted effort to get people vaccinated, including children, and break the cycle of infection and reinfection.

Data supports his assertion. In Mississippi, the state that had the lowest vaccination rate when the delta surge began three months ago, about 1 of every 1,439 residents has died since. That's about eight times the death rate of the most vaccinated state, Vermont, where about 1 of every 11,555 residents has died since.

"Get vaccinated, get vaccinated, get vaccinated," Nolan said.

Contributing: Mike Stucka

This article originally appeared on USA TODAY: COVID-19 deaths in US hit 700,000. When will the pandemic end?