Last January, our cover was an artist's rendering of the planet Earth as a SARS-CoV-2 virus molecule. In my accompanying editorial, I wrote that it was “unfathomable that over 275,000 Americans have died from COVID-19” and that the number would likely increase. Now here we are, a year later, with another COVID-19 cover. The white flags in the cover photo, installed on the National Mall in Washington, DC, by artist Suzanne Brennan Firstenberg, represent each person who has died from the virus. (See On the Cover for more details.) Sadly, according to the Centers for Disease Control and Prevention (CDC), as of November 28 this number had reached 776,070—well over double last year's tally. The flags offer a stark visual image of the magnitude of our loss.
What's especially startling is that the United States leads all countries in both deaths and confirmed cases. The World Health Organization reports that, as of November 29, U.S. confirmed COVID-19 cases totaled 47,837,599; India was second with 34,580,832. Globally, 5,200,267 people have died from the disease. It's disheartening that the United States has lost so many people and could lose so many more, given that vaccines are available.
There was hope that the two vaccines that received emergency use authorization from the Food and Drug Administration last December would bring the pandemic under control. And in the early days of 2021, when the vaccines became available in communities, people scrambled to find appointment times and waited in long lines to be vaccinated. But that initial urgency petered out amid safety concerns, misinformation, and political posturing, and health officials had to resort to advertising campaigns and rewards to encourage vaccinations among the 47 million still unvaccinated adults.
At year's end, we've seen demonstrations against forced vaccinations in many states and termination of unvaccinated personnel in many sectors (including health care, in which it's estimated that 30% of health care workers are unvaccinated). Challenges to vaccine mandates are being pursued in the courts, and time will tell if statutes to ensure the public good will prevail over individual freedom to make health decisions. In the meantime, hospitalizations and deaths from COVID-19 continue, mostly among the unvaccinated. And as we begin 2022, there is an uptick in breakthrough cases in vaccinated individuals, especially among those with comorbid conditions and in areas where there are high numbers of cases (a reason to continue masking in those places, the CDC says)—as well as the threat of new variants.
The past year didn't bring resolution of most of the issues that plagued us in 2020: social inequities and civil unrest, increased gun violence, substance abuse, climate disasters. In November, the CDC released another heartbreaking statistic for 2021: drug overdoses increased by 28.5% over 2020, up from 78,056 to over 100,300.
For nurses and other health care workers, the year has been especially difficult. The Lost on the Frontline initiative from Kaiser Health News and the Guardian estimates that more than 3,600 U.S. health care workers died in the first 12 months of the pandemic. After a second year of being overwhelmed by caring for people who could have prevented their illness through vaccination and being the target of angry patients and families, nurses are leaving hospital positions. Many are doing so reluctantly, saying they just can't do it anymore. As noted in the Atlantic, “Health-care workers aren't quitting because they can't handle their jobs. They're quitting because they can't handle being unable to do their jobs.” And as we've reported in prior issues of AJN, a similar trend is happening in public health and long-term care settings.
On a positive note, children ages five years and up are now able to receive the vaccine and the CDC has recommended booster shots to increase potentially waning immunity in adults vaccinated more than six months ago. It is hoped this will help drive cases down. Innovations and revelations that came about because of the pandemic, like increased autonomy for NPs, more opportunities to access care via telehealth, new partnerships between academia and practice settings (see this month's Special Feature), and heightened awareness of how critical nurses are to a functioning health system, will perhaps drive badly needed system changes. There is reason to hope that 2022 will be a better year.