President Joe Biden on Monday confronted the country's once-unimaginable loss -- half a million Americans in the covid-19 pandemic -- as he tried to strike a balance between mourning and hope.
The U.S. topped 500,000 deaths, as recorded Monday by Johns Hopkins University, as states redouble efforts to administer the coronavirus vaccine after last week's winter weather closed clinics, slowed deliveries and forced tens of thousands of people to miss their shots.
Biden held a sunset moment of silence and a candle-lighting ceremony at the White House and ordered that American flags be lowered at federal buildings for the next five days.
Addressing the "grim, heartbreaking milestone," Biden delivered a eulogy for those killed by the virus, saying he felt as if he knew them.
"We often hear people described as ordinary Americans. There's no such thing," he said Monday evening. "There's nothing ordinary about them. The people we lost were extraordinary."
"Just like that," he added, "so many of them took their last breath alone."
Biden spoke in deeply personal terms, referencing his own losses as he tried to comfort the huge number of Americans whose lives have been forever changed by the pandemic.
"I know all too well. I know what it's like to not be there when it happens," said Biden. "I know what it's like when you are there, holding their hands, as they look in your eye and they slip away. That black hole in your chest, you feel like you're being sucked into it."
The president, who lost his first wife and baby daughter in a car collision and later an adult son to brain cancer, sought to leaven the grief with a message of hope.
"This nation will smile again. This nation will know sunny days again. This nation will know joy again. And as we do, we'll remember each person we've lost, the lives they lived, the loved ones they left behind," he said.
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"We have to resist becoming numb to the sorrow. We have to resist viewing each life as a statistic or a blur or, on the news. We must do so to honor the dead. But, equally important, to care for the living," Biden said.
The U.S. toll is by far the highest reported in the world, accounting for 20% of the nearly 2.5 million coronavirus deaths globally. But the true numbers are thought to be significantly greater, in part because many cases were overlooked, especially early in the outbreak.
The first known deaths from the virus in the U.S. were in early February 2020. It took four months to reach 100,000 deaths. The toll hit 200,000 in September and 300,000 in December, then took just over a month to go from 300,000 to 400,000 and another month to climb to 500,000.
Average daily deaths and cases have plummeted in the past few weeks. Virus deaths have fallen from more than 4,000 reported on some days in January to an average of fewer than 1,900 per day.
Despite the rollout of vaccines since mid-December, a closely watched model from the University of Washington projects the death toll to rise to 589,000 by June 1.
But experts warn that dangerous variants could cause the downward trend to reverse itself. And some experts say that not enough Americans have been inoculated yet for the vaccine to be making much of a difference.
Instead, the drop-off in deaths and cases has been attributed to the passing of the holidays; the cold days of midwinter, when many people stay home; and better adherence to mask rules and social distancing.
VACCINE DISTRIBUTION
Snow, ice and weather-related power outages last week closed some vaccination sites and held up shipments across a large swath of the nation, including in the Deep South.
As a result, the seven-day rolling average of administered first doses fell by 20% between Feb. 14 and Sunday, according to data from the Centers for Disease Control and Prevention.
The White House said about a third of the roughly 6 million vaccine doses delayed by bad weather were delivered over the weekend, with the rest expected to be delivered by mid-week, several days earlier than originally expected. White House coronavirus response coordinator Andy Slavitt on Monday attributed the improved timeline to an "all-out, round-the-clock" effort over the weekend that included employees at one distributor working night shifts to pack vaccines.
In Louisiana, state health officials said some doses from last week's planned shipments were delivered over the weekend and were expected to continue arriving through Wednesday. New York City Mayor Bill de Blasio said last week's supply arrived Monday. And in Nashville, Tenn., health officials were able to vaccinate more than 2,300 senior citizens and teachers over the weekend after days of treacherous weather.
Some hospitals, clinics, community sites and pharmacies that are in Louisiana's vaccination network will get double allocations of doses this week -- just as Gov. John Bel Edwards starts offering shots to teachers, day care workers, pregnant women and people ages 55 to 64 with certain preexisting conditions.
New York City officials expected to catch up on vaccinations after being forced to delay scheduling tens of thousands of appointments last week, the mayor said Monday.
"That means we've basically lost a full week in our vaccination efforts," de Blasio said.
More than 44 million Americans have received at least one dose of either the Pfizer or Moderna vaccine, and about 1.6 million per day received either a first or second dose over the past seven days, according to the CDC.
The nation's supply could expand significantly if health regulators approve a single-shot covid-19 vaccine developed by drugmaker Johnson & Johnson.
The company said it will be able to provide 20 million U.S. doses by the end of March if it gets the green light, and it would have the capacity to provide 100 million vaccine doses to the U.S. by the end of June.
ADAPTING TO VARIANTS
Additionally, the Food and Drug Administration said Monday that vaccine developers would not need to conduct lengthy, randomized controlled trials for vaccines that have been adapted to protect against coronavirus variants.
The recommendations, which call for small trials more like those required for annual flu vaccines, would greatly accelerate the review process at a time when scientists are increasingly anxious about how the variants might slow or reverse progress made against the virus.
The guidance was part of a slate of new documents the agency released Monday, including others addressing how antibody treatments and diagnostic tests might need to be retooled to respond to the virus variants.
Together, they amounted to the federal government's most detailed acknowledgment of the threat the variants pose to existing vaccines, treatments and tests for the coronavirus, weeks after the FDA's acting commissioner, Dr. Janet Woodcock, said the agency was developing a plan.
"The emergence of the virus variants raises new concerns about the performance of these products," Woodcock said in a statement Monday. "We want the American public to know that we are using every tool in our toolbox to fight this pandemic, including pivoting as the virus adapts."
Most of the manufacturers with authorized vaccines or candidates in late-stage trials have already announced plans to adjust their products to address the vaccine variants. The Moderna and Pfizer-BioNTech vaccines use mRNA technology that the companies have said can be used to alter the existing vaccines within six weeks, although testing and manufacturing would take longer.
STUDY IN SCOTLAND
Meanwhile, researchers in Scotland reported Monday that first doses of the Pfizer-BioNTech and AstraZeneca shots greatly reduced hospital admissions from covid-19 among the elderly -- by up to 85% and 94%, respectively.
British public health officials hailed the results from the "real-world" studies showing that the vaccines are beginning to have a positive effect in the coronavirus pandemic. Arne Akbar, president of the British Society for Immunology, called the initial data "extremely promising."
The researchers analyzed a data set covering the entire Scottish population of 5.4 million, of which 1.1 million people -- about 20% of the population -- have received a first dose of the Pfizer or AstraZeneca vaccine. Then they compared the vaccinated against the unvaccinated, and they saw strong evidence of protection.
From December until the middle of February, more than 8,000 people ended up in hospitals with covid-19 in Scotland, but only 58 of those patients came from the vaccinated group.
Combining results for both vaccines for people 80 and older, there was an overall 81% reduction in hospital admission by the fourth week, said Aziz Sheikh, professor of primary care research and development at the University of Edinburgh and one of the principal investigators.
Sheikh cautioned that the immunity offered by the first doses of the vaccines could wane. But more will be known as researchers follow the vaccinated after their second doses.
Alongside these encouraging results, British Prime Minister Boris Johnson on Monday outlined the next steps in lifting the country's third national lockdown, a "road map" that he said he hopes will be "cautious but also irreversible."
Information for this article was contributed by Heather Hollingsworth, Tammy Webber, Jonathan Lemire, Josh Boak, Brian Hannon, John Antczak, Jonathan Mattise, Melinda Deslatte, Rachel La Corte, Sophia Tareen, Wayne Parry, Matthew Perrone and Zeke Miller of The Associated Press; by Noah Weiland, Katie Thomas and Carl Zimmer of The New York Times; and by William Booth and Karla Adam of The Washington Post.
