Americans are Suffering: Looking Beyond Covid-19

Photograph by Nathaniel St. Clair

Nearly one year ago, in April 2020, Dr. Lorna Breen, the ER medical director at New York Presbyterian Allen Hospital, committed suicide. She had earlier contracted Covid-19 while treating patient.  According to her father, “She was — in every way — in the trenches of this war, fighting the effects of this COVID virus that she contracted herself,” he said. “She went home and stayed for a week-and-a-half before she felt obligated to go back to the trenches and help, so that’s what she did.”  She committed suicide shortly thereafter. 

Dr. Breen is but one of the more then half-million — 514,000 as of March 1st! — people was have died from Covid-19; little data is available about those who have taken their own life.  As with Dr. Breen, the stresses associated being an ER doctor likely contributed to her fateful decision.  Such stresses are shared by many “essential” workers.  As the Centers for Disease Control and Prevention (CDC) reports, millions of other Americans are enduring all manner of stresses, including the loss of a jobs; eviction for failing to pay back rent or foreclosure for failing to pay their mortgage; burdened by debt; feeling locked in by stay-at-home requirements, leading to increased domestic violence, including child abuse; and still others.

Understandably, the media and public attention has been focused on the deaths caused by the pandemic and the vaccines that might bring an end to it.  It has extended and deepened the recession, exposing the profound racial and class disparities in society.  The former U.S. Surgeon General, Jerome Adams, admitted, “I and many black Americans are at higher risk for COVID. That’s why we need everyone to do their part to slow the spread.”  He identified a host of factors contributing to this situation including preexisting conditions such as diabetes, high blood pressure and heart disease as well as the lack of access to health care.

Sadly, today’s appropriate focus on coronavirus casualties and vaccines has led many to overlook the deepening social crisis the nation has been enduring for more than a decade.  A growing proportion of Americans are enduring the painful decline in their quality of life.  One example of the crisis is startling: During the half-century between 1959 and 2016, Americans’ life expectancies increased by nearly 10 years.  However, the Covid-19 pandemic has contributed to an expected drop of 1.13 years, bringing life expectancy to 77.48 years.

Sadly, in the years before Covid the death rate grew significantly. Between 2010 and 2017, the death rate increased from 328.5 to 348.2 per 100,000 people.  “There has been an increase in death rates among working age Americans,” said Dr. Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University. “This is an emergent crisis. And it is a uniquely American problem since it is not seen in other countries. Something about life in America is responsible.”

Woolf notes, “while it’s a little difficult to place the blame on despair directly, the living conditions causing despair are leading to other problems.”  He adds, “for example if you live in an economically distressed community where income is flat and it’s hard to find jobs, that can lead to chronic stress, which is harmful to health.”

Before Covid hit, the principle causes for this increase in the death rate was due to what Woolf and others identify as “diseases of despair.”  They include drug overdoses, suicides, alcohol abuse and a “diverse list of organ system disease.” Three examples illuminate the nature of despair:

+ Between 1999 and 2017, fatal overdoses increased by 386.5 percent; in 2017, more than 70,000 deaths occurred because of drug overdoses and opioids accounted for more than 47,000 of those.

+ During the same period, deaths due to alcohol abuse conditions – e.g., chronic liver disease and cirrhosis of the liver — rose by 40.6 percent.

+ Between 2000 and 2016, death rates among three involving unintentional injuries, Alzheimer’s disease and septicemia increased.

Much of this suffering is rooted in a person’s stagnate or declining wages or earnings. The Hill reported, “The coronavirus has revealed the vulnerability of millions of American workers, leaving them without that much-needed next paycheck, and with no guarantees of a future gig.”

The Economic Policy Institute (EPI) confirmed this assessment in its analysis of the wage crisis in America: “From 1979 to 2018, net productivity rose 108.1 percent, while the hourly pay of typical workers essentially stagnated — increasing only 11.6 percent over 39 years (after adjusting for inflation).” The EPI adds, quite pessimistically: “This means that although Americans are working more productively than ever, the fruits of their labors have primarily accrued to those at the top and to corporate profits, especially in recent years.”

To compensate for flattening of wages and earning, Americans have become addicted to debt.  The New York Federal Reserve estimated that, in mid-2019, consumer debt approached $14 trillion.  The four major categories of dept and their amount are: (i) mortgages at $9.4 trillion; (ii) student Loans at $1.48 trillion; (iii) auto debt at $1.3 trillion; and credit-card loans at $1.08 trillion.  As everyone knows, debt carries more than a monetary burden.

These developments fueled growing inequality, a situation compounded by the unchecked pandemic and its economic and social consequences.  In the pre-pandemic era, inequality was felt most acutely among the poor and working classes, especially children.  Harvard’s Raj Chetty, of the Opportunities Insights group, wrote, “our research shows that children’s chances of earning more than their parents have been declining. 90% of children born in 1940 grew up to earn more than their parents.”  He concluded, pessimistically, “Today, only half of all children earn more than their parents did.”

Their assessment is confirmed by a JAMA (Journal of the American Medical Association) published study, “Life Expectancy and Mortality Rates in the United States, 1959-2017.”  It warned, “life expectancy at birth, a common measure of a population’s health, has decreased in the United States for 3 consecutive years.”  It adds:

The recent decrease in US life expectancy culminated a period of increasing cause-specific mortality among adults aged 25 to 64 years that began in the 1990s, ultimately producing an increase in all-cause mortality that began in 2010. … By 2014, midlife mortality was increasing across all racial groups, caused by drug overdoses, alcohol abuse, suicides, and a diverse list of organ system diseases.

The study’s data came from the National Center for Health Statistics and the U.S. Mortality Database for 1959 to 2017. Americans are dying at an ever-growing rate and this many one of Trump’s unspoken legacies.

JAMA pessimistic assessment is compounded by the findings of a May 2019 study of the American Journal of Public Health, “The Depths of Despair Among US Adults Entering Midlife,” by Lauren Gaydosh, et. al.  Drawing on a sample of 18,446 “self-identified as non-Hispanic White, non-Hispanic Black, or Hispanic” Americans, it assesses “change in indicators of despair from adolescence to adulthood using multilevel regression analysis, testing for differences by race/ethnicity, education, and rurality.”

Most surprising, Gaydosh’s study found a rise in despair among “the young adult cohort now reaching midlife that cuts across racial/ethnic, educational, and geographic groups may presage rising midlife mortality for these subgroups in the next decade.”  It notes, “The factors underlying these patterns remain unknown.”  But adds most provocatively:

However, current explanations point to labor market changes driven by globalization and technological change, leading to deteriorating job opportunities, wage stagnation, and declining rates of upward mobility for low-educated individuals.  These economic factors undermined social support by eroding traditional family structures and religious participation, resulting in despair.

It adds: “Although these trends affected all racial/ethnic groups, scholars suggest that historical advantages lead to greater feelings of relative subordination among low-educated Whites compared with low-educated racial/ethnic minorities and that Blacks may be ‘inured to insults of the market” and insulated by strong support networks of kin and religion.’”

The National Institute of Mental Health (NIMH) reported that “an estimated 17.3 million adults in the United States had at least one major depressive episode. This number represented 7.1% of all U.S. adults.”  The American Psychological Association claims that “approximately 40 million American adults ages 18 and older, or about 18.1 percent of people in this age group in a given year, have an anxiety disorder.”  It adds, “major depressive disorder affects approximately 14.8 million American adults, or about 6.7 percent of the U.S. population age 18 and older in a given year.”

Depression and despair are often manifest in the growing condition of obesity.  According to the CDC, from 1999–2000 through 2017–2018, the prevalence of obesity increased from 30.5 percent to 42.4 percent of the population; the prevalence of severe obesity increased from 4.7 percent to 9.2 percent.

Among the most extreme symptoms of despair and depression are increases in the murder rate and suicides.  The New York Times reported that “the average murder rate across 20 major cities averaged 37% higher at the end of June than at the end of May” – a 6 percent increase over 2019.  The Times report was based on the finding by Richard Rosenfeld, a criminologist University of Missouri-St. Louis.  In a separate study, Rosenfeld notes, “compared with the previous three-year average, homicide rates decreased during April and May of 2020.”  As the economy “opened” and a version of pre-Covid-19 “normal life” returned, the murder rate rose dramatically.

The CDC reports that suicide “was responsible for more than 47,000 deaths in 2017, resulting in about one death every 11 minutes.”  Going further, it adds, “Every year, many more people think about or attempt suicide than die by suicide. In 2017, 10.6 million American adults seriously thought about suicide, 3.2 million made a plan, and 1.4 million attempted suicide.”

Americans are suffering and this suffering is compounded by a host of determining factors, including Covid-19 and recession.  Together, they’ve contributed to a significant increase in unemployment, debt, homelessness and despair.  They have only compounded the growing inequality between the superrich and the rest of Americans, especially the working classes and the poor.  The deepening socio-economic crises are mediated by age, race, gender and where one lives — and these factors will define what “recovery” means.   Nevertheless, the suffering will continue and, sadly, only get worse.




David Rosen is the author of Sex, Sin & Subversion:  The Transformation of 1950s New York’s Forbidden into America’s New Normal (Skyhorse, 2015).  He can be reached at; check out