As we commemorate the fifth anniversary of the World Health Organization declaring the novel coronavirus a pandemic, this is the first of a six-part MSNBC Daily series that reflects on the million American lives lost, the political polarization and the declining trust in public health measures that followed the virus’ spread and assesses the country’s preparedness for the next pandemic.
An oxygen concentrator being used by Lorena Martínez (not her real name) hums like a funeral dirge in her cramped Washington, D.C., apartment, its plastic tubing snaking across the carpet that her 13-year-old daughter vacuums between homework assignments and administering her mother’s insulin injections. At 37, the former bakery manager survives as a living Venn diagram of America’s pandemic failures. She was infected with Sars-Cov-2 (the Covid virus) in the summer of 2020 and had a complex hospitalization resulting in a kidney transplant and an inexplicable lung condition that has left her dependent on oxygen.
Even as one part of America was questioning the efficacy of masks and social distancing, another part was fighting for breath in overwhelmed hospitals.
Her story crystallizes the pandemic’s cruel duality: Even as one part of America was questioning the efficacy of masks and social distancing, another part was fighting for breath in overwhelmed hospitals where doctors tried immunosuppressants, ventilation techniques, antivirals, antibiotics and anything else in the proverbial medical kitchen sink.
The machines that kept Lorena alive testify to medicine’s triumphs; the child shouldering this burden for an overlooked community exposes its bankruptcies. Five years later, we remain two nations: one that feels justified in minimizing Covid and rejecting any mitigation strategies and the other trapped in the long memory of infections, isolation and death.
The evocative image of Covid that former President Joe Biden often cited, a family dinner table with an empty chair, is replicated in countless homes across the nation. Even so, a narrative of resilience and recovery often dominates the official discourse.
The Covid-19 pandemic reveals itself not as a singular event but as a multifaceted crisis that exposed deep-seated fault lines in American society. The numbers tell a chilling tale: over 111.8 million confirmed cases and 1.2 million lives lost as of February 2025. Yet, these statistics, as vast as they are, fail to capture the pandemic’s true scope: the silent suffering, the economic devastation and the erosion of social and scientific trust.
From the outset, the pandemic cleaved the nation into two distinct camps. On one side stood those who embraced public health measures, sometimes at great personal and economic cost. This America witnessed firsthand the horrors of overwhelmed hospitals and clinics, where health care workers battled exhaustion and death daily or at least acknowledged and accepted as true reports of what was happening. The virus quickly surged past influenza, strokes, suicides and car crashes to become the third-leading cause of death in 2020 and 2021, behind only heart disease and cancer. This America, driven by a sense of collective responsibility, lined up for vaccines, wore masks religiously and curtailed social gatherings.
On the other side, beliefs that reports about the virus were false or exaggerated and concerns over personal freedom and economic hardship fueled resistance to lockdowns, mask mandates and vaccination requirements. This America viewed public health restrictions as an infringement on individual liberties, questioning the severity of the virus and the motives behind government interventions. This group of Americans, taking their cues from social media and partisan news outlets, contributed to a climate of mistrust and division.
The economic consequences of these divergent approaches have been profound. The U.S. gross domestic product contracted by 3.5% in 2020, a decrease not seen since the end of World War II. The pandemic’s economic toll as of January 2023 was $4 trillion in government expenditures alone.
The government’s response to the crisis was unprecedented in scale. Operation Warp Speed assembled the best scientific minds to speedily and safely develop vaccines. The CARES Act, with its Economic Impact Payments, sought to provide a lifeline to struggling Americans. The Federal Reserve slashed interest rates and implemented liquidity facilities to stabilize financial markets. These measures came at a cost, with the national debt ballooning to levels unseen in peacetime and businesses large and small suffering from stay-at-home orders and distancing requirements. Perhaps the worst have been the effects on the children who missed graduations or attended most of their classes via computer screen and the adults whose deaths were marked only by virtual forms of grief.
This America questioned the severity of the virus and the motives behind government interventions.
The most uncomfortable pandemic truths lie not in what we got wrong, but in what we refused to see in the evolution of a novel virus. Early missteps — from dismissing aerosol transmission risks to underestimating asymptomatic spread — weren’t mere scientific growing pains; they were systemic failures of imagination that proved deadly for vulnerable populations. Our policy responses, though unprecedented in scale, became Rorschach tests for America’s structural inequities. While white-collar workers Zoomed into virtual meetings, 72% of Black workers and 65% of Latino workers remained trapped in front-line jobs with Covid mortality rates 2.1 times higher than those of their white counterparts.
The $5 trillion stimulus package that saved Wall Street failed to protect a variety of immigrant front-line workers (meatpackers, drivers, grocery store clerks) without relief checks or sick leave — the very essential workforce we applauded nightly from our doorsteps.
Five years after the start of the pandemic, America’s recovery remains fractured by policy choices and viral aftershocks. Unemployment rates have plummeted, but at least 3.6% of adults now battle long Covid— a medical limbo where 68% see no symptom relief after two years. The administration’s reinstatement of 8,000 unvaccinated troops contrasts starkly with long Covid’s $168 billion annual productivity drain. The unanswered questions loom largest: Could viral remnants awaken dormant diseases? Will long Covid’s $3.7 trillion care burden eclipse initial deaths? The changes the Trump administration is implementing will hamper our ability to answer these questions. The Trump administration’s 2025 executive orders have defunded 13 key health agencies, reducing budgets for pandemic preparedness while eliminating 5,200 public health positions, including 10% of the Centers for Disease Control and Prevention’s outbreak and public health leadership. Where inadequate testing capacity once plagued communities, we now face active suppression: New Food and Drug Administration guidelines have halted emergency use authorization for Covid rapid tests, privileging “natural immunity” narratives over diagnostic transparency. The supply chain vulnerabilities exposed in 2020 have become policy choices: The Department of Health and Human Services’ travel restrictions now prevent epidemiologists from investigating H5N1 outbreaks unless mortality rates exceed 5%. As the MAHA Commission focuses on food additives and “technological habit” reforms, the pandemic playbook that guided us through successive Covid waves gathers dust in agency archives. The lesson rings clear: America’s public health vulnerabilities aren’t merely systemic; increasingly, they’re by design. Five years after the start of the pandemic, America stands fractured yet paradoxically transformed. The crisis magnified our deepest divides — urban versus rural, privilege versus poverty, individualism versus collective survival — while stress-testing democracy itself. Yet from this crucible emerged unexpected resilience: telehealth revolutions, remote work permanence and newfound reverence for grocery clerks and nurses. America’s public health vulnerabilities aren’t merely systemic; increasingly, they’re by design. Now comes the existential task: weaving these fractured realities into a national tapestry that honors both our losses and our adaptations. The pressing question isn’t whether we’ll face another pandemic, but whether we can reconstruct a society in which Lorena’s oxygen tubing and Wall Street’s recovery packages occupy the same moral universe. The answer to this question will determine whether we can confront the H5N1 outbreaks now spreading through Midwest dairy farms, reverse plummeting childhood vaccination rates’ fueling measles resurgences in 32 states and address climate-driven disease vectors creeping northward — all while navigating a political landscape in which pandemic-era fractures have metastasized into active hostility toward public health institutions. Our capacity to rebuild trust in science and bridge these divides may prove the ultimate test of whether Lorena’s story becomes a relic of 2020s failures or a harbinger of a 2030s collapse.
Dr. Kavita Patel
Dr. Kavita Patel is a teaching professor of medicine, Division of Hospital Medicine, at Stanford University and a board-certified internal medicine physician. She served in the Obama administration as director of policy for the Office of Intergovernmental Affairs and Public Engagement in the White House. Her area of expertise is around the intersection of health policy, clinical medicine and innovation. She also spends time advising venture capital and is a medical contributor for NBC News. 
