COVID-19 is the leading cause of death in the US - again

• The coronavirus has surged to become the leading cause of death in the US again for the first time since spring.
• The COVID-19 death rate in the US is equivalent to a new 9/11 every 1.2 days.
• To turn this around, President-elect Joe Biden will need a strategy to unite all 50 states in tackling the pandemic, according to public-health experts.

The coronavirus pandemic has become the number-one cause of death once again in the US, a position it also held during the spring.

Since November 1, the virus has killed more people in the US than heart disease, cancer, chronic lower-respiratory disease, transport accidents, or suicide, according to an analysis published Thursday in the Journal of the American Medical Association.

The US recorded a record of 3,400 deaths on Wednesday, according to the COVID Tracking Project.

"The fact that a condition that was unknown a year ago now ranks as the leading cause of death at the end of this year is just shocking," Howard Koh, a professor at Harvard's T. H. Chan School of Public Health, told Business Insider. "We need to do everything we can to have this illness revert back to the unfamiliar condition it once was."

Koh was not involved in the new analysis, but he co-authored an accompanying opinion piece.

COVID-19 probably won't be the overall leading cause of death for 2020. But it will be close. The researchers behind the new analysis compared COVID-19 mortality in the US from March to October with leading causes of death during the same months in 2018, when the most recent data is available. Only cancer and heart disease killed more people during that time. For people aged 85 and older, the coronavirus was the second leading cause of death, after heart disease.

"Many, if not most, COVID-19-related deaths could have been prevented," Koh and his co-authors wrote. "Critical public-health strategies must remain a major societal focus for the present and future."

A new 9/11 every day

The COVID-19 death rate in the US has been equivalent to a new 9/11 attack every 1.5 days, according to the new analysis, though in the last week it has grown to a 9/11 about every 1.2 days.

The comparison is "tragically appropriate," said Koh, who was the Massachusetts Commissioner of Public Health during the attacks in 2001. Like the 9/11 attacks, he said, the pandemic "seemed to come out of nowhere." It has also "completely upended all aspects of life in our society, and it's going to have prolonged aftereffects for many, many years to come," he added.

Put another way, the daily death toll is equivalent to 15 passenger planes, each carrying 150 people, crashing every day.

But the official numbers are likely an undercount. Koh and his colleagues write that calculations of excess deaths caused by the pandemic probably underestimate the toll by at least 20%.

Overall, the pandemic will likely prolong a trend of declining life expectancy in the US.

"Good health is so fragile and we cannot take it for granted," Koh said. "Public health protects our good health, 24/7. When prevention works, absolutely nothing happens. And all you have is the miracle of a perfectly normal, healthy day. And that's what everybody is craving right now."

But the upcoming holidays and associated travel and gatherings will likely spur further spread of the virus.

"We would need the public to follow recommendations from all public-health leaders, led by the CDC, about restricting or canceling travel plans. Those recommendations were pretty much ignored over Thanksgiving," Koh said. "We just cannot repeat that again."

Uniting 50 states with 50 different strategies

Though the US comprises just 4% of the world's population, it accounts for 19% of global COVID-19 deaths. It has reported more deaths than any other country.

It certainly didn't have to be this way. At the national level, a lack of clear public-health guidance and a president who spread misinformation and downplayed scientific expertise hampered efforts to build a united front against the virus.

"We've had 50 states following 50 different strategies throughout 2020," Koh said. "That unfortunately ended up negating the impact of the shutdown."

Koh and his co-authors recommended a path forward that includes better coordination between federal, state, and local leaders to increase testing capacity and contact tracing, along with focused outreach about vaccines to communities of color. They also suggested the government should send more resources to overwhelmed hospitals and healthcare workers, along with passing a stimulus package to aid schools, businesses, and people facing eviction.

"The new president has to articulate a national strategy as step one," Koh said. "We have not had that consistent communication throughout the first 11 months of this pandemic, unfortunately."

President-elect Joe Biden has said that once he takes office, he'll institute a 100-day mask mandate, distribute 100 million vaccine doses in 100 days, and make opening schools a priority. Biden has also pledged that his administration will enlist more contact tracers and establish emergency funding sources for vulnerable Americans and essential workers.

With the recent authorization of Pfizer's COVID-19 vaccine, a light flickers at the end of the tunnel. Moderna's is likely to follow suit this week. US officials estimate they will be able to vaccinate 20 million people - primarily frontline healthcare workers and nursing-home residents - by the end of December.

"I'm hopeful that 2021 will be a much better year and that next year will end with this pandemic largely behind us," Koh said. "But that will only happen if we rally as one nation and tackle this pandemic in a united fashion."