400,000: The invisible deaths of covid-19

In a Connecticut hospital room, a woman less than 48 hours from death posted on Facebook: “It is now just a matter of trying to keep me comfortable till I pass.”

A few days before Christmas, less than a week before he died at home, a California man texted his daughter: “Vaccines on the way. Gettin kinda close.”

Four hundred thousand Americans have now died of covid-19. It took 12 weeks for the death toll to rise from 200,000 to 300,000. The death toll has leaped from 300,000 to 400,000 in less than five weeks.

The numbers are huge and the coronavirus pandemic has dramatically changed daily life, from work to play to the most basic of human relationships. Yet these are, by and large, invisible deaths: Coronavirus victims who die in the hospital often spend their final days cut off from family and friends, their only human contact coming from medical personnel hidden behind layers of protective gear. Even those who die at home often decline in quarantine, keeping a lonely vigil over their body’s fight.

Beyond death, covid’s casualties suffer further indignities: Storage in refrigerator trucks parked outside overwhelmed funeral homes, funerals that must be closed to mourners, lonely burials, cremations delayed by weeks or months because of the backlog.

The pace of death has never been faster, despite all efforts by scientists, public health officials and politicians. The historically swift development of effective vaccines, improved treatment of the most severe cases and a stronger consensus around mask-wearing have failed so far against the shortcomings of an overwhelmed health-care system, a painfully slow start to the vaccination campaign, and a continuing political divide over how serious the virus is and how hard to try to contain it.

Just three months ago, Anthony Fauci, the nation’s infectious-disease chief, imagined that “if we don’t do what we need to in the fall and winter, we could have 300,000 to 400,000 covid-19 deaths.”

Now, with more than 1 of every 1,000 Americans dead from the virus, a University of Washington model that predicted the current totals forecasts 567,000 U.S. deaths by April 1, a number that could jump above 700,000 if mask mandates are eased in the interim.

In the middle of a grim winter marked by mass death, seemingly uncontrolled illness and the most unnerving threat to U.S. democracy in more than 160 years, amid the rapid acceleration of coronavirus cases and deaths, an increasing portion of Americans are ready to take the vaccine - 60 percent, according to an Axios-Ipsos survey this month, up from 48 percent a month earlier. In addition, a majority remain worried about catching the virus (77 percent in a Quinnipiac poll last month.)

Each death from covid-19 is at once a number and a unique tragedy, and each is a strangely distant demise - so many invisible deaths in lonely places.

“Dear friends, I’ve been in the hospital for over a week with Covid,” Earla Dawn Dimitriadis wrote on Facebook on Dec. 1. She explained that paramedics had found her at home, “lethargic and barely hanging on ... Unfortunately they are unable to keep my levels up. There was damage done to my lungs and pneumonia set in. I’m unable to talk on the phone, due to lack of oxygen. But now that I have my phone I can post some. Please pray "

Her friends replied with 205 prayers, hugs and crosses.

They were friends from the after-school program in Stamford, Conn., where Dimitriadis, 66, had spent more than 25 years, teaching art and running operations. They were customers of the business she’d created to sell jewelry she made at home. They knew her as a woman who posted online not about politics but about the beauty of a blue moon, the importance of finding one’s true path and the sweetness of her cat, Chatty Cathy.

Later that day, from the ICU at St. Vincent’s Medical Center in Bridgeport, she posted again: “When I was a little girl, I would grab the Sears catalogue and circle my ‘wishes.’ I usually never received any of the items, but it always would make me feel good inside. ... So during my time here in the hospital, (I’m) putting together a wish list of things I love, and make me smile. It helps to get me through these days in isolation ICU and focus on beauty instead of all these machines and monitors.”

Beneath that message, she posted photos of bejeweled dragonflies, their wings spread wide, their direction strong and clear.

Dimitriadis grew up in New York’s Hudson Valley and didn’t get past junior high school. But as an adult in Connecticut, she had three children, went back to school, earned a bachelor’s degree and a master’s in psychology, wrote plays, developed her art and launched her business.

On Dec. 3, she posted: “I’m losing the battle with Covid ... I’m ready to go and not be in pain anymore. I love you all ... This will probably be my last post. Be kind to each other. I love you "

The comments poured in: “Keep fighting!” many said. People prayed for her. A woman apologized “that I was not so open to your help.”

“I can’t lose you,” a grandson wrote.

On the phone, Dimitriadis told her two daughters to be strong, that this loss would make them stronger, recalled Jennifer Ritz Sullivan, 36, the younger daughter.

“She was fine with everything in life,” Sullivan said. “She told us she would always be with us.”

Dimitriadis, who declined to be put on a ventilator, was struggling to breathe through an oxygen tube. She couldn’t talk after that last call, but she posted on Facebook a few songs that comforted her, songs of faith by Josh Groban and Alan Jackson, and Gerry and the Pacemakers’ version of “You’ll Never Walk Alone:”

“At the end of the storm, there’s a golden sky, and the sweet silver song of a lark ...”

On Dec. 4, Sullivan received a brief text from her mother: “They’ll be moving me into hospice soon.”

A nurse told Sullivan they would turn down Dimitriadis’s oxygen “and it was just a matter of time.” Sullivan stayed up all night, waiting.

At 10 a.m. on Dec. 5, Sullivan sent her mother one last text:

“Mom, I don’t want to bother you. I know you can’t read this but I want you to know. I’m sitting outside and it is snowing. I am talking to you out loud hoping that you can hear me. I’m thinking about all the good times that we had. Thinking about the way your hands were always the softest, your skin was always warm and soft, and smelt like tea rose ...”

“I am so proud to be your daughter,” Sullivan texted. “I love you to the moon and back. I look forward to seeing you again.”

There would be no reply.

A few hours later, while her daughters were on the phone with each other sharing stories and photos, they got the call.

Dimitriadis had posted the details of her decline even though “she’d tried to shield people from pain all her life,” Sullivan said. “But in her final days, dying by herself, she wanted to share with folks that this is possible for anyone to get. She told her story for a reason.”

When the coronavirus first hit South Florida, Steven Neher, a nurse practitioner, and his longtime partner, Christian Riddell, who works in customer service for Air Canada, decided they needed to be strict about following the guidelines.

Neher worked at the Hillsborough County Falkenburg Road Jail in Tampa, a place, like any enclosed community, where viruses spread easily. But for months, the facility seemed clear of the coronavirus.

“For the longest time, we never knew anybody who got it,” Riddell said. “We hardly went anywhere, and we’d wear masks if we did.”

Neher, 49, and Riddell, 48, figured that as relatively young men with no health problems, “even if we did end up getting it, it might be like a bad flu and we’d just get over it,” Riddell said.

Then, the week before Thanksgiving, a worker at the jail tested positive. Two days later, Neher felt fatigued.

“In the 10 years I’ve known him, he’s never gotten sick to the point where he spent the day in bed, or even a half-day,” Riddell said. They’d met on the dating site Match.com and six months later, “he knew I was his forever.”

The couple ran a home-based business called Tipsy Candles, and their candle-making studio, filled with five-pound jugs of each fragrance, produced a powerful aroma when they cooked.

Suddenly, Neher couldn’t smell a thing. He lost his sense of taste. He went to a clinic for a coronavirus test. Positive.

He “asked for what he called the Trump cocktail, all the medications he thought he needed,” Riddell said. He got vitamins, antibiotics, steroids and an inhaler.

Neher “was like, ‘I have this, and I’m going to get rid of it,’” Riddell recalled.

The couple had a small Thanksgiving at home, and Neher started feeling better. But in early December, he started having trouble breathing.

On Dec. 4, he got a portable oxygen unit. They stacked pillows in their bed to prop Neher up as he slept. Riddell tucked their two dachshunds - Reese and Truffles - into Neher’s arms, and Riddell slept on the floor next to the oxygen machine.

The next day, Neher knew he had to be hospitalized. He couldn’t make it to his front door and needed an ambulance.

“It was hard for him to move, it was hard for him to breathe,” said Denise Bruscino, a critical-care nurse and longtime friend who texted with Neher throughout the days. “He was very anxious because he felt like he couldn’t breathe. He wanted anxiety medication so he could sleep, but they needed to keep him awake and upright to help his breathing.”

Neher’s friends wanted to decorate his room with poster-size photos of his family, friends and dachshunds, but the hospital wouldn’t allow it.

“Covid patients are very alone,” Bruscino said. “The only contact they have is with the staff, who are dressed head to toe in gear with face shields and masks and gowns and gloves and booties. You just barely see our eyes. It’s a very scary time for them.”

Neher was put on a ventilator, and could no longer call.

After a week in the hospital, things were looking up, Riddell said. They texted often.

But on Dec. 27, Riddell texted and nothing came back.

Neher spent his days mostly unconscious, sedated because of the tube in his throat. He’d be awakened only for doctors to check his neurological functions - a squeeze of a nurse’s hand, a blink. Then he’d be put back to sleep, Bruscino said.

“He knew what was going on the whole time, right up to the end,” Riddell said. “When doctors said they were going to intubate him, he gave the thumbs-up. They kept telling us, sometimes it takes 30 days, or 60 or 80, for people to get better. They kept saying that, even the night before he passed away.”

On Dec. 29, Neher’s heart stopped. Doctors restarted it. It didn’t work.

“It all happened so quickly,” Riddell said. When he went to pick up his partner’s backpack, a nurse told Riddell that Neher had “told her that he was scared. And I couldn’t be there with him.”

Yee Se Choa Ong, 76, worked long hours as a cardiologist in Muskogee, Okla., where he had settled with his wife, Ann, after medical school.

Growing up in the Philippines, Ong knew about the medical needs of rural areas, and Oklahoma, which ranks near the top in the United States for rates of heart and lung disease, seemed a place where he could help.

For more than four decades, Ong and his wife - a Kentucky native with a master’s in child mental health - devoted themselves to their clinic, their children hanging out in a play area as Ong finished his rounds.

As the coronavirus hit the area hard - Muskogee County has lost 58 residents - and the town’s small hospital was overwhelmed, Ong’s hours got longer.

“He had patients in the hospital who were dying their last breath on this earth and they said, ‘This can’t be covid, you must be mistaken, covid is a hoax to make Trump look bad,’” said Ong’s daughter, Jasmine Ong, 43, a veterinary student in Colorado.

On a Thanksgiving Zoom call, Ong told Jasmine that the hospital was full. A couple of days later, around midnight on Nov. 28, Ong collapsed - probably from exhaustion - at the hospital while taking care of covid patients. He hit his head and suffered a traumatic brain injury.

Hospitalized in Tulsa, he seemed to be recovering, and kept asking nurses to let him have his cellphone and clothes so he could get back to work. He even tried to recruit one of his nurses to come work for him in Muskogee.

On their video chats, Ong told his daughter he wanted to take a long road trip to see her in Colorado, then drive to see her brother Emil in the Bay Area. Ong also wanted to go back to his home city of Cabanatuan in the Philippines, which he had not visited since 1972, to see his siblings again and help poor patients there. Jasmine could be his medical assistant, he said.

“He kept making plans for the future,” Jasmine said.

But on Dec. 16, he began to have trouble breathing. Both he and Ann - who had been at his bedside the whole time - tested positive for the coronavirus. His conditioned worsened rapidly, he was quickly put on a ventilator, and he died Dec. 21, with Ann holding his hand.

Earlier that night, she had held the phone to his ear so Jasmine and her brother could say their goodbyes.

“I just said all the things you say to your father when you know he’s going to die,” Jasmine said, “that you love him and you’re very proud of him and thanks for being my dad and doing everything you’ve done for me.”

Jasmine blames the loss - to her family and to Muskogee - on Oklahoma’s leaders, chief among them Gov. Kevin Stitt, a Republican and Trump acolyte who has resisted a mask mandate as the virus has ravaged the state.

“You have blood on your hands - make no mistake,” she wrote on Facebook. “You have deprived an entire community of one of its greatest champions and hardest workers.”

On his last day, Jim Matzorkis told his daughter he was feeling a little better - but he didn’t want to jinx it. There was too much good stuff just ahead. It was five days until Christmas, a week and a half before he would retire as executive director of the Port of Richmond in Northern California’s East Bay. Matzorkis had plans.

His covid case had been relatively mild, at least in comparison with stories he’d heard. Matzorkis, 68, awoke on Thanksgiving morning feeling like he had a cold, or perhaps the flu. He tested positive for the coronavirus a couple of days later but never developed respiratory problems. Then again, he told his family, he never felt “quite right” after that.

He never saw a doctor in person.

“They didn’t want him to come in, because he wasn’t experiencing any of the major symptoms that people are being hospitalized for,” said Ileana Matzorkis, 32, the younger of two daughters born to Jim and his wife, Beverly, his high school sweetheart. “They just did a few e-visits.”

Jim ensconced himself downstairs in their bluff-side home in Montclair, a wooded neighborhood along the Oakland Hills in the Bay Area, quarantining for 10 days while his wife stayed upstairs. Then his doctor told him he was no longer contagious and could resume activities. Matzorkis had plenty of them in mind.

Born to a Greek family, a man of outsized enthusiasm, Matzorkis and his wife had moved to San Francisco for college and taken jobs with Bill Graham Presents, the legendary concert promoter. The job led to an unfortunate brush with fame: In 1977, at the Oakland Coliseum, he was savagely beaten by members of Led Zeppelin’s management and road crew. Matzorkis sued for $2 million and won.

He left the music business and immersed himself in family and his Greek roots, taking his daughters, Melanie and Ileana, to Crete several times - a tradition he asked them to continue even if he were not around.

As Christmas 2020 neared, Matzorkis kept telling his daughters he didn’t feel fully himself. He got fatigued, lacked appetite. Friends checked on him constantly.

He was a person of meticulous routines, and on the night of Dec. 20 he was performing one of them, checking every lock in the house before going to bed. About 11 p.m., “he was coming back from locking an upstairs door, and he yelled out for my mom, and he collapsed in the hallway,” Ileana said. “He knocked down the railing on the stairs when he fell. His heart just stopped.”

Beverly called 911 and tried to perform CPR. Paramedics arrived and did the same, but Matzorkis was gone before his daughters arrived from their nearby homes.

In the wake of his death, and absent an autopsy, his family traced the possibilities. Matzorkis had been on medication for high blood pressure, and several years earlier he had dealt with blood clots.

He’d been in fine health recently, but his past clots made him an almost textbook example of a person vulnerable to covid’s ravages.

“I’m not blaming anyone, but I wish he could have seen a doctor in person,” Ileana said. “Maybe, with his history, someone would have thought about the effects of covid on his heart.”

Matzorkis had been especially keen to resume travel - to Greece, of course, but also to Mexico, where he planned to add to his massive collection of top-shelf tequilas. Instead, his daughters cleaned out his desk at the port, arranged for burial in his family’s plot in Cleveland and helped their mother adjust.

They’ll have a memorial service when conditions allow. “But when will that be - and what will have happened between now and then?” Ileana said. “That’s the scary part.”

The Washington Post’s Emily Guskin and Julie Tate contributed to this report.