So far, more than 4½ million people have died from COVID-19, including nearly 700,000 Americans. And those numbers — particularly the global figure — may be seriously understated.

And deaths are just a small part of the story, since the death rate from the virus is relatively low, but COVID also comes with lasting, often debilitating effects that experts are still discovering. In fact, the list of effects is growing not only because it’s a new virus, but also because it’s mutating.

So far, over the past 20 months, we’ve been fairly fortunate to live in an area that’s somewhat isolated, has few places where a high concentration of people would gather, and which has leaders who’ve taken the threat of COVID seriously. City, county and college leaders were among the loudest voices for social distancing; the City Council enacted a mask mandate before the state did and held firm in the face of criticism. Keene State College was one of the leaders in contact tracing, quarantining and regular testing, going so far as to test sewage near the college to get a jump on potential viral spikes.

That, however, was then, and this is now. The biggest current battle is over vaccinations. When they were developed in late 2020, the vaccines were seen by all but a few anti-establishment outliers as the path back to normalcy. However, two things happened during the interim.

One is that the pandemic as a whole, and the vaccines specifically, became political fodder, leading a percentage of people to opt not to get them. Because not enough were vaccinated, variants of the virus were given the opportunity to develop, some proving more contagious and deadly than the original.

As the threat has rebounded, assertive protests — from those either tired of living through a pandemic and ready to pretend it no longer exists or who for some reason see a conspiracy in the government asking people to inconvenience themselves to help protect others — have curtailed the sort of protections that kept us safe a year ago. There are no mask mandates, no vaccination orders (though the president has announced his intention to push one on employers).

And the result? More cases. More deaths. More stress.

Dr. Don Caruso, CEO of Cheshire Medical Center, hears much of the frontline stories from his staff. Last week, he told The Sentinel’s editorial board he’s been compiling local numbers independently of the state. Cheshire Medical’s numbers are higher than the state’s, and Caruso thinks it’s because the state gets all the testing from every source — including places like Keene State and nursing homes that test the same people repeatedly. That, he says, gives them more tests, but not necessarily a broader look at the issue. Cheshire tests everyone admitted to the hospital, plus everyone who shows up at its public testing site.

“We think we’re actually getting a better cut of the community, because we’re not testing the same people over and over,” Caruso said.

And what do his numbers show? A much higher positivity rate for the virus than the state is reporting. For the week of Sept. 17-23, for example, Cheshire’s testing showed a positivity rate of 8.3 percent, compared to 3.7 percent reported for Cheshire County by the state.

Such numbers are why Caruso has been pushing city leaders to re-establish a mask mandate, and why he — along with the city manager, Keene State president and SAU 29 school superintendent — issued a public statement of concern, asking residents to vaccinate, mask and socially distance from others.

Besides pushing for the return of a masking mandate, Caruso would like to see more pressure put on those who thus far haven’t chosen to get vaccinated. Until the vaccination rate rises significantly (about half of Cheshire County residents are vaccinated), he says the pandemic isn’t going anywhere.

Caruso noted nurses at the hospital have endured negativism and mistreatment — even been punched, he said, while administering care — and with staff stretched thin, everyone has been asked to go full tilt since the start of the pandemic. That doesn’t bode well for his staff or the patients they see for any kind of condition.

The message Caruso is sending is that this is unlike anything we’ve seen in our lifetimes — still — and it’s not going away if it isn’t taken more seriously.

COVID has overwhelmed almost everything else for the past 18 months, but it’s not the only illness affecting people. Think about showing up at the hospital with chest pains or after an accident and finding the staff overworked, with no ICU beds available.

“I think our politicians are just hoping this will go away,” Caruso said, noting he hears the same from local business owners. “But we’re putting people at risk.”

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