Public health collapsing as COVID pandemic enters its 7th year

Soon after the emergence of COVID-19, the International Committee of the Fourth International made the correct analysis that the pandemic had to be understood as a trigger event in world history. It did not create a crisis in public health, but rather exposed and accelerated longstanding processes: the erosion of life expectancy, the dismantling of scientific institutions, and the subordination of human life to the profit requirements and military-strategic interests of the financial oligarchy.

The world has now entered the seventh year of the COVID pandemic, with the United States facing the 12th major wave of infections. Conservative estimates place cumulative COVID deaths in the United States at over 1.2  million, while excess-mortality analyses indicate a substantially higher toll. Globally, excess-mortality modeling places the true pandemic death toll in the tens of millions, with central estimates near 27 million worldwide, far exceeding official counts. Transmission continues at high rates—presently at roughly 1 million infections per day, with more than 240 million infections recorded in 2025 alone. Reinfections are widespread, and Long COVID remains a mass disabling condition affecting millions.

What has ended is not the pandemic, but any acknowledgement by the political and media establishment that COVID-19 remains a major threat. There is zero political commitment to even the meager combination of mitigation, surveillance and data-gathering. This was not and is not an oversight. It is a decision to conceal the ongoing harm that is affecting the entire global population.

As has been repeatedly demonstrated, the COVID pandemic has exposed an intensifying attack on the working class. The consequences of the public health collapse, combined with the broader assault on material living conditions, have produced a stark divergence in life expectancy between the bourgeoisie and the working class. Research by economists Angus Deaton and Anne Case demonstrated that life expectancy in the United States began to diverge sharply along class lines around the turn of the millennium. This divergence accelerated after the financial crisis of 2008, when life expectancy among working class layers declined for the first time in decades, and it was dramatically intensified by the pandemic.

A long-term comparative analysis of US mortality trends from 1980 to 2023 estimates approximately 14.7 million excess deaths in the United States relative to other high-income countries. These deaths were not the result of a single event but of accumulated structural disadvantages—inequality, underinvestment in public health and unequal access to care—that were sharply exacerbated by the pandemic. Each excess death represents a life cut short, families destabilized and human potential permanently lost.

Class differences in the impact of COVID-19

During the earliest phase of the ongoing COVID pandemic, life expectancy fell far more sharply among poorer and working class layers than among the wealthiest. Exposure risk, access to care, the ability to isolate and the burden of long-term disability followed class lines.

Now, barely six years later—a brief period in historical terms—international evidence confirms the devastation wrought by the COVID pandemic and how it continues to sicken population health.

In Finland, one of the most detailed pictures of the cumulative health impact of COVID has emerged through analysis of national healthcare data. Ilkka Rauvola, an equity research analyst, examined data from Avohilmo, Finland’s national primary healthcare registry maintained by the Finnish Institute for Health and Welfare.

Using time-series analysis, Rauvola showed that since 2019, the cumulative share of the population diagnosed with illness has risen sharply across nearly every major disease category. By 2025, diagnoses involving mental and behavioral disorders, immune and blood disorders, nervous system diseases and metabolic conditions had increased to roughly one and a half to nearly two times pre-pandemic levels. He correlated these findings with wastewater surveillance showing sustained SARS-CoV-2 circulation at levels comparable to early Omicron peaks. This indicates that COVID persists at a hyper-intense endemic state, with temporary lulls driven only by massive infection waves that briefly suppress transmission before the next surge.

Rauvola warned that this trajectory—the impact on health systems from a mass disabling event—represents a structural sustainability crisis. Even a well-resourced welfare state cannot absorb a continuously rising disease burden driven by repeated infection and long-term impairment. If COVID alone is eroding population health under such conditions, the implications for countries actively dismantling public health infrastructure are grave.

To understand why this raises such a profound alarm, it is necessary to situate the present crisis in the historical context of what public health has achieved—and what is now being reversed.

In the course of the 20th century, public health interventions—vaccination, clean water systems, sanitation, community water fluoridation and disease surveillance—produced some of the most dramatic gains in human longevity ever recorded. Vaccination alone is estimated to have saved tens of millions of lives globally over the past 50 years. In the United States, routine childhood immunization reduced infant and child mortality to a fraction of early-20th-century levels.