In 1996 I was a doctor at the Department of Veterans Affairs Medical Center in Leeds. A cluster of deaths on a medical ward at the V.A. occurred and eventually a nurse, Kristen Gilbert, was charged, tried and convicted in 2001 of intentionally murdering four patients and attempting to murder two others at the V.A. She is now serving four consecutive life terms without parole, plus 20 years in a federal penitentiary in Texas.

Ms. Gilbert is an example of a serial killer, defined generally as someone who commits three or more murders over a period of at least one month, and who does so for personal psychological reasons.

In 2021 I’m a retired doctor with public health training, living in Northampton. Over 550,000 deaths due to COVID-19 have occurred in the United States. No one has been charged, tried, or convicted of intentional or unintentional homicide. No one has been called to account for the over 450,000 excess deaths above the 100,000 reasonably expected to occur due to a novel pandemic.

These are the figures provided last month by Dr. Deborah Birx, Mr. Trump’s coordinator of his administration’s COVID response. She said, “There were about 100,000 deaths that came from that original surge. All of the rest of them, in my mind, could have been mitigated or decreased substantially.”

Dr. Birx’s comments seem to be an attempt to place herself in a better light given her unwillingness to speak out forcefully about the COVID crisis as it was occurring, or to resign in protest over the mismanagement of the outbreak in which she played a key role.

While the excess deaths from COVID caused by an individual’s intentional or unintentional homicide may superficially sound like mass murder, that term is reserved for the situation where one or more people kill four or more people in one location at one period of time. Unintentional homicide may result in charges of second degree murder, felony murder, misdemeanor manslaughter, and involuntary manslaughter.

Unintentional means that the person responsible for deaths did not realize the consequences of his actions or inactions. The criminal justice system also considers individuals who cause the deaths of other people through negligence or recklessness to be criminals. Under the criminal justice system, these criminals are charged with manslaughter.

When a government’s actions or inactions result in the deaths of many it is called homicide by state actors. This may be considered lawful or unlawful. When over 50,000 people perish, it is considered a mass killing. Some are considered crimes against humanity. The term “democide” has been used to describe murder by government as a general term, whether extrajudicial or by systematic homicide.

And when specific groups are targeted, killings may be described as genocidal, meaning the targeting of an ethnic racial, religious, or national group.

Given the disproportionate impact of COVID on Black, Latinx and Indigenous populations in the U.S., it is reasonable to consider the genocidal impact of both governmental action and inaction in addressing COVID effectively.

In a Feb. 16, 2021 report, the Kaiser Family Foundation noted that older Black, Hispanic, and American Indian/Alaska Native adults were nearly twice as likely to die of COVID as older white adults. COVID cases among Black and Hispanic Medicare beneficiaries were 1.6 times higher than the rate observed among white beneficiaries, and COVID cases among American Indian and Alaska Native beneficiaries were 1.7 times higher than among white beneficiaries, the data show.

Hospitalization rates for Black, Hispanic, and American Indian/Alaska Native Medicare beneficiaries were at least double the rate among white beneficiaries.

As a nurse, Ms. Gilbert most likely recited a nurse’s oath, not unlike the Hippocratic oath that doctors recite, in which nurses swear, among other things, that “I will abstain from whatever is deleterious and mischievous, and will not take or knowingly administer any harmful drug.” If she did recite the oath, she violated it.

President Trump also recited an oath at his inauguration. The oath presidents recite says:

“I do solemnly swear (or affirm) that I will faithfully execute the Office of President of the United States, and will to the best of my ability, preserve, protect and defend the Constitution of the United States.”

The words “faithfully execute” means that the president must act diligently and in good faith, and take affirmative steps to pursue the best interests of the country. In his response to the pandemic, Trump violated that oath.

Kristen Gilbert has been held accountable for her crimes. Who will be held accountable for the Trump administration’s actions leading to nearly a half-million unnecessary deaths in our country? How and when will anyone be held accountable?

Richard Brunswick, M.D., M.P.H. is a retired primary care doctor living in Northampton.