Health Letter, December 2020
By Michael Carome, M.D.
Since March, the U.S. has far outpaced all other countries in the total numbers of confirmed coronavirus cases and coronavirus disease 2019 (COVID-19) deaths. Most of these infections and deaths are a direct result of President Donald Trump’s utterly chaotic, incompetent and reckless response to the pandemic.
Researchers at Harvard University and the University of Pennsylvania School of Medicine recently sought to quantify the number of excess COVID-19-related deaths in the U.S. — in comparison with other economically advanced countries — that could have been prevented if the U.S. had taken the necessary public health measures to contain the spread of the pandemic. Their sobering results were published online by the Journal of the American Medical Association (JAMA) on Oct. 12.
For the JAMA study, the researchers compared the COVID-19 death rate in the U.S. to those of 18 other countries within the Organisation for Economic Co-operation and Development (OECD) with populations exceeding 5 million and gross domestic products greater than $25,000 per person. They calculated the COVID-19 per capita death rate for each country for the period from Feb. 13, 2020, through Sept. 19, 2020, and then estimated the number of excess COVID-19 deaths in the U.S. in comparison to each country under the following three scenarios: if the U.S. had had a mortality rate comparable to each country since the start of the pandemic, since May 10, and since June 7. The two scenarios with the later start dates were used to account for lag times in the implementation of public health policy interventions to control the pandemic.
The researchers’ findings on excess COVID-19 deaths in the U.S. are summarized in the Table below.
|Table: COVID-19 Mortality in the U.S. Through Sept. 19, 2020, Compared With That of Other Countries*|
|Country||COVID-19 Deaths per 100,000 Since Start of Pandemic||Excess U.S. COVID-19 Deaths|
|Since Start of Pandemic||Since May 10, 2020||Since June 7, 2020|
|Low mortality (COVID-19 deaths, fewer than 5 per 100,000 people)|
|Moderate mortality (COVID-19 deaths, 5-25 per 100,000 people)|
|High mortality (COVID-19 deaths, more than 25 per 100,000 people)|
*Source: Bilinski A, Emanuel EJ. COVID-19 and excess all-cause mortality in the US and 18 comparison countries. JAMA. Oct. 12, 2020. [Published online ahead of print]
As of Sept. 19, 2020, the U.S. had a total of 198,589 COVID-19 deaths, or 60.3 deaths per 100,000 people. Only three countries had higher per capita COVID-19 deaths: Belgium, the U.K. and Spain. The countries with the lowest per capita COVID-19 deaths since the start of the pandemic were South Korea, Japan and Australia (only 0.7, 1.2 and 3.3 deaths per 100,000 people, respectively). Canada had 24.6 deaths per 100,000 people.
In comparison with 15 of the 18 OECD countries included in the study, the U.S. would have had far fewer deaths if its COVID-19 death rate since the start of the pandemic had been similar to these other countries. Relative to these 15 countries, the estimated excess COVID-19 deaths in the U.S. ranged from 4,136 compared with Italy to 196,161 compared with South Korea. Only the U.K., Spain and Belgium had excess COVID-19 deaths compared with the U.S. since the start of the pandemic.
Particularly striking are the estimated numbers of excess COVID-19 deaths in the U.S. for the period beginning on June 7, 2020, a time by which the U.S. should have been able to implement the same public health policy interventions used by other OECD nations to control the pandemic. In comparison with all other 18 OECD countries included in the study, if the U.S. COVID-19 death rate had been comparable to each country since June 7, the estimated excess COVID-19 deaths in the U.S. ranged from 54,529 compared with Israel to 88,771 compared with South Korea.
Given our country’s wealth, scientific and medical resources and technological prowess, the U.S. was fully capable of containing the coronavirus pandemic to the same extent as countries like South Korea, Japan and Australia.
A JAMA editorial published online on Oct. 12 discussing the health and economic toll of COVID-19 in the U.S. concluded the following:
When a pandemic reaches the health, social, and economic scale of COVID-19, regardless of the precise number of deaths that have occurred by a certain date, an intense, persistent, multipronged, and coherent response must be the order of the day and an urgent priority for the nation.
Tragically for many tens of thousands of Americans who have died from COVID-19, the Trump administration’s response to the pandemic has been anything but “intense, persistent, multipronged, and coherent.” Fortunately, President Elect Biden intends to reverse course and implement the type of aggressive, coordinated national public health response needed to save lives. Inauguration Day can’t come soon enough.