Framing the Pandemic Response

There seems to be a new line of defense when talking about the United States’s COVID response. It started with the president saying that the increase in COVID cases was due to increased testing, which probably has some validity, since very few places in the world have conducted enough testing to have an idea how many people have actually contracted the disease. Of course, if the increase were entirely due to increased testing, you’d expect it to be pretty uniform across states, so the fact that states that have opened up more quickly are the ones with the spikes seems to indicate that something else is going on. According to the Johns Hopkins Coronavirus Research Center, as of July 5, new COVID cases in Florida were above 9,000 a day, while new COVID cases in New York were 600 a day. New York has been heavily testing, so that’s not the reason. Adjusting for population, Florida and Arizona, both of which have been resistant to any kinds of restrictions and have quickly reopened, had rates of new cases over 13 times the rates in New York and New Jersey, which, after high early numbers, have been fairly stringent in their regulations.

But that’s only part of the story. The people who believe that America is doing a great job in tackling the pandemic will then tell you that the increase in cases doesn’t mean anything. The people who are now getting the disease, they say, are younger and fitter, and what we should actually be looking at is the mortality rate. So how do those numbers look? Well, it’s absolutely true that, as medical professionals are learning more about how to treat COVID, and since care homes are taking more precautions, deaths as a percentage of cases have gone way down—worldwide. That’s a good thing, and to be expected. This was a brand new virus and a lot of the normal protocols turned out to be harmful rather than helpful. We are learning things every day about what makes certain cases more severe and which groups of people are most affected. But let’s look at US deaths compared to those in other countries.

In total mortality since the beginning of the crisis, the United Kingdom has the highest fatality rate in the world. According to Johns Hopkins, as of July 5, the UK has a rate of 66.66 deaths per 100,000 people. The US is only about 2/3 of that, at 39.82 deaths per 100,000 people. But the UK has not exactly covered itself with glory in the handling of the pandemic. Specifically, in the early weeks, they did what New York and New Jersey did: Afraid of running out of hospital space, they sent older people they did not know were infected into care homes, where the infections raged out of control and were responsible for a huge proportion of the deaths. Other countries in Western Europe, many of whom were hit almost a month before the UK experienced its peak, had better numbers, but they were still higher than the US. There are good reasons for this. The US did have quite bad early numbers in large cities that were hit early. The population density and concentration in most of Western Europe are more like New York than they are like most of the US, so just naturally, there were higher rates of infection in those high-density areas. Even so, Germany, which was hit early, did a good job of identifying and containing the virus, and has a mortality rate of only 10.88 per 100,000. Why? Part is due to more ICU capacity, so there was never a mass shifting of people from hospitals to care homes, part was due to the recognition of a need for a quick and accurate track and trace system coupled with an early and total lockdown, and, I would argue, part was due to the population’s banding together instead of fighting one another about the quick lockdown.

But even though the UK, Spain, and Italy had high initial numbers that still make for a total mortality rate that is higher than the US, there’s one thing that’s pretty clear when you look at the data. First, let’s look at the shape of the curve for biweekly confirmed COVID-19 deaths in a few countries. (All these numbers and graphs are from Oxford University’s excellent site, Our World in Data. I suggest actually looking at the links, because there are a lot of interactive charts and you can find more granular detail. In general, I’ve found Johns Hopkins to be the most complete for state-level information, but Oxford’s site is a lot more user-friendly and provides more international data.)

Brazil, whose President Jair Bolsonaro, pictured below, was scornful of any attempts to contain the virus and has just tested positive for COVID-19, never had the early peaks of the US and Europe, but now has the highest number of deaths in the world.

Jair Bolsonaro

(Note, President Trump, that even President Bolsonaro is wearing a mask.) But the US, with a moving average bi-weekly death toll of 10,252 as of July 8, has been hovering around that number for a month. In contrast, even the UK shows a consistent downward trajectory since its peak around the third week in April. In contrast, Italy, France and Spain have gone down rapidly to their current levels, even though they are now opening their economies. Yes, you say, but these countries are all quite a bit smaller than the US. Here are the numbers per 1,000,000 population:

Again, the UK is not a model of success, but its numbers are going down, while the US’s are staying constant after a big jump up at around the middle of June, when states started opening up. Regardless of the UK’s tepid response to fighting the pandemic, it seems obvious that the US’s problems are not a result just of greater testing. They are a result of incompetence and inconsistency, and, as Anthony Fauci has warned, it could get worse if we don’t take the right precautions now. I am already nervous about autumn in the UK. If there is not a change of attitude in the US, I’m worried that I may not be able to get back there for the foreseeable future.

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