In an interview in early August, when over 1,000 Americans were dying each day due to Covid-19, President Trump was asked how he could consider the disease to be then under control. He responded “They are dying, that’s true”, and then went on to say “it is what it is. But that doesn’t mean we aren’t doing everything we can. It’s under control as much as you can control it.”
If it were true that the disease was “under control as much as you can control it”, then deaths in the US would be similar (as a share of population) to what they are in other countries around the world. It is the same disease everywhere. And it would especially be true now, more than nine months into this pandemic. While much was still not known in the early months on how best to bring this terrible disease under control, we now know what has worked in other countries plus we have results from numerous scientific studies.
In particular, it has become clear that a highly effective measure to contain the virus is also the simplest: Everyone should just wear a mask when out in public. The experience of East Asian countries, which will be examined below and where mask-wearing was common even before Covid-19, is consistent with this. There are also now scientific studies backing this up, as discussed in an editorial published on July 14 in JAMA – the Journal of the American Medical Association. Dr. Robert Redfield, the head of the CDC, was a co-author of that editiorial, and in interviews and press conferences since he has made clear that if everyone simply wore a mask when in public, the disease would be brought under control in as little as four to eight weeks.
Dr. Redfield said the same in testimony to Congress on September 16 (although with a more cautious time scale, allowing between 6 and 12 weeks for the pandemic to be brought under control). Indeed, Dr. Redfield noted in that testimony that wearing of masks could be more effective than even a vaccine, as any vaccine that is developed will likely have an effectiveness of 70% or less. A mask, if worn, can do better.
But getting most of the population to wear a mask requires political leadership, and that has been sorely lacking under President Trump. Indeed, under Trump the wearing of masks has been turned into an issue of political identity, and he has even mocked Joe Biden and Democrats generally for wearing them. Trump also asserted, on the same day as Dr. Redfield’s congressional testimony, that the doctor was wrong in his medical advice on masks.
The sad result is that death rates from Covid-19 in the US are now not simply higher than in many other countries around the world, but higher by a large multiple. There is no basis for asserting that this disease is “under control as much as you can control it”.
We will examine here what other countries have been able to achieve in comparison to what the US has, basically through a series of charts. A word on the data: The figures were all calculated from the reported deaths by country from Covid-19 downloaded from the site maintained by the Center for Systems Science and Engineering at Johns Hopkins University. The data were downloaded on the afternoon of September 15, with the country data current through September 14.
B. US Compared to Canada and Europe
The chart at the top of this post shows the number of deaths from Covid-19 per day per million of population (based on a rolling seven-day average ending on the date shown), from January 29 through to September 14, in the US, Canada, and Western and Eastern Europe (with Eastern Europe covering the Baltics through to Albania).
Starting with the US, deaths rose rapidly in late March and early April, peaked in mid-April, and then fell. This continued until early July. But then, as a number of states rushed to re-open their economies in May and especially June (with the strong encouragement of Trump), death rates rose again, doubling from their not-so-low early-July lows. They then came down modestly in August and the first half of September, but remain far higher than elsewhere.
The profiles in Europe and Canada are different in an important way. While death rates rose early in Western Europe (and to rates higher than what came later for the US), when much was still not known about the virus and how it was spread, they were then brought down to very low rates – well below those of the US. And they have remained low (at least so far). This is in contrast to the US, where death rates rose in July as lessons on how to manage the virus were ignored.
Canada followed a similar profile to that of Western Europe, although with an initial peak that came later (and with a substantially lower peak – only half that of Western Europe), with then a decline to low levels that have remained low. In Eastern Europe, early rates in the spring never rose that high, but then still came down by June. Since then they have risen some, but to rates that remain well below those of the US (at less than a third of the US rate, as of mid-September).
Breaking this down for some of the major countries of Western Europe:
Rates peaked early and at high levels in Italy, France, and the UK, but then all came down and remained down. The peak in Germany came at roughly the same time as that of the US (but at well less than half the US rate), and then came down to an extremely low level. As of mid-September, the death rate in Germany is only 2% of the US rate. If it’s “under control as much as you can control it” in the US, as Trump asserted, why is it that the death rate, per million of population, can be 98% less in Germany?
There are two special cases in Western Europe that are worth examining – Spain and Sweden:
Rates rose rapidly and to quite high levels in Spain early in the crisis. Its hospital system was overwhelmed and many died. But then Spain brought down the rates to very low levels by June and July. They have, however, trended up since mid-August, as it appears Spain opened up its seasonal tourism industry too rapidly (tourism as a share of GDP is far higher in Spain than in any other OECD member country). But even with the recent increase, the number of deaths per million in Spain remains less than half (45%) of what the rate is in the US as of mid-September.
(One might also note the negative numbers recorded for the number of deaths in Spain due to Covid-19 for a period in late May, as well as an odd spike up in late June. The reason for this is that Spain revised its counts of the number who had died from Covid-19 as they later reviewed what had been submitted during the peak of the crisis. A focus on the statistics was not the highest priority earlier – saving lives was. It is of course impossible for there to be a negative number of deaths. But figures are recorded each day for the cumulative number of deaths due to Covid-19, and when that total was revised down on May 25, the daily change in the total (which is the basis for the daily death count) will be negative (and will be negative for a week, as the numbers are seven-day averages). And a later upward revision in late June will look like a spike up.)
Sweden is also an interesting case as, early in the crisis, it deliberately decided not to mandate closures of restaurants, offices, and other non-essential work locations, but rather left this to be decided by each entity. But the policy failed: Deaths from Covid-19 rose to rates well above US levels (and was especially far above the rates of its Nordic neighbors of Norway, Finland, and Denmark, although below the peak levels seen in Italy, Spain, France, and the UK). The rates then fell relatively slowly in Sweden. They eventually moved to policies more in line with the rest of Europe, and eventually saw similarly low rates.
D. US Compared to East Asia, Australia, and New Zealand
As an earlier post on this blog on the number of Covid-19 cases discussed, the countries of East Asia, as well as Australia and New Zealand, show what is possible if serious measures are taken to control the spread of the virus (and possible in a region with more travel and business exposure to China than any other region). The measures required are not exotic. Nor did they require resources that others did not have. All that was required were the standard public health measures used to control the spread of any infectious disease – extensive testing with follow-up tracing of contacts and quarantining of those exposed, plus the normal and widespread use of simple masks. With such measures, Taiwan was able, for example, to keep open its schools basically throughout (in February it extended its regular Chinese New Year holiday by an extra two weeks, but has since followed its regular schedule).
The result was few cases of Covid-19, and few deaths:
The rates for all the countries listed on the chart were plotted. But they were all so close to zero that, other than for the few names shown, one could not distinguish one from the other.
There was an increase in the rates since mid-July in Australia, and to a lesser extent in Hong Kong (and a far lesser extent in Japan), as some of the earlier controls were eased. But these have all now been brought back under control. And even with these outbreaks, the rates never approached the US rates.
E. Who are the Comparables for the US?
Who, then, might have a record comparable to that of the US? Among the larger countries:
Donald Trump can be proud to say that death rates in the US have, since June, been lower than the rates in Mexico and Brazil. The US has not performed as poorly as they have. The pattern in South Africa is somewhat odd in that its rates were higher than those of the US between mid-July and mid-August, but are now substantially less. And Russia as well as India have had lower rates throughout.
All this assumes the tracking statistics on deaths from Covid-19 are accurate, and one might question this for some of these countries. As was discussed above for the case of Spain, such numbers can be difficult to assemble even with resources that the countries here do not have. But for the ranges in the numbers seen here, the conclusions would still hold even if the rates were substantially higher. As of mid-September, the South African rate would have needed to have been twice as high, and the Indian and Russian rates three times as high, to reach the US rate.
Note that I have not included China. If it were added, it would show extremely low death rates per million throughout, with a peak of just 0.1 in mid-February. But while the deaths from Covid-19 may well have been low compared to others (particularly when expressed per million, given its population), I am not confident they were in fact that low. Restrictions on the news media and what they can report do not engender confidence.
But overall, to find countries with records on management of Covid-19 comparable to what they have been in the US, one needs to look at countries with per capita incomes that are far below that of the US. The US has thought of itself as belonging in the top rank of countries. But for this, the only countries with comparable death rates from Covid-19 are countries that, before Trump, the US had not normally been grouped with.
F. What Deaths in the US Would Have Been at the Rates Other Countries Have Been Able to Achieve
As noted at the top of this post, President Trump claimed that the disease is “under control as much as you can control it.” But as we have seen, it is not. Other countries, facing the same disease, have been able to manage it with far lower death rates than the US has had. How much of a difference would this have made?
Little was known about the disease early in the crisis, and one can argue that countries were searching then for what best to do. And after the high early peaks, the rates did come down in the US as well as in Europe and Canada. But then the US reversed course while rates continued to fall elsewhere. It is thus this more recent period that most clearly shows the consequences of the choices the US made compared to others. For the purposes of this exercise, we will therefore look at the period since August 1.
From August 1 to September 14, a period of 45 days, US deaths totaled 40,459. This is a bit over a fifth (21%) of the total US deaths as of September 14 of 194,493. It is still a substantial figure: The number of US soldiers who died in battle in the Korean War totaled 33,739, and the number who died in the Vietnam War totaled 47,434. But based on the numbers of deaths per million in other countries and regions, how many would have died for a population equal to that of the US?:
If the US had had the number of deaths per million that Romania had over this same period, then 31,700 would have died, or about three-quarters of the number of Americans who died. If the US had the rate of Albania, about 20,800 would have died, or about half the number of Americans who died. One might ask that if “it is what it is”, and that “It’s under control as much as you can control it”, why is it that Romania could control it so that there would only be three-quarters as many deaths, and Albania could control it so that there would only be half as many deaths? Neither Romania nor Albania has the resources the US has, plus they are small and open.
Other cases are more extreme. If the US had the rate over this period of the EU as a whole, there would have been 5,465 deaths. Instead, it was 7.4 times higher. At the rate of Canada, there would have been 2,184 deaths. Instead, it was 18.5 times higher. And Singapore and Taiwan both had zero deaths over this period. The most recent death (as of this writing) was on July 14 in Singapore and on May 11 in Taiwan. If the US had their rates, there would have been no deaths.
There is of course a wide range here. Plus things may change. Infection rates have been rising in Europe in recent days, and increases in death rates may soon follow. The US has also today (on September 22, as I write this) passed a significant milestone: More than 200,000 have now died in the US from this disease. And there are widespread concerns that rates will increase this fall and winter across the Northern Hemisphere in a “second wave”, as more people remain inside and as they become less vigilant as time goes on. One has seen this with prior infectious diseases, particularly those that spread through the air. There is also increasing pressure to reopen schools for in-class teaching and to fully reopen businesses.
So there is uncertainty on how this will progress. But based on what we know for the last month and a half, a question to address is why the Trump administration has not been able to do as good a job of reducing deaths from this virus as have the governments of Romania, Albania, Bulgaria, Russia, Spain, Australia, Croatia, Serbia, Luxembourg, Portugal, Poland, France, Greece, Hong Kong, Italy, Sweden, Czechia, Slovenia, the Netherlands, Belgium, the United Kingdom, Canada, Switzerland, Hungary, Austria, Ireland, Japan, Denmark, Lithuania, Germany, Norway, Slovakia, Latvia, Finland, South Korea, Estonia, New Zealand, Singapore, and Taiwan.
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