Tag Archives: policy

Death Rates due to Covid-19: An International Comparison

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A.  Introduction

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.

Trump’s Attack on Social Security

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Trump famously promised in his 2016 campaign for the presidency that he would never cut Social Security.  He just did.  How much is not yet clear.  It could be minor or it could be major, depending on how he follows up (or is allowed to follow up) on the executive order he signed on Saturday, August 8 while spending a weekend at his luxury golf course in New Jersey.  The executive order (one of four signed at that time) would defer collection of the 6.2% payroll tax paid by employees earning up to $104,000 a year for the pay periods between September 1 and December 31 (usefully straddling election day, as many immediately noted).

What would then happen on December 31?  That is not clear.  On signing the executive order, Trump said that “If I’m victorious on November 3rd, I plan to forgive these taxes and make permanent cuts to the payroll tax.  I’m going to make them all permanent.”  He later added:  “In other words, I’ll extend beyond the end of the year and terminate the tax.”

The impact on Social Security and the trust fund that supports it will depend on how far this goes.  If Trump is re-elected and he then, as promised, defers beyond December 31 collection of the payroll tax that workers pay for their Social Security, the constitutional question arises of what authority he has to do this.  While temporary deferrals of collections are allowed during a time of crisis, what happens when the president says he will bar the IRS from collecting them ever?  The president swore in his oath of office that he would uphold the law, the law clearly calls for these taxes to be collected, and a permanent deferral would clearly violate that.  But would repeated “temporary” deferrals become a violation of the statutory obligations of a president?  And he has clearly already said that he wants to make the suspension permanent and to “terminate the tax”.

There is much, therefore, which is not yet clear.  But one can examine what the impact would be under several scenarios.  They are all adverse, undermining the system of retirement benefits that has served the country well since Franklin Roosevelt signed the program into law.

Some of the implications:

a)  Deferring the collection of the Social Security payroll taxes will lead to a huge balloon payment coming due on December 31:

The executive order that Trump signed directs that firms need not (and he wants that they should not) withhold from employee paychecks the 6.2% that goes to fund the employee share of the Social Security tax.  But under current law the taxes are still due, and would need to be paid in full by December 31.

Suppose firms did decide not to withhold the 6.2% tax, and instead allow take-home pay to rise by that amount over this four-month period straddling election day.  Unless deferred further, the total of what would have been withheld will now come due on December 31, in one large balloon payment.  For those on a two-week paycheck cycle, that balloon payment would have grown to 54% of their end of the year paycheck.  It is doubtful that many employees would be very happy to see that cut in end-year pay.  Plus how would firms collect on the taxes due on workers who had been with the firm but had left for any reason before December 31?  By tax law, the firms are still obliged to pay to the IRS the payroll taxes that were due when the workers were employed with them.

Hence most expect that firms will continue to withhold for the payroll taxes due, as they always have.  The firms would likely hold off on forwarding these payments to the IRS until December 31 and instead place the funds in an escrow account to earn a bit of interest, but they would still withhold the taxes due in each paycheck just as they always have (and as their payroll systems are set up to do).  This also then defeats the whole purpose of Trump’s re-election gambit.  Workers would not see a pre-election bump up in their take-home pay.

b)  But even in this limited impact scenario, there will still be a loss to the Social Security Trust Fund:

Thus there is good reason to believe that Trump’s executive order will likely be basically just ignored.  There would, however, still be a loss to the Social Security Trust Fund, although that loss would be relatively small.

Payroll taxes paid for Social Security go directly into the Social Security Trust Fund, where they immediately begin to earn interest (at the long-term US Treasury rate).  Based on what was paid in payroll taxes in FY2019 ($1,243 billion according to the Congressional Budget Office), and adjusting for the fewer jobs now due to the sharp downturn this year, the 6.2% component of payroll taxes due would generate approximately $40 billion in revenue each month.  Assuming the $160 billion total (over four months) were then all paid in one big balloon payment on December 31 rather than monthly, the Social Security Trust Fund would lose what it would have earned in interest on the amounts deferred.  At current (low) interest rates, the total loss to Social Security would come to approximately $250 million.  Not huge, but still a loss.

c)  If collection of the 6.2% payroll tax is deferred further, beyond December 31, the losses to the Social Security Trust Fund would then grow further, and exponentially, and become disastrous if terminated:

Trump promised that “if re-elected” he would defer collection by the IRS of the taxes due further, beyond December 31.  How much further was not said, but Trump did say he would want the tax to be “terminated” altogether.  This would of course be disastrous for Social Security.  Even if the employer share of the payroll tax for Social Security (an additional 6.2%) continued to be paid in (where what would happen to it is not clear), the loss to Social Security of the employee share would lead the Trust Fund to run out in less than six years.  At that point, under current law the amounts paid to Social Security beneficiaries (retirees and dependents) would be sharply scaled back, by 50% or more (assuming the employer share of 6.2% continued to be paid).

d)  Even if the Social Security Trust Fund were kept alive by Congress acting to replenish it from other sources of tax revenues, under current law individual benefits would be reduced on those who saw their payroll tax contributions diminished:

There is also an issue at the level of individual benefits, which I have not seen mentioned but which would be significant.  The extent of this impact would depend on the particular scenario assumed, but suppose that the payroll taxes that would have come due and collected from September 1 to December 31 were permanently suspended.  For each individual, this would affect how much they had paid in to the Social Security system, where benefits are calculated by a formula based on an individual’s top 35 years of earnings (with earnings from prior years adjusted to current prices as of the year of retirement eligibility based on an average wage inflation index).

The impact on the benefits any individual will receive will then depend on the individual’s wage profile over their lifetime.  Workers may typically have 20 or 25 or maybe even 30 years of solid earnings, but then also a number of years within the 35 where they may have been not working, e.g. to raise a baby, or were unemployed, or employed only part-time, or employed in a low wage job (perhaps when a student, or when just starting out), and so on.

There would thus be a good deal of variation.  In an extreme case, the loss of four months of contributions to the Social Security Trust Fund from their employment history might have almost no impact.  This would be the case where a worker’s income in their 36th year of employment history was very similar to what it was in their 35th, and the loss in 2020 of four months of employment history would lead to 2020 dropping out of their employment top 35 altogether.  But this situation is likely to be rare.

More likely is that 2020 would remain in the top 35 years for the individual, but now with four months less of payroll contributions being recorded.  One can then calculate how much their Social Security retirement benefits would be reduced as a result.

The formulae used can be found at the Social Security website (see here, here, and here).  Using the parameters for 2020, and assuming a person had earned each year the median wages for the year (see table 4.B.3 of the 2019 Annual Statistical Supplement of Social Security), one can calculate what the benefits would be with a full year of earnings recorded for 2020 and what they would be with four months excluded, and hence the difference.

In this scenario of median earnings throughout 35 years, annual benefits to the retiree would be reduced by $105 (from $17,411 without the four months of non-payment, to $17,306 with the four months of the payroll tax not being paid).  Not huge, but not trivial either when benefits are tied to a full 35 years of earnings.  That $105 annual reduction in benefits would have been in return for the one-time reduction of $669 in payroll taxes being paid (6.2% for four months where median annual earnings of $32,378 in 2019 were assumed to apply also in 2020 despite the economic downturn).  That is, the $669 not paid in now would lead to a $105 reduction in benefits (15.8%) each and every year of retirement (assuming retirement at the Social Security normal retirement age).

The loss in retirement benefits would be greater in dollar amount if the period of non-payment of the payroll tax were extended.  Assuming, for example, a scenario where it was extended for a full year (and one then had just 34 years of contributions being paid in, with the rest at zero), with wages at the median level throughout those now 34 years, the reduction in retirement benefits would be $316 each year (three times as much as for the four-month reduction).  Payroll taxes paid would have been reduced by $2,007 in this scenario, and the $316 annual reduction is again (given how the arithmetic works) 15.8% of the $2,007 one-time reduction in payroll taxes paid.

All this assumes Social Security would continue to pay out retiree benefits in accordance with current law and assumes the Trust Fund remained adequate.  The suspension of these payroll taxes would make this difficult, as noted above, unless there was then some general bailout enacted by Congress.  But any such bailout would raise further issues.

e)  If Congress were to appropriate funds to ensure the Social Security Trust Fund remained adequately funded, the resulting gains would be far greater for those who are well off than for those who are poor:

Suppose Congress allowed these payroll taxes to be “terminated”, as Trump has called for, but then appropriated funds to ensure benefits continued to be paid as per the current formulae.  Who would gain?

For at least this part of the transaction (the origin of the funds is not clear), it would be the rich.  The savings in the payroll taxes that would be paid in order to keep one’s benefits would be five times as high for someone earning $100,000 a year as for someone earning $20,000.  The tax is a fixed 6.2% for all earnings up to the ceiling (of $137,700 in 2020, after which the tax is zero).  The difference in terms of the benefits paid would be less, since the formulae for benefits have a degree of progressivity built-in, but one can calculate with the formulae that the change in benefits from such a Congressional bailout would still be 2.3 times higher for those earning $100,000 than for those earning $20,000.

One might question whether this is the best use of such funds.  Normally one would want that the benefits accrue more to the poor than to those who are relatively well off.  The opposite would be the case here.

f)  Importantly, none of this helps those who are unemployed:

Unemployment has shot up this year due to the mismanagement of the Covid-19 crisis, with the unemployment rate rising to a level not seen in the US since the Great Depression.  Unemployment insurance, expanded in this crisis, has proven to be a critical lifeline not only to the unemployed but also to the economy as a whole, which would have collapsed by even more without the expanded programs.

Yet cutting payroll taxes for those who have a job and are on a payroll will not help with this.  If you are on a payroll you are still earning a wage, and that wage is, except in rare conditions, the same as what you had been earning before.  You have not suffered, as the newly unemployed have, due to this crisis.  Why, then, should you then be granted, in the middle of this crisis where government deficits have rocketed to unprecedented levels, a tax cut?

It makes no sense.  Some other motive must be in play.

g)  This does make sense, however, if your intention is to undermine Social Security:

Trump pushed for a cut in the payroll taxes supporting Social Security when discussions began in July in the Senate on the new Covid-19 relief bill (the House had already passed such a bill in May).  But even the Republicans in the Senate said this made no sense (as did business groups who are normally heavily in favor of tax cuts, such as the US Chamber of Commerce), and they kept it out of the bill they were drafting.

The primary advisor pushing this appears to have been Stephen Moore, an informal (unpaid) White House advisor close to Trump.  He co-authored an opinion column in The Wall Street Journal just a week before Trump’s announcement advocating the precise policy of deferring collection of the Social Security payroll tax.  Joining Moore were Arthur Laffer (author of the repeatedly disproven Laffer Curve, whom Trump had awarded the Presidential Medal of Freedom in 2019), and Larry Kudlow (Trump’s primary economic advisor and a strong advocate of tax cuts).

Moore has long been advocating for an end to Social Security, arguing that individual retirement accounts (such as 401(k)s for all) would be preferable.  As discussed above, the indefinite deferral of collection of the payroll taxes that support Social Security would, indeed, lead to a collapse of the system.  Thus this policy makes sense if you want to end Social Security.  It does not otherwise.

Yet Social Security is popular, and critically important.  Fully one-third of Americans aged 65 or older depend on Social Security for 90% or more of their income in retirement.  And 20% depend on Social Security for 100% of their income in retirement.  Cuts have serious implications, and Social Security is a highly popular program.

Thus advocates for ending Social Security cannot expect that their proposals would go far, particularly just before an election.  But suspending the payroll taxes that support the program, with a promise to terminate those taxes if re-elected, might appear to be more attractive to those who do not see the implications.

The issue then becomes whether enough see what those implications are, and vote accordingly in the election.

The Spread of Covid-19: Trump States vs. Clinton States – An Update

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An earlier post on this blog compared the spread of Covid-19 in the states that Trump had won in 2016 to that in the states won by Clinton, with data through June 24.  This post will update those figures to July 16.  The trends have become even clearer.

As seen in the chart above, new cases in the states won by Trump have continued to shoot upwards, at an alarming pace.  They had reached 22,000 new cases per day as of June 24 (based on a seven-day rolling average ending on that date), but have now (as of July 16, just three weeks later) more than doubled to 48,500.  The decisions to rapidly reopen by the governors of such Trump-won states as Florida, Georgia, Texas, and Arizona, as well as others, have clearly been a disaster.  The virus is now spreading rapidly in those states, and some of these governors are now putting back in place (albeit only partially) the social distancing measures that had earlier worked.

Daily new cases are also now clearly increasing in the states won by Clinton.  This trend was still too recent to be clear in the data through June 24.  But the pace of spread in the Clinton states is far below that of the Trump states, and the number of new daily cases in the Clinton states (16,500 as of July 16) is only one-third the number in the Trump states.

The trends in the figures for the number of deaths from Covid-19 have also now become clear:

In the previous data through June 24, the daily number of deaths (again based on seven-day rolling averages) had come down from their mid-April peaks to a relatively flat level as of mid-June.  This had marked a sharp decline of over 80% in the daily number of deaths in the Clinton states (where peaks early in the crisis in New York had overwhelmed the hospital system, at a time when still little was known on how best to treat the extremely sick), and by a lesser but still significant decline (about 50%) in the Trump states.

Since mid-June, the daily number of deaths in the Clinton states has been relatively flat (hovering between about 200 and 300).  But there has now been a significant increase in deaths in the Trump states, rising from a trough of about 280 per day to now almost 500, an increase of about 75%.  And the path points to a continued rise, as one would expect given the even sharper rise in daily new cases (as there is a lag – deaths occur several weeks after when a case is first confirmed).

These trends should be worrisome in the extreme.  They are not the consequence of increased testing in the US, as Trump has repeatedly asserted.  While testing was slow to start in the US (the administration had bungled the roll-out in February and into much of March), there has not been a significant change in test availability since mid or late April, and certainly since May.  The increases in cases started in June.  More people are now being tested because more people are getting sick, and seek a test as they come down with the symptoms.  And the increase in the number of people dying from the disease is certainly not a consequence of testing, but rather of more people becoming sick.

More could be done, but sadly this presidential administration isn’t.  And it would not be all that difficult.  As I had noted in my June 25 post, a relatively easy measure would be for everyone to wear masks.  Since that post, Robert Redfield (the head of the CDC) noted in an interview on July 14 that “if we could get everyone to wear a mask right now, I really do think that over the next four-six-eight weeks we could bring this epidemic under control” (see this YouTube video of the interview, starting at about the 4-minute mark).  He noted that this is not difficult – the problem is just that not enough people do it.

For many of those refusing to wear a mask – some adamantly so – the issue is seen as political.  The problem started with Trump, where at the April 3 press conference announcing CDC guidelines calling on people to wear face masks, Trump simultaneously emphasized that he would not himself abide by those guidelines.  With any other president, this would be unbelievable.  Since then, supporters of Trump have increasingly seen the issue as one of making a political statement rather than as the public health matter that it is.  A recent academic study found that political partisanship is the most important factor in explaining whether or not people will wear masks and exercise other social distancing recommendations, and that this partisan difference has grown over time.

This has even become violent.  In early May, for example, a security guard at a Famlly Dollar store told a customer she would need to wear a face mask to enter, as per the state orders of the time.  She returned with members of her family about 20 minutes later who shot the guard, who died.  More recently, a 43-year old man entering a convenience store without a mask was asked by another customer to put on a mask.  He responded by stabbing the 77-year old customer.  The man then fled, was later spotted by police, and started to attack the policewoman who then shot him.  He died.  And there have been, sadly, a number of such incidents.

Those refusing to wear face masks when in public insist that such a requirement infringes on their “freedom”.  Thus, as a matter of principle, they refuse to do it.  If it was indeed the case that the only one suffering harm from not wearing a mask was that individual only, I would not be so concerned.  But that is not the case – others exposed may then become infected, and possibly even die.  It is similar to speed limits on highways.  If the only one who might be harmed by speeding is the speeder only, I would not be so concerned.  But speeders may harm, and possibly kill, others as well.  Hence we have speed limits and those limits are enforced.

Refusing to wear a face mask under a belief that it is an infringement on freedom, and responding with threats or even violence when asked to do so, is madness.  With true leadership in Washington we would have a president who would act on this.  Not only would that president model responsible behavior by wearing a face mask himself when in public or when meeting with others, he would also call on all his supporters to do so as well.  They might listen to him.  But his refusal to do so speaks volumes itself.