July 27th, 2020

// The Wealthy World’s Response to COVID-19, in Four Graphs … The U.S. Comes in Dead Last

The Wealthy World’s Response to COVID-19, in Four Graphs
… The U.S. Comes in Dead Last

After six months of COVID-19 pandemic, let’s pause, and assess the performance of countries and their leaders.  Sadly, by most standards the U.S. has little to be proud of.  (All data come from Worldometers)

Since it’s only fair to compare countries with comparable resources and healthcare infrastructure, we’ll look at the “Wealthy West” – the U.S., Canada, and a dozen Western European nations.  (Others, like Japan, Taiwan, Australia, and New Zealand, aren’t shown because their COVID-19 numbers are too small to show up on these graphs.)  Also, to level the playing field statistically, we’ll present per capita numbers rather than the raw numbers.  

Total Cases.  We begin with the daily progress of new cases, the most widely-used measure of the pandemic’s spread: 


Every nation’s curve peaked 4-6 weeks after the pandemic first took hold, but with peaks several times greater in the hardest-hit countries (Spain and Belgium) than in the least-hard-hit (throughout Scandinavia).  As measures such as face masks and social distancing took hold, twelve of the fourteen countries then saw a dramatic, steady decline in new cases.  Those countries now typically see fewer than 10 new cases per MM in a typical day.  

Sweden and the U.S. are the outliers, with little or no decline from the initial peak and a further surge around week 13.  Sweden’s new cases are now down roughly 70% from their peak, while the U.S.’s have risen to levels never seen in even the hardest-hit countries.  Sweden is noteworthy because it alone chose to take a laissez-faire approach, keeping schools and many businesses open throughout.  But in the U.S., there is simply no positive way to spin the pandemic’s progression.  Some try to attribute the U.S.’s current surge to an increase in testing, but even if that were true (see below), more testing just cannot explain that many new cases.  

Deaths.  With fewer cases comes fewer deaths.  Also, all over the world the case fatality rate– i.e., the ratio of deaths to reported cases – for COVID-19 is declining.  Reasons include better medical understanding of how to treat the most serious cases, healthcare systems that are now less heavily stressed, and a demographic shift in infections to younger patients, since COVID-19 is clearly most destructive to the elderly.  

The following graph shows reported COVID-19 deaths by month, with the most recent months shown darkest and to the left.  Countries are sorted in descending order of total deaths per capita since June 1 – roughly when most economies began to reopen:  


April saw the most deaths for every country shown, with steady monthly declines since then.  Many countries are now reporting just a handful of COVID-19-related deaths per week.  However, three countries stand out for deaths since June 1 – the U.S., Sweden, and the U.K.  Sweden saw high deaths continuing into June because of its continued surge, but the pace has slowed significantly in July.  The U.K.’s ongoing high number of deaths continues to trouble and baffle – witness Prime Minister Boris Johnson’s recent announcement of an independent inquiry into the government’s response.  However, the U.S.’s number does not baffle: the continuing surge in cases makes more deaths inevitable for at least a few more weeks, even at the lower mortality rates we’re now seeing.  

To put the U.S.’s deaths in harsher perspective: the European countries shown (excluding Sweden and the U.K.) plus Canada, have a combined population roughly equal to the U.S.’s.  Yet in the nearly two months from June 1 through July 26, that group of twelve countries has reported a total of only 6,400 COVID-19 deaths, compared to 41,000 in the U.S.; proportionally, the comparison is even starker for July alone.    

Testing.  Second only to motivating or mandating safe public practices, testing is the most important action a nation can take to control a pandemic’s spread, especially when a significant portion of those infected are asymptomatic.  It’s critically important that nations test strategically – that is, testing people as the result of contact tracing, periodic testing in high-risk and high-contact occupations like health care and food service, and testing individuals when a recent experience justifies it.  

By contrast, necessary testing occurs simply because people show symptoms.  At least one test is needed to confirm a COVID-19 diagnosis, at least two more to confirm a recovery, and a few additional tests for obvious candidates like the patient’s housemates.  Testing for these reasons doesn’t really enable a nation to control a pandemic’s spread.  The following graph shows the progress of total strategic tests performed in 40 relatively affluent countries worldwide – we assume that each reported case generates six necessary tests, with the remainder of a nation’s total tests considered as strategic tests:  


The U.S. has significantly ramped up its strategic testing, but so has virtually everyone else.  Even today, the U.S. ranks just in the middle of the pack.  Claims that the U.S. leads the world in testing are flatly untrue – and would be even if we showed total rather than strategictesting as the metric.    

Lastly, turnaround time matters!  Having to wait 8-10 days for the results of a COVID-19 test is a little like waiting four months for the results of a pregnancy test.  The average turnaround at the two major U.S. testing labs is now 4-6 days, and that doesn’t include the time needed to schedule a test, deliver it to the testing lab, and communicate the result back to the patient.  This is a huge problem, especially with the current surge creating high demand for necessary tests.  

Red state/blue state.  The following graph tracks the weekly progression of new cases in U.S. states, divided into six groups depending on how they voted in the 2016 presidential election – red for Republican, blue for Democrat.  Color intensity varies with the margin of victory.  California, an outlier in many respects, is shown in green:


A clear pattern emerges.  In the early stages of the pandemic, a small but populous group of states, virtually all in the Northeast or the industrial Midwest, was hit the hardest, and most were heavily blue states in 2016.  Then, from mid-April to mid-May, virtually every hard-hit state saw declines in new cases, while the others stayed low.  Now, in the recent surge, the hardest-hit states include every state in the South, plus California, Arizona, and three less populous mountain states.  

This graph is not intended as a political statement – it is, after all, nothing more than publicly available data.  The enormous state-to-state differences in how COVID-19 has spread are clearly attributable to how quickly states chose to reopen their economies, and how closely their residents observed sound personal health practices.  But the underlying causes of those differences bear discussion.  

SUMMARY.  The numbers show that the U.S.’s performance in response to the pandemic has been shockingly poor, if not disastrous.  They reflect a failure to control the spread of new cases, continuing deaths, inadequate testing, and the politicization of decisions that should be purely science- and data-based.  All this has happened in spite of available resources in and economic sacrifices by the U.S. that are comparable to the other countries of the Wealthy West.  Clearly, a sober, honest national discussion about balancing individual freedom with public safety and economic well-being with personal health is necessary, or history is doomed to repeat itself.  


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