why the relatively good US numbers for COVID-19 mortality?

Major news sources are reporting that the USA has had the most cumulative COVID-19 deaths. That is a meaningless statistic, since our population is, for example, seven times larger than Spain’s. On a per capita basis, the US is reporting far fewer cumulative deaths than ten major OECD countries.

(My analysis of data from Our World in Data.)

One objection is that we are experiencing the pandemic later than Spain and Italy, and our per-capita cumulative rate will grow to meet theirs. However, assuming we peak (as expected) early this week, then we should not converge with Italy and Spain.

For a more precise comparison, here are per-capita cumulative deaths on the 30th day after each country saw its deaths reach one in ten million.

(I have consulted Kevin Drum’s daily updates to find Day 30 for each country. Several nations have not yet reached Day 30 and are not shown.)

The ratios are, indeed, smaller in this second graph than in the first. For example, on April 10, Spain had almost six times more cumulative deaths per capita than the USA that same day. If you compare the two countries on their respective Day-30’s, which happened weeks apart, the ratio is just 4.8-to-one. Still, the gap is unlikely to close much further, which means that Spain’s outcome will be four or five times worse than ours.

Another objection is that national aggregates are misleading because health outcomes in the USA are badly unequal by race. If per capita mortality for African Americans and Native Americans were shown separately, those numbers might look much worse. Then again, white Americans would then look even more fortunate in international comparison.

The same goes for regional breakdowns. On its own, New York City would look bad, but removing New York would make the national statistics look even better.

A third objection is that these statistics are inaccurate. No doubt, some COVID-19 deaths are not being appropriately counted. However, I am using deaths instead of diagnoses, because mortality statistics are generally considered pretty reliable and comparable across countries. Also, the epi-curves in these countries are rising smoothly in the expected ways.

A fourth objection is that we have only considered the first wave. If the pandemic revives in a second wave, all bets are off. I would say that it is wise to prepare for a second wave, but the only data we can discuss come from the current phase. It’s worth trying to analyze what it means.

Assuming that these statistics are fairly accurate, there doesn’t seem to be a meaningful relationship between COVID-19 mortality and the size of a welfare state (% of GDP spent on social welfare). The correlation would be positive (more spending goes with higher mortality), but the scatterplot is diffuse.

Nor is there a correlation between COVID mortality and health expenditures per capita, adjusted for purchasing power.

The preliminary evidence suggests that public policy, political leadership, and the social contract matter much less in this pandemic than I would have thought. I think we must look elsewhere for explanations of the variance in COVID-19 deaths.

Some differences in national outcomes may be due to social and geographical factors, such as the median age of populations, population density, or the frequency of living together in intergenerational households. I suspect a major variable is the timing of the onset of the disease. By the time the pandemic was starting its rise in the USA, many Americans had already become alarmed by the news from Italy and Spain; we self-isolated pretty rigorously. Like Iran, Italy and Spain didn’t have the benefit of as much warning. Meanwhile Taiwan and South Korea did better because they had previously experienced SARS.

This analysis is preliminary and amateurish and could easily change. That said, it challenges my own ideological priors. I would have assumed that Donald Trump would make things worse here than in other countries, and that our lack of health coverage would set us up for failure. It is always worth challenging your own ideological premises when conflicting evidence arises.

It’s also important to prepare for a summer and fall in which anti-Trump forces will try to blame the US situation on him, and the most cogent defense will be that the US is actually faring better than most social democracies. I don’t expect Trump to present his defense with any discipline, but his critics should be ready for it.

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About Peter

Associate Dean for Research and the Lincoln Filene Professor of Citizenship and Public Affairs at Tufts University's Tisch College of Civic Life. Concerned about civic education, civic engagement, and democratic reform in the United States and elsewhere.