A grim series of articles published today in the Journal of the American Medical Association makes clear just how hard the United States has failed at controlling the ongoing novel coronavirus pandemic—from the country’s horrifying death toll to its inability to drag down its shamefully high death rates.
It was already clear that the US has tallied more deaths from the coronavirus than any other country and has one of the highest death rates per capita in the world. But, according to one article in the series, the US is also failing to lower COVID-19 death rates—even as harder-hit countries have managed to learn from early disease peaks and bring their rates down substantially.
For the analysis, researchers Alyssa Bilinski of Harvard and Ezekiel Emanuel of the University of Pennsylvania compared the shifting COVID-19 death rates of 18 high-income countries during three time windows. The idea was to see how death rates changed as countries adopted different public health interventions, especially if they had seen surges in cases early on that boosted their overall death rate during the pandemic. Specifically, Bilinski and Emanuel looked at COVID-19 deaths per 100,000 people starting from February 13, May 10, and June 7, with all three windows ending on September 19.
The United States was in the “high mortality” category from the start, with 60 COVID-19 deaths per 100,000 since the beginning of the pandemic in February. This puts the US in line with Italy (59), the United Kingdom (63), Spain (65), and Belgium (86). However, as the time periods shifted later into the pandemic, those rates dropped substantially for the countries—except the US. Italy’s death rate dropped to 9 and 3 since May and June, respectively. The United Kingdom’s rate fell to 16 and then 5. Belgium’s went down to 12 and then 4.
But, the United States’ death rate, meanwhile, stayed high at 37 since May and 27 since June. The only other country that comes close to rivaling the US in its meager progress is Sweden, which saw death rates of 57, 23.5, and 10 in the three windows.
“After the first peak in early spring, US death rates from COVID-19 and from all causes remained higher than even countries with high COVID-19 mortality,” Bilinski and Emanuel conclude. “This may have been a result of several factors, including weak public health infrastructure and a decentralized, inconsistent US response to the pandemic.”
In another article in the JAMA series, researchers at the Virginia Commonwealth University and Yale focused on the United States alone. They compared the expected number of deaths in the US to the actual number between March and August, finding more than 225,000 extra deaths—a 20 percent jump. And only 67 percent of those extra deaths were directly linked to COVID-19 on death certificates. The rest may have been misclassified or been due to disruptions in health care during the pandemic or other pandemic-related problems.
If the pandemic continues in the US as it has, the researchers’ estimate suggests that there may be more than 400,000 excess US deaths for the whole of 2020. The significance of this estimate “cannot be overstated,” write Howard Bauchner, editor-in-chief of JAMA, and Phil Fontanarosa, JAMA’s executive editor, in an accompanying editorial. The toll “accounts for what could be declines in some causes of death, like motor vehicle crashes, but increases in others, like myocardial infarction.”
In yet another article, a team of psychiatrists highlights that every single extra death creates its own radius of devastation. “Each COVID-19 death leaves an estimated 9 family members bereaved,” the psychiatrists write. This “projects to an estimated 2 million bereaved individuals in the US,” given the 225,000 extra deaths so far. “Thus, the effect of COVID-19 deaths on mental health will be profound.”
They go on to explain how this tandem epidemic of grief will lead to spikes in prolonged grief disorders, substance abuse, and societal disruption. And this toll doesn’t include the mental health distress of health care workers, who witness first-hand the ravages of COVID-19 disease and deaths.
“Devastation is imminent”
“In summary, a second wave of devastation is imminent, attributable to mental health consequences of COVID-19,” the psychiatrists write. “The magnitude of this second wave is likely to overwhelm the already frayed mental health system, leading to access problems, particularly for the most vulnerable persons.”
With the extra deaths, long-term health problems, looming mental health crisis, and loss of gross-domestic product from the pandemic, Harvard economists David Cutler and Lawrence Summers estimate that cumulative financial costs of the COVID-19 pandemic will be $16 trillion.
Of course, the health, death, and economic tolls won’t be felt equally, write Lisa Cooper of Johns Hopkins University and David Williams of Harvard. The implications for the United States are “sobering,” they write, but are “even more profound for communities of color.”
“The COVID-19 pandemic has further compounded health, social, and economic disparities in communities of color,” they add. “The effects of 2020 will be felt for years to come.”