Contribute Try STAT+ Today

More than 120,000 Americans have now perished from Covid-19, surpassing the total number of U.S. dead during World War I. Had American leaders taken the decisive, early measures that several other nations took when they had exactly the same information the U.S. did, at exactly the same time in their experience of the novel coronavirus, how many of these Covid-19 deaths could have been prevented?

That isn’t a hypothetical question. And the answer that emerges from a direct comparison of the fatalities in and policies of the U.S. and other countries — South Korea, Australia, Germany, and Singapore — indicates that between 70% and 99% of the Americans who died from this pandemic might have been saved by measures demonstrated by others to have been feasible.

At least three factors enable meaningful comparisons of these nations with the United States. First, we scaled up their population sizes and Covid-19 deaths to match those of the U.S. Second, in each of these countries, roughly 80% or more of the population lives in urbanized, transmission-prone areas, similar to the U.S. Third, the pandemic took root earlier in these other countries than here, as measured by the date of the 15th confirmed case in each, meaning that foreign leaders had to act with less information to guide their decisions than did U.S. leaders.

advertisement

To compare each country’s responses to the pandemic on a consistent basis, we turned to the work of an Oxford University team that has constructed a stringency index based on 13 policy responses (lockdowns, border closings, tests, etc.) to measure how strongly each country responded over time. The Oxford index shows that 14 days from the date of the 15th confirmed case in each country — a vital early window for action — the U.S. response to the outbreak lagged behind the others by miles. The U.S. stringency score of 5.7 at that point was 25% of Australia’s (23), 23% of Germany’s (25), 18% of Singapore’s (32), and only 15% of South Korea’s (38).

Due to exponential viral spread, our delay in action was devastating. In the wake of the U.S. response, 117,858 Americans died in the four months following the first 15 confirmed cases. After an equivalent period, Germany suffered only 8,863 casualties. Scaling up the German population of 83.7 million to America’s 331 million, a U.S.-sized Germany would have suffered 35,049 Covid-19 deaths. So if the U.S. had acted as effectively as Germany, 70% of U.S. coronavirus deaths might have been prevented.

advertisement

Seventy percent, though, is the most conservative estimate. Scaled-up versions of South Korea, Australia, and Singapore would have experienced 1,758, 1,324, and 1,358 deaths, respectively, in the four months after 15 cases were confirmed in each country. Had we handled the coronavirus as effectively as any of these three countries, roughly 99% of the 117,858 U.S. Covid-19 deaths might have been averted.

 

Country Population (millions) Date of 15th confirmed case Stringency Index two weeks after 15th case Number of deaths, four months after 15th case Deaths scaled up to U.S. population equivalent
Singapore 5.85 2/1 32 24 1,358
Australia 25.5 2/6 23 102 1,324
South Korea 51.2 2/2 38 272 1,758
Germany 83.7 2/12 25 8,863 35,049
United States 331 2/14 5.7 117,858 117,858

Sources: Worldometers, Statista, Oxford Covid-19 Government Response Tracker (accessed 5/20/20).

Our conclusions are strengthened by their consistency with the results from different methodologies. Two notable epidemiological projections, based on theoretical models of transmission and “idealized hypothetical assumptions,” have estimated that between 80% and 90% of American deaths could have been averted had lockdowns and social distancing begun two weeks earlier.

For a more granular perspective, we compared the American response to the actions taken by South Korea. By the time South Korea experienced its 15th confirmed case on Feb. 2, it had spearheaded a massive public information campaign, mobilized private sector players to produce testing kits, and expedited regulatory approval for these newly developed tests. Within a week, tests were widely available. Within three weeks, schools and public spaces were closed, large gatherings had been banned, and 26,000 people had been tested.

In contrast, President Trump consistently ignored confidential and public early warnings from experts and intelligence agencies prior to the 15th confirmed U.S. case on Feb. 14, then acted far more slowly and inconsistently than South Korea. The White House banned flights from China on Feb. 2 but later permitted more than 40,000 travelers from China to enter the U.S. From February through April, President Trump made dismissive and contradictory statements to which government agencies and the public paid close attention.

Often taking cues from the president’s words, state by state measures were rolled out piecemeal. Florida and Georgia, for example, waited until April 3 to issue stay-at-home orders while South Carolina held off until April 7.

Another crucial failure involved testing. Three weeks after the 15th Covid-19 case had been confirmed in the U.S., only about 10,000 tests had been administered. By an equivalent point in its epidemic, South Korea had administered approximately 17 times more tests per capita than the U.S. had done. This testing fiasco crippled vital early contact tracing efforts when hot spots could have been contained.

South Korea’s decisive actions during this critical early window produced a dramatic disparity. By mid-March, each of the two countries had suffered about 90 Covid-19 deaths. But throughout April, while a total of 85 South Koreans died from the disease, an average of more than 85 Americans died per hour. This divergence only widened as time passed.

Although federal, state, and local governments share responsibility for American health policy and implementation, ultimate accountability during a national crisis heavily rests on the occupant of the White House. At a minimum, the president, perhaps through a tough “testing czar,” should have empowered private companies, labs, and hospitals to augment public testing efforts — as South Korean policymakers did — and imported readily available tests from elsewhere if necessary. If there were shortages of testing components, the president should have immediately invoked the Defense Production Act rather than waiting for months to do so for this purpose. And when the CDC and the FDA fumbled early testing efforts, President Trump responded: “I don’t take responsibility at all.”

The administration has advanced innumerable excuses and scapegoats for the vast U.S. death toll: China, the World Health Organization, the Centers for Disease Control and Prevention, former President Barack Obama, the media, and more. Yet other countries with the same information — or alleged misinformation — as the U.S. had at the time took earlier, decisive steps to quell the spread of SARS-CoV-2, the virus that causes Covid-19. Relative to the United States, their actions dramatically cut their death tolls and, on average, South Korea, Australia, Germany, and Singapore are opening up their economies sooner and more safely than the U.S.

Two recent studies published in Nature confirm the “astonishing effectiveness” of the type of government interventions we have discussed, especially when adopted early. Our analysis shows that with the same actions actually taken by other nations large and small, from East and West, the U.S. could have prevented 70% to 99% of its Covid-19 deaths. This has been a needless tragedy.

Isaac Sebenius graduated from Harvard College in May 2020 with a degree in molecular and cellular biology. James K. Sebenius is a professor of business administration at Harvard Business School and director of the Harvard Negotiation Project based at Harvard Law School.

  • Thats it keep blaming Trump. No problem with Biden calling the banning of flights from China zenophobic. No problem wit Cuomo and Pelosi celebrating the Chinese New Year amongst large crowds calling the Covid epidemic overblown. You know as most Americans know who the real culprits are. China, W.H.O. and the mainstream media. It wouldn’t of mattered who was in charge thats why they call it a world wide pandemic. Put most of the blame where it belongs at China”s feet for deceiving the world and shutting down travel between domestic destinations but leaving the internation airport open to spread the virus worldwide.

  • This is an interesting analysis. The comparisons are compelling evidence that the US might have fared much better with much lower mortality with a different approach. But the author seems far too confident in the limited analysis and assigning blame. The comparison countries are all quite different from the US in different ways and it is still unclear whether these inherent differences or government policy were most crucial in the different outcomes. Are cultural differences playing a role? Does individual behavior make a difference? Would US citizens have complied well with any early recommended precautions? In some of these countries, there may be significant differences on an individual level (conformity, mask-wearing, hygiene) or cultural level which are affecting spread of the infection. How much does government policy affect this behavior and how much is it playing a role? Are there critical differences such as travel restrictions which had the largest impact in some countries which are more isolated? How effective would the same policy changes, if effective, be here? How much should the CDC have done given their primary role in a pandemic? Shouldn’t the CDC have a plan of action at least in terms of recommendations and data collection (testing) which functions separate from the executive branch? Did the CDC advise the Trump administration appropriately? Why wasn’t the CDC recommending mask wearing, avoidance of large gatherings, etc. In January? Why didn’t the CDC ensure an early functional testing regimen or screen/quarantine travelers more effectively? What is the role of Congress? Would the opposition party have undermined the administration’s actions? There is evidence they did oppose the travel restrictions and were in a contentious impeachment battle with the President. Why was the Congress oblivious to the possible risks? Why were local leaders, most notably in New York, oblivious to the risks and not preparing? With so many unanswered questions, the article’s conclusions seem premature.

    In addition, I wonder about other countries which may not fit the article’s simple narrative. What about Japan? How did it fare so well when it was not as aggressive in confronting Covid as many other countries on a government policy level? How did its response compare to the US? Are there cultural or other factors which played a bigger role in their better outcome?

    • The assumptions made in this article using limited facts to discredit one individual as responsible for the number of deaths in the US does not shine a bright light on the knowledge gained by attending or working at Harvard University. This sounds more like an attempt at a political “hack job”. Makes me glad I did not waste a small fortune attending those same classes. The points made by Mr. Remmler in response far outweigh the lack of thinking put forth in the article.

  • Steve White, on the contrary, I have not put words in your mouth — I have taken pains to actually quote you. You just don’t like to have your words and positions dissected.

    Now we’re down to “wet markets” (aka farmer’s markets) are we? H1N1 “Spanish flu” may well have jumped from Kansas farm animals to humans in 1918 (you know, that pandemic that killed somewhere between 50 and 100 million worldwide). Factory farming and even smaller-scale farming all over the world (especially chickens and pigs) represent a definite hazard for viral recombination of novel influenza pathogens. Are you an advocate for shutting down commercial pig and chicken farming in the U.S. and all over the world?

    There is often substantial uncertainty about the path of animal viruses to humans. After all these decades, there is still substantial uncertainty about human immunity to influenza viruses and how influenza pandemics arise and spread. Did you think that bashing China and saying you want to “punish” them for perceived transgressions (while hypocritically deflecting from or ignoring actual Western transgressions) is going to make the Chinese more willing to collaborate with Western scientists? China is an economic, technological, industrial and scientific powerhouse, and has shown very little propensity for imperialistic and colonial behavior (as compared to the West). Perhaps you might consider the possibility that the majority of Chinese are OK with their system. I favor constructive engagement rather than attempting another regime change hybrid war via neocons like Bolton and Michael “we lied, we cheated, we stole” Pompeo. Hong Kong is China and China’s internal business, not the business of the CIA, Marco Rubio, Tom Cotton and Pompeo, et.al.

    The gross pseudoscience of this “Stat News” article which attempts to whitewash the terribly destructive and unnecessary U.S. lockdown is bad enough. The attempted piggybacking of China scapegoating adds insult to injury. Attend to the pseudoscience and gross negligence of U.S. politicians (and some scientists).

  • Dr. Dawson, I think the onus is on hospitals transferring presumed Covid patients to nursing homes to demonstrate that those patients test Covid negative before transfer, and I doubt that that was done in most instances (do you have data on this?). I don’t doubt that some nursing home patients died of neglect (but the proximate cause of even that would be lockdown). Covid is claimed to have caused great mortality in nursing homes (all over the world). As a pathologist, I understand the vagaries of attributing cause of death. Even so, no matter how it eventuated (sources of infection), the Covid death toll in nursing and care homes was great. Covid risk factors were understood early on. The bottom line is that government policies (worldwide) failed to protect the vulnerable. I lean toward Covid being more of a nosocomial disease than community acquired.

  • The US responded faster than most other nations, before the WHO admitted we should have. 80% of COVID19 deaths were over 64 years old while local governments put COVID19 positive patients into nursing home type of facilities. Who did what?

  • The real issue is that even today many folks are not practicing social distancing and a some refuse to wear masks. It’s amazing the level of independence people expect to exercise “Because”. It’s happening many places in strongly liberal Chicago contrary to state and local leaders direction. Nothing to do with government guidance, just strong willed people wanting to exercise their rights. I have even been ridiculed for wearing my mask! Oh, your one of them!

  • While it’s always convenient (and common) for the media to blame Donald Trump for all the world’s ills – I shouldn’t have to remind you how our government works.

    How convenient you forget to mention exactly what the CHAIR OF THE HOUSE INTELLIGENCE COMMITTEE and his fellow co-conspirators were doing FOR THREE MONTHS without so much as a mention of what was going on. In fact, when Trump started restricting flights at the end of January – Nancy Pelosi HELD A PRESS CONFERENCE to say that the President was merely trying to distract from his impeachment – and HOW MANY more WEEKS did they continue their charade while the numbers increased?

    And folks wonder why nobody trusts the fake news media. Talk about being a diode – everything is one way only for you folks. You would rather see this country fail than even ATTEMPT to do anything out of fear it might make the President look good.

  • Dr. Wirt: Janice L. asked me not to write long posts. I think we have both told our sides of it, but you seem compulsive about putting words in my mouth. Trying one more time – going forward from this mess, it appears China is not going to close the wet (to be clear, wild animal and newly domesticated animal) markets, it appears we are not going to learn how CoV2 got from the original animal host to man, and there is no assurance Chinese doctors will be allowed to sound the alarm when a new novel virus emerges there, which many public health people think is likely. I want those things to change. That’s it.

  • Janice L. I know I tend to go on but it is often impossible to cover everything. Particularly with this doctor who is so persistent in not reading what i am writing and insists on disputing things I never said.
    But, often with these Comments, if a layman comes up with something too short, his reasoning is not understood, and really I look for dialogue and not to dominate anything – I can not learn by dominating and the original intent is to learn, in order to survive the epidemic.
    But, I will try to keep it shorter.

Comments are closed.