The proportion of Americans dying from coronavirus infections is the highest in the developed world, according to a study of global mortality rates that shows the U.S. pandemic response left citizens exposed to the lethal disease.
Early in the outbreak, the U.S. mortality rate from COVID-19 was lower than in many other hard-hit countries, including the U.K., Spain and the Netherlands, according to the report Monday in the Journal of the American Medical Association. But as spring turned to summer, the U.S. largely failed to embrace public health and policy measures that have helped other countries reduce death rates.
If U.S. deaths after May 10 had occurred at the same pace as in Spain, the U.S. mortality rate would be 47% lower, with 93,247 fewer people dying, the report found. More than 100,000 fewer Americans would have died if the U.S. had the same mortality rate as the Netherlands. Sweden's mortality rate was 22% lower, though it took fewer steps to curb the virus's spread.
The U.S. leads the world in total coronavirus deaths, with 214,776 as of Monday, according to data from Johns Hopkins University. Brazil ranks second with 150,488 deaths.
America's failure to control the outbreak is forecast to be costly. When lost output and health setbacks are taken into account, the economic toll of the pandemic is expected to exceed $16 trillion, or about 90% of U.S. annual gross domestic product, according to a separate report in JAMA on Monday.
Other ripple effects are also expected. On average, nine family members are affected by the loss of each person who dies of COVID-19 in the U.S., creating a pool of 2 million mourners, according to another article in JAMA by psychiatrists from NYU Grossman School of Medicine.
No country has an effective vaccine, treatments or hospitals that give them an advantage over the rest of the world, said Ezekiel Emanuel, vice provost for global initiatives at the University of Pennsylvania. The difference comes down to each country's response, he said.
Since the global chaos of the virus's first wave abated, "it's quite clear that the United States has been worse than every other country, including high mortality countries, in responding to the outbreak," Emanuel said. "That has produced tens of thousands, if not 100,000 deaths from COVID."
Researchers compared deaths per 100,000 people in Organization for Economic Co-operation and Development nations with populations exceeding 5 million and per capita gross domestic product of $25,000 or more.
An update of another study conducted earlier this year suggests the U.S. also hasn't corralled excess mortality associated with the pandemic. The analysis takes into account factors such as a decline in fatal motor-vehicle accidents and increased deaths from delayed treatment for heart attacks and strokes.
The number of U.S. deaths caused directly or indirectly by the pandemic is 20% higher than the public counts of virus deaths detailed daily in the news, said Steven Woolf, director emeritus of the Center on Society and Health at Virginia Commonwealth University in Richmond. Wolf said excess deaths occurred mainly in states that reopened earlier and experienced outbreaks that persisted into the summer.
"It's one thing to look in the rearview mirror," Woolf said. "Looking forward, it seems important for national leadership to recognize that easing restrictions in the midst of a national pandemic is just going to delay control of transmission and not only prolong the death toll, but the ripple effects on our economy."
States like Florida, Texas and Arizona that opened earlier also suffered longer, with excess deaths rising for more than 16 weeks. States including New York and New Jersey that were hit early and took aggressive measures saw mortality rates recover in less than 10 weeks, Woolf said.
More than 400,000 excess deaths are expected to occur in 2020, said Howard Bauchner, editor-in-chief of JAMA, and Phil Fontanarosa, the executive editor, in an editorial in the medical journal on Monday.
"These deaths reflect a true measure of the human cost of the Great Pandemic of 2020," they wrote. These deaths far exceed the number of U.S. deaths from some armed conflicts, such as the Korean War and the Vietnam War, and deaths from the 2009 H1N1 pandemic, and approach the number of deaths from World War II."
Even when medicines, like those given to President Donald Trump, and vaccines are widely available, Americans will have to continue to use measures like social distancing and mask wearing to limit transmission of the virus, Emanuel said. Such steps will be particularly critical in the winter and spring, when colder weather pins much of the country indoors.
"Now that people have seen the other approach is a failure, I do think success is possible," Emanuel said. "It won't be easy."