Commentary: The US response to COVID-19 hasn’t been a train wreck. We’re just average

The COVID-19 pandemic has taken another turn with new variants BA.2 and BA.2.12.1, which are apparently more contagious but less severe than their predecessors, causing a new mini-wave of infections in the U.S. Nationally, cases are up, but deaths and hospitalizations remain relatively low for now. Amid what amounts to an emerging sixth wave, the U.S. has received disproportionate criticism at home and from international observers for its handling of the pandemic. But over recent months, events worldwide should dispel notions of exceptional American malfeasance.

You probably haven’t seen some of these things reported about the pandemic:

At more than 82 million, the U.S. still has by far the most diagnosed cases of any country. But in the last year, a number of advanced nations have had much greater case rises than the U.S. and now have higher case levels adjusted for population size. Since the beginning of May 2021, diagnosed COVID-19 cases in the U.S. have gone from roughly 33 million to 82 million — a rise of about 150%. In the same interval, cases in the United Kingdom have gone up by 300%; in France, 400%; in Germany, 600%; in Japan, 1,400%; and in South Korea, the rise has been an astronomical 13,500%.

All these countries except for Japan now have a higher per-capita case rate than the U.S., which is an adjustment for population size. Even Sweden, which is often cited as a model for containment of the pandemic, has had a greater case rise than the U.S. in the last year and now has a similar per-capita case rate.

With total COVID-19 deaths here approaching 1 million, the U.S. also has more deaths than any other country in the world. But when adjusted for population size, the U.S. ranks 16th in the world in deaths per capita. Most of the countries with more per-capita deaths are in Eastern Europe — Hungary, Croatia and Lithuania — along with two South American countries, Peru and Brazil. If crude mortality is considered independent of the population — that is, deaths per number of diagnosed cases since the start of the pandemic — at 1.2%, the U.S. is squarely at the world average, neither especially high nor low. The figures do not suggest the U.S. stands out from the crowd.

In the face of new variants, COVID-19 cases and especially COVID-19 deaths are dropping dramatically worldwide. Right now, there are fewer than 2,500 deaths per day worldwide — down more than 85% from the peak and the lowest level since the early days of the pandemic in March 2020. This drop in worldwide deaths is a reason for long-term optimism. The current U.S. decline in deaths has been substantial: This country is incurring a lower percentage of worldwide deaths than at any time previously in the pandemic.

However, the U.S. is still responsible for a higher percentage of the world’s deaths than any other country (16%). This is obviously not because of poorer medical care and is unlikely to be because of worse management of the pandemic. It is probably the result of less prior immunity in the U.S. than elsewhere, as well as a higher percentage of high-risk patients, i.e., elderly, immunocompromised or obese.

U.S. vaccination rates are within a few percentage points of those in most Western European countries, and a link between vaccination and death totals does not explain why U.S. deaths were also comparatively higher throughout most of 2020, before vaccines were available. Despite low vaccination rates, every African country has a lower per-capita death rate than those in the U.S. and most wealthy Western European countries.

Vaccination unquestionably reduces any single COVID-19 patient’s chances of death but does not translate easily to a nation’s reduced death rates. Two of the countries with the world’s highest vaccination rates, Brazil and Peru, also have among the highest per-capita death rates. Rate of vaccination is only one aspect of immunity. Native immunity and previous COVID-19 infection are also important determinants of response to COVID-19. Even within vaccination rates, a whole host of variables are important: type of vaccine, number of doses, the interval between doses and time since last dose.

None of this is to take the U.S. off the hook in its handling of the pandemic. Both the Trump and Biden administrations declared victory way too early. For too long, the public health community put most of its faith in vaccine research; therapeutics were almost an afterthought. This wasn’t necessarily a bad strategy, but the rapid and unexpected emergence of variants rendered it less effective than anticipated. The Centers for Disease Control and Prevention and many public health agencies nationwide have been clumsy in marshaling their response to this viral evolution. Partisan politics often influenced what should have been the straightforward science of epidemiology: what, exactly, is happening and what should we do about it. As a result, there have been too many contradictory or inaccurate statements by too many government officials.

Despite what you may read or hear, the U.S. has done no better or worse than most other countries. We Americans have no cause to wave the flag nor to hang our heads.

Dr. Cory Franklin is a retired intensive care physician. Dr. Robert A. Weinstein is an infectious disease specialist at Rush University Medical Center.
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