200,000 Americans are now confirmed dead from Covid-19

A failed government response and America’s structural disadvantages contributed to the highest coronavirus death toll in the world.

The number of Americans confirmed to have died in the Covid-19 pandemic has now reached 200,000, according to the most authoritative public databases — a larger loss of life than many public health experts thought possible in the spring.

The actual number of victims is significantly higher. The New York Times reported last month that from March 1 to July 25, there were about 60,000 more “excess deaths” than confirmed Covid-19 deaths in the US. That means about 60,000 more people died over that time than expected, on top of all of the reported deaths attributed to the pandemic. Some number, potentially a very large number, of those deaths were likely coronavirus-related but not counted as such because of America’s inadequate testing.

The US is still averaging about 800 reported deaths every day, so the body count is going to continue. The number of new deaths should decline because the number of daily cases has dropped by nearly half since late July. But if cases spike again in the fall and winter, when cold weather and less social distancing could lead to greater spread, the number of American deaths will grow substantially in the coming months.

The scale of America’s Covid-19 death toll is staggering. Six months into the crisis, the US has by far the most confirmed pandemic deaths in the world (50,000 more than the country with the second-most deaths, Brazil). Even adjusting for deaths as a share of the country’s population, America has one of the highest fatality rates anywhere. Since February 6, the day of the first confirmed Covid-19 death in the US, more Americans have died of this disease than died in most of the wars America has fought over its history combined.

Christina Animashaun/Vox

“Shocked — that would be the word that I would say captures my response to our current death numbers from the vantage point of February,” David Celentano, who leads the Johns Hopkins School of Public Health’s epidemiology department, told me.

That was more or less the consensus of all the experts I spoke to.

Natalie Dean, a biostatistics professor at the University of Florida, was asked in May as part of an academic survey to offer a range of projections for US Covid-19 deaths by the end of 2020. She put 250,000 deaths in the 90th percentile, one of the worst possible outcomes in her view at that time, when fewer than 100,000 people had died from the virus.

It now seems likely the US will reach that total in confirmed deaths by year’s end.

“I expected that this would be challenging, but I didn’t expect how desensitized we as a country would become to over 1,000 Americans dying a day,” Dean said. “The goalposts keep moving, and what once seemed unimaginable is now a daily reality.”

America had some natural disadvantages in trying to contain the coronavirus. But a lackluster and disorganized government response is also to blame for the loss of so many American lives.

Americans were already less healthy than their peers before Covid-19 struck

The US health care system made us less prepared for a pandemic than other developed countries with universal health care; it has fewer hospital beds, doctors, and nurses, and more people are uninsured.

But the United States had another important structural disadvantage: Americans are less healthy than people in other developed countries, which made Americans more vulnerable to a pathogen like Covid-19 that is more dangerous for people with preexisting conditions.

Looking at how likely Americans are to die prematurely from a few common conditions (heart disease, cancer, diabetes, chronic respiratory disease), the US outpaces a number of European countries, along with Canada, Japan, and South Korea. Several of those diseases have been associated with a higher risk of severe complications from Covid-19, and the Centers for Disease Control and Prevention reported that most people who died after contracting the coronavirus had other underlying medical conditions.

Peterson-Kaiser Health System Tracker

Life expectancy in the US has been deteriorating compared to the rest of the world since the early 1980s, for structural reasons including socioeconomic disparities; less government support for health care, education, and employment; and the recent epidemics of drug overdoses and suicides.

“I’d like to point out that the US is currently 46th in the world in terms of life expectancy. So why would Covid-19 deaths be any different?” David Rehkopf, a social epidemiologist at Stanford University, told me over email. “What is important to realize is that it wasn’t always this way in the US. From 1975-1980, we were 17th in the world in life expectancy. But there has been a slow (and recently not so slow) decline since the early 1980s.”

But those structural disadvantages alone are insufficient to explain the pandemic’s toll in the United States. Age is one of the most proven indicators of Covid-19 risk, likely contributing to the high death counts in countries with an older population like Italy, but America is actually younger on average than most European countries.

Instead, ineffectual, and misguided responses to Covid-19 by the Trump administration and many states have also contributed to the scale of the tragedy.

The United States has done a poor job containing Covid-19

Eleanor Murray, an epidemiologist at Boston University, was asked on Twitter in late January, before anyone in the US had died of Covid-19, what her best guess would be about the state of the coronavirus pandemic a year from then. She cautioned about the degree of uncertainty, but she pointed to recent respiratory outbreaks like SARS (fewer than 800 dead in 2003) and MERS (about 860 deaths since 2012) as possible precedents.

“I still think that at the time, that was a reasonable prediction, given what we knew, but it’s clear that the pandemic has not played out like SARS or MERS,” Murray told me. “Some of that has to do with features of the virus — the presence of presymptomatic spread makes control much harder for SARS-CoV-2 than for SARS.”

“But,” she added, “a lot of it has to do with failures in response.”

Other experts also cited the federal government response to explain such a large number of American deaths. Vox’s German Lopez has laid out all the ways in which President Trump’s administration has failed in its Covid-19 strategy, and what is striking is how comprehensive that failure is. In brief:

• Trump’s travel bans targeting China and especially Europe were largely ineffective.
• The US struggled in the critical first few weeks of the outbreak to develop an accurate test and to expand its testing capacity, allowing the virus to spread undetected.
• The scientific consensus was initially against wearing masks, but even after experts shifted in favor of masks as the evidence of their effectiveness grew, Trump refused to wear a mask well into the summer and often cast doubt on the expert consensus.
• The Trump White House has undermined and muzzled public health authorities and stoked speculation about the unreliability of official statistics, including the death count.
• States, lacking clear and consistent guidance from the federal government, relaxed their social distancing policies even though their outbreaks were not contained enough to reopen their economies according to the metrics laid out by experts.
• Scientists are cautiously optimistic about a speedy timeline for developing a Covid-19 vaccine, but Trump’s apparent attempts to influence the approval process could end up compromising people’s willingness to take a vaccine.

“In February, I knew 200,000 deaths were theoretically possible, but I honestly didn’t believe we’d get to that point. Surely we’d get it under control well before that level of mortality, right?” Tara Smith, an epidemiologist at Kent State University, told me. “I hadn’t anticipated not only the lack of federal response but the active undermining of our federal scientific leadership within the CDC, FDA, and NIH.”

Mario Tama/Getty Images

Judging by cases per capita or deaths per capita, the US has had one of the most widespread and deadly coronavirus outbreaks in the developed world, with policy response rates significantly worse than countries like Germany, New Zealand, or South Korea.

There are various ways to measure the depth of the American failure, but here is a particularly striking one: If the US had the same Covid-19 death rate as Canada, as many as 120,000 people could still be alive. Other projections have told a similar story: If the country had acted more quickly and decisively, thousands of deaths could have been avoided.

Instead, the US has reached yet another ignominious landmark in the pandemic, and more will inevitably follow.

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