Why is the USA being hit so hard by the COVID-19 pandemic?

(my answer on Quora)

The United States has several COVID-19 hotspots but is actually doing a lot better than many OECD countries. This question has to be addressed on a per capita basis. Remember this virus has a relatively high R nought value in the unmitigated scenario and appears to be carried by those who are asymptomatic (35% of all infected according to the CDC). Let us look at the numbers.

As of May 28th 2020 the US death rate as a result of this novel coronavirus sits at 312 deaths per million. This number is significantly lower than Spain (580), the UK (558), Italy (548), France (439), The Netherlands (345) and Belgium (810). Only Germany (102) boasts less of a death rate, when the US is compared to the larger population Western European countries. From a cultural and demographic perspective this comparison has utility.

Death rate numbers (These are from May 22nd, My numbers are of May 28th.) Pattern still holds. although Brazil is moving up the chart. Source: Business Insider.

But before we go further let us breakdown these hotspots. The devil as always is in the detail. US deaths are not uniformly distributed nationwide. The three biggest trouble spots are New York, New Jersey and Connecticut (Tri-State Area). Deaths per million for each of these are 1,524, 1,284 and 1,073 respectively. If you remove this asymmetry from the data set and correct for a lesser population than the US death rate per million drops to 203. Still high but less than Switzerland (220) and not too far off the Canadian number of 185.

The Tri-State Area deeply impacts the overall death number. I have written already about the issue in New York State in particular. It does not make for pleasant news. Gavin Kanowitz's answer to Is Governor Andrew Cuomo handling the Coronavirus well in New York?

Source: CBC News (Situation has changed a little since April 30th - Tri-State deaths account for roughly 41% of all COVID US deaths).

Now the Tri-State need not shoulder all the blame (especially of late) - Illinois (409), Massachusetts (963), Michigan (538), Pennsylvania (422), Maryland (402) and Louisiana (590), Rhode Island (639) and Delaware (354) all have death rates well north of the national average. Much of this has been driven by high death rates at elderly care facilities however there are various localized factors at play here as well.

Despite this observation 39 states fall under the 312 average. Many of them well below this number in fact. This includes the population heavy states of California (101), Texas(55), Florida (110) and Ohio (181). At present 22 of the 50 states actually have double digit death rates not too dissimilar to COVID-19 strong performing nations such as Austria, Norway and Denmark.

So again one cannot analyze the superstructure of the US without reference to the skewed nature of the hotspot effect.

At present the US is no longer a brand new COVID-19 locale. That was the true March but two months later the country has been front and center of the viral onslaught.

Infection rates vary widely across the United States. The Darker the colour the greater the infection rate. Source: Stanford Big Local News

Granted the American death rate is higher than Brazil, Russia and India. However each of these three countries are at a much earlier stage in the overall pandemic and there is reason to believe that all three are greatly under reporting both their case loads and death rates. In fact as it stands now Brazil looks to be one of the new epicenters for the virus. Mexico as well is not far behind.

South Korea, Taiwan and Singapore have done relatively well so far with COVID-19 compared to all Western nations including the US. However they have also framed their specific responses in a way that would be inconsistent with certain facets of North American civil liberties. While I commend their approach it is important to note that there is a specific cultural aspect to the way other countries are dealing with this that is not necessarily transferable to the West,

Oddly enough the South Koreans have not been as forceful with respect to a national lockdown as much as most of the US and Canada has. Where they have succeeded is in targeting and isolating the infected and adhering to an early testing regime. South Korea to their credit has been planning for this for some time as they were hard hit by both SARS (2003) and MERS (2012).

Of course this does not mean that the US has not been deeply impacted by the virus. It most definitely has. The country has more than 103,000 deaths and although positive cases numbers as a percent of total new tests are dropping one can expect more deaths in the future. One should not forget though when looking at the data that there is a lag time as well before this falling ratio impacts the death rate number. The situation is foretasted to improve according to the Institute for Health Metrics and Evaluation (IHME). IHME | COVID-19 Projections. Time will tell. Modelling has been less than stellar throughout this pandemic.

Meanwhile it is imperative that testing rates, which have moved steadily upwards are further elevated. Couple that with an isolation of the infected and more contact tracing and the scourge of this virus can be contained. We have already seen this in Germany and elsewhere.

Sources

1. CDC estimates that 35% of coronavirus patients don't have symptoms
2. Coronavirus Update (Live): 5,867,784 Cases and 360,438 Deaths from COVID-19 Virus Pandemic
3. Latin America is now the 'epicenter of the outbreak,' says health official
4. Trouble ahead for India's fight against Covid-19
5. Putin lifts Russia's stay-at-home orders as cases soar
6. A Coronavirus Mystery Explained: Moscow Has 1,700 Extra Deaths
7. 42% of COVID-19 Deaths in Nursing Homes & Assisted Living Facilities
8. Provisional Death Counts for Coronavirus Disease (COVID-19)

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