In the small part of the debate I saw last night, Kamala Harris did ask one interesting question. Why is the U. S. mortality rate due to COVID-19 higher than that of any other major country? I would interested in an answer to that question.
I recognize that she unquestionably attributes that to the incompetence of the Trump Administration. I suspect that if Hillary Clinton had been elected in 2016 we would be hearing complaints about the incompetence of the H. Clinton Administration in slowing the spread of the disease.
I can offer some speculations. There seems to be some evidence that the strain of the virus we have faced is different from that which struck China, South Korea, and Japan. Additionally, those are all countries that are quite homogeneous and have high degrees of social cohesion. I believe those two characteristics are related. I should add that the number of blacks, Hispanics, and Native Americans in those countries is quite small. The number of deaths due to COVID-19 among Asian Americans is relatively small, too, albeit higher than in China, South Korea, and Japan.
I also think that the question is overly dismissive of Brazil and Mexico, two countries with which the U. S. has much in common. Our death rate is not dissimilar to that in those countries. As I’ve pointed out before, the mortality rate due to COVID-19 in the U. S. among whites is not dissimilar to the mortality rate among Germans.
I know that the prevalance of obesity in the black population is quite high, high in the U. S. generally, and obesity seems to increase the likelihood of death if you contract COVID-19. I don’t know what the factors behind obesity are. I think in all likelihood it’s multi-factorial including behavioral, genetic factors, and stress.
I also think that lockdowns, at least in the highly politicized way in which they were implemented in the U. S., are very unlikely to be effective in slowing the spread of the disease. How politicized? At least here in Chicago express deliveries continued as usual regardless of how inessential what they were delivering might have been. I think it’s a stretch to think that lawn service workers, city workers performing non-emergent services, and people working at the DMV (it’s the Secretary of State’s Office here) are essential. What percentage of workers are truly essential? I strongly suspect it’s a lot less than 50%.
I think you have hit upon three of the most likely reasons: Virus characteristics, ethnic makeup, and (rich country) obesity and its related issues.
The other one, I suspect, is that the gross death statistic needs to be parsed. It is skewed by the nursing home debacle, especially in NY and NJ. People don’t want to talk about it, but it weights the overall mortality average. Even Sweden, who otherwise did it right, has been criticized for high death rates, but acknowledges that it botched the nursing home issue.
Really doubt virus variation is the answer. It doesnt look like it changes that much. Not sure what role genetics has since it hasn’t had the same effect in Africa for blacks. Also looks like a lot of variability by country for hispanics. Obesity I can buy. Demographics is important. Countries with fewer old people should have lower death rates. Also, our lack of testing made sure that we were hit hard early.
Always happy to talk about nursing homes. No one is really quite sure how to protect them with a realistic plan. Places that have lower death rates in nursing homes seem to generally have lower overall death rates although that doesnt always hold . Some places like Australia claim to have had better success with the measures they took, but it is hard to compare data as definitions and populations are always the same. (Note that the US i just a bit above the OECD average. )
https://medicalxpress.com/news/2020-06-canada-worst-elderly-home-coronavirus.html
Steve
That contradicts the statements by Chinese and South Korean physicians that the COVID-19 they’re seeing now looks different than the one they were treating in February.
Most of the countries in Africa are in the tropics and there’s a lot more sunlight in those countries than here. The ability to synthesize Vitamin D with sunlight varies based on genetics. That is one of the reasons blacks in the U. S. are frequently deficient in Vitamin D another being the inability to digest milk (milk is the most common source of Vitamin D supplementation). Also when you look at the population pyramid for Ghana, for example, and compare it with ours it’s clear that age is a significant factor, too. Elderly are 3% of the population there compared to 16% here. It’s a bit hard to ferret out but my back-of-the-envelope calculation of the black elderly population in the U. S. is 12% of total black population.
I’m open to the possibility that genetics has nothing to do with mortality but for that to be true you’d need for health care given to blacks here being substandard. That’s not just an accusation against our system it’s an accusation against physicians of which I am greatly skeptical. One of the things that is different between Ghana and the U. S. (besides genetics, age distribution, wealth, and geography) is that in Ghana the average patients are black while here they aren’t. Sadly, I do think there is a predisposition among physicians or at least among some to treat the average patient. I don’t believe that has made the difference but I would be open to the argument if enough evidence were provided.
That tends to contradict the claim that Sen. Harris made in the debate.
I didn’t watch the debate so I don’t know what was exactly asked, but I don’t agree with the assumption that the U.S. death rate is higher than any other major country. By excess deaths per capita, Spain, UK and Belgium have had more deaths. Netherlands, Sweden and Portugal are close. Overall, Europe as a whole has had about the same excess death rate as the U.S. maybe slightly less, depending on how you define “Europe.”
If one isn’t looking at excess deaths, then you have to deal with how different countries report or don’t report deaths. OTOH, most Latin American countries don’t appear to have baseline data to make that calculation, but appear to be much higher than the U.S. or Europe.
It has been observed that out in the bush in Africa if an entire village were to die of COVID-19, it might not have been discovered yet.
I will try to list the factors in order of importance.
1. Age structure. The risk of dying is 160x for a 40-49 vs 5-17 age groups. 9x for a 65-74 vs 40-49. Just based on age, the US (median age 38.5) should suffer roughly 100x-1000x the number of deaths of Nigeria (median age 18.1); and that’s what we see (~200000 vs 1113).
2. Obesity. The risk of hospitalization/dying is 3x for those with diabetes or CVD; conditions driven by obesity. It is estimated 30% of Americans are obese, 4%/5% of Japanese/South Koreans are. The only countries with a higher percentage of obese people then the US are Pacific Island countries.
3. State capacity / social cohesion — the ability of a Government to impose draconian measures or have the population voluntarily relinquish their freedoms. China, Cuba come to mind for state capacity; Japan, South Korea for social cohesion. All the discussions about trying centralized isolation, or differences in the powers of contact tracers in East Asia vs here come to mind.
4. Not virus variation but cross-immunity. Some percentage of the population have immune system’s that react to COVID, before exposure to COVID (from blood samples taken before COVID existed) — speculated due to exposure to other strains of coronavirus.
Here is another paper on that https://www.bmj.com/content/370/bmj.m3563 .
Here’s a thought exercise — with the exception of sub-Sahara Africa, there is a correlation between the geographic distance from Wuhan, China and severity of the pandemic. i.e. East Asia and SE Asia better then Eastern Europe / Mid East / India, Western Europe worse then Eastern Europe, North America worse the Europe, South America (the opposite side of the Earth from Wuhan) the worst.
Could that correlation be related to exposure to some other factor “X” that provides cross-immunity?
5. Mass gatherings (protests or political rallies). No matter if it takes place outdoors or participants wear masks — it has an effect.
How does the US rank? Per capita or CFR?
https://www.npr.org/sections/goatsandsoda/2020/08/05/899365887/charts-how-the-u-s-ranks-on-covid-19-deaths-per-capita-and-by-case-count
And “excess deaths” will be a politicized statistic.
In any event, a focused strategy clearly would have been better wrt death, although perhaps not civil liberties. With what we have spent due to our peanut butter approach the vulnerable could have been quarantined but fed Mortons quality steak, crab and lobster everyday, had pools constructed for exercise, and endless entertainment options. But they would have been prisoners.
If you don’t like that, then quityerbitchin because the vulnerable and policy makers made risk choices, including sending dubious candidates back into the homes. Unfortunately, the peanut butter approach also resulted in tremendous and broad based costs to the less or almost invulnerable. Small business owners, school aged people, etc etc. Talk about taking away civil liberties or state imposed costs.
All for politics. The ability to destroy an economy and people for perceived political gain. Ghoulish.
Although U. S. obesity rates are higher for all races, variance between races accounts for some of the difference:
Central and Eastern Europeans are fatter than Japanese people. Who knew?
And it’s such easy pickings to tar the incumbent with. Now that you have the advantage of hindsight and an uninformed electorate.
210 thousand dead and Trump just let it happen.
(Prosecutor stares daggers)
Related, it would sure be interesting to view complete video of the Rose Garden super spreader event.
Following the behavior of each individual looking for clues such as distance, speech lengths and volume that may teach what not to do.
‘I suspect that if Hillary Clinton had been elected in 2016 we would be hearing complaints about the incompetence of the H. Clinton Administration in slowing the spread of the disease.’
No, IMO Her Odiousness would have received nauseatingly disgusting effusivie praise for her heroic efforts to combat the most lethal plague in history since the English Sweats no matter how many people died. In fact IMO the higher the death toll the greater the praise would have been because the flatterers would have claimed it showed lethal the beast was and would have been worse were it not for said efforts and OMG how much it would have been worse under an OMB administration.
If they had even bothered to declare an emergency that is. The H1N1 plague was pretty damn bad, but the Obama administration didn’t get around to instituting one until it was on the wane. I sincerely doubt that we would have seen all the lockdowns and other social virtual signaling like mask wearing. But this is my opinion.
‘Note that the US i just a bit above the OECD average.
That tends to contradict the claim that Sen. Harris made in the debate.’
Harris lied. Is that a surprise?
My concern regarding the post-mortem of the epidemic is how political and ideological the spin will be. Political partisanship and Cancel culture is now starting to seriously compromise the pursuit of truth in the sciences to the point of denial. Conclusions that do not agree with the narrative that systemic racism/sexism is 100% responsible for hospitalization/treatment/mortality outcomes of anything will in the future make objective analysis and usable recommendations and policies impossible resulting in more unequal outcomes that will be blamed on the boogeyman systemic (you name it). Facts are not racist, but you can’t tell the Social Justice crowd that, because they reject reason and reality in favor of their own reality.