The share of Americans who succumb to COVID-19 is dropping and is lower than many peer nations.
The U.S. death toll hit a once-unfathomable 150,000 Wednesday after Northeast nursing homes were battered early, minority populations faced outsized risks and the South and West experienced a midsummer resurgence.
Pandemic trackers put the share of U.S. residents who test positive and then die at 3.4%, far better than the 15% in the United Kingdom and roughly 14% in France and Italy, or 7.6% in Canada.
“You look at our mortality rate. You look at our death rate. You look at different statistics. We’re doing very well. But one death is too many,” President Trump said last week.
Experts who are tracking the pandemic say case mortality tends to vary widely because of several factors, making nation-to-nation comparisons difficult.
The ability to identify more cases through testing lowers the case-to-fatality ratio. Demographics also matter because an older population overall will have more deaths. Plus, health care resources differ widely around the world and not everyone is using the same standards in determining what is a “COVID-19 death.”
There are also different ways of measuring the situation. Case fatality rates give patients a sense of how likely they are to die after infection, while other metrics look at the share of deaths in a population.
The U.S. case fatality rate is down from closer to 6% in late April and early May, when states such as New York and New Jersey reported eye-popping numbers. Patients were succumbing from infections they acquired weeks earlier, as states grappled with cases that went undetected.
Nursing homes accounted for an inordinate share of early deaths in Washington state and then large percentages of fatalities from coast to coast. As many as 4 in 10 deaths nationwide are linked to nursing homes and long-term-care facilities, leading to state investigations and federal efforts to test workers and shield residents.
The 3.4% case fatality rate in the U.S. is based on known cases. But with so many asymptomatic carriers going untested, the real number is probably closer to 0.6%, according to experts who have offered their best estimates.
The sprawling economic fallout from springtime lockdowns raises questions about whether they were worth it at all, given the seemingly low rate.
But the coronavirus discovered in December in Wuhan, China, is wily. It spreads easily and proves to be more deadly than flu, which has a death rate closer to 0.1%. The new virus has killed more people on a populationwide basis than combat troops in World War I, the Korean War and the Vietnam War combined.
“That 150,000 is the number to look at,” said William Schaffner, an infectious disease specialist at Vanderbilt University.
Many governors felt forced to issue shelter-in-place orders when hospitals showed signs that they could be overwhelmed. Leaders have halted or reversed efforts to restart their economies after transmission spiked across the Sun Belt as summer started. The transmission is suspected to be from crowded bars, graduation parties, protests and other gatherings — taxing hospitals once again.
How much a nation shuts down appears to be a factor in tamping down transmission and the deaths that follow. Draconian lockdown measures in Wuhan, China, are credited for keeping down the death rate in the early weeks, though some doubt the credibility of Beijing’s reporting. The U.S. and other countries are calling for investigations into the communist power’s handling of the outbreak.
Taiwan and some other places managed to avoid shelter-at-home orders altogether, but only because they had a robust testing regime and the ability to quickly identify potential patients, said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security.
“None of that existed in the U.S., and our testing protocols — and the deficiencies engendered by the failed rollout of a test kit — predictably led to the situation [New York City] faced in March,” Dr. Adalja said. “Stay-at-home orders could have been avoided if the right actions were taken in January, February and March. Precision-guided public health interventions could have been deployed instead of blanket orders that were the only blunt tool that many governors could wield at the time.”
Deaths are a “lagging indicator,” so upticks in fatalities show up in the data a few weeks after surges in infection rates. Florida reported a new single-day high of 216 deaths Wednesday, while parts of Texas have been reporting new daily highs, including 64 deaths in Hidalgo County on Tuesday.
Other states battered by the surge across the Sun Belt show declining positivity rates, suggesting they might be turning a corner.
Many governors say their states cannot afford to lock down their economies again, so they are banking on other measures to control the spread, such as partial closures of enclosed spaces or widespread use of masks. Texas Gov. Greg Abbott, a Republican, shocked many by ultimately agreeing to issue a mask mandate for most Texas counties.
The good news is that Americans are generally more likely to survive COVID-19 than they were at the outset of the pandemic.
“I think it’s probably a combination of things. The more you test, the more you’ll find and the more you’ll find asymptomatic and milder cases, and that tends to reduce the mortality rate,” Dr. Schaffner said. “We know so much more about the virus now and how it makes you sick, so our supportive care in the hospital is better. In addition, we now have three recognized treatments: remdesivir, dexamethasone and convalescent plasma.”
Also, states reporting surges in cases say the median age is in the 30s, making the patients less vulnerable to bad outcomes.
Dr. Anthony Fauci of the White House coronavirus task force, though, has warned that even if young people are less likely to die, they are prolonging the pandemic by flouting guidelines and getting infected. Plus, the wider the transmission, the more likely it is that seniors and other vulnerable people will be exposed and die.
As it stands, Johns Hopkins University says the U.S. has lost 45.24 per 100,000 residents to the virus.
The university is tracking the numbers for 20 countries that are being hit hard by the virus. It found the U.K. fared by far the worst, with 68.95 deaths per 100,000, followed by Peru and Chile with 57.58 and 49.05, respectively.
The U.S. isn’t far behind. It is slightly worse off than Brazil and Mexico and in a far worse position than Russia, with 9.23 deaths per 100,000.
Experts caution that while the focus on deaths is natural, there is more to the story, as surviving patients have reported a host of problems, including the inability to regain lung capacity.
“You can manipulate how you express death rates to suit one’s purpose,” said Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine. “Also, now we know it goes way beyond deaths, long-lasting and permanent disability to lungs, vascular system, heart, brain after people are hospitalized.”