Evaluating the US Response to COVID-19

 How well did the US response to the COVID-19 pandemic work?  This post examines both COVID-19 tests and deaths, and compares them to data from other countries - mostly European countries, since their culture and political system are similar to the US.

Let's start with a look at COVID-19 deaths. We'll use 7-day rolling averages to smooth out day-to-day variations, and use death per million population so that we can compare countries of different sizes. 

During the initial phase, death rates at the peak  were lower in the US than in Italy and France, two of the hardest-hit European countries. But US death rates were about 3-fold higher than in Germany.

But if we extend the graph until August, the picture changes:

In the three European countries, death rates dropped dramatically. In contrast, the drop in the US was less pronounced. We can see the differences better if we use a log scale for the y axis:

The graph below  shows a comparison of how much COVID-19 deaths were reduced from the maximum to August 1:

 Whereas France, Germany, and Italy reduced daily COVID-19 deaths by between 55-fold and 135-fold,  the US only achieved a 2.4-fold drop. In other words, the US efforts to contain COVID-19 were between 22-fold and 55-fold less effective than the efforts in France, Germany, and Italy.

But what about COVID-19 testing?

There have been some repeated claims that the US has done "the most COVID-19 testing in the world". However, these tests are both false and very misleading.

In terms of absolute numbers, the country that has performed the most COVID-19 tests is China, with 90.4 million tests compared to 60 million to 64 million tests in the US. But absolute numbers mean little, since countries differ vastly in population size and COVID-19 cases.

When population size is taken into account, the US drops down to the 19th spot on the Worldometers ranking:

But while population size is one factor to consider, the more important factor is the number of actual COVID-19 cases in a country: a country with more infections also needs to test more. If we look at the number of tests relative to the number of confirmed COVID-19 cases, the US does poorly:

It is illuminating to examine how the ratio of tests to cases developed over time in different countries:

Note that the y-scale is logarithmic. For the last few weeks, the tests/cases ratio for the US has been about 12. For the European countries shown, the ratio has been above 100 - typically 10 to 20 times higher than in for the US.

If we look at the ratios in April in the graph above, and know how severe the COVID-19 pandemic was in the different countries, a clear relation becomes visible: the countries with the lowest amount of testing had the worst epidemics. Of the European countries shown, Greece had the lowest number of COVID-19 deaths in April (relative to population size), followed by Germany. Greece also had the highest ratio of tests per case, again followed by Germany. The countries with the worst epidemics in April were Italy, the UK, and the United States - all countries with substantially less COVID-19 testing.

The same pattern was present again and again during the COVID-19 pandemic: less testing meant more COVID-19 deaths, and often out-of-control growth. Currently, two countries with very rapidly growing COVID-19 case numbers illustrate this: Brazil and South Africa.

With adequate COVID-19 testing, people can see rapidly raising infections, and adjust their behavior, often even before mandatory public health measures are initiated. But without sufficient testing, the warning flags go up too late. The real scope of the epidemic remains hidden from view; infections keep multiplying rapidly; and the end results is a large death toll, as was seen in Italy, Spain, France, New York City, and many other places.

The bottom line

The efforts to contain COVID-19 in the US have been substantially less effective than in other countries, including several of the European countries that were hit hardest by the COVID-19 pandemic. As a result, the current number of new COVID-19 infections and deaths is an order of magnitude higher in the US.

Even though the US has performed the second-highest number of COVID-19 tests in the world, the high level of active infections means that the current COVID-19 testing capacities are insufficient. This is evident in the poor performance of the US when comparing the test-to-case ratio with other countries. Average wait times for test results of more than 4 days, and wait times of 10 days or more for 10% of tested individuals, also underscore the shortcomings of COVID-19 testing in the US, and severely limit the potential effectiveness of contact tracing and related measures to contain the spread of COVID-19.