By Cory Franklin

I recently wrote an opinion piece for the Chicago Tribune on the role experts play in public policy: “Have we become too reliant on deferring to experts?”

The article was controversial, and not surprisingly generated letters to the editor, pro and con, in the Tribune and other outlets that ran the piece. One in particular, in the Star Tribune of Minneapolis was notable.

Concerning whether business leaders should have been consulted on US COVID lockdown strategies, the reader opined, “I would argue that with nearly 1 million COVID deaths in the U.S. and the worst COVID mortality rates of all developed countries (per the The New York Times), business leaders have no business weighing in on this life-or-death matter.”

Now the role of business leaders is not at issue here.

 Rather, it is the writer’s claim, including the link in the New York Times, that the US has the worst COVID mortality of all developed countries.

Devi Sridhar, head of the global public health program at the University of Edinburgh, is quoted in the Times, “Death rates are so high in the States — eye-wateringly high. The United States is lagging.” Note the term “eye-wateringly high.”

Some clarity is in order.

 Does the US have the worst COVID mortality in the world?

 No.

 It is first important to acknowledge that the US has indeed experienced the most COVID deaths in the world, roughly 1 million, slightly more or less depending on your source. (As an aside,

 I believe that presidential policies have little to do with death figures. Yet it is interesting that during the previous administration, the media kept a constant watch and duly reported each death benchmark passed: 100,000; 200,000; 250,000; 300;000.

And now, during the current administration, there has been little mention of the 1 million benchmarks. (Interesting how the focus has shifted.)

The evidence for worst mortality rests on comparisons of per capita death rates with selected countries including those of Western Europe, Canada, Japan and Australia (per capita numbers normalize for population size). The Times article includes this passage:

“Two years into the pandemic, the coronavirus is killing Americans at far higher rates than people in other wealthy nations, a sobering distinction to bear as the country charts a course through the next stages of the pandemic. Cumulative U.S. Covid-19 deaths per capita are highest among other large, high-income countries.”

The selection of comparison countries is what is known as the “Texas sharpshooter fallacy” – shoot a bullet into a fence and then draw a target around it. Voila, you hit a bullseye!

Actually, the US ranks 16^th in the world in deaths per capita.

Most of the countries ahead of it are in Eastern Europe (e.g., Hungary, Croatia, Lithuania) along with, notably, two South American countries, Peru and Brazil.

An expert quoted by the Times, Joseph Dieleman, an associate professor at the University of Washington, said, “The U.S. stands out as having a relatively high fatality rate.” Yet if crude mortality is considered independent of population- that is, deaths per number of diagnosed cases – the US is at the world average, neither especially high nor low.   The figures do not suggest the US stands out.

Are COVID death numbers related to poverty? Not particularly. 

The Times article acknowledges that US deaths per capita are exceeded in Russia, Ukraine, Poland, Greece and the Czech Republic. It attributes this to those being “poorer nations where the best Covid treatments are relatively scarce.” Only one of those countries, the Czech Republic, has a per capita death total exceeding that of the US; the rest are at or below US levels. But if COVID deaths were directly related to poverty, why does every African country have a lower per capita death rate than the US or most wealthy Western European countries? In fact, the wealthiest African country, South Africa, also has the continent’s second highest per capita death rate.

Are the high death totals in the US directly related to lower vaccination rates? Not directly.    

From the Times article: “Some of the reasons for America’s difficulties are well known. Despite having one of the world’s most powerful arsenals of vaccines, the country has failed to vaccinate as many people as other large, wealthy nations.” 

Vaccination is only one facet of immunity – and this depends on the type of vaccine, number of doses, interval between doses, and time since last dose. It does not take into account native immunity or previous COVID infection (articles citing US vaccination numbers generally do not account for past US COVID infections).

Vaccination unquestionably reduces any single COVID patient’s chances of death but does not translate easily to overall death rates. Two of the countries with the world’s highest vaccination rates, Brazil and Peru, also have two of the highest per capita death rates. Africa, where vaccination numbers are low, has extremely low per capita death rates.

US vaccination rates are within a few percentage points of most Western European countries, and a link between vaccination and death totals does not explain why US death rates were also comparatively higher throughout most of 2020 – before vaccines were available.  Also, since the Times article was published at the beginning of February, death totals in the US have fallen faster than in many countries it is unfavorably compared to.

There is no readily available explanation for why deaths in the US are relatively high. It is unlikely because of poorer medical care or poorer handling of the pandemic; every country has faced its own internal criticisms.

A guess would be less natural immunity in the US than elsewhere as well as a higher percentage of high-risk patients, i.e., elderly, immunocompromised, and obese. This remains conjecture.

But the assertion that the US has the worst per capita death rate or highest mortality rate in the world is not true.

 “Eye-wateringly high” is theater, not science.

-30-

Cory Franklin is a doctor who was director of medical intensive care at Cook County Hospital in Chicago for over 25 years. An editorial board contributor to the Chicago Tribune op-ed page, he writes freelance medical and non-medical articles. His work has also appeared in the New York Times, Jerusalem Post, Chicago Sun-Times, New York Post, Guardian, Washington Post and has been excerpted in the New York Review of Books. Cory was also Harrison Ford’s technical adviser and one of the role models for the character Ford played in the 1993 movie, “The Fugitive.” His YouTube podcast Rememberingthepassed has received 900,000 hits to date. He published Chicago Flashbulbs in 2013, Cook County ICU: 30 Years Of Unforgettable Patients And Odd Cases in 2015, and most recently coauthored, A Guide to Writing College Admission Essays: Practical Advice for Students and Parents in 2021.