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More than 120,000 Americans have now perished from Covid-19, surpassing the total number of U.S. dead during World War I. Had American leaders taken the decisive, early measures that several other nations took when they had exactly the same information the U.S. did, at exactly the same time in their experience of the novel coronavirus, how many of these Covid-19 deaths could have been prevented?
That isn’t a hypothetical question. And the answer that emerges from a direct comparison of the fatalities in and policies of the U.S. and other countries — South Korea, Australia, Germany, and Singapore — indicates that between 70% and 99% of the Americans who died from this pandemic might have been saved by measures demonstrated by others to have been feasible.
At least three factors enable meaningful comparisons of these nations with the United States. First, we scaled up their population sizes and Covid-19 deaths to match those of the U.S. Second, in each of these countries, roughly 80% or more of the population lives in urbanized, transmission-prone areas, similar to the U.S. Third, the pandemic took root earlier in these other countries than here, as measured by the date of the 15th confirmed case in each, meaning that foreign leaders had to act with less information to guide their decisions than did U.S. leaders.
To compare each country’s responses to the pandemic on a consistent basis, we turned to the work of an Oxford University team that has constructed a stringency index based on 13 policy responses (lockdowns, border closings, tests, etc.) to measure how strongly each country responded over time. The Oxford index shows that 14 days from the date of the 15th confirmed case in each country — a vital early window for action — the U.S. response to the outbreak lagged behind the others by miles. The U.S. stringency score of 5.7 at that point was 25% of Australia’s (23), 23% of Germany’s (25), 18% of Singapore’s (32), and only 15% of South Korea’s (38).
Due to the exponential viral spread, our delay in action was devastating. In the wake of the U.S. response, 117,858 Americans died in the four months following the first 15 confirmed cases. After an equivalent period, Germany suffered only 8,863 casualties. Scaling up the German population of 83.7 million to America’s 331 million, a U.S.-sized Germany would have suffered 35,049 Covid-19 deaths. So if the U.S. had acted as effectively as Germany, 70% of U.S. coronavirus deaths might have been prevented.
Seventy percent, though, is the most conservative estimate. Scaled-up versions of South Korea, Australia, and Singapore would have experienced 1,758, 1,324, and 1,358 deaths, respectively, in the four months after 15 cases were confirmed in each country. Had we handled the coronavirus as effectively as any of these three countries, roughly 99% of the 117,858 U.S. Covid-19 deaths might have been averted.
|Country||Population (millions)||Date of 15th confirmed case||Stringency Index two weeks after 15th case||Number of deaths, four months after 15th case||Deaths scaled up to U.S. population equivalent|
Sources: Worldometers, Statista, Oxford Covid-19 Government Response Tracker (accessed 5/20/20).
Our conclusions are strengthened by their consistency with the results from different methodologies. Two notable epidemiological projections, based on theoretical models of transmission and “idealized hypothetical assumptions,” have estimated that between 80% and 90% of American deaths could have been averted had lockdowns and social distancing begun two weeks earlier.
For a more granular perspective, we compared the American response to the actions taken by South Korea. By the time South Korea experienced its 15th confirmed case on Feb. 2, it had spearheaded a massive public information campaign, mobilized private sector players to produce testing kits, and expedited regulatory approval for these newly developed tests. Within a week, tests were widely available. Within three weeks, schools and public spaces were closed, large gatherings had been banned, and 26,000 people had been tested.
In contrast, President Trump consistently ignored confidential and public early warnings from experts and intelligence agencies prior to the 15th confirmed U.S. case on Feb. 14, then acted far more slowly and inconsistently than South Korea. The White House banned flights from China on Feb. 2 but later permitted more than 40,000 travelers from China to enter the U.S. From February through April, President Trump made dismissive and contradictory statements to which government agencies and the public paid close attention.
Often taking cues from the president’s words, state by state measures were rolled out piecemeal. Florida and Georgia, for example, waited until April 3 to issue stay-at-home orders while South Carolina held off until April 7.
Another crucial failure involved testing. Three weeks after the 15th Covid-19 case had been confirmed in the U.S., only about 10,000 tests had been administered. By an equivalent point in its epidemic, South Korea had administered approximately 17 times more tests per capita than the U.S. had done. This testing fiasco crippled vital early contact tracing efforts when hot spots could have been contained.
South Korea’s decisive actions during this critical early window produced a dramatic disparity. By mid-March, each of the two countries had suffered about 90 Covid-19 deaths. But throughout April, while a total of 85 South Koreans died from the disease, an average of more than 85 Americans died per hour. This divergence only widened as time passed.
Although federal, state, and local governments share responsibility for American health policy and implementation, ultimate accountability during a national crisis heavily rests on the occupant of the White House. At a minimum, the president, perhaps through a tough “testing czar,” should have empowered private companies, labs, and hospitals to augment public testing efforts — as South Korean policymakers did — and imported readily available tests from elsewhere if necessary. If there were shortages of testing components, the president should have immediately invoked the Defense Production Act rather than waiting for months to do so for this purpose. And when the CDC and the FDA fumbled early testing efforts, President Trump responded: “I don’t take responsibility at all.”
The administration has advanced innumerable excuses and scapegoats for the vast U.S. death toll: China, the World Health Organization, the Centers for Disease Control and Prevention, former President Barack Obama, the media, and more. Yet other countries with the same information — or alleged misinformation — as the U.S. had at the time took earlier, decisive steps to quell the spread of SARS-CoV-2, the virus that causes Covid-19. Relative to the United States, their actions dramatically cut their death tolls and, on average, South Korea, Australia, Germany, and Singapore are opening up their economies sooner and more safely than the U.S.
Two recent studies published in Nature confirm the “astonishing effectiveness” of the type of government interventions we have discussed, especially when adopted early.
Our analysis shows that with the same actions actually taken by other nations large and small, from East and West, the U.S. could have prevented 70% to 99% of its Covid-19 deaths. This has been a needless tragedy.
Isaac Sebenius graduated from Harvard College in May 2020 with a degree in molecular and cellular biology. James K. Sebenius is a professor of business administration at Harvard Business School and director of the Harvard Negotiation Project based at Harvard Law School.
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