Covid-19: Why is America’s death toll so high? | The Economist

published on July 2, 2020

America is now the epicentre of the coronavirus pandemic

America has passed the grim milestone of 20,500 deaths

to overtake Italy as the world’s worst-hit nation

Many blame the president for the scale of the crisis

These are the lonely times for a president

All the decisions come to you

And he’s made just about all of them wrong

But the causes of America’s failings in dealing with the virus

run far deeper

Independent of Donald Trump, America is a country that always

would have found fighting a pandemic to be difficult

regardless of who the president was

When the novel coronavirus hit America

President Donald Trump’s administration was slow to act

Early on the president was, you know, reassuring Americans that

things would not get so bad

We have it very much under control in this country

We had 12 at one point

and now they’ve gotten very much better

He seemed to be worried about the stockmarket

and its vacillations

And I think that there was a series of critical weeks

in which the threat was underplayed

The administration’s initial complacency

was set to store up problems for the weeks ahead

There was a sense that we didn’t need to develop

the amount of ventilators that we had

the number of personal protective equipment

that could go out to doctors

And what we find now is that we’re in the midst of

kind of a national shortage of those things

On March 9th the Trump administration promised millions of test kits

crucial to monitor the spread of the virus

Yet, by the end of the month

only around 200,000 tests had been completed

This is a serious thing

and right now the federal government is failing

But this failure wasn’t entirely down to President Trump’s inaction

Thousands of Americans may have been exposed to the coronavirus

but have not been tested

The first tests created by the Centres for Disease Control

a federal agency, didn’t work

Private and academic labs around the country

tried to develop their own tests

but were initially hampered by strict regulations

and a laborious approval process

That’s a technical failing and a bureaucratic failing that

perhaps could be laid on the president

But one of the things about America is that

public-health authority is incredibly devolved

to states and cities in terms of how they respond

so that the federal government actually can’t order these things

America’s federal system grants states the authority

to decide when and how to respond in a

public-health crisis like this pandemic

And every state has responded differently

The state’s 90m residents are being told to stay at home as much as possible

Faced with an escalating crisis

the governor of New York announced a state-wide lockdown on March 20th

We’re going to put out an executive order today

New York state on pause

We need everyone to be safe

otherwise no one can be safe

On the same day in Florida

spring breakers were revelling on beaches

If I get corona, I get corona

At the end of the day, I’m not going to let it stop me from partying

Here, there would be no lockdown for almost another two weeks

During which time the virus continued to spread across the country

Some states called for non-essential businesses to be closed

and for people to stay at home much earlier than others

The fact that borders remain open between the states

complicates efforts at containment

While some states might have, kind of, shut down at this time

you know, California, Washington, Oregon

if a resident from there goes to Florida and then comes back

you can see how it could exponentiate from there

That’s the weakness of a system that relies on decision-makers

in 50 states and numerous jurisdictions

A virus doesn’t respect state lines

And efforts to halt the spread of the virus

have been impeded by another aspect of America’s political system

Democrats, what do they do?

They want to use a deadly virus as a political weapon

against the president

Partisan politics are crippling America’s response

to the coronavirus pandemic

Politics has infected America’s handling of the outbreak

Republican and right-leaning politicians

have been slower to impose restrictions than Democrats

I am pleading with you

to stay home

Stay home

unless it is necessary for you to go out

Part of the reason that is

it starts in cities, so it’s taken off in

places like New York and Seattle and California

And these are places that tend to have Democratic mayors

tend to have Democratic governors

When political scientists, kind of, try and account for

the rate of infection, how rural your state is and all the rest

They still see that

Republican governors are slower to implement social-distancing measures

There is even evidence that Americans’ adherence to the rules

crucial to halting the spread of the virus

is also being influenced by party loyalty

So you see, at least from what we can measure from cell-phone data

Republicans seeming to take social distancing less seriously

than Democrats

This blanket spread of shutting down businesses

it’s an economic disaster for Michigan and

people are sick and tired of it

GPS data show that Democratic voters

in the 2016 presidential election

have cut travel more than Republican voters

In Hawaii where the majority voted Democrat in 2016

people more than halved their travel in March

In Wyoming where the majority voted Republican

travel actually increased slightly

It’s supremely unhelpful for response to a virus to be

politically polarised because the virus, obviously

infects whomever it can

On April 11th America overtook Italy

to become the worst-hit country in the world

The damage the virus is causing in America

is compounded by the nature of its health-care system

American hospitals are a business

much more so than in other parts of the world

There’s no financial incentive for hospitals to

have extra beds in the ICU, or extra ventilators, or

extra pulmonologists who can specialise in intubation

Only 305 of America’s 6,000 or so hospitals

offer the most intensive treatment available

That’s if patients even make it to hospital

Roughly 12% of Americans don’t have health insurance

Around 23% of those who do have insurance are underinsured

which means they could be hit with high charges

More than half of working-age people

have health insurance through their employers

But now with over 20m Americans claiming unemployment

many may lose that access

If you have more people afraid of getting treatment then

you know, the mortality rate might be higher than it ought to be

All of those things mean that

a pandemic would have strained the American health-care system

quite a lot no matter who was president

The Trump administration has promised some help

to those who don’t have access to health care

Today I can so proudly announce

that hospitals and health-care providers treating

uninsured coronavirus patients

will be reimbursed by the federal government

using funds from the

economic relief package Congress passed last month

Yet there are still a lot of unanswered questions

about exactly what and who is covered by the federal fund

For much of America, the peak of the coronavirus pandemic

is not yet in sight

On April 16th

President Trump presented a set of guidelines on

how and when social-distancing measures could be lifted

He made it clear that the next move

is up to each individual state

Every state is very different

They need to remain closed we will allow them to do that

And if they believe it is time to reopen

we will provide them the freedom and guidance

to accomplish that task

Yet the president immediately undermined his own guidelines

by showing support for a growing protest movement

demanding an end to lockdowns

These are people expressing their views

I see where they are and I see the way they’re working

They seem to be very responsible people to me

Donald Trump has presided over, and done much to encourage

America’s disjointed response to the pandemic

The combination of an erratic president

federalised government

and a complex and fragmented health-care system

means America’s already high death toll

will continue to mount

I’m Idrees Kahloon, I’m the US policy correspondent for The Economist

I’ve been writing about how coronavirus has been

affecting Americans of all stripes

If you want to read more of our coverage you can see the link beside me

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