America lagged behind in its fight against the new coronavirus before ever coming to the United States.
We talked about how the US health system made us less prepared for a pandemic than other wealthy countries with universal health care. But the US had another major structural disadvantage: we are clearly less healthy than our economic peers. Given what we know about how Covid-19 affects people with chronic conditions – particularly those with cardiovascular disease and diabetes – Americans were particularly vulnerable to this specific pathogen.
A graph tells the story, looking at how likely Americans are to die prematurely from a few major conditions (heart disease, cancer, diabetes, chronic respiratory disease). The US surpasses all European countries on the list, along with Canada, Japan and South Korea.
“The burden of disease from cardiovascular disease, chronic respiratory disease and diabetes is also higher in the United States than in comparable countries,” Cynthia Cox, director of the Peterson-KFF Health System Tracker, told me. “Those are certainly factors that make the US more susceptible to a problematic outbreak.”
This is something that the United States controlled. But, as we discussed earlier this year in our international healthcare series, the fact that America does not provide universal coverage, combined with the high out-of-pocket costs Americans have to pay for their medical care, has led to worse health outcomes than patients experience in our peer countries.
And only in America will there be a huge spike in the uninsured rate due to the economic recession caused by the corona virus. But these problems have been with us for a long time and they have made us more vulnerable in the coronavirus pandemic.
On the other hand, Cox noted, the United States did have an important structural advantage – although it’s not really something we can take credit for. The US population is considerably younger than that of wealthy European countries. Covid-19 is the most difficult for the elderly, and simply having an older population can make a country more vulnerable to the disease.
If things get out of hand, the US has an average death rate (a metric that also depends on how widespread testing is, but currently the test situation here is more “stubbornly mediocre” than “dangerously bad”) compared to other countries.
But looking at our age demographics, it’s not an impressive feat. Some of the hardest-hit countries in per-capita deaths – Italy, Spain, and France, for starters – also have proportionately more older people than the United States. On the other hand, Germany has relatively more older people, but they are also healthier than the US. And they benefited from a stronger public health response to the Covid-19 threat.
Each country’s coronavirus experience depends on several factors. Some of them are under the control of a country (the strength of the health system and the resulting well-being of the population) and some are not so much (long-standing demographic trends).
What we know for the United States is that our coronavirus response was hampered by the variables we could influence if we had acted before the virus ever got here. But this is a virus that affects older people more severely, of which we have fewer than our peers, and it is less dangerous for younger people, unlike deadly pathogens from the past.
In a way, it is a grim warning to us. A big reason why the coronavirus pandemic has not been worse so far – and it’s all relative, as more than 75,000 Americans have lost all their lives – is a little bit of luck.
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