America fell behind in its battle against the novel coronavirus before it ever came to the United States.
We have talked about how the US health system made us less prepared for a pandemic than other rich countries with universal health care. But the US had another important structural disadvantage: we are markedly less healthy than our economic peers. Considering what we know about how Covid-19 affects people with chronic conditions — particularly people with cardiovascular diseases, as well as diabetes — Americans were especially vulnerable to this particular pathogen.
One chart tells the tale, looking at how likely Americans are to die prematurely from a few key conditions (heart disease, cancer, diabetes, chronic respiratory disease). The US outpaces all the European countries on the list, along with Canada, Japan, and South Korea.
:format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/19954719/full.png)
“Disease burden due to cardiovascular disease, chronic respiratory disease, and diabetes is similarly higher in the US 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 prone to a problematic outbreak.”
This is something the US had control over. But, as we covered in our international health care series earlier this year, America’s failure to deliver universal coverage paired with the high out-of-pocket costs Americans are forced to pay for their medical care has led to worse health outcomes here than patients experience in our peer countries.
And only in America will there be an enormous spike in the uninsured rate because of the coronavirus-driven economic recession. But these problems have been with us a long time and they have made us more vulnerable in the coronavirus pandemic.
On the other hand, Cox pointed out, the US did have one important structural advantage — though it’s not really anything we can take credit for. America’s population is meaningfully younger than that of rich European countries. Covid-19 is hardest on the elderly, and simply having an older population can make a country more vulnerable to the disease.
:format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/19954721/age.png)
When it all shakes out, the US has a middling case fatality rate (a metric that is also dependent on how widespread testing is, though, at this point, the testing situation here is more “stubbornly mediocre” than “dangerously bad”) compared to other countries.
But going by our age demographics, it’s not an impressive performance. Some of the hardest-hit countries in deaths per capita — Italy, Spain, and France, for starters — also have proportionally more older people than the US does. On the other hand, Germany has a larger elderly population, relatively, but they are also healthier than the US. And they benefited from a stronger public health response to the Covid-19 threat.
:format(webp):no_upscale()/cdn.vox-cdn.com/uploads/chorus_asset/file/19954723/total_covid_deaths_per_million__1_.png)
Every country’s coronavirus experience is dependent on different factors. Some of them are within a country’s control (the strength of its health system and the resulting well-being of its population) and some are not as much (long-standing demographic trends).
What we know for the US is that our coronavirus response has been hindered by variables which we had the power to influence, had we acted before the virus ever came here. But this is a virus that more severely affects older people, of which we have fewer than our peer countries — and it’s less dangerous for younger people, unlike deadly pathogens of the past.
It is, in a way, a grim warning for us. A big reason the coronavirus pandemic hasn’t been worse so far — and it’s all relative, considering more than 75,000 Americans have already lost their lives — is a little bit of luck.
