[This was originally published on Medium on October 15, 2020.]
According to the polls, 40% of all Americans and 80% of Republicans approve of Donald Trump’s response to the coronavirus crisis.
This is surprising given the facts we are surrounded by.
We entered this crisis as the country ranked in 2019 the #1 most prepared country to handle a global pandemic by an international panel of experts. The United States is touted as having the most advanced healthcare, is chock full of leading epidemiologists and is the wealthiest country in the world with the most resources to respond. We were ready.
Where are we now? The very worst, with over 210,000 deaths (which is more than triple the number of Americans that died in Vietnam).
The US has the most confirmed infections and the highest death count among all countries. Among the top 50 wealthiest countries in the world, the United States ranks 6th worst when looking at normalized deaths (deaths per 100,000 population).
Read on to see the data showing that of the 180 countries WW, the US has ranked among the worst in all key metrics, why the Trump administration deserves most of the blame, and how Trump’s failure has cost 175,000 unnecessary deaths.
I’m intentionally not addressing in this post what we should have done as a country to economically respond to this crisis, but instead focus on the efforts to stop the virus. The key to reopening America and getting our economy going was first getting the virus under control, which we never did. Countries that did get the virus under control like Taiwan, South Korea, Norway, New Zealand, and China have proven that an effective response to the virus was key to opening their economies.
Count of Coronavirus infections and deaths
Let’s take a walk through the data….
Building a scoreboard to understand how well we’ve done in battling the coronavirus is simple. There are over 180 countries to compare our response to, many different metrics to look at and tons of available data.
Let’s start with the simplest metrics. Number of people infected & number of reported deaths.
Based on the simple counts of infections & coronavirus deaths, the US ranks the very worst. #1 most infections & deaths out of all countries.
Normalized Count of Coronavirus infections and deaths
Another way to compare our response to other countries is to normalize the coronavirus counts using population data.
The chart below shows the coronavirus infections per 100,000 population.
Using normalized data, the US ranks as the #5 worst country in terms of infections across the top 50 wealthiest countries.
How about deaths?
Normalizing the death count from coronavirus, puts the US as the #6 worst among the 50 wealthiest countries in the world.
Are there other metrics we can look at that might paint a more complete picture?
One metric that Trump touted at the Republican National Convention is our death rate. Trump said, “The United States has among the lowest case fatality rates of any major country anywhere in the world.” This statement is false.
The death rate is the number of coronavirus deaths divided by the number of infections. Our death rate at 3.0% puts us in the bottom third of the wealthiest 50 countries across the world, and the bottom quarter when compared to all 180 countries.
Natural Rate of all Deaths
If you are somehow skeptical of the reporting of coronavirus cases and deaths or if you believe that people dying from coronavirus are just people who would have died anyways because of some deadly risk factor, there is another interesting way to look at the data that might convince you. Looking at all reported deaths (ignoring the cause) paints an interesting picture. The death rate in any particular year is quite easy to predict because it is fairly stable across the many causes of death. Looking at the trends in 2020 shows the remarkable spike from coronavirus deaths.
Chart source: New York Times
The chart above compares deaths by week in 2020 to a statistical average for the years 2015 to 2019 compiled by the US Centers for Disease Control. As of the date of the analysis (Sept 23, 2020) there were 266,000 excess deaths above the statistical average. For the same reporting period, the US had ~200,000 coronavirus deaths.
So the US isn’t making up the coronavirus death numbers and to think that most of the coronavirus deaths are people with health problems who would have died soon anyway is wrong.
The New York Times conducted this analysis worldwide as well, if you are curious to learn more. If you’d like a second source, you can see data from the CDC here. The Financial Times did a similar analysis.
Does this all boil down to mistakes in New York?
I’ve heard some people suggest that the failures in the US are due to New York Governor Andrew Cuomo sending sick coronavirus patients to nursing homes early in the pandemic. Cuomo’s decision was likely a mistake and may have cost many lives but is not a factor in our overall poor results. Let’s see how the US numbers stack up if you remove New York from the analysis above.
Removing New York doesn’t change a thing…
Total coronavirus infections: US #1 worst in the world
Total coronavirus deaths: US #1 worst in the world
Normalized coronavirus infections: US #7 worst among 50 wealthiest countries
Normalized coronavirus deaths: US #11 worst among 50 wealthiest countries
I’ll spare you the charts, but all the data is available here.
How bad is 200,000 deaths?
Last point on death counts before we move on to our response… It’s our human nature to normalize a number like 200,000 as we have heard this number grow over six months. I thought it would be valuable to put the coronavirus in perspective by comparing it to other events and causes of death.
A few sound bites from the data above…
Thus far, more people in the US have died from coronavirus than Americans that died in World War 1 and the Vietnam War combined.
The number of Americans that have died from coronavirus is more than three times the number of Americans that died in Vietnam.
The number of Americans that have died from coronavirus thus far is half the number of Americans that died in World War 2.
Thus far, coronavirus has claimed a third the lives that cancer does every year in the US.
And this pandemic is far from over. Predictions are that by the end of the year the US could see a total of 410,000 coronavirus deaths, which puts the total on par with the number of Americans lost in World War 2.
It’s indisputable that the US’s handling of coronavirus has been terrible. Who’s fault is it?
How this is Trump’s failure and what a great response would look like
We knew early on what needed to happen to stop the coronavirus. Epidemiologists have been preparing for a pandemic for decades and we all learned very quickly about things like social distancing, contract tracing, quarantine, and the challenges of vaccine development. There certainly was a lot to learn, but we had a good head start of knowledge.
Surrounded by the world’s top epidemiologists and medical professionals, with more resources than any other world leader at his disposal, Trump simply had to get the right people in the room, listen, plan, communicate and repeat this daily, weekly, monthly.
Rather, what we saw from Trump was division, blame, confusion, and chaos.
He completely abdicated his responsibility by not executing a national response to the coronavirus.
Trump’s failures were many, but I’ll narrow it down to two major failures: 1) his total failure in managing communications and 2) the lack of a coordinated national response.
Communication was the most important job for Trump and he failed
The most important thing in leading a company, organization or country through a crisis is clear, trustworthy communication. During a global pandemic, with doubters & conspiracy theorists rampant on social media, in a country of over 300M people, communication was the most critical element of a national response and was uniquely Trump’s job.
How would a great leader have handled communication?
A great leader would have recognized that to beat back the coronavirus would require communicating clearly and consistently to earn the trust of the population. We needed all Americans to come together around a few simple practices: stay at home, social distance, wash your hands, and wear masks.
A great leader would have developed a full communication plan to ensure that every American had the latest guidance on how to stop the spread, including consistent messaging through regular TV speeches, social media posts, print advertising, billboards and more. Trump, more so than anyone, could have united us in a response. His base would have listened to him and so would have the rest of the country.
A great leader would have worked closely with state governments and their governors to ensure consistent communication at all levels of government. What we all needed to do would have been repeated by state, county, and city officials.
A great leader would have been transparent and with the backing of US’s technology prowess, would be leading the world in tracking data about the spread down to the zip code, in the US and worldwide. This critical data would allow local governments to respond appropriately to their local situation.
A great leader would have served as a role model following the guidelines himself, wearing a mask, social distancing, and showing cautiousness and care in planning events.
A great leader would have shared our learnings with the world. Coronavirus isn’t a zero-sum game — we all win if we squelch the virus and can restore global travel and trade.
Great communications have been touted as a key reason for Taiwan and South Korea’s extraordinarily successful responses. Taiwan a country of 25M has had a total of 527 cases. South Korea (50M residents) has had 25k, compared to 7 million in the US. These countries are “open” and have been open through much of the crisis due to their great response — people are back to work. Because of this South Korea’s economy suffered less than all major economies (except China) and is forecasted to see a GDP drop of only 1% for 2020.
Winston Churchill led Britain through a moment in history of much greater impact and peril. The German blitzkrieg of September 1940 was specifically designed to demoralize the British people through chaos and erode support for the war. Churchill famously rose to the occasion with effective communication, regularly delivering radio speeches, and distributing videos and posters to reassure the shaken populace and help strengthen the resolve of the British people. Churchill’s oratory and communication with the British people was key to winning WW2 and to developing his reputation as one of the greatest wartime leaders ever. Communication was the critical factor and was uniquely his role.
Trump claimed early on that he considered himself a “wartime president” but his failure to act as one couldn’t be more complete. Trump has even admitted this giving himself a “D” on public relations in a Fox News interview in September. Of the all the aspects of the US federal government’s response to coronavirus, communications is the thing that Trump is most uniquely responsible for.
In contrast to the steady wartime leadership of Churchill, Trump’s communication has been sowing division, chaos, confusion, and pointing blame.
- Division: Early on, rather than bringing states together for a coordinated response, Trump lashed out at blue state governors such as Gretchen Wilmer in Michigan and Jay Inslee of Washington. Yet praised red state governors who were going against CDC guidelines.
- Chaos: With lockdowns happening in Minnesota, Michigan, and Virginia in April Trump tweeted “LIBERATE MINNESOTA”, “LIBERATE MICHIGAN” and “LIBERATE VIRGINIA”. This directly undermined the efforts of the governors in those states to get the coronavirus under control.
- Confusion: In April, Trump started daily briefs which were a disaster. In these rambling briefs, he suggested that disinfectant or light could be used as a cure, pushed hydroxychloroquine as a proven cure (which it never was), and pushed the country to open again (though we weren’t ready). He even bragged that he would take hydroxychloroquine, which led to the death of an Arizona man who followed Trump’s lead and ingested some. Rather than developing a consistent message, Trump lashed back and forth on masks, lockdowns, and cures.
- Denial: Despite having been fully briefed as to the seriousness of covid-19 in February, Trump consistently tried to wish it away with denial. Trump on Feb 27 “It’s going to disappear. One day, it’s like a miracle, it will disappear”. He has consistently downplayed the threat. Recently, after leaving Walter Reed hospital to be treated for coronavirus, Trump tweeted “Don’t be afraid of covid”. Trump’s lack of seriousness in discussing coronavirus, sent the wrong message to the country when everyone needed to take it seriously.
- Blame: Trump regularly blamed states, China, the WHO, Obama, the CDC, whoever, furthering the division, mistrust and conspiracy theories.
A National Response
The conservative media has come to Trump’s defense in suggesting that this is a battle that should be fought at the state level.
Fighting an actual war, the squadrons of soldiers on the ground, the ships at sea, the planes aflight do the actual fighting, but the generals and commanders who coordinate across squadrons, battalions, and fleets provide essential leadership, strategy, and communication. Leaving the coronavirus response to states was like leaving individual squadrons to fight a war on their own.
The depth of knowledge and expertise needed to successfully fight the coronavirus exceeded what most state & local governments were ready for. States and local governments were left to figure this out on their own, which led to a hodge-podge of responses, and confusion among the populace. We needed to come together as a nation to fight this common enemy with a leader capable of uniting us.
The countries that have had the most success in responding to this crisis like Sweden, New Zealand, South Korea, China, and Taiwan had strong national responses which included great communications, rapid & widely available testing, and aggressive contact tracing, all of which the US has essentially failed at.
Early on, the US mistakenly turned down diagnostic tests from the WHO and instead we went it alone waiting for the CDC to develop its own test. This cost the US valuable weeks at the start of the outbreak.
Testing came slowly in the early months, lagging other countries, and even many months later in August, free testing wasn’t widely available, and results were coming too slowly, this according to Anthony Fauci.
In South Korea, in contrast, residents were able to get tests for any reason and results texted to them the same day — this as early as March & April.
Contact Tracing has been lackluster in the US, again left to up to the states. With millions out of work, the Federal government count have ramped up a big national contact tracing program to get a segment of people back to work and serve as a valuable tool in stamping out coronavirus.
Trump failed to lead the country through this crisis. How many deaths is his failure responsible for?
Trump’s failures have cost the country 175,000 lives
Looking across the world at the deaths per 100,000 people in the top 50 wealthiest countries, we can imagine how many deaths we’d have experienced if we had responded as effectively.
In ranking the best countries, Japan has ranked 10th so far and has had 1.3 deaths per 100,000 population. At the same rate, the US would have 4,300 deaths, saving 210,000 lives. Three Vietnam wars worth of American fatalities would have been avoided had we responded as well as Japan.
Let’s give ourselves a little more leeway… What if we just ranked right in the middle — 26th out of the 50 wealthiest countries. Denmark is 26th and has 11.5 deaths per 100,000 population. At the same rate, the United States would have 38,000 deaths, 175,000 deaths fewer than we do today.
Trump’s failures have cost the United States at least 175,000 lives.