Two years into the pandemic, the coronavirus is killing Americans at far
higher rates than people in other wealthy nations, a sobering
distinction to bear as the country charts a course through the next
stages of the pandemic.
The ballooning death toll has defied the hopes of many Americans that
the less severe Omicron variant would spare the United States the pain
of past waves. Deaths have now surpassed the worst days of the autumn
surge of the Delta variant, and are more than two-thirds as high as the
record tolls of last winter, when vaccines were largely unavailable.
With American lawmakers desperate to turn the page on the pandemic, as
some European leaders have already begun to, the number of dead has
clouded a sense of optimism, even as Omicron cases recede. And it has
laid bare weaknesses in the country’s response, scientists said.
“Death rates are so high in the States — eye-wateringly high,” said
Devi Sridhar, head of the global public health program at the University
of Edinburgh in Scotland, who has supported loosening coronavirus rules in parts of Britain. “The United States is lagging.”
Some of the reasons for America’s difficulties are well known. Despite
having one of the world’s most powerful arsenals of vaccines, the
country has failed to vaccinate as many people as other large, wealthy
nations. Crucially, vaccination rates in older people also lag behind
certain European nations.
The United States has fallen even further behind in administering
booster shots, leaving large numbers of vulnerable people with fading
protection as Omicron sweeps across the country.
The resulting American death toll has set the country apart — and by
wider margins than has been broadly recognized. Since Dec. 1, when
health officials announced the first Omicron case in the United States,
the share of Americans who have been killed by the coronavirus is at
least 63 percent higher than in any of these other large, wealthy
nations, according to a New York Times analysis of mortality figures.
In recent months, the United States passed Britain and Belgium to have,
among rich nations, the largest share of its population to have died
from Covid over the entire pandemic.
For all the encouragement that American health leaders drew from other
countries’ success in withstanding the Omicron surge, the outcomes in
the U.S. have been markedly different. Hospital admissions in the U.S.
swelled to much higher rates than in Western Europe, leaving some states
struggling to provide care. Americans are now dying from Covid at
nearly double the daily rate of Britons and four times the rate of
Germans.
The only large European countries to exceed America’s Covid death rates
this winter have been Russia, Ukraine, Poland, Greece and the Czech
Republic, poorer nations where the best Covid treatments are relatively
scarce.
“The U.S. stands out as having a relatively high fatality rate,” said
Joseph Dieleman, an associate professor at the University of Washington
who has compared Covid outcomes globally. “There’s been more loss than
anyone wanted or anticipated.”
As deadly as the Omicron wave has been, the situation in the United
States is far better than it would have been without vaccines. The
Omicron variant also causes less serious illness than Delta, even though
it has led to staggering case numbers. Together, vaccines and the less
lethal nature of Omicron infections have significantly reduced the share
of people with Covid who are being hospitalized and dying during this
wave.
In Western Europe, those factors have resulted in much more manageable
waves. Deaths in Britain, for example, are one-fifth of last winter’s
peak, and hospital admissions are roughly half as high.
But not so in the United States. Record numbers of Americans with the
highly contagious variant have filled up hospitals in recent weeks and
the average death toll is still around 2,500 a day.
Chief among the reasons is the country’s faltering effort to vaccinate
its most vulnerable people at the levels achieved by more successful
European countries.
Twelve percent of Americans 65 and over have not received either two
shots of a Moderna or Pfizer-BioNTech vaccine or one Johnson &
Johnson shot, which the C.D.C. considers fully vaccinated, according to
the agency’s statistics. (Inconsistencies in C.D.C. counts make it
difficult to know the precise figure.)
And 43 percent
of people 65 and over have not received a booster shot. Even among the
fully vaccinated, the lack of a booster leaves tens of millions with
waning protection, some of them many months past the peak levels of
immunity afforded by their second shots.
In England, by contrast, only 4 percent of people 65 and over have not
been fully vaccinated and only 9 percent do not have a booster shot.
“It’s not just vaccination — it’s the recency of vaccines, it’s whether
or not people have been boosted, and also whether or not people have
been infected in the past,” said Lauren Ancel Meyers, the director of
the University of Texas at Austin’s Covid-19 modeling consortium.
Unvaccinated people make up a majority of hospitalized patients. But
older people without booster shots also sometimes struggle to shake off
the virus, said Dr. Megan Ranney, an emergency physician at Brown
University, leaving them in need of extra oxygen or hospital stays.
In the United States, cases this winter first surged in more heavily
vaccinated states in the Northeast before moving to less-protected
states, where scientists said they worried that Omicron could cause
especially high death tolls. Surveys suggest that the poorest Americans
are the likeliest to remain unvaccinated, putting them at greater risk
of dying from Covid.
America’s Omicron wave has also compounded the effects of a Delta surge
that had already sent Covid deaths climbing by early December, putting
the United States in a more precarious position than many European
countries. Even in recent weeks, some American deaths likely resulted
from lengthy illnesses caused by Delta.
But Omicron infections had edged aside Delta by late December in the
United States, and epidemiologists said that the new variant was most
likely responsible for a majority of Covid deaths in the U.S. today.
“These are probably Omicron deaths,” said Robert Anderson, the chief of
mortality statistics at a branch of the C.D.C. “And the increases we’re
seeing are probably in Omicron deaths.”
Still, the United States’ problems started well before Omicron,
scientists said. Americans began dying from Covid at higher rates than
people in western European countries starting in the summer, after the
United States had fallen behind on vaccinations. During the Delta surge
in the fall, Americans were dying from Covid at triple the rate of
Britons.
By tracking death certificates that list Covid as a cause of death or
as a contributing factor, Dr. Anderson said, the C.D.C. is able to
ensure that it is counting only those people who died from Covid — and
not those who might have incidentally tested positive before dying for
unrelated reasons.
It is too early to judge how much worse the United States will fare
during this wave. But some scientists said there were hopeful signs that
the gap between the United States and other wealthy countries had begun
to narrow.
As Delta and now Omicron have hammered the United States, they said, so
many people have become sick that those who survived are emerging with a
certain amount of immunity from their past infections.
Although it is not clear how strong or long-lasting that immunity will
be, especially from Omicron, Americans may slowly be developing the
protection from past bouts with Covid that other countries generated
through vaccinations — at the cost, scientists said, of many thousands
of American lives.
“We’ve finally started getting to a stage where most of the population
has been exposed either to a vaccine or the virus multiple times by
now,” said Dr. David Dowdy, an epidemiologist at the Johns Hopkins
Bloomberg School of Public Health. Referring to American and European
death rates, he continued, “I think we’re now likely to start seeing
things be more synchronized going forward.”
Still, the United States faces certain steep disadvantages, ones that
experts worry could cause problems during future Covid waves, and even
the next pandemic. Many Americans have health problems like obesity and
diabetes that increase the risk of severe Covid.
More Americans have also come to express distrust — of the government,
and of each other — in recent decades, making them less inclined to
follow public health precautions like getting vaccinated or reducing
their contacts during surges, said Thomas Bollyky, director of the
global health program at the Council on Foreign Relations.
A study published in the scientific journal The Lancet
on Tuesday by Mr. Bollyky and Dr. Dieleman of the University of
Washington found that a given country’s level of distrust had strong
associations with its coronavirus infection rate.
“What our study suggests is that when you have a novel contagious
virus,” Mr. Bollyky said, “the best way for the government to protect
its citizens is to convince its citizens to protect themselves.”
While infection levels remain high in many states, scientists said that
some deaths could still be averted by people taking precautions around
older and more vulnerable Americans, like testing themselves and wearing
masks. The toll from future waves will depend on what other variants
emerge, scientists said, as well as what level of death Americans decide
is tolerable.
“We’ve normalized a very high death toll in the U.S.,” said Anne Sosin,
who studies health equity at Dartmouth. “If we want to declare the end
of the pandemic right now, what we’re doing is normalizing a very high
rate of death.”
