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Is the US bad at treating COVID-19 cases?

It's time for my sorta-weekly look at the COVID-19 pandemic, but this time I want to focus on something a little different. If you take a look at the case rate, the US has been doing pretty well for the past couple of months, falling from 500 per million to 200 per million. Meanwhile, countries like Germany and the Netherlands are skyrocketing, and others are increasing too, though at more normal rates.

But if you look at fatality rates, the picture is totally different. The US rate has declined to 3.5 deaths per million—which is good news—but that's still three times higher than most other European countries.

To get a better sense of this seeming paradox, we need to look at the case fatality rate, which tells us the percentage of COVID-19 cases that eventually turn into deaths. Here it is:

CFR is an imperfect measure, but the differences are so stark that this hardly matters. Over the past couple of months the CFR has doubled in the US and is now twice as high as in Germany and four times as high as the UK.

The case fatality rate tends to bounce up and down a lot, and the US rate hasn't always been higher than everyone else. Still, it's generally been pretty high, and lately it's spiked to a point pretty near its all-time peak.

Why? Why are so many more people dying of COVID-19 in the US than in other large peer countries?

120 thoughts on “Is the US bad at treating COVID-19 cases?

        1. haleddy

          Spain!

          Yes, the rates are lower. But, that’s only part of the story. I’ve been overweight, borderline obese by BMI most of my adult life - but have always walked 5+ miles daily.

          Arrived in Spain in June and have lost significant weight - not skinny, but average here. I’m eating more, drinking more, and not exercising a drop. Eventually the stress level will go down, but emigrating is ultra stressful. So, what gives?

          I walk closer to 10 miles daily just living. I go up and down 52 stairs multiple times daily. I eat 5 meals a day, sitting down. I have 5-7 cups of coffee that combined are less volume than 1 big ass Starbucks. The food is less prepared. Olives, tomatoes, and seafood every day. I take an afternoon nap. I sleep full nights.

          This is typical living - for everyone. It’s not weight, that resolves itself. It’s lifestyle. My fridge and cupboards won’t store Costco, I need to go to the market more often. At 15 mph, one way streets, and very limited parking, what a waste to drive the 3/4 mile to the clinic. At .15€ for a single medication that was 100$ In the US I can choose to function rather than survive.

          It’s pretty amazing.

          BTW, as mentioned elsewhere, we mask up here. Including OUTSIDE. There is not resistance to immunization. All that walking, and those meals, coffees, beers, and wine are enjoyed TOGETHER. Community is the secret sauce.

    1. Crissa

      How about 'we don't detect the disease at the same rate'?

      Why just don't treat people. It's a function of our healthcare system by which not seeking care is a feature rather than a bug.

      1. n1cholas

        Sure, but I bet it isn't as prevalent, severe and undertreated.

        Hell, we could probably go meta and go beyond just Western World minus the US and "universal healthcare" vs the US let the poors die healthcare system and say medical and health knowledge in general.

        To put it another way, if Americans were more knowledgeable about health and wellness, they'd have already demanded universal health care. Yet, they don't, just look at the state and Federal legislators elected for the past 100 years.

  1. haleddy

    OK. Opening mouth.

    We emigrated to Europe due to 1)SHITTY US Healthcare [specifically for managing a chronic condition]; 2)US Political Psychosis; 3)Social Lifestyle; 4)Food. Critically, we are working - not retired - and are not living an expat lifestyle.

    We live in a small Spanish town of 20K people, and are within 30 minutes of 6M in urban areas and 15 minutes of the Mediterranean. (It's hard duty, but someone has to do it.)

    We arrived on June 8, 2021 - just as everyone in the US was ripping of their masks and the immunization rates began to drop. Here in Spain, everyone was still masking up - OUTSIDE. Guess what, 5 months later, everyone is still masking up OUTSIDE! INSIDE, there is not even a question.

    We instantly had access to the Spanish healthcare system, like everyone else in the country. No one hesitates to go to the clinic at the earliest sign of illness. And, they do not fear losing their job or income, or not being able to afford taking care of their health. Early diagnosis!

    Aggressive contact tracing is the order of the day. One of our employees tested positive, they found everyone he had interacted with for 2 weeks prior. All tested, quarantined, ... .

    Everything is not perfect, but OMG! There is a different world out here.

    People give a fuck. About strangers. About others. That is the reason the death rate is lower in Western Europe. Period.

  2. Vog46

    One of the problems I have seen here and in many other publications is that we want "averages" and better numbers for something that is morphing as we speak.
    Like many pandemics the more people that have the antibodies at the same time the better. In years past these diseases spread like wild fire through many of the population centers because we didn't have the knowledge or technology to come up with vaccines quickly.
    Think about it this way
    When covid first was recognized as a danger we made the decision, based upon deaths from out highest at risk group = the elderly - to rush vaccines to the market and we took precautions as an INTERIM measure - masking, social distancing, wiping down surfaces etc
    We developed vaccines based upon the initial covid, then Alpha and Beta variants. THINK ABOUT THIS FIR A SECOND we already had native, Alpha and Beta variants of the disease BEFORE we even developed vaccines.
    We got vaccines rolling out just as Delta came along which was 10X more contagious and which took off in July
    We rushed vaccines to those at risk and thought the problem was "over" DELTA change all of that. Within the Delta variant itself there are 60 different genome sequences with the latest called DELTA + being 10% more contagious than the original delta.
    Previous knowledge is helpful but also gives a false sense of security because we are seeing so many variations that we no longer can rely on "figures" provided by our governments.
    Why?
    Well, on top of being a changing "thing" we do a lousy job of coordination of facts and figures because not only is the disease changing, but it has become a political football. We have 50 individual stats that use different methods in collecting and distributing data that are now under the influence of "politics".
    Add to that the corporations that produce the vaccines who have a vested MONEY interest in promoting their products.
    How many of us were relieved when the vaccines rolled out? How many of us felt that "well its an old folks disease" and didn't affect the young working class folks and their children.
    Now with Delta and Delta PLUS we are seeing those aged 21-54 being affected badly by it, Here's something from Minnesota:
    ********The proportion of deaths involving people younger than 65 has increased from 12% before June 1 to 26% since that time********* — with Monday's report including the deaths of an Itasca County resident in the 25-29 age range and a Dakota County resident in the 45-49 age range. ***********Conversely, long-term care facility residents made up 60% of COVID-19 deaths reported before June 1, and 26% since that time.*************
    https://www.startribune.com/minnesota-tops-500k-boosters-as-covid-19-breakthrough-infections-rise/600114198/

    And many of these cases are break through cases but we will NEVER know the extent of them because the younger crowd got milder cases of CV from native, Alpha and Beta so they didn't get tested.
    Now DELTA and PLUS are equally distributed in both younger and older age groups
    Natural immunity is temporary
    Vaccine immunity is temporary (but can be measured)
    Super immunity or a combination of both is also temporary

    But NONE of this works against a disease that is changing so often

    Get the shot, get the booster and lets get on the pharma industry to CHANGE the formal to match the newest variants.
    The Israeli study that showed "ONLY" 0.19% breakthrough was badly flawed in that they used people in their health care industry for the study and all of them had robust immune systems already.
    THATs why the study had such a low break through rate. Also keep in mind that Israel has Universal conscription all males and females are required to serve in the military and those folks are vaccinated against everything.

    The time has come for the United States government to get tough on our population. Vaccine mandates have been around since George Washington
    Corporations that started early and were strict are surviving like Tyson Foods and other food processor.
    It is time to END coverage for medical bills for the un-vaccinated UNLESS it can be medically proven they cannot get vaccinated. Given the choice, insurance companies would gladly turn their back on the un-vaccinated.
    And finally we need a national means of gathering information that is consistent and up to date. We have 50 different states doing it differently - and rather than propose a national healthcare system - we need a national healthcare data base that cannot be altered by governors of either party.
    Natural immunity sucks, lag time is a disgrace our death rates are too high
    Pretty bad for the only industrialized nation i the world with private healthcare..
    We are exceptional alright

    1. Spadesofgrey

      Dude, natural immunity is far better than vaccines for spread. Your useless vaccine mandate crap is outdated considering the large amount of adults already vaccinated.

      You make useless posts showing your uneducated ignorance. A nostril rip and pain would do you some good for your anti-science ways.

        1. rational thought

          You know you linked simply to a Google search and not any specific story. But I assume you are referring to the cdc study which seems to say in the media reporting and even at the cdc site that vaccine immunity is better than natural.

          But those headlines are clearly misleading if you actually take the time to READ more of what the study actually did, rather than just jump on the misleading headline that confirms what you want to believe.

          I have pointed this out many times before but largely ignored as so many just cannot hear anything that might contradict what they think .

          The cdc study compared those who were vaccinated vs those who were not and all had already been infected . So it did not compare vaccine immunity alone vs natural immunity alone. It compared what we refer to as hybrid immunity vs natural immunity alone. And found hybrid was better.

          Now that may still be am important finding as it indicates that getting vaccinated after infection still has a value . But it does not show what you think it does. And hard to blame you for that when the cdc itself clearly mischaracterizes their own study , and have to believe that was a deliberate misleading by the cdc ( which them makes you question other things coming from them).

          Now , do I think spades is exaggerating at least when he says natural immunity is " far " better for spread? Yes, I tend to think the numbers support that mostly, but not conclusive and far better is too much.

          My best guess now is that , for spread ( note NOT talking about preventing death in those who get infected), that natural immunity is much better ( maybe even far better ) in short term . I think the data supports that as you see cases just plummet after a big wave causing a lot of natural immunity.

          But mid term , like maybe 3 to 6 months, I would not be surprised if vaccine immunity is better. Long term 6 + months, I bet natural immunity goes back ahead ( assuming no booster) as then both have most people lose antibodies and now depends on immunity memory making more if needed.

          My theory here is that natural immunity produces a little better antibody, as the immune system saw the actual virus ( totally unpersuaded that the mrna vaccine can trick immune system into better antibodies than seeing real virus ) . But I expect that the two dose vaccine does " trick " the immune system into continuing to produce antibodies for a longer time , by fooling it that you got infected twice.

          Note that, if vaccine is better than natural immunity in preventing spread mid term, that does NOT mean better for the individual. The immune system has to allocate resources to where it is needed . If it stops making antibodies, that is because the immune system judgement is that they are not needed enough to make it worth the resources used . If the immune system is tricked into making antibodies by vaccine, what is that preventing those resources from being otherwise used for ? That is a concern.

          1. rational thought

            And I do expect again that, when I clearly point out that most posters here are flat just plain wrong re the cdc study , they will just ignore the scientific facts and go on believing what they want.

              1. rational thought

                Since crissa made the assertion that what she posted proved spades wrong , but it was just a Google search, and the search produced some results that argued for natural immunity being better, had to assume that it was meant to refer to the FIRST search result, which was that KY cdc study whose characterization was so flawed .

                So I responded to that as it still annoys me that people refer to it as showing something it does not , and more annoyed that the cdc deliberately ( have to assume) misrepresented it .

                And still nobody, including you , has had the common courtesy to acknowledge I am right about that . Strange for a supposed " science based " community to be so unwilling to acknowledge a science based argument.

                But then you refer to that other study which I had read and was somewhat confused by . Yes, it is at least comparing actual only natural immunity with only vaccine. But in a strange way which makes me wonder as to its conclusions. And again , though not as bad , the language used seems to imply that they measured how well the vaccine immunity worked versus natural.

                First , the final conclusion seems hard to believe. As I have said, I tend to conclude that maybe vaccibe immunity is better mid term . If you tell me 1.5 times, possible. Over 5 times? Really . That makes me question how you got the result. And the summary is not nearly as transparent as to the details as compared to say the Israeli study.

                They looked at 90 to 179 days. Why just that ? Strange that they used such an arbitrary cutoff. And exactly when was the study done? I would note if done say in June , almost all of the natural immunity in that time frame would be from winter wave and near the beginning of that time period while the bulk of vaccine would be from the end . So comparing apples to oranges. Natural immunity 5 months old vs vaccine 2 months is not a fair comparison.

                Did the cdc fine tune their study criteria to manage to get the result they wanted. Wonder if it would be reversed if done today in fla where such a period would advantage natural.

                And they are comparing not the general public or some representative group, but those who were hospitalized ( I think with covid like symptoms only but not sure). That is a strange choice and still not quite sure how it biased the result but clearly you cannot say it provides general conclusions re the immunity comparison.

                And of course there are differential vaccination rates for age race etc. Which the study says they adjusted for. But do I trust that they adjusted fairly? Nope .

                First the

                1. rational thought

                  OK, I see the period which was a long one of January to September 2021.

                  Which i think this study is crap .

                  Consider that most hospitalizations during that period where they were tested positive for covid would be in January and February 2021, because that was when there were so many cases during winter wave. And that would of course be when the chance of having covid ( and not something else) if hospitalized for symptoms would be the highest. And , using their criertia for period of 90 to 179 days would mean that , during that period with most cases and largest chance of having covid ( independent of immunity status ) would be far higher , how many cases would be included in the vaccination group ? Near zero . Because nobody was vaccinated until December except trial participants so cannot get to 90 days. But lots of the natural immunity set would be in those months of Jan and Feb.

                  By July 30, when covid was much lower and lower chance ( independent of immunity) , the prior period would be Feb to March. Lots and lots of vaccinations during that period but much less infections . So in good period you have a higher share of the vaccinated group and in bad period a higher share of natural group.

                  And all because of the arbitrary period chosen. What a coincidence.

                  This study is utter and compete crap. And any scientist with any competence had to understand they were manipulating the data to get a result they wanted falsely. This is scientific malpractice flat out.

                  I might say you should be embarrassed for citing it but you just trusted the cdc . The cdc should be embarrassed.

  3. Silver

    In Sweden, the health authorities no longer recommend testing for all who get symptoms. If you are fully vaccinated, don't need medical care, haven't been traveling, haven't been exposed to the virus (as far as you know), and are not requested to get tested as part of a tracing effort, you are no longer required to get tested. You can still get a test, of course, but it may not be free of charge.

    This will obviously affect the covid statistics, including cfr, and many in Sweden (including myself) seriously question this decision. We'll see what happens. They claim there are many other ways to keep track of the spread, and I'm sure there is, but the ability to keep consistent records seems vital to me.

    1. rational thought

      That is interesting.

      I think that, if covid has dropped low enough that the very large majority with certain symptoms have something else , and you are still testing those with more covid specific symptoms and contact tracing, that testing those with any symptoms might be almost useless and clog up the system.

      But what symptoms are they saying do not need testing?

      There is one class which are very common things for many that they live with for others reasons as normal life.

      For me personally, I have various medical issues causing " symptoms " . Headaches ( sinus drip) acid reflux ( cough), indigestion ( ibs). Almost never a week goes by when i do not have at least one of those symptoms. If I got tested for any symptoms, I would be getting tested multiple times a week.

      Then there are things like fever and more cold or flu like symptoms, which are not as common but could be caused by cold or flu. Better chance that is covid but , even during waves , most places usually not. When cases as low as Sweden, very likely not covid .

      Of course, then there are symptoms like extreme shortness of breath and especially loss of taste and small which are much more likely covid . Have to expect that testing still reccomended there.

      So i assume that saying no testing for just a little cough , or headache or indigestion, which really does make sense to me . But what about things like a mild fever ..are they still reccomending testing for that ?

      Interesting though different policies. Sweden saying no testing for some symptoms. Uk seems to want to test everyone weekly no matter what.

      1. Silver

        Advice throughout has been to test if you have had symptoms (that could indicate Covid) for 24 hours. The reasoning being that 24 hours gives you time to self-evaluate a bit, compare with your usual asthma/allergy/headache or whatever. This aspect of deciding whether to get a test is still the same. The difference now is that even if you have every reason to believe that you may have Covid, if you are fully vaccinated and so forth (see my comment above) you are not recommended to get tested. You are just to stay at home and self isolate.

        Everyone expects cases to increase in Sweden as they have already elsewhere in Europe, and that countermeasures may have to be reinstated. If this includes testing even for fully vaccinated, it seems unfortunate, for future studies if nothing else, to not have had consistent rules for testing throughout.

        I believe the reason is that Sweden constitutionally is very big on people’s rights and freedom. Any rules, even those not strictly enforced by law, have to be reasonable and proportional. I guess it is not considered reasonable, in the current situation, to make people who would most likely not get severely ill (and not infect others either as long as they follow the stay-at-home rule) take a test.

  4. Vog46

    There are far too many studies done both here and abroad NOW that show vaccines are better than natural immunity against CV re-infection. Both impart high levels of antibody response but neither provide protection after 4 months.
    To even THINK that natural is somehow better is like saying hey put bleach in your veins.
    What piqued my interest in break through cases was the Israeli study because at the time of their study DELTA had not fully come on the scene. The details of the study remained somewhat confusing in that their break through rate was so low compared to our break through rates and I could not figure out why.
    Until I saw exactly WHO they studied - 600 workers i their own national healthcare system. People who were used to sanitizing, who were used to wearing masks on a daily basis and on top of that people who had served in their military or reservists who by mandate HAD to get vaccinated against everything
    But our CDC studies are based upon KNOWN breakthroughs that they describe as people who have been DIAGNOSED to have had covid or who have records of vaccination.
    The natural immunity folks want to sew doubt in the CDC because that would prove Faucci right as opposed to Trump who hated Faucci for calling out the seriousness of the pandemic early which then Trump TRIED to disparage by saying it would go away by Easter. Never has one person been so wrong about something and has to this day so many people still believing he was right.
    Thats why I go with over seas studies from countries with national healthcare systems. They have consistent numbers reported nationwide using the same criteria for reporting those numbers. They do NOT have a Ron DeSantis changing the head of his health deportment and change the way deaths are reported in the middle of a pandemic. That just simply doesn't happen overseas. And it certainly didn't happen through most of our own 50 states but the plant fact is that each state has a different way to report which is shameful on a national level.
    For a pandemic response our private, for profit health care system failed us miserably and the politicians in DC and the state capitals made it much worse.
    Now, we are having a much higher instance of CFR (a lousy metric). A much younger crowd now getting infections and are dying.
    And the natural immunity folks are using doubt to keep alive their futile belief in the natural way. International studies that we have posted here show that SO FAR vaccines are better than natural immunity. Yes other countries tested a much higher number earlier on. But no one - IN THE WORLD - anticipated or planned for DELTA. But the subsequent studies are NOW SHOWING the natural immunity caused by Native, Alpha and Beta Covid cases diminishes just as fast as the vaccine immunity does and like the vaccine after just a few short months is basically worthless.
    And because of the DOUBT that has been sewn they have the issue they can cling to in their hopes of proving their case
    Follow the science. Japanese scientists are now working on a vaccine to provide protection against all forms of Sars both known and unknown. This would END the need for people to get sick in order to have immunity
    The only thing Trump did was operation warp speed that allowed us the opportunity to vaccinate the most vulnerable of our population early on. It also allowed us a chance to STUDY the effectiveness of the vaccines in real time
    Unfortunately, in our haste we decided to go with what we had at the time.
    And we are driving a stake through natural immunity arguments and against our own pharma industry - at least for now.
    Anyone who believes in natural immunity now after 750,000 dead needs to catch COVID now and die.
    And they sure as HELL should pay for their medical care when in fact we have the means to minimize that level of care through vaccination

    1. rational thought

      You often contradict yourself in your ramblings and come to conclusions not really warranted by your preceding statements so hard to really dissect what you say.

      But I do agree with a lot of what you say and then you go off the deep end .

      But I will try on a few points.

      1) first the studies have been all over the place and somewhat contradictory on this issue, like so much with covid . So makes it real hard to come to any firm conclusions from them.
      You seem to rush to accept any study that seems to agree with you and find any reason to dismiss any that do not , rather than to just consider the evidence.
      But you say a lot of things that fit pretty close to what I said. Antibodies lasting four months? Not quite and too simplistic - more like they tend to fade out over time and at different rates for different people. Not surprisingly, those who got sick from covid keep their antibodies longer - those asymptomatic might never develop them at all.
      But saying they last 4 months is a decent simplification as to maybe " half life " on average. To me it is more like a gradual decline and maybe 6 months is where you really see a drop in community protection.

      2) your statement seem to equate vaccine and natural immunity as about the same on antibodies.
      Which is exactly consistent with my speculation except I guess that vaccine antibodies might last a touch longer than natural ( on average) in mid term 3 to 6 months. But I also guess that the natural antibodies work a bit better than vaccine . Plus you just ignore any immunity other than antibodies existing. Long term is always going to be through things like t cells and memory to produce antibodies if infected.
      The statements you make just do not really conflict with what I said .

      3) when I say look at facts , I mean more than studies ( which I more and more distrust).
      I also look at real world case counts and what that implies. And I modify my opinion based on that .
      One thing I have seen is that community spread really does seem to increase when vaccination gets 6 months old ( at least the way we and uk and Isreal did it). Which has moved me somewhat closer to your thinking that vaccinations just do not work at 6 month and after . They still do work, just not enough to get the R for vaccinated below 1.0. At least long term. Before I guessed that vaccinated R will stay just below 1.0 for years or permanently. Now I think more like just above 1.0 which is disappointing.
      I have more hope for long term natural immunity as we have the evidence of ny , NJ, and other places where there was a huge wave over a year ago. Looking at current case rates and comparing based on vaccination, restrictions, etc. Seems obvious it is still having some effect lowering spread. Enough that long term natural immunity has an R below 1.0, likely not . But it helps.
      And short term natural immunity obvious works great , and better than vaccine. The way cases just collapse after a huge wave can only be explained by it . Explain why fla is now lowest in nation and went down so fast otherwise.

      4) but cases go down so fast after a big wave that just looking at natural immunity traditionally ( i.e for those who were " infected " ) cannot explain it all.

      My guess is " micro infections " . We tend to define an " infection" as enough virus to cause you to get sick or have any significant chance of infecting someone else. Or which will have enough virus to be picked up in testing.
      But there can be numerous " micro infections " where the virus is too small in number to do anything and innate immune system takes care of it. But also where virus gets by the innate immune system but is knocked out real quick by a good immune system ( one trained by vaccine or prior infection). So no threat of spread and no effect except can that help to reactivate immunity like a booster? Maybe natural and prior vaccine immunity is boosted by both a true significant reinfection and a micro one . And so a big wave by having a lot of virus around, gives a chance for old immunity to be reactivated while still good enough.
      And that would invalidate in a way the studies comparing natural and vaccine immunity because you do not have micro vaccinations..
      Or , to look at it another way, natural immunity looking at just " infections " the way we count it underestimates the extra micro ones also adding immunity and that would not be picked up the way studies are done. So natural better than vaccine not on individual but on community . Or not better but there is more of it than estimated.

      5) since you have cited the cdc study from KY too - incorrectly- I sure wish you are someone would have the grace to actually respond and concede that I am 100% right on that once you read it. The headline summaries are totally misleading or false

      6) you give no cites for your new criticism of the Israel study and what you say makes no sense as the numbers in the study are over 600.

      But say they did only study medical workers. Clearly that would bias all infections lower in all groups so how would that bias the comparisons of the groups ? If both those with natural and vaccine immunity are BOTH washing hands and masking more than general public, yes, fewer breakthrough but proportions the same..

      And same point re the unvaccinated uninfected group if they were doing same thing - which should reduce infections there too.

      But re comparison to no immunity, I can see that biasing the results some . But I would say maybe more likely the opposite direction you think

  5. someBrad

    Late to this, but isn't all about vaccination rates? If you are vaccinated you can still "get covid" to the degree that you test positive but don't really get sick or don't get very sick. Since our vaccination rates are lower, more of our cases are serious, no?

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