The other day I was talking to an English woman, inevitably about the “lovely” weather we’ve been having so far in May (think of a day in early January in northern California) and as soon as she learned that I’d lived in the San Francisco Bay Area for twenty-seven years she began to opine on the “terrible” death toll in the USA. “They have it so much worse than over here,” she exclaimed. “Our National Health Service is wonderful! We’ve been spared, but in the USA they must be piling dead bodies up on the streets.”
As an ordinary person she was naturally ignorant of the facts. Her notions were, like those of all ordinary people, put into her head by the mass media. It would never have occurred to her to look at the data for herself.
I thought it would be vaguely interesting to see if she could reason her way through the issue. “Well,” I said, “the USA has more than four times as many people as the UK, so logically we should expect to see at least four times as many deaths if the USA was faring as well as the UK, and we’d expect to see more than four times as many deaths if the USA was doing worse than the UK.”
She began to struggle with the concept. Not wishing to appear too slow, she reluctantly concurred; I was uncertain as to whether or not she’d really grasped the concept but decided to continue as though we’d at least reached Base Camp on our attempted ascent to the heights of intellectual prowess.
“As I’m sure you know,” I continued, “the UK’s present mortality rate attributed to SARS-COV-2 is approximately 130,000. As the UK has a population of just under sixty-seven million, this means the number of deaths is presently just under two-tenths of one percent. Or, to put it another way, if we took ten thousand British people we’d expect nineteen of them to die of covid-19.” I could see we were struggling to reach Camp One on our ascent, but like an overly optimistic Sherpa I pressed on. “Meanwhile the USA has experienced approximately five hundred and eighty thousand deaths…”
“See!” she shouted happily, “I told you they have it worse than we do!”
“But the USA has a population of approximately three hundred and thirty-two million people,” I continued, hoping that something might sink in. “So this means that the number of deaths as a percentage of population is less than what we’ve seen in the UK. To put it another way, if we took ten thousand US residents we’d expect seventeen and a half of them to die of covid-19. Which is fewer people than in the UK.”
She stared at me, uncomprehending. I wasn’t surprised. After all, the human brain isn’t evolved to cope with abstract concepts and certainly isn’t evolved to cope with large data sets. “But more of them have died,” she said plaintively, obviously feeling that somehow I was trying to confuse her. “Because they don’t have the NHS. It’s the best in the world, you know.”
It was time to switch from Sherpa mode to Parent mode. “Of course it is,” I said comfortingly. She smiled, just like a child who’d been given a chocolate bar after a long and difficult wait.
In reality the British NHS isn’t the best in the world. The UK’s own Nuffield Trust reported not long ago that the only dimension in which the NHS scores highly is being free at the point of delivery, because the NHS is funded directly from tax revenues. On every other measure the NHS is mediocre at best and lagging at worst. The UK has Europe’s worst cancer survival rates, for example, because it takes an eternity before a cancer sufferer gets properly diagnosed and even longer before they can get treatment. But for ordinary British people who, like ordinary people everywhere, always believe what they’re told, the NHS really is the best in the world and who cares about mere facts to the contrary.
This conversation, however, reminded me that we still don’t have a good explanation for why US residents haven’t seen a much higher per capita mortality rate from SARS-COV-2.
We know that being very old and frail, being very sick, and being obese are the three main risk factors. The British are an ageing society, most people in the UK have an appalling diet (Scotland has the world’s highest rate of Type II diabetes, for example), 28% are obese and a further 36% are fat, and very few take any form of meaningful exercise. So it’s not surprising that the UK is near the top of the list when it comes to per capita covid-19 fatalities.
What is surprising, however, is the state of play in the USA. US residents have on average an even more atrocious diet than the British, 41% are obese, and a further 45% are fat. On this basis alone we’d expect to see the per capita mortality rate of the USA exceeding that of the UK. Worse yet, although the USA spends more than twice as much as the nearest big spender (France) on health care (presently an astonishing 18% of GDP) it achieves very poor outcomes, with US citizens now dying earlier than the previous generation. But when it comes to covid-19 deaths the USA is several places below the UK on the per capita mortality charts. Moreover, while British people can camp out in UK hospitals waiting to be seen (average wait times can exceed several weeks), nearly seventy-five million US citizens are effectively without any access to health care of any kind. This is because twenty-nine million remain uninsured, while the rest can’t afford the high co-payments associated with all forms of treatment and medication.
So why are comparatively few US residents dying of covid-19?
Early on, demographers tried to explain the situation by pointing out that a larger percentage of US residents live in rural and semi-urban areas compared to people in Europe. This argued for a slower spread and hence an initially lower mortality rate. But we’re some 14 months into the pandemic now (relative to its appearance in major Western nations) and it’s clear that population dispersion can only account for a very small part of the story.
While there is presently very little published data on which to base a firm argument, I’m increasingly coming to suspect that the surprisingly low per capita mortality rate in the USA is due to the very fact that the most vulnerable in the USA are also those who can’t afford health care. At first this seems counter-intuitive as an argument. Surely these people, who are typically the most obese with the worst pre-existing conditions, should comprise nearly all covid-19 deaths?
It’s only when we look more closely at the situation on the ground that things become more obvious. Early on in the course of the pandemic, doctors rushed patients into induced coma so they could be placed on ventilators. But by the summer of 2020 a great many doctors were pointing out that this regimen was reliably killing at least 80% of patients. By the early autumn, papers were being published in medical journals and (very rarely) in more accessible places. Everything was pointing in the same direction: ventilating patients is a very poor strategy when it comes to treating SARS-COV-2. In fact even as early as April 2020, Time Magazine was publishing articles pointing out that many doctors were saying clearly that ventilators were killing patients and should not be used to treat covid-19 patients.
Sadly, doctors are just people like the rest of us and so when new waves of infection arose, they resumed killing their patients by forcing them into induced coma and putting them on ventilators. Predictably the death rates climbed precipitously. Hospitals were protecting themselves against lawsuits (you can sue a hospital for failing to do something; it’s much harder to sue if the hospital is doing what all the other hospitals are also doing). Doctors were protecting themselves against relatives demanding that everything possible should be done. In addition, doctors hate feeling powerless. Putting patients onto ventilators was simply the easiest thing to do when once again the world was panicking and the mass media was spreading fear and hysteria — the thing the mass media specializes in doing.
Hence people who couldn’t afford to be rushed to hospital and put on ventilators were, ironically, better off than those with health insurance and the ability to pay the exorbitant deductibles. By avoiding ventilation, most of the very poorest in US society recovered from covid-19 while their better-off peers were once again dying in record numbers thanks to being put onto ventilators. And of course the mass media continued to praise doctors for ventilating patients and ordinary people continued to stand on balconies and in their front yards applauding the wonderful heroes who were, in reality, killing 80% of their patients. It’s a bizarre situation where one can genuinely propose that not having access to health care services becomes an unintended benefit.
We will likely have to wait twenty years before the reports are written and some belated attempt is made to learn the lessons created by our fear-induced folly. And even then I doubt ordinary people will understand anything or learn anything of importance. Because there will be new shows to watch and new video games to play and new celebrities to follow and new scandals to gossip about and new media-sensation fearmongering to be terrified by.
For anyone wanting to learn more about why ventilating people is a terrible way to treat covid-19 symptoms, this article provides a doctor’s perspective.