[Cory Franklin] High COVID-19 death rate in US

Following his recent retirement, Dr. Anthony Fauci reflected on his government role during the COVID-19 pandemic. When asked about the high per capita COVID-19 death rate in the US, Fauci replied, “Something clearly went wrong. And I don’t know exactly what it was. But the reason we know it went wrong is that we are the richest country in the world, and on a per capita basis we’ve done worse than virtually all other countries. And there’s no reason that a rich country like ours has to have 1.1 million deaths. Unacceptable.”

What did he mean by that? His implication seems to be that there should be a correlation between a nation’s wealth and a lower per capita COVID-19 death rate. If so, it follows that our rich country should have a low per capita death rate; since we don’t, we must be doing something fundamentally wrong.

That’s a logical assumption and a common sentiment in the news media and among many experts. Studies linking COVID-19 deaths to poverty in the US do not answer the question because they have sometimes failed to account for confounding variables -- Are residents in poorer states older, fatter, with more diabetes? -- or they have used data from the first half of the pandemic (death patterns have shifted somewhat since the appearance of the omicron variant).

There is one overall problem with the theory that wealthy countries have lower per capita COVID-19 death rates: It is contradicted by actual worldwide outcomes. There is no evidence that national wealth protects against COVID-19 deaths. It is a complex scenario, but in fact, the evidence suggests the opposite -- when all countries are considered, COVID-19 may be primarily a disease of affluent countries.

When he drew a correlation between a country’s wealth and a low per capita death rate, Fauci, who has been quoted as saying, “I represent science,” appears to have ignored the worldwide data -- a distinctly unscientific approach. Much of the scientific community and news media focus on COVID-19 outcomes from Western Europe, Canada, Japan and Australia to draw conclusions. Those conclusions are not supported by outcomes that include the world’s poorest countries.

Staring at us are the figures from Africa: According to available statistics, per capita COVID-19 deaths on that continent are one-sixteenth that of the US and, in some of the poorer countries, much lower than that. Africa, the poorest continent, with 17 percent of the world’s population, has registered less than 4 percent of the world’s COVID-19 deaths. It doesn’t take a statistician, a Ph.D. or an army of graduate students to realize there can’t be much of a correlation between national wealth and COVID-19 mortality.

The immediate rejoinder is that there has been bad data collection and poor reporting of COVID-19 deaths in Africa. This does not begin to explain why in places such as Nigeria and Benin, if only 1 percent of the deaths were being reported -- which itself would be pretty much impossible to conceal from the public -- the per capita death totals would still be less than half the per capita death rate of the US.

The reason Africa is faring better is not poor reporting, dollars spent, public health measures/infrastructure, medical treatments or even vaccination. (Africa is the only continent where less than 50 percent of the population is vaccinated against COVID-19.) It is probably because Africa has more open environments, a younger population not as susceptible to the virus, a lower rate of obesity especially in sub-Saharan Africa and less diabetes. Factors such as genetic resistance in the African population and protective immunity from past exposure, which might affect outcomes, are also subjects for future investigation.

The situation is, of course, reversed in most of the industrialized world -- an older, more obese world. There are variations on that theme -- why certain countries have a lower per capita death rate than others -- that may have to do in small part with how the pandemic was managed, but the differences are much more likely to be due to the medical profile of each population and the associated population immunity to COVID-19, either natural or acquired.

While the world’s richest countries have per capita death rates below that of the US, none of them is distinguished by having especially low rates internationally. Put simply, none of the wealthiest countries had a magic bullet that made its COVID-19 death rates “acceptable,” to use Fauci’s term.

The virus is, and always has been, the pandemic’s main actor. Our actions can save lives -- yes, and that is important -- but when you are talking about millions of COVID-19 deaths, what we do has affected this only at the margins. The data from Africa, and some other poor countries, strongly suggests Fauci’s hubris, and that of others, was to ascribe an agency to our actions we never possessed.

We are in the back seat blithely giving directions, while the virus is firmly ensconced in the driver’s seat, controlling the car. And it doesn’t matter whether the car is a late-model Tesla or an old beat-up Ford.

Cory Franklin

Dr. Cory Franklin is a retired intensive care physician. -- Ed.

(Tribune Content Agency)