COVID-19 has scrambled the meaning of American exceptionalism.
For a century or more, the United States has been a beacon of hope and strength to the rest of the world. But its response to the pandemic, many public health experts say, has been uniquely hapless, ineffective, undisciplined and selfish. By some measures, the United States has handled the health crisis as badly as any country has.
Although the United States represents only 4% of the world’s population, it accounts for a quarter of all COVID-19 cases and 22% of all deaths.
The country whose military and economic might won the Second World War, and whose confidence and technological wizardry planted the first human being on the moon, now finds itself as a reverse role model during the worst public health crisis in a century.
“The U.S. response — I exaggerate not — is a textbook example of how to do it wrong,” said Dr. William Schaffner, an infectious disease specialist at Vanderbilt University Medical Center.
To be sure, some American states, particularly in New England, have fared better than others, but that only reflects the disjointed national response, epidemiologists say.
Relatively successful countries such as Denmark, Germany, Senegal and Thailand have put out messaging that is clear, consistent and transparent. They have implemented nationwide policies guided by science rather than politics. And above all, they have exerted strong national leadership.
“The first thing I would say is that they have had a national policy,” Schaffner said. “That is also the second, third and fourth thing. They had a national policy. That national policy was decided on very quickly and it was communicated clearly and consistently and based on public health principles.”
Community spirit has proven stronger elsewhere than in the United States, say some health policy experts.
“One of the things that strikes me about the rest of the world compared to the U.S. is there is much more of a community sense,” said Dr. Krutika Kuppalli, vice chair of the Infectious Diseases Society of America’s Global Health Committee and an infectious disease doctor who has worked in Asia and on Ebola in Africa. “The U.S. is much more about ‘I’ than ‘we,’ whereas in other countries it’s more ‘we’ than ‘I.’
“In a pandemic, the thing has to be about ‘we’ not ‘I.’”
Anna Petherick, a researcher at the School of Government at the University of Oxford, which analyzes government COVID-19 responses, said Americans show a lot of skepticism toward government directives.
“There are good things about that attitude, but it doesn’t serve the country well at a time of crisis when you need to coordinate, when you perhaps need to give up personal freedom for the collective good.”
South Korea and the United States both recorded their first cases Jan. 20, yet South Korea has held its outbreak level to 30 cases per 100,000 people, compared with the U.S. figure of 1,655 per 100,000.
Last week, New Zealand had gone 100 days without detecting a single example of community spread of the virus before encountering an outbreak that prompted the government to postpone the general election for a month. The United States surpassed 5 million cases and 160,000 dead around the same time, with cases mounting in six states and high transmission rates prevailing in more than a dozen others.
Countries such as South Korea and Denmark have removed nearly all coronavirus-related restrictions. In the United States, authorities in numerous hotspots have either had to pause or roll back reopening some businesses. Hundreds of public health experts and medical professionals have signed on to a letter calling for a national shutdown now, in the sixth month of the pandemic.
“If our response had been as effective as South Korea, Australia, or Singapore’s, fewer than 2,000 Americans would have died,” their letter asserts. “We could have prevented 99% of those COVID-19 deaths. But we didn’t.”
Last week, White House senior adviser Jared Kushner defended the Trump administration’s strategy. In an interview with CNBC, he said the administration led by overseeing the procurement, production and distribution of masks, ventilators and other resources.
“With regards to a national strategy, the job of the federal government was to get the resources that the country needed,” said Kushner, who is also the president’s son-in-law.
“You heard all these hysterical reports about doctors on the front lines not being able to get masks, not having enough ventilators, you had governors requesting a lot more ventilators than they needed, and again, every patient in America that needed a ventilator got a ventilator, President Trump distributed them properly,” Kushner said.
Foreign Policy Analytics, an independent research and advisory division of the journal Foreign Policy, examined multiple metrics to gauge the performance of 36 nations in responding to COVID-19.
In addition to each country’s death rate and case rate, researchers considered the state of each nation’s public health system before the pandemic; the timeliness and stringency of its public health actions (such as closures, social distancing, testing and contact tracing); the consistency, effectiveness and transparency of its communications; primacy of science in guiding policy; and coronavirus-related stimulus spending and public health funding.
“The United States is doing quite poorly,” said Fouad Pervez, a senior policy analyst at Foreign Policy Analytics and lead researcher on the index.
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Of the 36 countries, the index rated the United States 31st, ahead of only Indonesia, Turkey, Mexico, Iran and China, the last of which rated worst of all primarily because of its lack of economic intervention and poor transparency, including silencing doctors who raised early alarms about the virus.
New Zealand rated highest, followed by Senegal and Denmark. All received high marks for policy directives, economic support to prop up the public health system and mitigate financial harm to individuals and businesses, and consistent, clear, fact-based communications.
The index placed the United States around the median in its public policies, just above the median in its economic support and weak in its communications. The United States, the researchers commented, “has engaged in misinformation as much as any country in the Index.” On the other hand, the authors said, the U.S. has not limited press freedom in response to the pandemic, like China and Iran did.
Countries that have done well in containing the virus have not all adopted precisely the same measures. “New Zealand never pushed masks,” said Jennifer Nuzzo, an epidemiologist with Johns Hopkins University’s Center for Health Security.
Instead, she said, the island country succeeded through a large shutdown and contact tracing intensive enough to identify where most people got sick. Aiding the contact tracing was a requirement that people sign into businesses or restaurants they visited, making them easier to track down if infections were linked to those establishments.
Nuzzo said Taiwan, another island nation, also never needed to resort to a broad shutdown because it had enacted strong travel restrictions and a program of aggressive testing, contact tracing and isolation of those infected. Singapore also avoided large shutdowns until “being blindsided,” Nuzzo said, by an outbreak in dormitories housing migrant workers, a group that health authorities had not surveilled well.
In addition to strong testing and isolation, South Korea has been aggressive in using technology in contact tracing, Kuppalli said. The country not only uses GPS tracking on cellphones — users cannot choose to opt out — but contact tracers also use closed circuit surveillance and credit card activity to locate those potentially exposed, techniques likely to run into resistance in the United States.
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Kuppalli, who testified before a congressional committee last month contrasting COVID-19 responses in the United States with other countries, praised Scotland for being hyper transparent about what steps it was taking and for the empathy shown by health authorities.
“They have put out the messaging that everybody matters in the country, and we’re going to take care of you,” Kuppalli said.
Scotland had a broad shutdown and reopened businesses slowly, explaining all along how it was proceeding and why, Kuppalli said. Countries that followed that course had far fewer cases per capita when they loosened restrictions than the United States did when states began easing rules.
“The other countries did not open until they had the virus under control in terms of having either a low number of cases or they were fully on top of their cases in terms of testing, contact tracing and quarantining,” said Luisa Franzini, chair of health policy and management at the University of Maryland School of Public Health.
“In the United States, some states decided to reopen when cases were not even going down, when they were still going up,” Franzini said. “With cases getting worse, they just doubled down and began reopening anyway.”
Some epidemiologists pointed out that successful countries had national strategies as opposed to the American, state-by-state approach. Adopting measures that change at state boundaries might make sense with determining speed limits, but not with communicable disease.
“A virus doesn’t know boundaries of different jurisdictions,” Franzini said. A state with strict lockdown orders can’t protect itself from travelers from states with loose restrictions bringing the virus with them, she said, “so a haphazard approach doesn’t make sense.”
That disjointedness has prompted some states, including New York and New Jersey, to require visitors from hotspot states to quarantine.
Public health experts say some of the successful countries had some experiential advantages when COVID-19 struck.
“In contrast with the United States, people, particularly in South Asia, recalled the fear and the risk involved with failing to respond to SARS and MERS,” said Dr. Jon Andrus, an epidemiologist and former deputy director of the Pan American Health Organization. “They remember and built on their response. It didn’t dissipate like it does in the United States, where we have a crisis and then we calm down and forget until the next crisis.”
In a number of those Asian countries, the population was already used to wearing masks, Andrus said. But the mask-wearing, he said, symbolized something greater than a public health measure.
“There’s an acceptance of actions to keep my community safe above any ill-informed personal-freedom approach,” Andrus said.
That attitude is not widely accepted in the United States, Andrus said, and the rest of the world is noticing.
“My friends overseas see American exceptionalism as selfishness,” he said.