By Benjamin Mueller and Eleanor Lutz
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.
Cumulative U.S. Covid-19 deaths per capita are highest among other large, high-income countries
Several countries had higher per capita Covid-19 deaths earlier in the pandemic, but the U.S. death toll now exceeds that of peer nations.
New York Times database of reports from state and local health agencies (U.S. deaths); The Center for Systems Science and Engineering at Johns Hopkins University (world deaths); World Bank (world populations); United States Census Bureau (U.S. population) Note: Countries shown are those with the highest gross national income per capita among countries with a population of more than 10 million people.
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.
U.S. vaccinations lag behind other large, high-income countries
Despite beginning Covid-19 vaccinations months earlier than countries like Japan and Australia, a smaller share of people in the United States are now fully vaccinated.
Our World in Data (world vaccinations); Centers for Disease Control and Prevention (U.S. vaccinations) Note: Vaccination and booster data in some countries are available infrequently. Sweden data for booster doses is available only from Jan. 20, 2022.
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.
Risk Factors for Severe Covid-19
The population of these 10 high-income countries differ in many demographic factors that are associated with an increased likelihood of severe Covid-19 illness or death.
C.D.C (risk factors and U.S. vaccinations); World Health Organization via Our World in Data (obesity data); United Nations (age distribution data); Our World in Data (world vaccinations) Note: Age distribution data is the estimated population for 2020; data is as of 2019. Obesity data is the age-standardized estimate of obesity prevalence among adults; data is as of 2016.
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.”