The US has experienced more deaths from coronavirus disease 2019 (COVID-19) than any other country and has one of the highest cumulative per capita death rates.1,2 An unanswered question is to what extent high US mortality was driven by the early surge of cases prior to improvements in prevention and patient management vs a poor longer-term response.3 We compared US COVID-19 deaths and excess all-cause mortality in 2020 (vs 2015-2019) to that of 18 countries with diverse COVID-19 responses.
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Compared with other countries, the US experienced high COVID-19–associated mortality and excess all-cause mortality into September 2020. After the first peak in early spring, US death rates from COVID-19 and from all causes remained higher than even countries with high COVID-19 mortality. This may have been a result of several factors, including weak public health infrastructure and a decentralized, inconsistent US response to the pandemic.4,5
Limitations of this analysis include differences in mortality risk: the US population is younger but has more comorbidities compared with the other countries.6 In addition, since late August death rates have increased in several countries, and how mortality will compare with the US throughout fall remains unknown.
According to data from Johns Hopkins, the US compares poorly with other democracies that have federal systems. Deaths per 100,000 population:
- United States ..... 66.29
- Canada.................26.23
- Germany..............11.72
- Australia..............03.62
