Benchmarking COVID-19 Mortality in the United States

  1. Ruth Etzioni
  2. Elan Markowitz
  3. Ivor S. Douglas

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Abstract

On September 22 nd the US officially recorded 200,000 COVID-19 deaths. It is unclear how many deaths might have been expected in the case of an early and effective response to the pandemic. We aim to provide a best-case estimate of COVID-19 deaths in the US by September 22 nd using the experience of Germany as a benchmark. Our methods accommodate the differences in demographics between Germany and the US. We match cumulative incidence of COVID-19 deaths by age group in Germany to non-Hispanic whites in the US and project the implied number of deaths in this population and among the black and Hispanic populations under observed racial/ethnic disparities in cumulative COVID-19 mortality in the US. We estimate that if the US had been as successful as Germany in managing the pandemic we would have expected 22% of the deaths actually recorded. The number of deaths would have been lower by a further one-third if we could have eliminated racial/ethnic disparites in COVID-19 outcomes. We conclude that almost 80 percent of the COVID-19 deaths in the US by September 22 nd could have been avoided with an early and effective response producing similar age-specific death rates among non-Hispanic whites as in Germany.

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  1. ScreenIT

    SciScore for 10.1101/2020.09.30.20204586: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Naturally, there are numerous caveats in interpretation of these findings. First and most important, the analysis uses age specific death rates from Germany to represent mortality expected in the US if the US could have responded in a manner that produced mortality patterns similar to those observed in Germany. While age and race/ethnicity are primary drivers of mortality risk, there are many relevant differences between the US and Germany not captured here. These include differences in population density and travel patterns as well as culture, that could impact compliance with mitigation measures. Also of interest due to its prognostic significance, is the frequency of obesity – just under one fourth of German adults are obese10, whereas among US adults, the fraction obese is around 40 percent11. These differences suggest that our results may reflect an optimistic version of what we would expect even if the US had acted similarly in terms of mitigation policies and resources. Given these caveats, our analysis could be considered a thought experiment designed to provide a first quantification of a best-case scenario in this country. A further key point concerns what is meant by a COVID-19 death. Whether a patient is determined to have died of the virus is not a simple yes-no decision12. The definition of a COVID-19 death is not the same across countries, and even in the US varies across states and (in some cases) changes over time13. If the definition could be standardized th...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  2. Version published to 10.1101/2020.09.30.20204586v1 on medRxiv