Donald Trump recently “heard that we have one of the lowest, maybe the lowest, mortality rate anywhere in the world” from COVID-19. He certainly never heard this from anyone knowledgeable of the facts. As of Tuesday, with 4.5% of the world’s population, the U.S. had about 22% of the deaths from COVID-19.

There are two relevant rates that assess the mortality effects of a disease. The mortality rate is the number of deaths divided by the total population; the case-fatality rate is the number of deaths divided by the number of persons who have the disease (cases). For COVID-19, anyone with a positive test is considered a case.

For neither of these rates does the United States have “one of the lowest” in the world. In fact, the U.S. COVID-19 mortality rate is the 10th-highest in the world. As of early August, our rate was about 47 per 100,000 persons. This compares, for example, with rates of about 26 per 100,000 for Canada and 11 per 100,000 for Germany. In these countries, political leaders responsibly listened to scientists and public health experts in formulating policy. If persons in the U.S. had died of COVID-19 at the same rate as persons in Canada died, approximately 70,000 Americans would not have died. If Americans had died at the same rate as Germans, about 120,000 fewer Americans would have died.

The U.S. case-fatality rate of 3.3% compares favorably with many countries but is certainly not “one of the lowest.” According to the Johns Hopkins Coronavirus Resource Center, dozens of countries have lower case-fatality rates, including South Korea, New Zealand, Norway and the Czech Republic.

During an epidemic, the case-fatality is often unreliable, and comparisons between countries can be misleading. Accurate determination of the number of cases is problematic, particularly when asymptomatic or minimally symptomatic cases are common and diagnostic testing is variably available. If, as Trump claims, testing has been more widespread in the U.S. than in other countries, this would lower our case-fatality rate relative to other countries because more asymptomatic cases would be identified. Also, the case-fatality rate is affected by the age distribution within a population. Most Western First World countries have a higher proportion of elderly persons than the U.S., which increases COVID-19 case-fatality.

When reminded that more than a thousand Americans are dying of coronavirus each day, Trump responded, “It is what it is.”

It most certainly is: It is tragic that Americans are suffering more from this pandemic than citizens in many other countries.

Robert Blake, M.D., is emeritus professor of Family and Community Medicine at MU.


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