Why the death rate from COVID-19 is higher in the United States than in Canada

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The nation next door was a hot topic for Canadians during the coronavirus pandemic, with gossip frequently involving a certain politician who lives in a white Washington mansion.

The United States has a COVID-19 mortality rate about twice as high as that of Canada, with more than 200 death per million versus 100 per million in Canada.

CBC News consulted five infectious disease experts, academic studies and data collected by governments and companies to try to understand why.

The overwhelming opinion points to three main contributors: long-standing health care issues, politics and one city in particular.

While all experts have agreed that the U.S. government has rejected its swift response to the pandemic, most have said that the administration of U.S. President Donald Trump is only part of the larger story.

The gap between deaths in the United States and Canada is not a methodological quirk due to different reporting methods, experts said.

The United States had 1.2 million confirmed cases of COVID-19, the disease caused by the new coronavirus, and more than 71,000 deaths Tuesday evening, and Canada had more than 63,000 cases and nearly 4,300 deaths.

Mortality rates are more reliable measure than cases

Mortality rates are considered to more accurately reflect the spread rate than case totals, which are based on inconsistent testing standards from one jurisdiction to another.

“I think per capita deaths are a proxy for the extent of disease activity,” said Ashleigh Tuite, an epidemiologist at the University of Toronto.

It is important to see the disparity between the United States and Canada in a global context, she said: death rates in the United States are still far below those of Spain, Italy and Belgium.

Healthcare workers in a mobile COVID-19 test clinic in the Saint-Michel neighborhood of Montreal. Since testing is not uniform across jurisdictions, some experts consider death rates to be a more reliable measure of the spread of coronavirus than the number of confirmed cases. (Graham Hughes / The Canadian Press)

The difference in mortality rates between the United States and Canada may continue to change as the pandemic progresses. In fact, it shrinks regularly, according to data released daily by the European Center for Disease Prevention and Control,

In March, Americans died of COVID-19 at a rate per capita 3.6 times higher than that of Canadians. In the first half of April, it was 3.1 times. It was 1.7 times in the last half of April. In early May, death rates were similar.

In the United States, cases have already had a direct effect on Canadians. In Ontario, for example, the United States was from afar the largest source of early imported cases.

The gap in results widened in March when the virus hit New York.

New York, New York

The United States regretted that its busiest city was hit early.

“The preparedness of this initial city or geographic region will influence your death rate,” said Amesh Adalja, a pandemic preparedness fellow at Johns Hopkins University and of Baltimore Medicine.

The cities subsequently affected have benefited not only from overcrowding, but also from having more time to prepare, he said.

A study has identified the New York subway system as a major transmission vector. Outside of New York, death rates in Canada and the United States are much closer. (Brendan Mcdermid / Reuters)

Without the big apple, the gap between Canada and the United States looks very different. Almost half of the difference disappears. Go beyond the New York suburbs and Canada-United States death rates are even closer.

In fact, the death rate from COVID-19 is almost identical between Canada and the 47 American states that do not include a New York suburb, according to the data at the level of states and counties compiled by the site Worldometer.

Such comparisons are statistically hazardous, however, because the exclusion of a subnational region distorts the demography and urban-rural mix of a country.

Outside of New York and the sprawling suburbs of New Jersey and Connecticut, death rates in Canada and the United States are much closer. (CBC News)

What is undeniable is that New York was invaded by COVID-19, and one of its defining attributes – bulk – played a role.

New York has no rival in Canada in terms of population density, which epidemiologists identify as a contributing risk. He has twice the density from Vancouver, Canada’s most populous city.

Every day of the week, 5.4 million people cram into the New York subway system, push its metal turnstiles and fill up its cars, with a rail clientele more than six times that of the Toronto metro and streetcar.

In early March, before many understood the gravity of the crisis and before workplaces were emptied, infections spread throughout the city, with the public transportation system probably being a vector of transmission.

MIT researcher Jeffrey Harris described it in the title of a work document, not yet peer reviewed: “Subways have sown the massive coronavirus epidemic in New York. “

New York City was “a fire that could be easily started,” said John Brownstein, a Canadian-born epidemiologist at Harvard University.

Access to health and pre-existing conditions

It’s no secret that the underlying health conditions appear to make COVID-19 more lethal.

A report freshly published According to the U.S. Centers for Disease Control, almost three-quarters of people hospitalized in Georgia suffered from preexisting conditions that may worsen COVID-19.

Hypertension was the most common pre-existing health problem among the people in the Georgia study: about 67.5% had high blood pressure. Severe obesity was also on the list.

The United States has by far the highest obesity rate in the developed world and slightly higher hypertension rate than Canada.

The Georgia study found a large racial disparity: 83% of the coronavirus patients in the hospitals studied were African American.

CDC study is latest indication of black American blows Stronger than other population groups by COVID-19. (Comparable data for Canada is not yet available.)

WATCH | African Americans in Georgia have been severely affected by the coronavirus:

The black population of Georgia has been the hardest hit by the COVID-19 epidemic and highlights health care and economic inequality in the state. 1:59

This suggests some gaps in the American health care system that preceded the pandemic. There is a persistent gap in access to care, for example, with visible minorities more likely lack medical care Insurance.

Almost 10% of the American public lack of self-confidence before the pandemic, and that number is likely to increase as people lose jobs and employer-provided plans.

The US government has promised to cover test and treatment costs for uninsured people.

A US postal worker delivers mail from the New Jersey unemployment insurance office. With more unemployed as a result of the pandemic, more people will lose their employment insurance system. (Eduardo Munoz / Reuters)

But anecdotes and analysis warn people facing unexpected costs. In particular, minority groups and the uninsured must travel further for testing, according to a document Brownstein is co-author.

Minority groups, rural residents, homeless and people with mental health and addiction issues are less likely to receive care, says Stanford University infectious disease specialist Krutika Kuppalli .

“We see a high number in cities [and] areas where there are historically vulnerable populations, “said Kuppalli.

“These types of patients are very difficult to follow in healthcare and are the most vulnerable. “

Politics has an impact

Some American studies suggest that politics may have played a role in the practice of physical removal.

It’s consistent with many American public opinion polls showing a partisan gap in attitudes towards the pandemic, the Republicans being less worried than the Democrats.

Residents of countries that voted mainly for Trump in the 2016 election were less likely to perceive the risk, seek information or exercise a physical distance, according to a document published last month by university researchers from Chicago and Texas.

As the pandemic progressed, some governors, such as New York Governor Andrew Cuomo, on the right, established their own agenda for dealing with it and clashed with Trump over supplies and timeliness of the federal response. (Alex Brandon, John Minchillo / The Associated Press)

“Even when, objectively speaking, death is at stake, bias still colors beliefs about the facts,” the study authors wrote. They say their article, which is not yet peer reviewed, explains the differences in population density.

Another paper said Americans’ precautions against the virus may have been influenced by what they heard in political talk shows.

Viewers of Fox News hosted by Sean Hannity (who originally mocked the pandemic) were less likely to isolate than viewers of another Fox show hosted by Tucker Carlson (who took the threat seriously), according to the document from researchers at the University of Chicago.

Data tracking collected by Google of smartphones suggests that Canadians practiced more physical distance than Americans and started to do it earlier.

Google reports for Saskatchewan and Alberta show that people in these provinces are more distant than people in the other Montana and North Dakota.

Google data shows that Canadians have done a physical distance earlier and more widely. American research indicates that political attitudes have played a role in distancing decisions. (CBC News)

Clear public communication is essential in a pandemic, said Saverio Strange, Chair of Epidemiology and Biostatistics at the Western University of London.

Canadian politicians, although not perfect, have tried to convey consistent messages at the federal and provincial levels, guided by public health experts, he said.

In the U.S., Trump has repeatedly clashed with state governors at various stages of the crisis – criticizing their performance, discouraging some from reopening too slowly, and at one point also accusing a Republican ally of Georgia of reopening too fast.

Several governors expressed frustration with the mix of messages and the lack of a coordinated response and developed their own plans for get protective gear and curb the virus.

Canadian Health Minister Patty Hajdu and Prime Minister Justin Trudeau watch Surgeon General Theresa Tam answer a question at a press conference. Canadian politicians have delivered more consistent messages at the federal and provincial levels, said Saverio Stranges, president of epidemiology and biostatistics at the Western University of London. (Adrian Wyld / The Canadian Press)

Trump was faster in some aspects of his response than the Canadian government. He restricted travel much earlier and encouraged the use of masks earlier.

However, Trump’s message has ebbed and spread to fundamental details such as the severity of the crisis.

In February, a month after restricting travel from China, Trump was still insist the United States would have zero cases soon.

During this same period, Canada’s Minister of Health urged Canadians to store food.

The White House is still blowing hot and cold on the threat level ahead, releasing a careful plan for reopening, then encouraging protests in several states calling for an immediate reopening of the economy.

US initial response to pandemic hampered by test debacle at first but the country is now catch up in Canada in per capita screening rates.

It has completed 23,208 tests per million population, compared to 24,359 per million in Canada.

“The federal response to the United States is certainly responsible for our position,” said Adalja. “You had mismanagement from the start and minimized the threat. “



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