Americans’ poor health paved the way for COVID-19 deaths

By Andrew G. Biggs of AEI.

"Social media was briefly taken over by data purportedly showing that only 6% of Covid deaths were from the virus alone, leading some to conclude that Covid’s true death toll was only a small fraction of the reported 169,000 death. These claims were false. But they provide new perspective on how America’s ill health paved the way for the death of thousands of our citizens.

The Center for Disease Control’s September 2 release of Covid death data generated an internet firestorm: according to the CDC, “For 6% of the deaths, COVID-19 was the only cause mentioned.” Ninety-four percent of Covid deaths had so-called comorbidities such as diabetes, heart disease and obesity. This led to internet claims that the true Covid death toll is just 10,000 Americans, undercutting our nationwide economic, social and educational lockdown.

In fact, doctors regularly report multiple causes of death, including factors – such as respiratory failure – that a Covid infection might itself have caused. Moreover, the number of “excess deaths” in 2020 – that is, the additional deaths this year relative to what might be expected from prior years’ experience – is similar to the 169,000 deaths for which Covid was listed as a factor.

However, the CDC data do make an important point: that Americans’ poor state of health, mostly related to our own lifestyles, made the U.S. dramatically more vulnerable to Covid.

To date, the United States has suffered 56 Covid-related deaths per one million Americans, a death rate more than twice that of Canada and five times that of Germany, leading to claims that the federal or state governments have mismanaged the Covid response. That may be true.

But U.S. policymakers also suffered under the handicap that Americans entered the Covid pandemic in much poorer health than citizens of other developed countries. For instance, over 27,000 U.S Covid deaths list diabetes as a comorbidity, accounting for 16% of total Covid-related fatalities. But what if instead of having the highest diabetes rate among rich countries the U.S. had the same rate as Australia, with less than half the U.S. level? The same holds for obesity, listed as a comorbidity in 4% of Covid cases. Forty percent of Americans are obese, the highest in the developed world and over twice the OECD average. U.S. death rates from heart disease are also higher than most European and Asian countries. Hypertension is listed as a comorbidity in 22% of Covid deaths. If Americans simply had the same health status as other high-income countries, it is likely that tens of thousands of lives could have been saved.

Most Covid-related comorbidities are lifestyle-related. General practitioners tell me that their Type 2 diabetes patients can tell you their weight and know how it relates to their illness. They know that by losing weight their can reduce their risk of blindness, limb amputations or death. They simply aren’t able to do it.

Obviously, many other issues affect Covid death rates, from preexisting factors such as population density and mobility to policy responses including testing and quarantining. But had our country been in better health when Covid hit, our death toll almost surely would have been smaller. Americans should know that, under threat from Covid, poor personal health could leave their children orphans.

Some argue for sugar taxes, but the problem goes beyond sugar alone. Americans consume about 25 percent more calories per day than Dutch citizens, for instance, while exercising less. These are difficult issues to address using the typical policy levers.

Instead, public officials could exercise the bully pulpit, just as they did with cigarette smoking. Public statements, advertising and educational campaigns slowly helped shift our culture away from smoking, such that less than 15% of Americans smoke today, versus 42% in the 1960s.

We can’t do much today to reduce the comorbidities that made us so susceptible to Covid-19. But by strongly encouraging healthier lifestyles we can better prepare for the next pandemic, while improving Americans’ quality of life and cutting our sky-high healthcare costs."