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Donald J. Wheeler

Health Care

The Road to One Million

The United States is ranking first and last in all the wrong places

Published: Tuesday, October 6, 2020 - 11:03

On Sept. 29, 2020, the recorded worldwide death toll from Covid-19 reached 1 million. Six days earlier the United States reached 200,000 Covid-related deaths. So how did the United States with only 4 percent of the world’s population manage to capture 20 percent of the world’s deaths in this pandemic?

The 19 countries listed in figure 1 account for 85 percent of the Covid-related deaths worldwide, as reported by the European CDC. Here we can see how the U.S. death toll exceeds all others.

Figure 1: Number of Covid-related deaths reported by 19 countries as of Sept. 26, 2020

The short explanation for this dubious achievement is that between April 1 and the present, the United States had an average of 27 percent of the worldwide total number of confirmed cases of Covid-19. With that kind of market share, the high death toll was sure to follow. But a more detailed answer requires that we look at the number of deaths per capita and the rate at which these death tolls are growing.

Figures 2 and 3 show the per capita Covid-related deaths per million for each of the countries in figure 1 during the 30-week period from March 1 to September 26. These curves not only allow us to compare the levels of Covid-related deaths between countries, but also to see how these death tolls are changing over time. Figure 2 compares the United States with seven other first-world countries.

Figure 2: Per-capita Covid-related deaths since March 1 for eight countries

Since June, all but one of these curves have been basically flat. Yet the U.S. curve never really flattened out. It simply continued to climb throughout June, July, August, and September.

The table included in figure 2 shows both the per-capita death tolls as of September 26 (deaths per million population) and the amount by which these death tolls were growing each week (additional deaths per million per week).

For example, the U.S. per-capita death toll was 619 per million as of September 26, and this was growing by an additional 16.7 deaths per million each week. So by October 3 we would predict a per-capita death toll of about 636 per million for the United States. (The growth rates listed for each country are the average growth in the per-capita death toll based on the four-week period from August 30 to September 26.)

So how fast are the per-capita death tolls growing among these first-world countries? Germany had a growth rate of 0.5 additional deaths per million per week. Canada, Italy, the United Kingdom, and Belgium had growth rates between +1.0/week and +1.8/week. France had a growth rate of +4.0 deaths per million per week. And only Spain, with its recent resurgence of Covid, had a growth rate that approached that of the United States. Thus, among these first-world countries, the United States stands out as the one country that has not been able to “flatten the curve” of Covid-related deaths.

Figure 3 compares the United States with the 11 other countries from figure 1.

Figure 3: Per-capita Covid-related deaths since March 1 for 11 countries

Among these 12 countries, the U.S. per-capita death toll of 619 Covid-related deaths per million sits in fourth place, while the U.S. growth rate of 17 additional deaths per million per week is near the median value.

When we compare the United States with Iran, South Africa, Russia, India, and Indonesia, we find that the U.S. has more than twice the per-capita death toll and a higher growth rate. Thus, to date, the United States has done a poorer job of handling this pandemic than has Iran, South Africa, Russia, India, and Indonesia.

When we compare both the levels and the slopes in figure 3, we find that the U.S. is performing much more like Brazil, Chile, and Mexico than any of the first-world countries back in figure 2.

The bigger picture

The European CDC tracks the Covid cases and deaths for 208 countries and territories. When we rank these regions in terms of Covid-related deaths from those with the fewest deaths to those with the most deaths, the U.S. comes in at the bottom of the list in 208th place. (This is like turning figure 1 upside down.)

When we compute the per-capita Covid-related death tolls reported for these 208 countries and rank them from those with the fewest deaths per million to those with the most deaths per million, we find the U.S. near the bottom in 198th place. Only 10 countries have higher per-capita death tolls. In figure 2 we found three of these countries were Belgium, the United Kingdom, and Spain. In figure 3 we found that three more of these countries were Peru, Brazil, and Chile. The four remaining countries that are lower in the list because they have higher per-capita Covid death tolls than the United States are Ecuador, Bolivia, Andorra, and San Marino. Figure 4 summarizes these 11 countries that have the lowest rankings, and the highest per capita death tolls, in the world.

Figure 4:
Countries with highest per-capita Covid death tolls

It is interesting to note the dichotomy of growth amounts in figure 4. Five of the 10 countries have growth rates that exceed the U.S. value of 16.7 additional deaths per million each week, and five countries have lower growth rates. (The small countries of Andorra and San Marino have zero growth rates because they had no Covid-related deaths during the past four weeks.) This dichotomy suggests ranking the 208 countries from smallest to largest according to how rapidly the per-capita death tolls are increasing. In this ranking the U.S. is found in 191st place. Only 17 countries have per-capita death tolls that were growing faster than that of the U.S. These are the countries listed in figure 5.

Figure 5:
Countries where the per-capita Covid death tolls are growing the fastest

Here we see that the United States is doing a better job of restricting the growth of Covid-related deaths than Mexico, the Bahamas, and two Caribbean countries, three former Eastern Bloc countries, and 10 countries from Central and South America. Such is the company we keep.


Given the same warnings as the rest of the world, given the same access to medical and scientific knowledge, and given abundant resources to use in response, what has the United States accomplished?

Every country in the world has a smaller total number of confirmed cases of Covid-19 than does the United States. (rank 208 out of 208).

Every country in the world has far fewer Covid-related deaths than does the United States (rank 208 out of 208, figure 1).

Ninety-five percent of the countries in the world (197 out of 208) have a lower per-capita Covid death toll than the United States. (figure 4).

Ninety-one percent of the countries in the world (190 out of 208) have per-capita Covid death tolls that are growing more slowly than that of the United States (figure 5).

So, what can be said?  By turning a public health issue into a political issue, and by taking an all-or-nothing approach, the United States has found its way to the bottom.


About The Author

Donald J. Wheeler’s picture

Donald J. Wheeler

Dr. Donald J. Wheeler is a Fellow of both the American Statistical Association and the American Society for Quality, and is the recipient of the 2010 Deming Medal. As the author of 25 books and hundreds of articles, he is one of the leading authorities on statistical process control and applied data analysis. Find out more about Dr. Wheeler’s books at www.spcpress.com.

Dr. Wheeler welcomes your questions. You can contact him at djwheeler@spcpress.com