COVID-19 will kill 500,000 Americans. Here’s why.

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Among the questions I’m asked most often as host of the podcast Coronavirus: The Truth are: “How have other nations effectively contained the pandemic?” and “Why can’t the United States copy their success?”

For months, health experts have answered these questions by pointing to a combination of science and strategy. Other nations, they say, test more frequently, impose tighter social restrictions and boast stronger national leadership. Indeed, the American response has fallen short in each of these areas.

But neither science nor strategy, alone, explains why the United States accounts for more than 20% of the world’s COVID-19 deaths while making up just 4% of the world’s population. The problem isn’t that Americans lack the scientific knowledge or strategic ability to match global best practices. Rather, the problem can best be summarized with a phrase originated by management guru Peter Drucker: “Culture eats strategy for breakfast.”

To understand how other nations have effectively contained (or radically slowed) the coronavirus, it’s necessary to recognize the influence culture has over our thoughts, attitudes, and behaviors.

When we contrast American culture with that of other nations, we can confidently predict that the United States will never tolerate the kinds of national strategies that have worked elsewhere. And as a result, our country will lose 500,000 total lives before this pandemic ends. Here are two examples of those cultural differences:

South Korea’s collectivist culture helped slow the spread 

In February, both South Korea and the United States faced similar COVID-19 challenges. Cases were surging, little was known about the virus, and public health officials were in a panic. Both nations had confirmed their first COVID-19 cases around the same time, around January 20, but the two nations responded very differently thereafter.

Testing played an important role in South Korea’s effective response. By early March, the United States had conducted just 2,000 tests, whereas South Korea completed more than 140,000.

But testing, by itself, is a fairly weak containment measure. Thus, it South Korea’s next step that truly kept the virus in check. Unlike in the United States, South Korea adopted a rigorous national contact-tracing program that linked large databases of cell phone information, credit card transactions, and closed-circuit TV with a so-called Immediate Response Team (IRT), which was called in to stamp out potential flareups and super-spreader threats.

South Koreans sacrificed their personal privacy and allowed the government unfettered access to their personal data, which enabled health officials to identify and isolate all potentially infected individuals. Although 50 countries worldwide have since adopted some form of digital contact tracing to help prevent the spread of the disease, Americans view such tactics as unacceptably Orwellian. In a study of 2,000 Americans, 71% said that they would not download a contact-tracing app because of privacy concerns.

Therein lies a critical difference: Though many factors distinguish South Korea’s successful response from the ineffective and scatter-shot approaches taken in the United States, none has influenced overall mortality more than culture.

Throughout South Korea, cultural values include obedience to family, acceptance of authority, and acting on the good of the nation. These collectivist orientations enable the kinds of tradeoffs necessary to contain the virus: People forfeit their desire for privacy in return for a fast, effective, and comprehensive pandemic response. Though it would be inaccurate to attribute South Korea’s success solely to cultural differences or societal homogeneity, there’s no denying that people’s willingness to put the public interest above individual rights aided mightily in its battle against COVID-19.

By contrast, the idea of ceding electronic privacy to public agencies simply won’t fly in the United States. As a result, South Korea has reported fewer than 500 deaths in a nation of 50 million compared to 210,000 dead among 300 million Americans.

New Zealand’s faith in government shaped its success

New Zealand is about the size of Colorado with a similar population (between 5 and 6 million). In part because of its small footprint and geographic isolation, the Pacific Island nation has experienced only 25 total deaths from COVID-19.

There are, in general terms, sweeping cultural similarities between New Zealand and the United States. Cultural atlases describe the people of New Zealand in much the same way they describe Americans: affable, social, and individualistic. However, there’s one important cultural nuance that helps explain New Zealand’s incredibly low death rate. Its people boast a high level of public cooperation and compliance with the government, and they are more willing to relinquish individual freedom for the common good.

According to one poll, 88% of New Zealanders trust their government to make the right decisions about COVID-19 compared to just 59% of citizens from G7 countries (Canada, France, Germany, Great Britain, Italy, Japan, and the United States).

This consistent outpouring of public trust gave New Zealand’s Prime Minister Jacinda Ardern significant leeway and latitude when enforcing a stringent national containment response. The strategy, called “go hard, go early,” traded weeks of lockdowns for the promise of swift and a near-universal reopening. It is very hard to imagine a government-mandated, six-week lockdown taking place in a state like New Hampshire, where the emblem reads “Live Free or Die.”

Ultimately, without a citizenry willing to compromise personal privacy or sacrifice individual freedom, it is impossible to control this virus. New Zealand and South Korea have such cultures. The United States does not.

Culture: Why the U.S. will experience 500,000 COVID-19 deaths 

Science and strategy are vital to effective coronavirus containment. However, science and strategy are not the biggest barriers to progress in the United States.

After all, Americans are not inherently anti-science. Polling suggests most people in this country respect science and see it as a positive force in society. And the United States also has no shortage of strategic thinkers in healthcare or public policy, either.

The reality is that we know what to do. We just won’t do it. Americans lack the cultural commitment to doing what is necessary to slow the spread of this particular virus. If this were an outbreak of Ebola, a virus that kills 50% of all people it infects, the risks of the disease would overpower any stubborn cultural norm or value that might stand in the way of keeping Americans safe. But with a mortality rate closer to 0.5%, COVID-19 doesn’t pose the level of threat necessary to keep Americans masked, socially distant, or indoors as scientists recommend.

Likewise, if it were easy to detect infected people, we could eliminate the virus through approaches that Americans could easily accept (temperature screenings, symptom checklists, etc.). But with as many as 80% of COVID-19 infections mild or asymptomatic, people are capable of spreading the disease before they experience a sore throat, fever, or other telltale signs of infection.

Alas, with its “acceptable” death rate and surprisingly high rate of asymptomatic transmission, COVID-19 presents an unsolvable problem in a nation known for the words “give me liberty or give me death.” Phrased differently, the same freedom-loving individualist values that we Americans cherish—the ones that gave us rock-and-roll, the Civil Rights movement, and Silicon Valley’s startup culture—are the same national virtues that will make it impossible for us to control this insidious virus. Americans simply would not tolerate the same concessions as people in South Korea and New Zealand.

A powerful example of the influence of culture on the U.S. pandemic response is taking place in Iowa, a bellwether state in the upcoming presidential election. There, surveys show only 28% of residents wear a mask when they go out. According to a recent KHN report, Iowa health officials joined forces with Iowa University back in April to model the impact of the outbreak. They found that more than a thousand Iowans could be saved by adopting a universal mask policy. Researchers presented this the data and their recommendations to Republican Gov. Kim Reynolds, who concluded that a statewide mask mandate would be “not enforceable.”

As a cultural principle, the governor understood that Iowans, like tens of millions of Americans, will refuse even modest infringements on their civil liberties or personal privacy, except under the direst of circumstances.

Given our national culture, the United States will continue to experience consistently high rates of cases and deaths until a safe and effective vaccine is broadly administered. And that time is a long way off. In a recent interview, the CEO of Moderna, a leading vaccine developer, told the Financial Times he doesn’t expect to have approval until the Spring of 2021. Meanwhile, CDC Director Robert Redfield told the Senate Appropriations Committee it would take six to nine months to get the American public vaccinated once a vaccine is approved. That takes us into the fourth quarter of 2021 at the earliest. And, according to leading immunologist Dr. Anthony Fauci, the chances of a first-round coronavirus vaccine being highly effective are “not great,” which means nationwide viral control won’t happen until even later.

By that time (late 2021 or early 2022), the math indicates the U.S. death toll will reach half a million. Assuming the current count of 720 deaths a day in October holds steady and projected timelines for a vaccine prove correct, then anywhere from 260,000 to 320,000 more people will die over the next 12 to 15 months, bringing the total death count to half a million.

Of course, I hope I’m wrong. And I’d be remiss not to recognize that almost anything can occur, including a miraculous medical discovery or a helpful viral mutation. But hoping for a “Hail Mary” solution isn’t a viable strategy. The one thing we can say with full confidence is that there won’t be any meaningful changes in American culture over the next year and a half. And as a result, the death toll from the current coronavirus will rise far longer and to far higher than most Americans recognize or are willing to acknowledge.

Robert Pearl is a plastic surgeon and author of Mistreated: Why We Think We’re Getting Good Health Care–And Why We’re Usually Wrong. He can be reached on Twitter @RobertPearlMD.

Image credit: Shutterstock.com

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