It’s official. The US has provided the least effective response to the COVID-19 pandemic of any country in the world. That scathing indictment is buried in the back of a preprint of an article by Mexican researchers focused on the role of temperature in limiting the spread of disease, which barely mentions the bombshell in Figure 5. (Note: I contacted the lead author, who indicated he is preparing a second paper on just this issue.) Let me unpack it.

The authors, in a study designed how climate affected the epidemic, compared how rapidly the disease was doubling during the early stages of the epidemic in countries around the world. In each country, they looked at the first thirty days of the epidemic. The authors compared doubling times during the first ten days, the second ten days, and the third ten days (Td10, Td20, and Td30) of the epidemic. The start point for each country was the day that country saw its 100th case.

Assuming you don’t perceive you have an epidemic and don’t take major action before you have 100 cases, any intervention is irrelevant in determining Td10, because you are looking at infections resulting from exposure before you could intervene. It is determined primarily by the nature of the virus and the population density. As a result Td10 was similar among countries with similar climates. Td10 was shorter in temperate zone countries than for tropical and subtropical countries, a core thesis of the paper.

Among temperate zone countries, the Td10 did not differ dramatically, usually around two to three days. Twenty days into the pandemic, a country’s control strategy should be taking effect, which would appear as Td20 being greater than Td10. The graph shows this to be true for every temperate zone country in the world with one notable exception. The United States.

The United States had an initial doubling time similar to other countries. But Td20 in the United States was worse (shorter) than any other temperate zone country. The only other country in the world where Td20 was shorter than Td10 was the United Arab Emirates, and their Td20 was 4 days at that point as compared to 2 days in the US. It took the US 30 days to get their Td up to 4 days, but our Td30 was worse than any other country in the world. Korea, Japan, and Austria had the three highest values for Td30 at 16, 15, and 14 days respectively.

Some of that is undoubtedly the result of the woefully inadequate testing in the US. Improvements in testing rates might have meant we were catching more of the cases as time went on. This could explain the drop between day 10 and day 20, but it is a defense based on dysfunction. The fact that public health officials had no good way to gauge the severity and course of the outbreak plays a key role in the fact that, 30 days into the pandemic, the disease was doubling faster in the United States than anywhere else in the world.

The tragic irony is that the US CDC literally wrote the book on how to respond to a disease outbreak and set the standard for the rest of the world. Until now. Our current President claims the right to throw away every book and this is no exception. His administration has demonstrated no regard for the collective wisdom provided in that manual. Nowhere is this more clear in his communication strategy. Recognizing its importance, the book devotes an entire chapter to that challenge. At one point they discuss the choice of the messenger.

Risk communication literature identifies four factors that determine whether an audience, including journalists, will perceive a messenger as trusted and credible, including

  • Empathy and caring,
  • Honesty and openness,
  • Dedication and commitment, and
  • Competence and expertise

Donald Trump has yet to make a statement of empathy about the victims of the pandemic, has a well-deserved reputation for secrecy and a disregard for the truth, ignores social distancing and refuses to wear a mask, and has repeatedly demonstrated a stunning lack of understanding of basic medical science (Clorox quarantini anyone?). The book cautions against the politicization of communications yet he is alone among major world leaders in referring to the pandemic in political or partisan Tweets. In other words, everyone has followed the playbook of the CDC of the United States except the United States.

Many of us have long suspected that Trump’s profound failure as a leader in the face of the pandemic has had disastrous consequences. Now we have numerical proof.

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