Trump downplays COVID-19’s mortality rate in US

President Trump has repeatedly claimed that the U.S. has one of the lowest COVID-19 mortality rates anywhere in the world, even though the nation has recorded more deaths from the coronavirus than any other country.

The U.S. also has a mortality rate per 100,000 about twice that of Canada. While the U.S. rate is lower than Spain, the United Kingdom and Italy per 100,000 people, it is higher than such nations as Germany, France and the Netherlands.

But Trump is not focused on those numbers.

Rather than the mortality rate, Trump has been fixated on the percentage of people who die after contracting COVID-19, a figure called the case fatality rate. 

In doing so, he has downplayed the scope of the coronavirus outbreak in the U.S. and the extremely high rate of deaths as a proportion of the population.

By not specifying the figures he is using, Trump has also likely confused many people about how the U.S. stacks up with other countries.

“No. 1 low mortality rate,” Trump said during a Fox News interview with Chris Wallace last month. “You said we had the worst mortality rate in the world, and we have the best.”

In an interview on “Axios on HBO” broadcast Monday, Trump was challenged by journalist Jonathan Swan when he said “the United States is lowest in numerous categories, we’re lower than the world, we’re lower than Europe.”

When Swan asked Trump to clarify, Trump handed Swan a chart, revealing that he was referencing the case fatality rate. Pressed on the distinction, Trump maintained that the data should “go by the cases,” not by the population. 

Trump repeated that assertion from the podium of the White House briefing room on Tuesday

“I think, actually, the numbers are lower than others,” Trump said. “We, proportionately, are lower than almost all countries. We’re at the bottom of the list.”

According to Johns Hopkins University, the U.S. does have a relatively low case fatality rate of 3.3 percent, compared to countries like Canada (7.5 percent), the United Kingdom (15.1 percent), Italy (14.1 percent) and France (13.3 percent).

Among the 20 countries most affected by COVID-19 in the world, according to data compiled by Hopkins, the U.S. is 13th in terms of deaths per confirmed COVID-19 case.

The United States’ case fatality rate is still higher than Chile, India, Argentina, Russia, South Africa, Kazakhstan and Bangladesh. 

Case fatality can be influenced by factors including the demographics of people who get infected, the ability of hospitals to treat COVID-19 patients and whether testing finds more mild cases. 

“Case fatality is the chance of dying after you get a positive test. It reflects the amount of testing and access to effective medical care, not the speed at which Americans are dying of COVID,” said Josh Sharfstein, a vice dean at the Johns Hopkins Bloomberg School of Public Health.

Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security, said case fatality is not a bad statistic by itself, but it can’t be compared to the actual number of deaths per capita.

“Case fatality rate is important and the fact that it is lower in some countries is really reflective of the sophistication of the medical system, adeptness of critical care physicians and what segment of the population is getting infected,” Adalja said. 

The U.S. is averaging 65,000 new infections a day, and more than 1,000 people a day are dying from COVID-19.

In total, nearly 160,000 Americans have died of a COVID-19 infection, and focusing only on case fatality essentially ignores that number. 

That’s where the mortality rate, or deaths per capita, comes in. 

“Deaths per capita is a statistic that shows you a national snapshot about how widespread the severe cases are, how well are vulnerable populations being protected and how contained spread is,” Adalja said.

Minority populations, especially communities of color and Native groups, have been disproportionately hardest hit by the coronavirus in the United States. Lawmakers, advocates and public health experts have been pushing the Trump administration to take action and prioritize minority communities in its coronavirus response. To date, they say the administration has failed to help.

Minorities also make up a large share of the population of essential workers, magnifying the risk they already face from racial disparities in outcomes and access to health care. 

According to the Centers for Disease Control and Prevention, the mortality rate measures the frequency of occurrence of death in a defined population — in this case, deaths per 100,000 people, which includes both confirmed cases and healthy people.

Among the 20 countries most affected by COVID-19 in the world right now, the U.S. has the fourth-highest number of COVID-19 deaths per 100,000 people, ranking behind only the United Kingdom, Peru and Chile.

Globally, according to Johns Hopkins data, the U.S. is 10th, ahead of some of Europe’s hardest-hit countries like Spain, Italy and Sweden that have since taken control and substantially slowed the virus’s spread. 

But that list also includes the countries of Belgium and Andorra, which have such proportionally large numbers of deaths because of their small populations. 

A White House official said the U.S. mortality rate is similar to that in other industrialized countries.

Trump “has highlighted the U.S. is among the lowest when it comes to mortality rates of similarly industrialized countries,” the official said. “We also have one of the lowest case fatality rates — below the average of the world and below Europe — and that shows that our therapeutics like Remdesivir, convalescent plasma, and Dexamethasone are working.”

But during an interview with CNN’s Sanjay Gupta on Wednesday, Anthony Fauci, the nation’s top infectious diseases expert, agreed that the U.S. death rate was one of the highest in the world. He also suggested the U.S. is not doing as well as other countries in handling the disease.

“It is worth reminding people we’re not quite 5 percent of the world’s population, yet represent 20 to 25 percent of the world’s deaths … that has to be the worst, is it not the worst?” Gupta asked.

“I mean, it is. Quantitatively if you look at it, it is. I mean the numbers don’t lie,” Fauci said.