Why the United States leads the world in COVID-19 deaths

Frederick S. Southwick

As a physician working in the field of quality and safety in patient care, I have asked myself the question: Why does the United States lead the global ranking of COVID-related cases and deaths- 19?

The question prompted me to recall the case of my ex-wife, Mary, who ended up in intensive care with less than a 10% chance of survival due to physician errors. These mistakes are similar to mistakes made by public officials in managing the pandemic.

I concluded that the United States has the highest rate of COVID-19 cases and deaths in the world because we have not consistently applied infection control practices. Implementation has varied from state to state as governors in some states, including Texas and Florida, have banned measures to control the spread of SARS-CoV-2.

They made cognitive mistakes, or mistakes in thinking, which resulted in damaging decisions. They did not apply the principles of metacognition, the process by which the brain analyzes information and makes decisions.

Decision errors are one of the leading causes of preventable death in our health systems. These errors can be classified into two broad categories: hasty judgments and biased judgments. In the first category, the most common mistake is anchoring – fixing on a diagnosis.


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My ex-wife Mary ended up in intensive care because of cognitive errors. She first felt pain in her right foot before her leg started to swell. A general internist rooted in the diagnosis of thrombophlebitis (inflammation due to blood clots), ignoring the signs of systemic vasculitis (inflammation of blood vessels).

In the case of COVID-19, at the start of the pandemic, several governors adopted the “Great Barrington Declaration” which promoted openness of society to normal activity, claiming that the societal damage resulting from the implementation of infection control practices were more important than the damage from deaths caused by COVID-19[FEMININE[FEMININE

Sweden has adopted this policy, encouraging natural herd immunity. As a result, as of mid-December 2020, the total number of deaths from COVID-19 was 787 per million, an incidence 4.5 to 10 times that of neighboring countries Finland, Norway and Denmark. , countries that had implemented infection controls. Subsequently, the Minister of Health was sacked and Sweden now follows the policies of its neighbors.

Despite the Swedish experience, the availability of highly effective SARS-CoV-2 vaccines, and the evidence that people who have achieved immunity can naturally be re-infected, many governors remain entrenched in the practice of natural herd immunity. and continue as usual. In addition to anchoring, they practice premature closure by not allowing these new conditions and facts to influence their decisions, just as the internist ignored Mary’s unusual rash, nerve damage and heart attack. subsequent.

A third element associated with hasty judgments is framing bias or observation from a single point of view. Mary’s internist viewed Mary’s case as a simple thrombophlebitis rather than a multisystem disease. Likewise, these governors repeatedly emphasize the single view that infection control practices are bad for business. The views of nurses, doctors and other healthcare professionals as well as COVID-19 patients and their families have been ignored.

To back up their entrenched decisions, politicians show bias in their judgments. Governors select the data, claiming the masks are harmful and citing a retracted study falsely claiming the masks were associated with carbon dioxide build-up, as well as false claims that vaccines are toxic and ineffective.

Just as Mary’s internist ignored my concerns because I was “too emotional,” many politicians exhibit a visceral bias, an unfounded dislike for a group that causes them to reject their contribution. They expressed a strong anti-intellectual bias that encouraged the public to ignore infectious disease and epidemiological experts.

Finally, and most worryingly, science policies have been politicized. The word “freedom” has been linked to government mandates regarding the use of vaccines, wearing masks and other infection control measures. If you are for “freedom” you oppose the imposition of infectious disease practices.

The problem: The SARS-COV-2 virus does not differentiate between Republicans and Democrats. Those who ignore infection control practices in the name of freedom are more likely to be infected, become seriously ill, and die.

This explains why the highest number of deaths from COVID-19 are found in the “freedom” states of West Virginia, Alabama, Idaho, Wyoming, Florida and Texas. Data collected by Becker’s Hospital Review shows that daily deaths in those states are 3.5 to 6.6 times higher than in California and New York, two states that follow infection control practices.

Daily deaths from COVID-19 averaged over seven days from October 7 to 14, according to Becker's Hospital Review based on data from the New York Times website.

As Mary’s illness worsened, I changed doctors. The new doctor diagnosed her with vasculitis and began treating her with corticosteroids, saving Mary’s life. To save the lives of our fellow Americans, isn’t it time to choose governors who understand metacognition and avoid potentially fatal cognitive errors?

Frederick S. Southwick, MD, is an infectious disease specialist in Gainesville.

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