Dying in a Leadership Vacuum

Editorial from The England Journal of Medicine

Covid-19 has created a crisis throughout the
world. This crisis has produced a test of leadership.
With no good options to combat a novel
pathogen, countries were forced to make hard
choices about how to respond. Here in the
United States, our leaders have failed that test.
They have taken a crisis and turned it into a

The magnitude of this failure is astonishing.
According to the Johns Hopkins Center for Systems
Science and Engineering,1 the United States
leads the world in Covid-19 cases and in deaths
due to the disease, far exceeding the numbers in
much larger countries, such as China. The death
rate in this country is more than double that of
Canada, exceeds that of Japan, a country with a
vulnerable and elderly population, by a factor of
almost 50, and even dwarfs the rates in lowermiddle-
income countries, such as Vietnam, by a
factor of almost 2000. Covid-19 is an overwhelming
challenge, and many factors contribute to its
severity. But the one we can control is how we
behave. And in the United States we have consistently
behaved poorly.

We know that we could have done better.
China, faced with the first outbreak, chose strict
quarantine and isolation after an initial delay.
These measures were severe but effective, essentially
eliminating transmission at the point where
the outbreak began and reducing the death rate
to a reported 3 per million, as compared with
more than 500 per million in the United States.
Countries that had far more exchange with China,
such as Singapore and South Korea, began intensive
testing early, along with aggressive contact
tracing and appropriate isolation, and have ….


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