Yet US policymakers had at least four advantages over their European counterparts in countries such as Italy and Spain that should have led to lower excess mortality rates than in Europe:
First, there was more time to prepare. Genomic evidence suggests that Europe was the source of most infections that became evident in New York in early March. The US administration had three weeks’ more warning given the lag between initial rises in excess mortality in Italy and Spain versus the US Northeast. For the South, West and Midwest (accounting for 83% of the US population), the delayed spread of the virus should have provided an even greater advantage.
Second, the US has a younger population4 and COVID-19 mortality is significantly correlated with age.
Third, the US has a lower population density than Europe as a whole and for large conurbations within, and viral spread is greater in more dense populations.5
Fourth, the later onset should have enabled US authorities to take advantage of rapidly improving medical knowledge and capacity (the nature of the disease, treatment regimes, testing capacity, and the effectiveness of policies such as social distancing and masks).