Why the US has the most reported coronavirus cases in the world

President Trump said Tuesday the fact that the United States has the most coronavirus cases in the world is a “badge of honor” because it shows how much testing the country is doing.

While there are many factors at play when comparing how countries have fared in the coronavirus pandemic, public health experts say Trump’s explanation left out a key factor: The U.S. has so many cases because it was initially slow to respond to the outbreak and ramp up testing and other containment tools.

Experts say the U.S. is not alone in being hit hard by the virus because of a slow response, and it’s not off-the-charts worse when comparing on a per-person basis. Rather, the U.S. is similar to Italy, Spain and the United Kingdom — countries that have also been dealt a heavy blow from the virus.

“We’re probably grouped in with other worse countries,” said Ron Waldman, a professor at George Washington University’s school of public health. “Certainly Italy got killed, Spain got killed, Belgium, the U.K.”

The U.S. now has more than 1.5 million coronavirus cases and over 92,000 deaths, according to a Johns Hopkins University tracker, far more than numbers reported anywhere else in the world, though there are doubts about the accuracy of China’s figures.

The U.S. of course has a larger population than most countries, with almost 330 million residents. But even on a per-person basis, it ranks near the top in both cases and deaths. It has the 11th most cases per person of any country and ranks 13th in deaths, according to data compiled by The New York Times.

And when it comes to testing on a per-person basis, the U.S. is far from the leader, despite recent improvements. Denmark, for example, conducts about twice as many tests per person as the U.S., according to figures compiled by Our World in Data, yet still has less than half the cases of the U.S. per person.

Ashish Jha, director of the Harvard Global Health Institute, said no “serious person” thinks the U.S. has the most cases in the world because of its testing.

“It’s just that we had such a massive outbreak and we had six weeks of complete blindness to the pandemic because we had little or no testing,” he said.

The weeks during which the Trump administration did not ramp up testing capabilities allowed the virus to spread undetected, Jha said.

“Six weeks is a long time to not be paying attention to the biggest pandemic in a century,” he added.

The countries that fared the best were the ones that quickly implemented widespread testing, contact tracing, isolation of infected people and quarantining of close contacts, experts said.

“The countries that have been most successful are the ones that instituted those four elements of a coherent strategy early,” Waldman said.

He noted it was “a little bit easier” for smaller countries like New Zealand and South Korea, which are two of the countries that responded best. But even then, “compared to other countries, we got a very late start, very late start.”

For example, Germany, a country with a population of about 83 million and a culture that’s broadly similar to the United States’s, is seen as doing fairly well in fighting the virus. It has 212 cases per 100,000 people, compared to 470 in the U.S., and 10 deaths per 100,000, compared to 28 in the U.S., according to New York Times data.

On an absolute basis, the U.S. has by far the highest number of reported cases in the world, though one important caveat is the widespread doubt about the accuracy of the numbers reported out of China, where the outbreak began.

“I don’t think China’s outbreak is bigger than America’s, but am I sure? No, I’m not sure,” Jha said.

Some major European countries like Italy and the U.K. also “dithered” in their response, much like the U.S., Jha said. “I would not say across the board Europe had a better response,” he said.

Another factor is the size and diversity of the United States, especially given the various approaches from 50 states. States like Washington and Ohio have received high marks for their responses and “would compare very favorably with some of the best parts of Europe,” Jha said.

But overall, the failure to initially ramp up testing, contact tracing and isolation of infected people and their contacts, as South Korea did, is what contributed to the surge in U.S. cases, experts say.

“We had the first case on the same day, identified on the same day, and we took incredibly divergent paths, and here we are,” said Gavin Yamey, associate director for policy at the Duke Global Health Institute.

“It has been so distressing to watch needless suffering and death,” he said.

While the U.S. is now making progress by increasing testing, the underlying problem is that the virus has spread so far across the country.

“It is a good thing that we’re doing some testing,” Waldman said. “It’s not a good thing that we’re finding so many cases.”