In early March, doctors in Italy’s Lombardy region broadcast dire warnings to the rest of the world. Their hospitals were nearing capacity. They faced heart-rending decisions about which patients to save and which to let suffer. A few weeks later, similar nightmarish scenes began to play out in New York City. The pandemic had arrived in the States.
Europe and the United States have fought remarkably comparable battles against COVID-19. Throughout the spring, European outbreaks, case counts, and deaths forecast almost exactly what would follow two weeks later across the Atlantic. In late April, 12 days apart, the European Union and United States recorded their respective deadliest days.
But now, three months after the death tolls reached their devastating peaks, the two unions are charting increasingly divergent paths. Europe is recovering, swiftly and definitively, while the United States stalls and splinters.
Disease experts said the United States’ departure from Europe includes an even deeper, more concerning divide: The individual states themselves are on different paths, with some, such as Massachusetts, achieving remarkable recoveries that mirror their European counterparts and others facing rapidly-rising death tolls.
“What’s pretty clear to me is that barring some crazy change of policy in the EU, from everything I know, they’re going to stay pretty flat and pretty low. And what is clear from cases is that America is going to start ticking up,” said Dr. Ashish Jha, a physician and incoming dean of Brown University School of Public Health. “Right now, there’s a small divergence, but we’re really going to start seeing a difference.”
By some metrics, and despite popular narratives that praise European leadership in contrast to perceived American failure, the United States does not seem to have fared much worse overall than Europe. Five EU countries — Belgium, Spain, Italy, Sweden, and France — and the United Kingdom have seen more deaths per capita from COVID-19 than the United States. A look at the rolling average of daily deaths shows the European Union, with its 446 million people, peaking slightly higher than the United States, which has a population of 328 million. Like Europe, the United States has continued to see deaths decline since late April, albeit at a much slower rate.
But experts told the Globe that aggregated data can be misleading and, in the case of the US’ fight against COVID-19, overly optimistic.
“We need to start looking at the fact that there are really different outbreaks happening in the United States,” Jha said. “The aggregate stuff basically hides a story of two places going in different directions — one going up and one going down, and in aggregate it looks flat.”
The United States on Sunday reported 60,978 new cases and 476 deaths. Texas reported 80 new deaths, up from 29 just one week prior. In several states — including Texas, California, and Florida — daily death tolls are on the rise. Meanwhile, in the Northeastern states that were once the center of the pandemic, deaths continue to steadily fall.
“Part of the reason America looks like it’s doing really well is that one of the big [states] is dropping like a stone. That the number of deaths in New York is dropping so substantially swamps what else we’re seeing, even in hot spot states,” Jha explained.
The European Union has its variations, too. Each of the 28 member countries took its own approach to lockdowns — from Spain’s strict bans that confined children to their apartments for months to Sweden’s initial refusal to shutter businesses and schools. The countries also saw varying results. While more than 34,000 have died of COVID-19 in Italy, about 9,000 have died in Germany, a country with a significantly larger population.
But despite differently sized outbreaks, each European Union country has followed roughly the same path, with cases and deaths rising through April and then falling sharply, with no large, sustained spikes since.
Experts largely attributed the unified, sharp declines in infections and deaths to Europe’s carefully timed reopening plans.
“I think one of the things which has probably happened in the United States is that the case numbers didn’t go down long enough in many cases before the states started to reopen. Whereas the difference in lots of EU countries was that they were a lot more cautious and waited until cases were really, really low,” said Helen Jenkins, an assistant professor of biostatistics at Boston University School of Public Health.
Much of Europe and the United States began opening around the same time, in early and mid May. But while between 20,000 and 30,000 Americans were being diagnosed with COVID-19 each day at the time, the European Union was reporting well under 10,000 new cases per day.
“Although I’d say it’s dangerous to look at things in aggregate, I do think there are ways in which parts of the US are doing worse than Europe,” Jenkins said.
Large outbreaks in parts of the United States endanger us all, experts said — even in Massachusetts, which has successfully beaten back one wave of infection.
Jenkins noted that while European Union countries were able to close their borders, states do not have the same power to regulate domestic travel. “I do find that worrying, given that we’re in a pretty good position in Massachusetts,” she said.
“States in the Northeast that were hit really hard, brought the curve down, are now at risk of a second wave because of what’s happening in other parts of the country,” said Dr. William Moss, a physician and epidemiologist at Johns Hopkins Bloomberg School of Public Health. “In a pandemic situation, you can’t have that kind of variation at the state or local level, because we’re all in this together, and what happens in one state impacts what happens in another state.”
Moss said that disparate outbreaks and disjointed paths to recovery stemmed in part from decentralized leadership. “There’s been a delegation of responsibilities and policies and decision-making to the state and local levels. ... In my view, that’s been to the detriment of the United States.”
Moss added that this approach differs greatly from that of most countries that are now recovering from the pandemic, including European Union countries, which are smaller than the United States as a whole but on average are far more populous than individual states. “I think it’s an important comparison to highlight between the US and the European Union if only to make the point that what’s happening in the United States now was not inevitable,” he said.
“One can measure success at multiple levels. There can be success at a very local level. There can be success at a state level. And there can be success at a national level. But in order for the country as a whole to have an effective response, it has to be a unified, coordinated federal response.”