COVID-19: US federal accountability for entry, spread, and inequities-lessons for the future

Abstract

The United States (US) has been among those nations most severely affected by the first-and subsequent-phases of the pandemic of COVID-19, the disease caused by SARS-CoV-2. With only 4% of the worldwide population, the US has seen about 22% of COVID-19 deaths. Despite formidable advantages in resources and expertise, presently the per capita mortality rate is over 585/million, respectively 2.4 and 5 times higher compared to Canada and Germany. As we enter Fall 2020, the US is enduring ongoing outbreaks across large regions of the country. Moreover, within the US, an early and persistent feature of the pandemic has been the disproportionate impact on populations already made vulnerable by racism and dangerous jobs, inadequate wages, and unaffordable housing, and this is true for both the headline public health threat and the additional disastrous economic impacts. In this article we assess the impact of missteps by the Federal Government in three specific areas: the introduction of the virus to the US and the establishment of community transmission; the lack of national COVID-19 workplace standards and enforcement, and lack of personal protective equipment (PPE) for workplaces as represented by complaints to the Occupational Safety and Health Administration (OSHA) which we find are correlated with deaths 16 days later (ρ = 0.83); and the total excess deaths in 2020 to date already total more than 230,000, while COVID-19 mortality rates exhibit severe-and rising-inequities in race/ethnicity, including among working age adults.

Keywords: Border control; COVID-19; Health inequities; Occupational health; Pandemic preparedness; Trump administration.

Fig. 1

National OSHA complaints and COVID—19 deaths per million (7 Day Average), January 16-September 18, 2020

Fig. 2

Heatmaps showing the lagged correlations between OSHA complaint volume and COVID-19 cases and COVID-19 deaths, nationally and by US region, January 16, 2020—September 30, 2020

Fig. 3

Temporal trends in US age-specific racial/ethnic COVID-19 mortality rates, rate ratios, and rate differences: February 1—September 19, 2020