How Australia’s death rate is one-tenth of the U.S.
MELBOURNE, AUSTRALIA » If the United States had the same COVID death rate as Australia, about 900,000 lives would have been saved.
For many Americans, imagining what might have been will be painful. But especially now, at the milestone of 1 million deaths in the United States, the nations that did a better job of keeping people alive show what Americans could have done differently and what might still need to change.
Australia offers perhaps the sharpest comparisons with the American experience. Both countries are English-speaking democracies with similar demographic profiles. In Australia and in the United States, the median age is 38. Roughly 86% of Australians live in urban areas, compared with 83% of Americans.
Yet Australia’s COVID death rate sits at one-tenth of America’s, putting the nation of 25 million people (with around 7,500 deaths) near the top of global rankings in the protection of life.
Australia’s location in the distant Pacific is often cited as the cause for its relative COVID success. That, however, does not fully explain the difference in outcomes between the two countries, since Australia has long been — like the United States — highly connected to the world through trade, tourism and immigration. In 2019, 9.5 million international tourists came to Australia.
So what went right in Australia and wrong in the United States?
Australia restricted travel and personal interaction until vaccinations were widely available, then maximized vaccine uptake, prioritizing people who were most vulnerable before gradually opening up the country again.
Dozens of interviews, along with survey data and scientific studies from around the world, point to a lifesaving trait that Australians displayed from the top of government to the hospital floor and that Americans have shown they lack: trust, in science and institutions, but especially in one another.
When the pandemic began, 76% of Australians said they trusted the health care system (compared with around 34% of Americans), and 93% of Australians reported being able to get support in times of crisis from people living outside their household.
In global surveys, Australians were more likely than Americans to agree that “most people can be trusted” — a major factor, researchers found, in getting people to change their behavior for the common good to combat COVID.
But of greater import, interpersonal trust — a belief that others would do what was right not just for the individual but for the community — saved lives. Trust mattered more than smoking prevalence, health spending or form of government, a study of 177 countries in The Lancet recently found.
Greg Hunt had been Australia’s health minister for a couple of years when his phone buzzed Jan. 20, 2020. It was Dr. Brendan Murphy, Australia’s chief medical officer, and he wanted to talk about a new coronavirus in China.
Murphy said there were worrisome signs of human-to-human transmission.
The next day, Australia added the coronavirus, as a threat with “pandemic potential,” to its biosecurity list, officially setting in motion the country’s emergency response.
The first positive case appeared in Australia on Jan. 25. Five days later, when the Centers for Disease Control and Prevention confirmed the first human transmission of the virus in the United States, President Donald Trump downplayed the risk.
The same day, Hunt struck a more practical tone. “Border, isolation, surveillance and casetracing mechanisms are already in place in Australia,” he said.
Less than 24 hours later, on Feb. 1, Australia closed its border with China, its largest trading partner. On Feb. 3, 241 Australians were evacuated from China and placed in government quarantine for 14 days.
A full border closure followed. Hotels were contracted to quarantine the trickle of international arrivals allowed in. Systems for free testing and contact tracing were rolled out, along with a federal program that paid COVIDaffected employees so they would stay home.
The outbreak that many Australians see as their country’s greatest COVID test began in late June 2020, with a breakdown in Melbourne’s hotel quarantine system. The virus spread into the city and its suburbs from guards interacting with travelers, a government inquiry later found, and within a few weeks, daily case numbers climbed into the hundreds.
Kirsty Buising, an infectious disease consultant at the hospital, began to suspect — before scientists could prove it — that the coronavirus was airborne. In mid-july, on her suggestion, Royal Melbourne, a public hospital built to serve the poor, started giving N95 masks to workers exposed to COVID patients.
In New York, a city of 8 million people packed closely together, more than 300 health care workers died from COVID by the end of September, with huge disparities in outcomes for patients and workers from one hospital to another.
In Melbourne, a city of 5 million with a dense inner core surrounded by suburbs, the masks, a greater separation of patients and an intense 111day lockdown that reduced demand on hospital services brought the virus to heel. At Royal Melbourne, not a single worker died during Australia’s worst institutional cluster to date.
When Australians are asked why they accepted the country’s many lockdowns, its once-closed international and state borders, its quarantine rules and then its vaccine mandates for certain professions or restaurants and large events, they tend to voice a version of the same response: It’s not just about me.
“It was a somewhat authoritarian approach,” said Dr. Greg Dore, an infectious diseases expert at the University of New South Wales in Sydney. “There were lots of mandates, lots of fines for breaching restrictions, pretty heavy-handed controlling, including measures that were pretty useless, like the policing of outdoor masking.”
But, he added, the package was effective because the vast majority of Australians stuck with it anyway.
Now, more than 95% of Australian adults are fully vaccinated — with 85% of the total population having received two doses. In the United States, that figure is only 66%.