Opinion: Stand with public health

The annual Hoover Presidential Foundation Banquet on Oct. 7 featured the presentation of the first “Hoover Humanitarian Award” to President George W. Bush and Laura Bush. The award was inspired by Herbert Hoover’s public health leadership for the Commission for Relief in Belgium that saved millions from starvation and disease in the years following World War I, and again for his public health leadership in saving millions more in Europe in the wake of World War II.

President Bush received the award for his public health leadership in founding the President’s Emergency Plan for AIDS Relief in 2003, and Laura for her public health advocacy for cancer and other preventive programs for women. PEPFAR is credited with saving millions of lives from AIDS in Africa and changing the trajectory of the global HIV epidemic. To date, PEPFAR funding has totaled more than $110 billion to fight AIDS, tuberculosis and malaria in Africa and other countries.

Given President Bush’s public health credentials, one memorable line from his conversation with Margaret Hoover, of PBS’s "Firing Line,"was not surprising: “Get politics out of the public health.” While former President Donald Trump was not named, his politicization of the U.S. public health response to COVID-19 has contributed greatly to the U.S. death toll from this deadly virus. As the transition from pandemic to endemic COVID-19 begins, the grim toll has come into focus. The United States has suffered the highest pandemic death rate of all G-7 countries, and there is a wide divide between "red states," with COVID-19 death rates over 30% higher after the introduction of vaccines than those of "blue states."

Numbers again show US, Iowa faring worse than neighbors

As I have the past two Octobers, I have relied on data from the world-leading Institute for Health Metrics and Education, which uses uniform methods to report projections on COVID-19 deaths, disease, vaccination, face mask use and social distancing rates.

Of G-7 countries, Japan continues to have the lowest death rate (36 per 100,000), followed by Canada (124), Germany (176), France (235), Italy (296), the U.K. (303) and the U.S. (322). It would be inappropriate to compare the U.S. with Japan, an island nation, a constitutional monarchy and with people who wear masks even when there is not a pandemic. A better comparison is Canada, which has a higher proportion of elders age 65 and up (18.6% vs. 17%) but a lower percentage of people of color (27% vs 40%) — two well-established risk factors for higher COVID-19 death rates.

Canada has achieved a higher full vaccination rate, 86% vs 72% for the U.S., and higher mask use rate during high transmission in January 2022, 80% vs 50%. Comparison of COVID-19 death rates reveals a huge difference in cumulative COVID-19 deaths — over 650,000 preventable deaths — if the U.S. had achieved Canada’s current COVID-19 mortality rate.

More:Rankings show Iowans need more, not fewer, COVID-19 protections

In comparing Midwestern farm economy states, red state Nebraska currently has the lowest COVID-19 death rate (237 per 100,000), closely followed by blue states Minnesota (246) and Wisconsin (261), and then by red states Kansas (304), Iowa (323), North Dakota (340), Missouri (348) and South Dakota (353). In the fall of 2021, Politico analyzed state pandemic responses using health, economy, social and educational factors, and found that one state, Nebraska, came out with the best overall average.

While Nebraska did keep schools open, which fosters community viral transmission, it did the following very well: worked closely with the University of Nebraska’s world-class infectious disease experts to craft a science-based statewide plan; provided early and effective outreach to Nebraska nursing homes, packing plants and prisons; was the first state to accumulate a 120-day supply of personal protective equipment, or PPE; was among the most efficient states in getting federal funds to small businesses and in promoting takeout food and alcohol. While the Nebraska governor did not favor mandates, neither did he sign legislation that would preempt towns and cities from passing their own mask mandates. Nearly half of Nebraska’s population live in Omaha or Lincoln, both of which had mask mandates, as did several other towns. During high viral transmission in January 2022, Nebraska had a mask use rate of 40%; Iowa's was 28%. Nebraska currently has a middling fully vaccinated rate of 67%, a bit higher than Iowa at 63% and Missouri, the lowest, at 61%.

More:Opinion: Stand with public health in a perilous moment

Vaccination works to combat serious illness

Sweden provides a useful case study as to why keeping businesses and schools open, discouraging mask use by policy, and allowing those exposed but without obvious COVID-19 symptoms to return to school or work, has been severely criticized by its scientific and medical community. While Swedish public health measures tightened in 2021, Sweden’s current COVID-19 mortality rate of 198 per 100,000 is well over double that of neighboring Norway (78), which initiated early lockdowns, recommended mobility restrictions, now has a full vaccinated rate of 77% and had a mask use rate during high viral transmission in January 2022, of 60%, vs. 0% for Sweden.

Had Sweden achieved slightly younger Norway’s COVID-19 mortality rate, over 8,000 deaths could have been prevented.

Similarly, had Iowa (slightly older but lower percentage of people of color) achieved Nebraska’s current COVID-19 mortality rate, over 2,600 deaths could have been prevented.

COVID-19 omicron variants are still circulating, as is seasonal influenza, and exposure to both are expected to increase with winter weather. Fortunately, new highly effective bivalent omicron vaccines are widely available for everybody 5 years of age and older, as are effective influenza vaccines. In addition to full vaccination, the frail elderly and those immunocompromised should continue to wear masks and social distance.

Join President George W. Bush and stand with public health.

Dr. James A. Merchant is a former director of the NIOSH/CDC Division of Respiratory Disease Studies, professor emeritus of medicine and professor emeritus and founding dean of the UI College of Public Health.

This article originally appeared on Des Moines Register: Opinion: Stand with public health, save lives as we wrestle with COVID