The United States has quickly become the epicentre of the COVID-19 pandemic.
More than 2,500 Americans have lost their lives due to the illness since the pandemic broke out, according to Johns Hopkins University. There are more than 143,000 cases of the novel coronavirus in the U.S. as of Sunday night, more than China or Italy.
Simply by virtue of its size — the U.S. has 8.7 times as many people as Canada — the country was all but destined to have many more cases than Canada.
But the outbreak has gone far beyond that.
COVID-19 has brought the hardest-hit state of New York to a standstill. More than 1,000 people have died. Despite having a little over half the Canadian population, New York has more than 59,500 cases.
That’s more than nine times as many as Canada, which has about 7,405 confirmed cases, including 74 deaths.
Gov. Andrew Cuomo said worst-case scenario projections show New York would require 140,000 hospital beds and 30,000 ventilators in order to handle the peak of the outbreak.
What went wrong in the U.S. — and what was different in Canada?
While there have been widespread concerns about the availability of coronavirus testing in both countries, U.S. officials have faced sharp criticism for not making tests widely available until far too long after the virus arrived from China early this year.
A report in the New York Times concluded the failure was due to several factors, including technical issues, bureaucracy and a “lack of leadership at multiple levels.”
“The result was a lost month, when the world’s richest country — armed with some of the most highly trained scientists and infectious disease specialists — squandered its best chance of containing the virus’s spread. Instead, Americans were left largely blind to the scale of a looming public health catastrophe,” stated the report, which was based on 50 interviews.
Paul Offit, an infectious disease expert at the University of Pennsylvania, said the severity of the novel coronavirus was “largely ignored” by the U.S. government until there was already community spread.
“We were very slow to to prohibit travel into this country from China or regions in that area where the virus was circulating,” said Offit. “When we finally did that, it was too late.”
The country’s pandemic preparedness plan — put together in response to the 2009 H1N1 virus by Director of the National Institute of Allergy and Infectious Diseases Dr. Anthony Fauci — was also scrapped by the Trump administration, which Offit said left the U.S. ill-prepared for the COVID-19 outbreak.
By comparison, Canada’s leaders from multiple levels and political parties have called on Canadians to self-isolate and physically distance themselves to contain the spread of the virus.
The country’s strategy to deal with this pandemic has been adapted from its influenza preparedness plan, which was updated in 2018.
Prime Minister Justin Trudeau has also consistently deferred to the “advice of health professionals” in his daily press conferences to inform Canada’s approach.
Experts who spoke with Global News said a number of factors are driving the stark differences between how the pandemic is unfolding in Canada and the U.S.
One of the big ones is how Canada’s provinces have been able to work together on a response, said Stephen Hoption Cann, a professor at the University of British Columbia’s School of Population and Public Health.
“What we’ve seen through this spreading pandemic is that there’s a lot of co-ordination on quarantine measures and closures from one province to the next, whereas you see the U.S., the 50 states — there’s quite large differences in what’s happening from one state to the next.”
The provinces have also been able to quickly ramp up testing, Hoption Cann said. As of Monday, more than 220,000 COVID-19 tests have been carried out in Canada.
The Centers for Disease Control and Prevention have yet to release comprehensive numbers of Americans tested for COVID-19, but the COVID Tracking Project — a system run by data professionals that tallies every coronavirus test conducted in the U.S. — lists the total at around 850,000.
There’s also the differing structures of the health-care systems, he said. Canadians can access care without costs or insurance claims. And while some U.S. insurers have announced they’ll waive copay fees for testing, for example, there remain significant financial barriers in the system.
In New York City, high population density and social determinants of health such as income and housing are factors, according to Cynthia Carr, epidemiologist and owner of EPI Research in Winnipeg.
“You have people living in very overcrowded apartments and living situations, and those people will be at even higher risk,” she said.
The city has nearly 33,500 cases of the novel coronavirus and 776 deaths.
While there has been a large number in cases, Carr said the death rate in the city appears to be on par with other areas.
“The mortality rate, just like Canada, is still very much on the low side,” she said.
Sandra Albrecht, a social epidemiologist and assistant professor at Columbia University, added to this.
She said the city’s status as a travel hub for international and domestic tourism makes it particularly vulnerable when faced with a pandemic.
“In many ways, it’s what makes NYC a unique and exciting place,” Albrecht said.
“But when it comes to infectious diseases, the population density — having people so close together — is what makes it easy for them to take hold, and to spread so quickly.”
The population density in New York City more than doubles that of major cities like Toronto, with 10,935 people per square kilometre, according to a 2015 report from the U.S. Census Bureau.
Comparatively, figures from Statistics Canada in 2016 showed that Toronto had a population density of 4,334 people per square kilometre.
New York City also has large pockets of marginalized populations, who Albrecht said are at an even higher risk of becoming infected with COVID-19 and experiencing more severe disease.
That state’s hospitals are not fully equipped for the pandemic outbreak, which Albrecht said could also be a factor.
Personal protective equipment like surgical masks and gowns that repel fluid are in short supply across the country, she said.
Albrecht added New York’s lack of ventilators has also put doctors in the “awful” position of having to decide which patients will have access to a ventilator and which will be forced to go without life-saving equipment.
In an email to Global News, Charles Branas, chair of the department of epidemiology at Columbia, said “extreme, unprecedented measures are being taken, like building ICU beds in a tented hospital in Central Park.”
The situation is much less dire in Canada, which has set aside more than $11 billion to combat the virus.
Provinces that were hit hardest during the 2002-2003 SARS outbreak had ventilators stockpiled in case of emergency.
Ontario, which was hit hardest by the SARS pandemic, said Friday it had approximately 3,250 ventilators that were ready to be deployed.
As previously reported by Global News, the province of British Columbia has 1,272 ventilators, while Nova Scotia, who began tapping the private sector for supplies last week, reportedly has 240 ventilators and another 140 on order.
The Alberta government said it has 477 with another 50 on order while Manitoba health officials told reporters they had 243 ventilators with another 20 on order.
Saskatchewan has 91 adult ventilators for critical care, 80 additional subacute ventilators and 250 additional ventilators ordered.
Newfoundland and Labrador officials said they have 156 ventilators. Prince Edward Island has 19, with 15 on order.
Nunavut has the least amount of ventilators available at seven, but officials said all intensive care patients are transported out of the territory to be treated.
Paul-Émile Cloutier, president of HealthCareCAN, said in earlier interview with Global News that as long as the outbreak doesn’t worsen and overwhelm Canada’s health care system, provinces should have enough ventilators to meet their current needs.
If that were to happen, Cloutier, whose group represents health care organizations and hospitals, said Canada may find it difficult to find suppliers able to meet a sudden influx in demand for supplies.
“If there was a surge of patients coming through to which they would need to be hospitalized, then you may have a shortage of ventilators,” he said.
“Their issue is where would you get them?”