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

Eur J Epidemiol. 2020 Nov;35(11):995-1006. doi: 10.1007/s10654-020-00689-2. Epub 2020 Nov 2.


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.

Publication types

  • Review

MeSH terms

  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • COVID-19 / prevention & control
  • Federal Government*
  • Health Status Disparities
  • Humans
  • Personal Protective Equipment / supply & distribution
  • Public Health
  • SARS-CoV-2
  • Social Responsibility*
  • United States