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Roger:-

Over the first year of the pandemic, I followed US data very closely, esp. at the county level (see https://resilientcommunities.home.blog/2021/04/19/1-ac-what-the-data-tell-us/). The one consistent predictor of both cases and deaths was population density; even the CDC admitted that, albeit sotto voce. One of the things I quickly concluded was that indices (e.g., the CDCs SVI, and its components) such as the GHSI had no predictive or explanatory value. Selection of parameters may be part of that, as well as simply averaging components.

We in the US did a horrible job of prevention. Frankly, the CDC should be ashamed. Our care of those sick was mediocre – perhaps only slightly better than average. Lack of tests early on contributed to that.

But what isn't considered enough are the components of wellness. Health care contributes only 10-20%. Over half relates to various aspects of lifestyle; the rest can be thought of as environmental. In the US, the vast majority of deaths occurred among the elderly or the immuno-compromised. I suspect (have no data to know one way or the other) that our poor showing re the coronavirus has much to do with our keeping alive those who would otherwise have long since died in other countries.

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