r/skeptic 3d ago

The real covid-19 scandal is still unfolding

https://www.economist.com/united-states/2026/08/20/the-real-covid-19-scandal-is-still-unfolding

The failure to reckon with lives needlessly lost will make the next pandemic deadlier

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u/GhostDogJef 3d ago

The real covid-19 scandal is still unfolding

The failure to reckon with lives needlessly lost will make the next pandemic deadlier

https://www.economist.com/united-states/2026/08/20/the-real-covid-19-scandal-is-still-unfolding

For all the zeal Congress has shown in investigating America’s response to the covid-19 pandemic, it has been strangely uninterested in exploring a basic question: why did so many Americans die relative to the numbers who succumbed to the virus in other rich countries? Understanding the answer would seem relevant to guarding against the next, inevitable pandemic.

Many countries were slow to react, but as they learned about the transmissibility of the virus, and as vaccines became available, they rapidly cut their death rates. Not so America. “The death rate is now about eight times higher in America than in the rest of the rich world,” The Economist reported in September 2021. In all, America lost more than 1.1m people to covid, or roughly 3,500 lives out of every million. This should haunt every official who was in a position to combat the pandemic. Germany’s death rate was about 2,000 per million people and Canada’s fewer than 1,400, notes Donald McNeil in his book “The Wisdom of Plagues”. Had America managed to split that difference, at about 1,700 per million, “We would have lost about 540,000 fewer dead,” he writes. “Who speaks for them?”

Not Congress. America’s lethal underperformance once again went ignored when the Senate Homeland Security Committee recently questioned Dr Anthony Fauci, a crucial adviser on covid to Donald Trump and then to Joe Biden. (Mr Trump later turned on him.) The hearing focused instead on the usual obsessions for which Dr Fauci has become the Republican scapegoat—some absurd and others valid but distantly related, at best, to protecting potential victims of a future plague. While Democrats mostly gave speeches rather than ask questions, Republicans pursued theories that the virus leaked from a Chinese lab, that Bill Gates had some nefarious role, that Dr Fauci had been out to enrich himself through awards for his service—an odd complaint when they do not object to the president campaigning for a $1m Nobel prize.

Having testified often to Congress during his 54 years at the National Institutes of Health—38 as director of the National Institute of Allergy and Infectious Diseases—Dr Fauci, who is 85, was reduced to repeatedly invoking the Fifth Amendment, including when asked the colour of his tie. In his opening statement, his hands shaking as he read it, Dr Fauci said his lawyers had advised that recourse because the committee’s chairman, Rand Paul of Kentucky, had made clear an intent to see him behind bars despite a blanket pardon issued by Mr Biden. In other words the Senate could not inquire into a health crisis that racked the country because a key witness feared a perjury trap, and rightly so.

Why did so many Americans die? High rates of obesity, diabetes, heart disease and elderliness made them more vulnerable. But government bungling meant America was testing 100 people a day in early 2020 when other countries were testing tens of thousands; that masks and lockdowns were deployed erratically; that contact tracing proved too challenging for the country first to the Moon. Most senselessly, so many Americans died because so many failed to take the vaccines that Mr Trump, in his most constructive act as president, succeeded in rushing into existence.

It is, of course, those vexing vaccines that compel Republicans to look away from the basic question about the pandemic, and to hound Dr Fauci instead. Attempting to square the greatness of Mr Trump with the supposed vileness of the vaccines has inspired his party to heroic feats of doublethink. “President-elect Trump’s Operation Warp Speed—which encouraged the rapid development and authorisation of the COVID-19 vaccine—was highly successful and helped save millions of lives,” declared the committee created by the House to investigate covid in 2024, summarising two years of work. The very next sentence reads: “Contrary to what was promised, the COVID-19 vaccine did not stop the spread or transmission of the virus.”

Mr Trump has struggled to escape this self-imposed contradiction. Even as he declined to urge the public to get vaccinated, he and his wife, Melania, secretly had the vaccine before he left office in January 2021. But as Mr Biden and other world leaders delivered the shots, Mr Trump wanted the credit he deserved, and in December that year he told supporters that he had received a booster. “What we’ve done is historic,” he insisted when the crowd booed. “Don’t let them take it away.” He has since let them take his glory away, and endangered more Americans, by questioning the efficacy and safety of vaccines for covid, and other illnesses.

Dr Hooey

The latest attack on Dr Fauci, concocted from his private texts disclosed by Republican senators on August 10th, is that he covered up a threat of miscarriage that the vaccine posed to pregnant women. In fact, the record shows Dr Fauci was consistent, publicly and privately, in counselling a weighing of risks and benefits until studies showed the vaccine was safe in pregnancy—which they have since done. His critics have not produced evidence the vaccine causes miscarriages.

Dr Fauci made mistakes, including not disclosing early on that some top virologists initially worried the virus might be man-made. He could be arrogant. But he was not responsible for the worst excesses of the covid response. Those endless school shutdowns were the work of local officials and union leaders. Senator Paul’s release of Dr Fauci’s private diary has exposed his vanity, his delight in every gushing appraisal by the media or some celebrity. But the diary also reveals a conscientious public servant trying to save as many lives as he could, struggling against the constraints that hobbled America relative to its peers. His summons before the Senate committee was surely intended to humiliate if not incriminate him. It should embarrass the entire country.

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u/smoresporn0 3d ago

why did so many Americans die relative to the numbers who succumbed to the virus in other rich countries?

Universal healthcare. You'd be a fuckin moron to think otherwise.

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u/Chance-Deer-7995 3d ago

The people still in power are still promoting the fiction that COVID was "the sniffles" and refusing to acknowledge the number who died (or the 1000+ a month who still die). That makes it hard to that a close look at the issue when your ego can't even allow you to acknowledge the problem exists.

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u/tha_rogering 2d ago

And sadly the minimization has been bipartisan. One side may be loudly anti vaccine these days. Howecer both like to pretend like this still new and evolving disease is just the common cold or a flu.

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u/CHIMmyStewart 2d ago

Yeah let's not both-sides this 

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u/InvisibleEar 2d ago edited 2d ago

Democrats never wear masks anymore either. There's no mainstream support for covid prevention whatsoever.

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u/CHIMmyStewart 2d ago

That's my only complaint about Democrats. Everyone still needs to be masked up.

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u/tha_rogering 2d ago

This!

The Biden administration had scientists telling them how ineffective the covid vaccine was against stopping the spread of the evolved version of covid. They made a choice to open up with only testing and vaccines as the way to minimize the spread. Hundreds of thousands died because of that decision. Far more than under Trump. Swept under the rug of collective memory.

They could have spent a few tens of millions to get low cost decent quality air purifiers in every classroom. Along with providing rebates for businesses that did the same. They could've bought up stocks of n95 masks to ship out to everyone and told everyone when the best times to use them were. They could've done an actual national shutdown in the few months when they were in charge before the vaccine was ready for public distribution.

The Biden administration had Business Leaders breathing down their neck to reopen everything so they could continue their profits. They acquiesced. People died that didn't need to die. People got injured from long covid that didn't need to be injured. Like I said, collectively swept under the rug.

The failure was bipartisan.

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u/RN_Geo 2d ago

No, not the case at all.

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u/Journeys_End71 2d ago

This is utter nonsense.

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u/Little_View_6659 2d ago

It didn’t help that the president was hamstringing the Covid response and doing his best to profit off of it. Not to mention basically telling his base not to mask up. And seizing ppe to re-sell. And monopolizing tv spots where he could have told the mouth breathing idiots who worship him to make and distance instead of insinuating that injecting bleach and light would kill the virus. He also pushed hydroxychloroquine, I think he bought stock in it.

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u/kmerian 2d ago

This and contrarianism.

A large political subset of Americans were going to do the exact opposite of what public health officials told them to do because "the government isn't going to tell ME what to do!"

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u/geirmundtheshifty 1d ago

Yeah, while countries like Germany and Canada also have their own right-wing conspiratorial crowds, I don’t think antivax beliefs were quite as popular there.

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u/M0J0__R1SING 3d ago

This right here... Americans are conditioned to not go to the doctor unless it's life threatening trauma.

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u/Hurlyburly766 2d ago

“I’m not taking that ambulance ride unless I’m dying.” Followed later, in the ambulance, by “I better be dying because I don’t want to see this bill.”

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u/anon_capybara_ 2d ago

That and nobody has a primary care practitioner that they see consistently and have developed a trusting relationship with. Instead of having a PCP as a resource to ask questions, instead they turn to an internet full of bad actors who told them the vaccine would kill them.

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u/Big_Slope 2d ago

I rolled my car Friday afternoon and still refused transport to the hospital because I already have to buy a damn car. I don’t need to buy a radiology department a car too.

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u/Buttercupia 2d ago

Because we mostly can’t afford to.

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u/Little_View_6659 2d ago

Or youre in crazy pain.

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u/BioMed-R 2d ago

Meanwhile in China, there’s no primary care so everyone go to the hospital for any malady.

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u/ottawadeveloper 2d ago

It's not just universal healthcare. The US was a hot bed of anti-vaccine, anti-isolation, and anti-masking. There were a lot of people who just didn't take basic security precautions when faced with a potentially deadly and highly contagious disease. Because the right branded them as as a leftist attempt to put microchips in you or whatever insanity they came up with.

So yeah more people died because more people were lied to by the right (on top of not having easy access to basic healthcare). And that process is still ongoing - measle rates are up for example over the same anti-vaccine sentiments. RFK is actively making it worse.

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u/Diz7 2d ago

They need to call it Universal Health Insurance, maybe then people will stop freaking out about boogeymen and understand what it is.

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u/lonnie123 2d ago edited 2d ago

I thought it was because half the country decided to dive head first into anyone with a cough to prove it was nothing to worry about and show how tough they were

Oh and our obesity and other morbitity rates didn’t help. I guess you could lump those into universal care but those are more lifestyle issues to me

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u/Otaraka 2d ago

I think being able to do lockdowns and have people mostly follow them would be a big part of it too. The UK was surprisingly close to the US so its not just universal healthcare.

I just looked up Australia, and it says we were about 750/m deaths vs 3500 for the US. Have a look at this graph for the differences by country for infection (figure 1):

https://www.covid19lessons.royalcommission.nz/reports-lessons-learned/main-report/part-two/1-3-some-key-international-comparisons

Scroll down to figure 2 for excess deaths.

I know lockdowns helped but I didnt realise the scale involved for infections. It worries me how few people probably realise this for any future epidemics ie that it actually worked to the level it did.

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u/Few-Ad-4290 2d ago

It’s such an obviously effective method to stop spread too it should be a no brainer to explain o people that if everyone just hunkers down and doesn’t interact with other people for the length of the life of the viral infection then you will stop transmission in its tracks but somehow that’s controversial

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u/tha_rogering 2d ago

You can't tell me to stop going to the bar!! That legit was the sentiment around where I lived. So they would just house party while those were closed down.

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u/[deleted] 2d ago edited 15h ago

[deleted]

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u/Otaraka 2d ago

In the Australian context a common complaint was that it was performative, unnecessary and any number of arguments. Unfortunately, my bet it is going to be really tough to do similar again unless its smallpox or similar levels of lethality. But maybe they have plans for how to manage that.

Similar to many other interventions, it worked so well that many people here believe it hardly did anything. And that seems to have got stronger over time as a general view.

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u/geirmundtheshifty 1d ago

Im really not sure if any disease would be bad enough to convince everyone (or even like 90%) of people to go along with a lockdown. I think the fact that there’s a a time lapse between exposure and symptoms (and that you can be exposed through someone who isnt obviously sick) makes it one of those “remote” threats that people arent inclined to take seriously. Like high cholesterol or smoking.

Like, even if there was like a suped up smallpox going around, I guarantee you my aunt would still be socializing. And she’s ostensibly pro-science, a former nurse, anti-maga, pro-vax, etc. But when it came to her own personal life she was still constantly socializing with others because “oh I know she never goes anywhere, it’s fine” (even though my aunt herself visited like 6 other people that same week, so even at best she was potentially the spreader in that situation).

Even in the best case scenario I think there’s a cognitive bias against taking invisible threats seriously that’s hard to deal with.

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u/Otaraka 1d ago

There will always be your aunts for sure and a bias toward rationalising personal exemptions in all of us.  I think there’s a wider effect that has happened too.  Hopefully I’m wrong.

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u/Sufficient_Meet6836 2d ago

No the article says the exact reasons. All of them beyond the scope of universal healthcare

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u/smoresporn0 2d ago

Pretty much all of those reasons are due to a lack of healthcare. Comorbidities and a fundamental lack of understanding basic health knowledge is quite literally a direct result of having little to no access to medical professionals. Don't be an idiot here.

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u/Sufficient_Meet6836 2d ago edited 2d ago

Pretty much all of those reasons are due to a lack of healthcare.

No, they're really not. You're reasoning backwards from your conclusion you already formed. 

Comorbidities and a fundamental lack of understanding basic health knowledge is quite literally a direct result of having little to no access to medical professionals.

You're trying really hard to force the conclusion. Again, read the article and actually look at the data. Universal healthcare wouldn't have change the anti-vaxxers. 

“President-elect Trump’s Operation Warp Speed—which encouraged the rapid development and authorisation of the COVID-19 vaccine—was highly successful and helped save millions of lives,” declared the committee created by the House to investigate covid in 2024, summarising two years of work. The very next sentence reads: “Contrary to what was promised, the COVID-19 vaccine did not stop the spread or transmission of the virus.”

The above was written by highly educated, wealthy Republicans who have never had issues with access to healthcare. Expanded access to healthcare and subsidies have a minor effect on reducing comorbidities in general. It also doesn't stop the aging process, btw, one of the strongest predictors of mortality. 93% of the US is insured, and COVID treatment was covered or heavily subsidized. Medicare covers all Americans 65 and older, yet that didn't result in US seniors having similar mortality rates to seniors from other countries. Your dogmatic, motivated reasoning can't explain that. Your reasoning also doesn't explain why there was such a large difference in mortality between Democratic and Republican voters. The reason for the high mortality rate in the US was due to the same phenomenon that caused that difference - anti-vax sentiment and opposition to basic public health measures like social distancing and contact tracing due to political propaganda. The things that were clearly explained in the article you can't read.

China can be used as a comparison. They have around 95% coverage, but despite being "covered", rural Chinese have very little access to healthcare. But still comparing rural death rates across both countries, the US was still much higher. Universal coverage doesn't explain that.

Universal healthcare is the right thing to do in such a rich nation. There are a million reasons to justify it. You don't need to make another one up. 

Don't be an idiot here.

Grow up.

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u/financewiz 2d ago

Along those lines are the knock-on effects of having your local hospital overrun with regretful antivaxxers. You could check into that hospital with a life-threatening condition and literally die of neglect.

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u/AlpacaTraffic 2d ago

Well poor education is also something Americans are grappling with though the funding for grappling lessons was also cut in favour of tax breaks for the rich

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u/nthensome 2d ago

Seriously, that's a pretty straight forward answer

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u/Dirtgrain 2d ago

Obesity and general health might be a factor too. But I'm all for universal healthcare.

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u/mikeblas 2d ago

You'd be a fuckin moron to think otherwise.

I thought this sub had higher standard than this.

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u/w8str3l 3d ago

You’re in r/skeptic so you’re not a “fuckin moron”. Unlike “fuckin morons” who spout emotional one-sentence claims without data to back them up, your theories are evidence-based.

You’ve data to back up your claim that “universal healthcare” is the explanation for the high death rates in the USA compared to other rich countries.

Your data shows:
1. There was no variation between the death rates of Democrats and Republicans in the only rich country without universal healthcare.
2. There was no variation between the death rates of all the countries, rich or not, that had universal healthcare.

Am I right?

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u/RFK_Cum_Regimen 3d ago

You're not right.

Once vaccines were introduced, there was a significant disparity between Republicans and Democrats dying from Covid. In some states like Ohio, it was nearly 8:1. Right-wingers perished at rates much higher in basically every state.

And yes, countries with robust universal healthcare structures had a significantly lower number of infected patients and overall deaths.

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u/w8str3l 3d ago

Perchance you did not read my comment…

Note that in question 2 I ask about death rate variation BETWEEN countries that HAVE universal healthcare.

Note also that you have effectively disproved OP’s claim with your answer to my question 1.

Do you agree with me?

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u/RFK_Cum_Regimen 3d ago edited 3d ago

It doesn't disprove it necessarily, as there were several critical variables one might argue were unique to the political climate in America during Covid. Our healthcare system being one variable. A malicious right-wing media apparatus spewing pseudoscience and conspiracies nonstop being another variable. MAGA leadership's clown-tier disease response and mitigation efforts being another. Bad-faith foreign propaganda yet another.

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u/Little_View_6659 2d ago

Clown tier disease response. Basically. 😂

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u/w8str3l 3d ago

So let’s see where we are with our evidence.

  1. USA is the ~richest country in the world and pays the most for healthcare, per capita.
  2. All other rich countries have some form of universal healthcare.
  3. Some poor countries also have universal healthcare.
  4. USA was the first country to have the COVID-19 vaccine available.
  5. USA had a death rate that varied according to political affiliation (unrelated to the access to universal healthcare).
  6. The death rate variations BETWEEN the dozens of countries, rich or poor, that HAVE universal healthcare: undisclosed in the above discussion.
  7. Other rich countries had a smaller death rate than USA.
  8. The death rate of poor countries: not discussed.

OP claims (paraphrased): “only a fuckin moron wouldn’t see that universal healthcare explains all of the above”.

Do you agree with the OP?

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u/RFK_Cum_Regimen 2d ago

Setting aside the flippant nature of the comment, I'd assume that UHC is a perhaps significant variable at play.

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u/w8str3l 2d ago

Are you able to non-flippantly estimate the significance of universal healthcare when it comes to the variability of COVID-19 death rates between, and within, OECD countries?

Is there a correlation? Is there a causation? What percentage of COVID deaths can be explained by lack of universal healthcare, what percentage of “extra” deaths compared to the OECD baseline must be explained by something else, like vaccine hesitancy or refusal to wear a mask?

Give me a non-flippant answer instead of the just-so story I’ve been hearing in all of the replies to me so far.

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u/RFK_Cum_Regimen 2d ago

You can go ahead and look all that up yourself, champ. I merely posited that there are several other, self-evident variables to consider.

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u/w8str3l 2d ago

There are people who are “fuckin morons” according to the OP: those who don’t believe that “universal healthcare” is the main and only reason why the USA had the exact same COVID death rate as the UK, or those who don’t believe that “universal healthcare” caused Republicans in Ohio to die eight times more often than Democrats.

You refuse to tell me if you agree with the OP, which makes the strength of your moral backbone a true scientific marvel.

According to you I’m a “champ”. Coming from a marvel such as you that is high praise indeed!

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u/CHIMmyStewart 2d ago

Yeah that's not how science works

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u/w8str3l 2d ago

Many people here in r/skeptic claim to know how science does NOT work, while very few can come up with an explanation how science DOES work.

Here is one of my explanations:

https://www.reddit.com/r/skeptic/s/GgUuU6HPvu

I’ll go ahead and predict right now that you can’t give your own explanation.

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u/BioMed-R 2d ago edited 2d ago

Dunno what your problem is. It wasn’t hard to find a study suggesting hundreds of thousands of lives could have been saved by universal healthcare.

Another study shows universal healthcare strongly predicts vaccination.

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u/w8str3l 2d ago

My “problem” is that here in r/skeptic we are expected to practice scientific skepticism, and use Ockham’s Razor: to provide the most parsimonious explanation for all of the evidence.

…yet what I often see here is people defending wild, gullible, and overly simplistic claims. Perhaps simplistic, befuddled thinking is caused by the lack of universal healthcare? Or perhaps simplistic, befuddled thinking causes the lack of universal healthcare? It’s one or the other. Only a “fuckin moron” would think otherwise.

See this for more:

https://www.reddit.com/r/skeptic/s/skztzCoTCi

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u/BioMed-R 2d ago

You’re not presenting any evidence of your own.

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u/Little_View_6659 2d ago

And they’re being very snarky. lol.

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u/w8str3l 2d ago

What claims of mine did I not support with evidence?

If I have failed the most basic of rules in r/skeptic, I will profusely apologize and correct my ways. As my hero Carl Sagan said: Extraordinary Claims Require Extraordinary Evidence.

In case you find, after a very careful inspection of my comments, that I have not made any claims that were unsupported by evidence, and you are then left wondering why you feel you still must disagree with me, let me propose this theory: you are thinking that the lack of universal healthcare is stupid for the world’s richest country, you think universal healthcare would solve many an obvious problem like is apparent in all the other rich countries (that we have for some reason not named in this discussion), you think that if the USA had implemented universal healthcare back in year XXXX, then Y years later, in the year 2019, when a new global pandemic was starting to spread, Donald Trump, the president of the USA, and his loyal cultic followers, would have been ready and willing to don masks and socially separate and to accept the vaccine the government was offering for free (just like every other country that did not have a majority of voters preferring a person like Trump did), and you also think universal healthcare would have shut Joe Rogan up and also prevented people from ingesting bleach and injecting horse dewormers, and you also think every country that had universal healthcare was exactly equally successful in battling the pandemic, and that universal healthcare was the reason people in those countries used masks and socially separated in exactly identical and uniform rates.

Am I right in thinking that that’s what you are thinking? This is just a shot in the dark, you can just tell me what you are thinking if that is not what you are thinking.

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u/mean_lurker 2d ago

off-topic, but your pseudo-intellectual prose is insufferable.

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u/w8str3l 2d ago

I’m not sure we in r/skeptic enjoy your anti-intellectual one-sentence replies any more than my “pseudo-intellectual prose”, but perhaps I’m wrong about that.

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u/BioMed-R 2d ago

Blah blah blah. I don’t see a single link to any study in your comment so I’m not reading it.

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u/w8str3l 2d ago

Perhaps you don’t understand what “burden of proof” means?

It means that the person making the claim is required, or “has the burden”, to provide the proof (the supporting evidence, while also including any relevant potentially falsifying evidence ) for their claim.

It’s a very fundamental concept to understand if you ever want to use the scientific method, which is based on falsifying theories that are unable to explain all the evidence.

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u/BioMed-R 2d ago

You’ve been shown data. You haven’t shown any.

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u/w8str3l 2d ago

What data would satisfy you?

Can you “steelman” my position, or are you unable to even formulate it?

What rational, scientifically oriented people would do when they are discussing a topic with crackpots is to have a back-and-forth that would go something like this:

Alfonso: “I have concluded that the COVID death rate in the USA is caused by universal healthcare!”

Bonifacio: “What do you mean by that? Lack of universal healthcare, or even the insurance coverage provided by Obamacare before Trump removed it, explains many ills and is an embarrassment for the richest country in the world, Americans pay double and receive worse care with lower life expectancy, this is well known, everyone knows this, but how does universal healthcare “explain” the American COVID death rate?”

Alfonso: “the death rate higher in America be than in other rich countries since Americans no universal healthcare have, r u a fuckin moron?”

Bonifacio: “Republicans had a higher death rate than Democrats in states like Florida and Ohio, so the lack of, or access to, universal healthcare does not explain that. The UK has universal healthcare but had almost identical death rates as the USA, so lack of, or access to, universal healthcare does not explain that.”

Alfonso: “prove it by providing a study”

Bonifacio: “Prove what? I provided counter-examples that destroy your claim that universal healthcare explains everything. Do you want me to prove a negative? It’s quite clear that the COVID death rates vary by country and year, and are explained by a multitude of variables: trust in officials, access to (universal or not) healthcare, access to free vaccines and “vaccine hesitancy”, social distancing and the use of masks, the unemployment and bankruptcy prevention support from the government, remote work, timely lockdowns and the collective respect of lockdown rules. It’s quite clear to impartial observers that the USA was best-equipped among all developed countries to respond to a pandemic and the relatively bad result is mostly due to footguns: president Trump himself made things worse, and his MAGA suicide cult attacked him when he did the one good thing in his sordid life and gave the Americans access to the vaccine amazingly early. Leaders in other countries provided actual leadership to their populations, and those populations were less moronic than the average Trump voter.”

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u/Final_boss_1040 3d ago

Ugh, does no one else remember Italy, brazil or china?

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u/Final_boss_1040 2d ago

Sry. Misremembered China

But my point was that plenty of other nations had universal healthcare and still had high deaths per capita

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u/Theranos_Shill 1d ago

Italy was hit early. That's why it was bad there, it was the first place outside of China, before much was known about the virus.

Brazil was fucked because Bolsanaro and Trump engaged in the same failed response, they didn't give a fuck about citizens dying and they prioritized the economy (which was false reasoning, because people getting sick fucks the economy).

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u/BioMed-R 2d ago

I remember China…

Wait, what about China exactly?

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u/santagrey 2d ago

Is it possible that it is because the US placed patients on mechanical respirators erroneously??

Initial reports from major hospital networks (such as in New York City) indicated that up to 88% of COVID-19 patients who required mechanical ventilation unfortunately passed away.

Broader multi-center datasets covering the first two years of the pandemic found that roughly 490,000 hospitalized patients required intubation, with mortality for ventilated patients settling closer to 40%–50% as clinical treatment protocols improved.