Roughly 40% of U.S. coronavirus deaths could have been prevented, according to a report, "Public Policy and Health in the Trump Era," in the February 20 Lancet. The authors assert that the disproportionate impact of COVID-19 on the United States was a result of President Trump's policies of minimizing the threat and failing to act as the pandemic worsened. However, they note that the failures in responding to the pandemic are part of a larger trend in health outcomes in the United States, where life expectancy has been falling behind other wealthy nations over several decades. Using weighted averages, the authors estimate a total of 461,000 "missing Americans" who would still be alive if U.S. age-specific mortality rates equaled those of Canada, France, Germany, Italy, Japan, and the United Kingdom.