Although other wealthy countries have higher overall coronavirus mortality rates than the United States, the U.S. death rate since May is unrivaled among its peers, according to a new study published in JAMA.

Between the lines: After the first brutal wave of outbreaks, other countries did much better than the U.S. at learning from their mistakes and preventing more of their population from dying.

Why it matters: "If the U.S. had comparable death rates with most high-mortality countries beginning May 10, it would have had 44,210 to 104,177 fewer deaths," the authors conclude.

• Excess deaths have followed a similar pattern: The hardest-hit European countries had similar or higher rates of excess deaths of all causes to the U.S. early on, but these fell much lower than the America did after the first wave.

Yes, but: Death rates are not static, as this study proves, and outbreaks in several European countries have taken a turn for the worse lately.

Keeping with the theme of death, a separate study published in JAMA yesterday found that there was a 20% increase over expected deaths in the U.S. between March 1 and Aug. 1.

• Only 67% of the 225,530 excess deaths were attributed to the coronavirus.

Why it matters: Experts say that excess deaths are the best way to measure the true impact of the pandemic, as the number accounts for people who died of the virus itself without being counted and those who died of causes that could have been prevented in non-pandemic times.

Details: States have had widely varying experiences, with those hit hardest early on in the pandemic — New York, New Jersey and Massachusetts — seeing much higher excess death rates than the rest of the country.

• These three states accounted for 30% of all excess deaths in the U.S., even though they had shorter outbreaks than states that saw surges over the summer.

Government spending on testing and contact tracing pays for itself more than 30 times over, according to yet another paper published in JAMA (good series!).

What they found: Harvard economists David Cutler and Lawrence Summers calculated the total cost of the coronavirus pandemic at more than $16 trillion in the U.S. alone. Of that, about $7 trillion is attributable to loss of life and long-term impairment from the disease, Axios' Felix Salmon writes.

• Enhanced testing and tracing would cost about $6 million per 100,000 inhabitants, they calculate. Out of that population, 14 lives would be saved, on which they place a value of $96 million, and 33 critical and severe cases would be avoided, representing savings of $80 million.
• That adds up to $176 million in benefits from $6 million in costs — before taking into account any second-order effects from even fewer cases down the road.

The bottom line: "Currently, the U.S. prioritizes spending on acute treatment," write Cutler and Summers, "with far less spending on public health services and infrastructure."

• Going forward, they write, "a minimum of 5% of any COVID economic relief intervention should be devoted to such health measures."

The first coronavirus vaccine will likely get authorized within months, but that will only be the beginning of what's likely to be a long, chaotic vaccination process, the New York Times' Carl Zimmer reports.

The big picture: The first vaccines probably will offer only moderate protection against the virus, meaning we can't ditch our masks even if we get one. And we probably won't have a good way to choose between these vaccines once several of them are on the market.

• Some vaccines that are in earlier stages of development today may struggle to cross the finish line, even if they work better than earlier vaccines.
• And some vaccines may be pulled off of the market because they're unsafe.

Between the lines: Some of this is inherent to the breakneck speed of the vaccination effort, but some of it is a result of how that effort was designed.

• Earlier this year, some government scientists had wanted to test vaccine candidates against each other, instead of testing all of them against a placebo. But these kinds of trials are risky for drug companies, because they show the value of one vaccine against another.
• That information could be useful for patients, but is a business risk for manufacturers.
• "You have to have the total cooperation of the pharmaceutical companies to get involved in a master protocol," top infectious disease expert Anthony Fauci told NYT. "That — I don't know what the right word is — didn't turn out to be feasible."

China's entry into the COVAX initiative means the list of non-participants in the global effort to develop and distribute coronavirus vaccines has dwindled down to Belarus, Kazakhstan, Malaysia, Russia, the U.S. and five small island countries or micro-states, Axios' Dave Lawler reports.

Breaking it down: 183 countries with a combined 93% of the world's population are either eligible for subsidized access or have said they intend to participate, though some have yet to sign formal agreements.

How it works: By pooling resources, COVAX intends to invest in the development of at least nine vaccine candidates, secure lower-cost bulk access and distribute 2 billion doses to all participant countries by the end of next year.

• Distribution will initially be proportional to population, with guidelines calling for health workers and vulnerable groups to be vaccinated first.
• What to watch: It will not be easy to balance the interests of 180+ countries, some of which are building up their own vaccine stockpiles or attempting to negotiate the terms of their participation.

Driving the news: China was late to join COVAX, and the terms of its commitment aren't clear. But Beijing is attempting to contrast itself with the U.S. and counter the reputational damage it has suffered during the pandemic.

• The flipside: The U.S. appears to be the only country to have publicly rejected the COVAX initiative outright. It cited the influence of "the corrupt World Health Organization and China."

President Trump tested negative for COVID-19 with an Abbott BinaxNOW rapid antigen test "on consecutive days," according to a memo from White House physician Sean Conley shared by press secretary Kayleigh McEnany. Conley did not specify what days Trump tested negative.

According to the latest Gallup poll, Americans' willingness get a coronavirus vaccine dropped to 50% in late September, a dramatic 11-point fall from the previous month.

Fauci told CNN on Monday that the Trump campaign should stop airing an ad that uses comments he made without his permission and out of context.

White House Chief of Staff Mark Meadows refused to speak to reporters outside Amy Coney Barrett's confirmation hearing on Monday after they requested that he keep his face mask on.

Sen. Mike Lee (R-Utah) attended the confirmation hearing for Supreme Court nominee Amy Coney Barrett in person and gave his opening statement without a mask, a little more than a week after testing positive for the coronavirus.