There are a lot of numbers going around about the coronavirus pandemic. In a time of uncertainty, everyone wants answers. It’s one way of feeling like they have control. It’s not always possible to have good answers though.
New Scientist has a cautionary tale on treating death estimates from the pandemic as rock-solid.
YOU will probably have read that there are going to be X thousand deaths from coronavirus in the country you live in. You may also have read that there are going to be an order of magnitude more or fewer deaths. You would be right to be unsure which is correct. It could be any of them, or none.
President Donald Trump has been talking about a possible 100,000 to 200,000 coronavirus deaths in the US if his administration “does well” at tackling the virus. In the UK, there has been talk of 20,000 deaths if measures work and 250,000 without restrictions. There has been no shortage of other estimates put forward by people with little experience of epidemiology, some of which come in very low indeed.
These calculations, approximations and guesstimates from expert modelling studies and back-of-the-envelope blogging build a confusing picture, not least because they suggest that it is possible to assign a numerical value to covid-19’s future death toll at this point.
emphasis added
The editorial goes on to list 6 ways the estimates could be off, and sums it up with
“...the numbers you are hearing about death tolls, or how long restrictions will be in place, or how many people will need intensive care, should be taken not just with a pinch of salt but with a sack of it.”
Deaths not yet counted
There are other factors the New Scientist piece does not address or just barely touches on. One is that we may not have a good handle on how many fatalities are being caused by the virus. Indirect evidence comes from subtracting known virus fatalities from deaths from all causes, and comparing the numbers to what would be seen ‘normally’. There are reports of spikes in the death rate that aren’t explained by known virus fatalities alone.
Talking Points Memo has been following these issues for some days now. Regarding reported virus deaths, Josh Marshall observes
On the mortality front, I’ve now been able to confirm what I had strongly suspected: all the mortality numbers we are seeing include or until just recently included only those who had been tested positive for COVID-19. In other words, even many victims of the disease who clinicians assumed had COVID-19 are not included in these lists because they lacked a positive test. Some post-mortem testing is being done. But given the constraints on testing capacity, many clinicians and officials are understandably deciding that they should be reserved for the living.
This is not a cover-up. It’s a bureaucratic and technical reality our system is having difficulty catching up with. The CDC just issued guidance that issuers of death certificates need no longer require a positive test. “Ideally, testing for COVID–19 should be conducted, but it is acceptable to report COVID–19 on a death certificate without this confirmation if the circumstances are compelling within a reasonable degree of certainty.”
emphasis added
And…
It is important to note that with people told to stay away from emergency rooms unless they are seriously ill and with the justified fear of contracting COVID-19 a significant number of these fatalities are likely from other causes or deaths which would ordinarily have taken place in hospitals. But there’s little doubt a significant number of victims of COVID-19. It’s likely that some number of people are dying because they did not seek medical care.
One point about this is that some people are not making it to hospitals — they’re dying at home.
Location, Location, Location
Another way this uncertainty manifests is that different countries seem to be having different mortality rates. Josh Marshall compares a few here. Over at Mother Jones, chart master Kevin Drum has been tracking this for some time. Here’s his latest.
Figuring out why these numbers are different is going to be critical. (The BBC reports on an Italian town that’s being turned into a lab.) Josh Kovensky at TPM looks at what happened in Puerto Rico with Hurricane Maria and the Trump administration’s botched relief efforts.
Post-storm studies found that significantly more people died as an indirect result of the hurricane than the 64 people included in the official death toll. By the same token, people who died while never having been diagnosed with COVID-19 could be included in similar future studies.
The hurricane makes a particularly good comparison to COVID-19, Nazario argued, because it fundamentally damaged the island’s health care system and infrastructure, leading to questions over how many people died in the months that followed when access to care was limited.
...The resulting report estimated that 2,975 Puerto Ricans died following Hurricane Maria who would otherwise have survived in the four months following the disaster.
The number jibes with other estimates.
The enemy doesn't need to be Invisible IF we’re not looking in the right places
To make things more complicated, via CNN, there are reports that half of the people with coronavirus do not show any symptoms — but can still spread the disease.
"The results of the additional tests performed by deCODE have given an indication that efforts to limit the spread of the virus have been effective so far," the
government wrote last week, adding "testing in the general population will continue to elicit a much clearer picture of the actual spread of the SARS-CoV-2 virus in Iceland."
Some of the revelations have been stark. Although fewer than 1% of the tests came back positive for the virus, the company's founder Dr. Kári Stefánsson told CNN that around 50% of those who tested positive said they were asymptomatic,
confirming multiple studies that show that asymptomatic, or mildly symptomatic, people have played an important role in spreading the virus.
This is a problem in multiple ways. Without an accurate measure of infections, it’s impossible to accurately track infection spread, calculate mortality rates, or determine how well control efforts are working. The early failure of the U.S. to develop a working test, make use of existing tests, and test widely is having serious consequences.
The development of antibody tests to determine who has had the virus and recovered is also going to be critical going forward. Without those tests, we won’t be able to determine if people have acquired immunity or can be re-infected, or how many are still at risk in the absence of an effective vaccine.
Supply Side pandemics
One other way of thinking about coronavirus numbers. You hear about so many masks, so many ventilators, so many beds. Lt. Gen. Russel Honoré has been making the news rounds and points out that talking about millions of masks or hundreds of ICU beds is not as useful as looking at them as percent of capacity needed, or in days of supply. 5,000 masks is a good number if it means the hospital that has them has a 5 day supply. It’s not so good for a hospital if that’s only enough to get them through the next shift. Raw numbers are not a sufficient metric to measure how well things are going.
Josh Marshall at TPM has been following the supply story, and Federal actions are creating chaos and uncertainty.
...There are two key issues to consider here.
One is that the federal government is telling states that they are responsible for getting their own supplies and should only appeal to the federal government in emergencies. (See the recent debate about who the federal stockpile is for.) But at the same time federal authorities are seizing shipments that states, local governments and major medical organizations have purchased. At best this is a contradictory and poorly communicated policy.
It’s also very unclear just who is seizing the supplies, what they’re being used for or who is getting access to them. The assumption seems to be that they are being handed over to FEMA for distribution to other parts of the country. As explained by Admiral Polowczyk on Thursday at the White House briefing) or whether they are being distributed to other parts of the country on a preferential basis. We simply don’t know….
Who do you believe? Who do you trust?
Ideally government policy is informed by science and hard data. In the absence of information, the quality of leadership matters. When it is not possible to develop definitive solutions because there is information lacking — and there’s never enough information — what’s needed is people willing to assess the information that is available, make the best decisions they can on what they have, be willing to change course as more information comes in, and take responsibility for the results. Doing this openly and honestly is essential to keep trust in that leadership.
And then we have Trump.
In the absence of definitive answers, he’s been free to make up any story that fits the facts of the moment. If we get less than 100,000 deaths, he’ll declare it a win. (And if the real numbers don’t show up for weeks or months, he may get away with it, as he did with Hurricane Maria and Puerto Rico.) His followers will certainly believe it — even death is not enough to convince some of them. The fact that many people have mild cases or may not show symptoms makes it easier for them to discount the virus threat.
Trump’s frantic promotion of unproven drugs for the virus plays on the uncertainty. People who take the drug and have a mild case, or get the drug and aren’t killed by the virus will believe that Trump saved their lives. (As for the ones who die, well they won’t be voting for him, so who cares?) There’s a cynical calculation involved in recognizing that since most people will survive the disease, it is an opportunity to peddle a ‘cure’ to them.
Faith trumps fact, especially when facts are hard to come by. Believing in Trump is how his base deals with a world in which they find everything frightening. For some people a false idol is better than uncertainty. And for others, the false idol business can be damned lucrative. As Paul Krugman observes,
May be relevant to note that there is a long, close association between right-wing activism and medical quackery 1/
Rick Perlstein documented "mail-order conservatism" long ago 2/
Alex Jones peddled conspiracy theories as a vehicle for peddling nutritional supplements. Ben Shapiro, who is apparently the right's idea of an intellectual, is also in the patent medicine business 3/ https://brickhousenutrition.com/pages/benshapiro
Worth finding out whether, in addition to the desire for a miracle cure, there are some financial incentives for Trump to hawk a particular drug 4/
Bottom line
Uncertainty makes it difficult for people who actually know things to prevail over those who claim to know things; it’s the kind of climate in which snake oil salesmen thrive. Living with uncertainty is stressful. Here’s two points:
- The virus is out there, it’s spreading, and we are way behind in testing for it and getting the resources we need to treat those who become sick. That’s not good, but some leaders recognize it and are doing something about it.
- We do know this. Social distancing, hand washing, and face masks look like effective means of controlling its spread until we get a vaccine or find effective drugs. They seem to be making a difference if we keep doing the right things long enough.
We may not know everything we need to know about the coronavirus yet, but we know enough to start with what we have and where to look.
And not to listen to Trump.
Got any coping strategies? Please share them in comments.
One more thing — about that CDC Graphic of the Virus
As promised, here’s the story on the artists who take science and turn it into pictures. It’s what they do — but this time it’s gone farther.
...On Jan. 21, the day after the C.D.C. activated its emergency operations center for the new coronavirus, Ms. Eckert and her colleague Dan Higgins were asked to create “an identity” for the virus. “Something to grab the public’s attention,” she said. Ms. Eckert expected that whatever they came up with might appear on a few cable news programs, as their creations had in the past.
Instead, as the pandemic spread and intensified, their rendering’s reach did, too. “It started popping up around the world,” she said.
...She has seen her illustration turned into cookies and knitting projects. Someone recently told Ms. Eckert that her image haunts them on their occasional trips to the grocery store. If they reach out to touch something, they’ll picture that spiky gray blob and pause.
She was glad to hear it, she said. “It’s out there doing its job.”