Coronavirus deaths under-count.

[hay rick]

I have been watching and puzzling over 4 numbers for the last month. The numbers are worldwide COVID-19 cases, worldwide COVID-19 deaths, U.S. COVID-19 cases, and U.S. COVID-19 deaths. The puzzle has been that the ratio of deaths to cases is much higher worldwide than it is in America. The obvious possible explanations are worldwide under-counting of cases, American under-reporting of deaths, variations in healthcare systems, and variation in national responses.

My most recent calculation is that the ratio of deaths to reported cases is 6.3% worldwide, but only 2.7% in the United States. My expectation is that, at some point, these numbers will be used by the Trump campaign to support the claim that Trump's response was effective. It is obvious that the Trump campaign is already preparing a campaign to move the goalposts. Trump's reference to worst case scenarios in which 1 to 2.2 million Americans could have died is an obvious part of that effort. The 100,000 to 240,000 estimate of recent days has the Fauci seal of approval (non-contradiction). Any cumulative death toll under 100,000 will surely be touted as a victory. The public health need for good statistics clearly conflicts with Trump's political need to keep the numbers down. We need to be on the alert for an orchestrated attempt to sanitize the mortality numbers, at least through November.

Here's a recent NYT article on the subject: https://www.nytimes.com/2020/04/05/us/coronavirus-deaths-undercount.html

A coroner in Indiana wanted to know if the coronavirus had killed a man in early March, but said that her health department denied a test. Paramedics in New York City say that many patients who died at home were never tested for the coronavirus, even if they showed telltale signs of infection.

In Virginia, a funeral director prepared the remains of three people after health workers cautioned her that they each had tested positive for the coronavirus. But only one of the three had the virus noted on the death certificate.

Across the United States, even as coronavirus deaths are being recorded in terrifying numbers — many hundreds each day — the true death toll is likely much higher.

[jberryhill]

1. It's hard to hide excess mortality

Mortality is quite regular and predictable. Excess mortality sticks out like a sore thumb.

That is how we know the death toll from Hurricane Maria - from the excess mortality.

[hay rick]

3. The excess mortality has to be understood, reported, and noticed.

The Trump propaganda megaphone will drown out the latest reporting in the Lancet Journal.

[jberryhill]

5. First off...

it's the MMWR, not Lancet, and that's a tough one to bury considering it is a weekly tabulation.

And, secondly, it's kind of tough to get the state vital records offices on board with this conspiracy. It's a crime for a variety of people to fail to report a death, and most physicians, health care facilities, etc., are not risking jail time to hide a death. Or a lot of deaths.

[Bucky]

12. A lot will be written off as death by pneumonia

People determined to hide the truth have ways of laundering the statistics

[jberryhill]

14. There is no such thing as "excess pneumonia"

So, is Andrew Cuomo’s administration in on the conspiracy? And all of the other states? Because the federal government doesn’t handle state vital statistics.

As far as “writing it off as pneumonia” goes, that’s just plain stupid. The expected mortality from pneumonia is a known quantity. It will stick out like a sore thumb.

So, your plan is to just recategorize the deaths so no one notices, and get all of the doctors signing death certificates to go along with the plan:

[Hoyt]

2. We are long past having to count deaths to prove trump is incompetent and CV19 is not a "hoax."

Reliable stats are important, but even if the count is lower than actual, trump won't escape deserved blame.

[matt819]

4. It's what many of us have been saying here

There are just too damn many variables to trust the data that we are all see on sites like the Johns Hopkins page or worldometers or even WHO.

You have case fatality rates from .7% (Russia) to 1.7% (Germany, South Korea) to 3.1% (US) to 9.8% (Spain) and 12.4% (Italy), for a worldwide rate of 5.6%.

Without widespread testing, we really have no idea what the rates really are. There are people who were sick in late Jan/early Feb who are convinced they had it - all the right symptoms following air travel - but recovered. They are not in anyone's count.

And, of course, people who have called their doctor to describe symptoms are told to assume they have the disease but not to go to the ER until they are much, much worse. They're not counted.

Then there are the countries whose data we can't really trust. Is the outbreak in China really contained? And look at Russia. Really? And the US. Although our numbers are growing, I think collectively we believe it is much worse, largely because of the absence of widespread testing as well as the sad reality that our government can't be trusted.

Then there's how nations have responded. Germany and South Korea were on top of this from the start. The US moseyed into the fray a week or two ago, and a fairly substantial portion of the country is simply ignoring it because "liberty" or "blood of Jesus."

Then there's the number of "recovered." Those numbers are not moving particularly fast. Are the recovered not being reported? Are reporting hospitals and government entities waiting for a certain amount of time to pass before reporting these numbers?

The reality is that we won't really know the full scope of the damage until it's over, and I use "it's over" cautiously. Other similar viruses have dissipated in the past. Will this one? Will it mutate in something else, or many somethings else? In any case, only when things return to some form of normal will the statisticians et al be able to calculate the impact.

[Crunchy Frog]

6. It will take later demographic studies to get a handle on the true numbers.

I don't think they can suppress it forever, though.

[hay rick]

7. They don't have to suppress information or obfuscate forever. Just through November. nt

[defacto7]

8. Kick & R

[hay rick]

9. Another article suggesting 40% under-counting in NYC.

https://gothamist.com/news/surge-number-new-yorkers-dying-home-officials-suspect-undercount-covid-19-related-deaths

[Steelrolled]

10. It will take a year or more to really figure this out.

Although the fact that it is intertwined with politics might mean we will never know for sure.

[hay rick]

11. Related- more testing means more deaths will be attributed to COVID-19.

Therefore there is a perverse political incentive to discourage or at least not encourage testing. Something to watch. Article here: https://www.npr.org/sections/coronavirus-live-updates/2020/04/08/829955099/federal-support-for-coronavirus-testing-sites-end-as-peak-nears.

[shanti]

15. It's historical

The 1918 Spanish flu was undercounted too.

[uponit7771]

13. K&R, they can under count the deaths but they wont be ale to under cunt the hospitalizations

[fishwax]

16. NYC has had something like 250 per day dying at home the last few days

compared to 50-60 per day under normal circumstances. Many of them probably had the disease, but unless they were tested while alive, they will, at most, be reported as presumed cases, and won't be counted among those killed by Covid-19.

Yeah, we're definitely undercounting the deaths here, just as we're undercounting cases overall.