What's the Real Number?

The New York Times has a report that we have undercounted the death toll from COVID-19 by perhaps 40,000 people. Separately, the Financial Times has a report that we may have missed the global death toll by 60% of cases.

Concurrent to both of those is a growing belief among a lot of people that the death toll is not only overblown, but the virus is far more common and widespread than believed. The second part of this comes from the rush of press reports about antibody studies. To be sure, it appears the virus is more widespread, and more people have it. However, it is not nearly as widespread as some on the right think; the initial studies were pretty deeply flawed; and there is evidence some of the antibody tests were just bad, including triggering a positive based on the common cold.

Again, though, I can give you all the data. It’s on you whether you believe it.

But, we should acknowledge that Congress has provided a financial incentive for hospitals to overinflate deaths from COVID-19. Under the CARES Act, recently passed by Congress, hospitals will get 20% more Medicare/Medicaid money based on treatment for COVID-19 as a primary or a secondary infection.

I suspect our news headlines for the next five years will be plagued with stories of fraud and arrests due to COVID-19 reporting.

That 20% data has allowed a number of people to take comfort in the idea that all the deaths are exaggerated and things are not so bad therefore their prior belief that we never should have sheltered-in-place can be confirmed. I continue to be amazed at the people who are willing to twist or ignore any data that might suggest they were wrong.

We should, for example, be excited by antibody testing showing the infection is more widespread. It means the hospitalization and mortality rates are not nearly as bad as we first thought. But we should also keep the testing flaws and real-word data in check — hospitals around the world have been overwhelmed by COVID-19 at an alarming rate so even if the virus is more widespread, it still overwhelms hospitals more than a bad flu.

Concurrently, we need to consider the New York Times and Financial Times studies. COVID-19 seems to be more of an urban issue than a rural issue. It is a virus that plagues cities. Cities that have seen outbreaks have seen huge spikes in deaths generally.

Some will say that this is people refusing to go to the hospital for anything and they would be right. In that data is the heart attack victim, the stroke victim, etc, who were too scared to go to the ER. But the data is also less anomalous than that. The data is consistent across countries and cities that there are huge spikes in deaths in areas plagued by the virus — much more so than normal and much outside the bounds of normal ranges for strokes and heart attacks in those areas.

This reasonably does suggest COVID-19 is killing people at home.

On top of that, we are not making apples to apples comparisons in most things, including flu deaths. In the United States, the flu and pneumonia deaths are counted based on confirmed tests and presumed cases. COVID-19 numbers, as reported by the CDC, currently only included confirmed positive cases. Contrary to some speculation, the CDC is not yet reporting presumed cases of COVID-19 with the positive tests. New York City may be broadcasting that data and some sites may be reporting it, but the CDC is not.

There are those who claim that COVID-19 deaths are overinflated because people are dying of gunshot wounds but tested positive for COVID-19 and so are being categorized as COVID-19 deaths. Feel free to believe that if you want. I cannot dissuade what is becoming a dogmatic belief among some. What I can say is that it is silly to think there is a grand global conspiracy to rig the data and it is remarkable that globally we are seeing very similar rates of hospitalization and death. It is silly to think American hospitals were inflating their numbers to get federal money two months ago when the CARES Act wasn’t even being considered.

Sure, there could be an Illuminati controlling the data, inflating the deaths, and making sure every country is in that 20% hospitalization metric and 3-5% death rate. I guess someone somewhere could be secretly calling hospital administrators in Atlanta, New Orleans, Dallas, Paris, London, Berlin, and Prague telling everyone to boost their numbers to keep everything globally in line. “Only the American hospitals are going to get that 20% bonus, but we need to keep everyone’s data in line to help out those American hospitals,” he’d whisper to them and remarkably everyone who overshares on social media would keep it all a secret.

I guess that could happen.

Or maybe the virus really is bad. Maybe there are some cases that are mischaracterized. Maybe some of the deaths are exaggerated. But like Democrats claiming Republicans suppressed the vote and that’s how they won, maybe the data also shows that the effort to exaggerate and suppress are not vast enough to change overall outcomes. Right now, COVID-19 is killing people at a rate orders of magnitude higher than even a bad flu. Even if the numbers dropped based on error or fabrication, they’d have to drop massively to get down to flu rates just based on positive tests.

That again is something people are missing as they clutch the pearls of antibody testing as proof the virus is massively widespread. In 2018-2019, for an entire year, there were less than 7000 people who died of the flu or pneumonia based on a positive test. I’m excluding presumed cases. Just based on positive tests, less than 7,000 people died in the flu season of six months.

Thus far, in eight or nine weeks, over 50,000 Americans have died based on a positive COVID-19 test. Are we really to believe 40,000 of those deaths were from something other than COVID-19 and the paperwork was rigged? Was it 20,000? Or is it actually a pretty bad virus that is worse than the flu?

All I can do is give you the data. I can’t make you believe it.

What I can suggest, however, is that those who recognize how bad the virus is should not be poo-pooing the idea of reopening the country. It needs to reopen. We need to be cautious. But we sheltered in place for weeks, we got the viral rate down, and people need to get back to work.

The economic devastation is going to be brutal and the skeptics of the virus are right that the long term fall out is going to be damaging in terms of mental health, suicide, and livelihoods lost. I realize it is missed in the coversations out there, but it is possible to think this is a deadly virus that can overwhelm us and kill many and yet we still have to get out of our houses.

If the virus is coming back in the fall, we might as well start now finding ways to reopen and go on with life while accomodating it. There’s no better time than now to figure out the path forward.

Americans are not designed to sit in their houses doing nothing. Americans are not designed to take government handouts to not work. Americans are designed, at their founding, to embrace liberty or death. Might as well figure out a way to balance the two.