Three facts should define how we see COVID-19 – and whether America reopens. They are important, not much talked about. They should guide policy at all levels.
First, total deaths attributed to the virus may be inaccurate, due to death certificate discontinuities. Second, non-coronavirus deaths may be spiking from the shutdown. Third, virus deaths are clustered, while most counties have no deaths.
Facts matter. Different jurisdictions are attributing death to COVID-19 in different ways, and that has big implications. CDC guidance has been loose and changing, creating pervasive and systemic inaccuracy in state death counts. The guidance talks of assumptions in assigning cause of death, which is creating wild differences state to state.
Specifically, some authorities allow “cause of death” to be presumed, without testing. Others downplay comorbidities. While this may raise numbers for federal aid, it also overrepresents the population dying of COVID-19.
For example, a respiratory death in someone with advanced cancer, heart disease, emphysema, bronchitis, asthma, pulmonary hypertension, occupational lung disease, progressive stroke, diabetes, flu, pneumonia, liver disease, cirrhosis, or Alzheimer’s – could be identified as COVID-19. While the virus may hasten the outcome, the cause is elsewhere.
Compounding the problem, human judgments without testing are subjective. In a crisis, fear and public expectations reinforce over-classification. Corroborating overstatement of COVID-19 deaths is hard, but loose guidance suggests inaccuracy. One indication of overcounting is that leading causes of death in any given year include all the above.
In other words, people die annually of these diseases. When a terminal patient dies early from a respiratory ailment is that a “COVID-19 death”? At best, numbers are misleading. At worst, they are misinforming policy.
How inaccurate could they be? Colorado provides a good example. The state just admitted overcounting, saying many who tested positive for COVID-19 died of something else. As reported, “Colorado has made a stunning and significant change to the way it counts COVID-19 deaths,” markedly reducing “statewide figures.”
According to Colorado’s Public Health Department, the state was counting “those who tested positive for the coronavirus but died of other causes.” They say a realistic review changed everything. Of 1,150 people who tested positive, only 878 deaths are now “due to” COVID-19.
Beyond evolving “death certificate” guidance, states are realizing a test does not decide “cause of death.” Thus, a patient with severe organ damage who gets a verifiable cold and dies does not die of a cold.
In short, our count is compromised. As our “official” COVID-19 death toll nears 90,000, one must ask: Are these deaths typically found in top ten causes being re-catalogued COVID-19?
Of course, the media will not ask. They are ready to report big numbers. Still, now that Colorado has amended numbers, reducing overall deaths attributable to COVID-19, should other states follow? Should national aggregators?
Second, look hard at rising non-coronavirus deaths – correlated with the shutdown. Based on past studies, jumps may be expected in cancers (tied to postponed elective surgery), heart attacks and strokes (untimely diagnosis and elevated stress), drug overdoses (stress and poverty), alcohol poisoning and suicides (ditto).
History teaches stress rises in economic downturns as unemployment, insecurity, debt and doubt mount. In recent weeks, we have seen 33 million first-time unemployment claims, a record. One in five Americans who was employed in February today is not.
Worse, poorly managed states are bungling benefits, businesses are preparing for bankruptcy, and inexcusable delays dogged Congress in March and April – when the chance to save lives, jobs and businesses counted most.
If these circumstances did not elevate stress, other events did. Key consumer goods were hard to find, relatives hard to visit, churches and barbers closed.
Governors – each getting a paycheck – have done “daily crisis briefings.” Maybe numbers now suffering the economic shutdown should start to be tallied, too.
In short, two causes of higher non-coronavirus deaths are at work –
elevated economic stress and uncertainty about when America gets back to work. Taken together, they are a heavy counterweight. We cannot let the virus take precedence over reopening – even if reopening must be done thoughtfully.
At that point, we will be looking backwards, very possibly wishing we had reopened faster, gotten people back to work, lowered aggregate stress and uncertainty, restored economic normality.
Third, other facts favor accelerated reopening. Put aside constitutional arguments, balancing liberty with gubernatorial police powers. Look at county-by-county numbers.
At this point, more than half of all COVID-19 deaths – however you count – are in one percent of the nation’s counties. Those counties represent roughly 15 percent of the nation’s population.
By contrast, more than 50 percent of counties have had zero virus deaths – even under loose rules – and 63 percent of counties have had zero or one death.
Does that tell us something? Does that recommend we “bring the lights up” by county? Maybe so. Would that give us a reopening that gets half the country “back on our feet,” the rest assisted by monetary, fiscal, and presidential action?
In short, three facts – inaccurate death counts, spiking non-coronavirus deaths from duress, and good health for many – should tip the balance to thoughtful, measured, accelerated reopening. If we fear the future, we are unfaithful to our past. Some things are unknowable. Common sense says time to turn the dial.