Let's start with cases. The definition of a "case" can vary, but for the most part the numbers you see are the number of positive PCR tests. This is obviously a function of how many people get tested and the sampling frame for those tests. Right now in the U.S. we are not testing a random sample of the population anywhere. We are largely only testing people who present with severe enough symptoms to consider hospitalization, and some other situations such as the residents of nursing homes with a positive case. What we ought to be doing is what South Korea started doing from the beginning: testing all the contacts of known cases so that people who tested positive could be isolated. That's how they got control of the epidemic early, but it's far too late for that in the U.S. Therefore we actually have no idea how many people in the U.S. are, or have been infected.
There's another problem. The test we're using in the U.S. is not very sensitive. The best estimate is that it's 70% sensitive which means that nearly one third of people who are in fact infected will test negative. In much of the world, there is even less capacity to test and in many places people who get sick don't even get medical care. The actual toll in places like Iran, Iraq, Syria, Yemen, is completely unknown but absolutely must be far higher than what has been reported.
As for deaths, countries have different capacities and policies for counting them. For the most part only deaths in hospitals are reported, and only counted if the person had tested positive -- this is the case in both the U.S. and the U.K. But many people never make it to the hospital and some who do are never tested.
The daily tally of New York City residents who died at home with coronavirus-like symptoms exploded from 45 on March 20 to 241 on April 5, according to Fire Department of New York data - suggesting the city may be significantly undercounting COVID-19 deaths.. . .
And Alabama:
When patients arrive in the emergency room with trouble breathing, doctors may not know for sure if they have coronavirus. If those patients pass away, their families are no longer in the emergency room to help doctors understand the back story.“I'm never going to know, because I'm not going to test them in arrears and we generally don't do autopsies on these deaths,” she said. . . .
And it's worse than that. As Josh Marshall reports:For physicians on the frontlines facing uncertainty about what’s ahead, like Dr. Williams in Huntsville, having some idea of a death rate for the disease is helping her team prepare for what may come. She says she has read guidance from the CDC, which collects cause of death data from states, asking physicians to note “probable” or “presumed” COVID-19 deaths. But as a healthcare professional, she says she is not comfortable with that level of guessing, and the online death certificates she uses don’t give a “probable” option. “We tend to not want to put things that we can’t know for sure,” she said, adding that there’s a variable practice among doctors.
We’ve now seen the common pattern. A certain region or jurisdiction reports X number of COVID-19 fatalities over a given period. But when the average number of deaths for all causes is compared to these COVID-19 death tolls they are still dramatically higher than the COVID-19 numbers alone can account for. So we see a large number of unexplained deaths that are almost certainly due to the COVID-19 crisis, whether that is people dying of COVID-19 or dying from other causes at higher rates because of the social and medical care disruptions brought in its wake.
He goes on to discuss the example of Madrid:
The basic numbers. In 2019 they estimate there were 2,394 deaths between March 14th and March 31st in the Madrid region. In 2020 that number was 9,007. So a difference of 6,613. But the number of official COVID-19 deaths during that period was 3,439. So simple math, 3,174 unexplained deaths.
So will we ever know anything close to the truth? We'll probably come up with reasonably good estimates after the fact, but we aren't being told the truth in real time.
4 comments:
Question for Cervantes: Assuming the number of COVID-19 cases is much higher than we know, which means the amount of illness and number of deaths is much higher than we know, is it your view that given the time it will take for vaccines (~ 1 year), most people on Earth are going to acquire a case of COVID-19?
Many silver linings to come out of this crisis. Today, there were two wild turkeys in our front yard, loitering under the bird feeder for a few minutes. We've never seen that in four years here. Animals and birds are coming out into the open, without many humans around.
Also: reports in the media and on television are circulating that, as a result of data pertaining to ethnicity, the percentage of African-Americans hospitalized for COVID-19--behold!--is much, much greater than their percentage of a given population.
Who knew? Apparently, the corporate media. I've worked in food service and in a predominantly African-American school, and I can say empirically that I've marveled at some of my colleagues who come to work and bust their asses, day after day, while dealing with: diabetes, high blood pressure, cancer, lack of sufficient child care, lack of transportation, anxiety disorder, and other maladies physical and socioeconomic. But to our fearful, insulated, corrupt Republicans in government, the African-American population has remained undesirable, invisible and unimportant for centuries now. That has not changed for racists like McConnell, Trump and others. So many people have misinterpreted the "Black Lives Matter" movement and posters. They get indiganant--POLICE liver matter!"
They don't get it. We already KNOW that. But many of us don't know that African-Americans'--you know, besides, for example, those invisible "other" people like Richard Pryor, Barack Obama, Louis Armstrong, George Washington Carver, Paul Robeson, Oscar Micheaux, Muhammad Ali, Thurgood Marshall, Marian Anderson, Maya Angelou, Sammy Davis Jr., Frederick Douglass, Miles Davis, Ellis Marsalis and his sons, Harriet Tubman, Benjamin Banneker, Booker Little, Charlie Parker, Duke Ellington, Stevie Wonder, Tiger Woods, Oprah Winfrey, Langston Hughes, Joe Louis, Michael Jordan, Jackie Robinson, Beyoncé, John Coltrane, Zora Neale Hursont, Kobe Bryant, Will Smith, Serena and Vanessa Williams, Chris Rock, Tyra Banks, Denzel Washington, Martin Luther King Jr., W.E.B. DuBois, etc., the list goes on--lives ALSO matter. If it weren't for African-Americans, we wouldn't HAVE any culture. The great European musicians like Ravel and Stravinsky and Dvořák recognized this when they heard jazz, our greatest indigenous art form.
The answer to your first question is that in the absence of shutting down the economy, that would likely have happened. But given the extreme measures that most countries have taken, it likely won't. But at this point we just don't know how many people have been exposed and what level of herd immunity may have built up.
As for your second comment, I'll just add that all of the most disadvantaged people are disproportionately affected.
I agree that American artistic culture is very much built on African American culture. We all know that rock developed from African American music, as did popular music in general. But not everyone knows that the banjo is an African instrument. But there's credit to go around. For example, our comedic tradition comes out of Yiddish theater, as transmitted by way of the Marx brothers and the Three Stooges (whose schtick originated in Italian comedia del arte), among others. Yiddish drama also blended with the English theatrical tradition to produce our Broadway stage.
Points taken. It's so ironic that so little credit for our great indigenous music and comedy is attributed to Caucasians. Sure, we had a hell of a lot of avant garde "classical" composers, much of whose music is not played often if ever ... and Madison Ave. gave us the "indigenous" art form of advertising, but its value is spiritually bereft.
People should know, should see, should feel in their bones the value of immigrants' contributions.
America as we know it--it probably would have been better if Caucasians had never arrived--would not even exist without immigrants' contributions. Like I've said before, at virtually all of the marriage parties where I've worked as a caterer, all the Caucasian folk be dancin' to James Brown, Whitney Houston, Earth Wind & Fire, Stevie Wonder, etc. There'd be no dancing without this country's enslaved persons' descendants' soulful music ...
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