Estimation of total mortality due to COVID-19
healthdata.org
healthdata.org
> Our analysis follows four key steps. First, for all locations where weekly or monthly all-cause mortality has been reported since the start of the pandemic, we estimate how much mortality increased compared to the expected death rate....Second, based on a range of studies and consideration of other evidence, we estimate the fraction of excess mortality that is from total COVID-19 deaths as opposed to the five other drivers that influence excess mortality. Third, we build a statistical model that predicts the weekly ratio of total COVID-19 deaths to reported COVID-19 deaths based on covariates and spatial effects. Fourth, we use this statistical relationship to predict the ratio of total to reported COVID-19 deaths in places without data on total COVID-19 deaths and then multiply the reported COVID-19 deaths by this ratio to generate estimates of total COVID-19 deaths for all locations.
And, what, you may ask, are the biases of the models' authors with regards to the percentage of excess mortality due to Covid itself? Excellent question:
> Deaths that are directly due to COVID-19 are likely underreported in many locations, particularly in settings where COVID-19 testing is in short supply. Most excess mortality is likely misclassified COVID-19 deaths.
> Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality. For the reasons presented in this section, we believe that this is likely an underestimate.
As someone who has now spent the better part of his life creating statistical models, when you assume something is true, your model is likely to confirm your assumptions.
This is why statistical models are worthless without prospective validation. If you haven't shown that your assumptions are correct for the future, you're just making castles in the sky.
why?
I own an inherited blue Pelican paperbook copy from my pharmacist grandfather.
Basically: your response seems a bit nitpicky to me, which tells me that perhaps you're starting from a perspective where you're assuming the article is wrong and looking for holes to poke.
Look, nothing about this paper's conclusions is surprising at all. At all. We all know true covid deaths are higher than reported, because all such metrics underreport, for all diseases (and frankly almost all causes of death). The only question is "By how much?". So you don't like 400k. What's your counter?
I don't know the answer, and neither do you. But given that the top-line is asserting that there are 900k excess deaths due to Covid, the choice of assumption here is not some minor detail. There are lots of other plausible alternative hypotheses.
Aassuming X, then building a model that shows X is true, is not validating a hypothesis.
Please list them.
We have data about deaths going back many decades. It's very safe to say that if in 2010 you made a prediction about the number of expected deaths in 2011, you would have been very close to the real number. Same if you had predicted the deaths for 2019 in 2018.
Suddenly, after decades and decades of being almost perfect in your predictions, you would have been wildly wrong for the predicted number of deaths in 2020.
After decades of predictability, there was a whopping 20% increase in 2020 [1]. How can you possibly say it wasn't caused by Covid?
[1] https://jamanetwork.com/journals/jama/fullarticle/2778361
We also have plenty of time series data from effectively instituted lockdowns worldwide. Excess deaths rise prior to the lockdown, in line with but greater than reported COVID deaths. They continue rising until median COVID- time-to-death days after the start of lockdown. Then they fall, sharply, dipping below regular excess deaths (and tracking the fall in COVID deaths). That isn't a pattern that fits the "maybe some other factor like the lockdown itself caused the spike" hypothesis, and it is also the pattern that was predicted by the scientists advocating the lockdowns.
Sure, some deaths are caused by lockdown, but the evidence suggests a pattern of the deaths which have been[1] caused by lockdown being [more than] netted out by normal deaths prevented by lockdown.
Some days it's cold, and anthropogenic climate change models are just fancy math, but this doesn't make all climate hypotheses equally plausible
[1]there's a plausible argument lack of medical attention during lockdowns and/or long term economic consequences may have a significant death toll in future, but that doesn't affect the "excess deaths reported during COVID have matched COVID spikes evidence
It's interesting how you can't suspend your credulity to encompass the idea that there are alternative hypotheses for excess deaths, but you are more than happy to assert the existence of "vast datasets" to defend your own opinions.
Here are a few plausible alternative hypotheses that actually have substantial backing evidence, which can be obtained with trivial googling:
* Excess deaths due to missed treatments (we know this is happening, e.g. for cancer)
* Excess deaths due to untreated acute medical emergencies (e.g. physicians in NYC noticed the curious phenomenon of heart attacks disappearing from ERs during the height of lockdown
* Excess deaths due to drug and alcohol abuse (again, we know it's happening)
I'm sure there are many others worth consideration. My point is not to assert that any of these are automatically true, but that they merit consideration, and anyone who doesn't fairly consider them is probably not engaged in good-faith debate.
Nobody is disputing that excess deaths are happening, the question is why they're happening.
Again, not sure why I can’t reply directly to timr, but the data in the graphs on EuroMOMO is not spelled out, it’s just data. That’s no reason to dismiss it?
You can start by asking questions like- why do some neighbouring countries have different profiles? Why do some not have any excess mortality? Why do some have multiple spikes?
I would be curious which ones that would be.
Again, I get the distinct feeling that you're arguing with methodology here not because there's anything particularly suspicious with IHME at all, but because the conclusion (that the US is approaching 1M covid deaths, something that should surprise no one) is politically inconvenient.
I don't know. I don't cross-check my thoughts with every "expert" in the world before I express them. I have expertise in this field; I can think for myself.
> Again, I get the distinct feeling that you're arguing with methodology here not because there's anything particularly suspicious with IHME at all, but because the conclusion (that the US is approaching 1M covid deaths, something that should surprise no one) is politically inconvenient.
You have no idea what my politics are. I am saying that this model reflects the assumptions used to create it. Nothing more, nothing less. It is not a validation of the assumptions -- it is a regurgitation of the assumptions.
I mean, duh. Usually hypotheses are right! You're right that it would be more interesting if it showed some kind of confounding effect or whatever.
But it didn't. It turns out that the boring explanation seems like the right one: the anomalously high number of people who died of unexplained reasons in 2020 was just the giant global pandemic. Oh well.
It's disengenuous to say Covid is the cause if politicians used hamfisted responses that led to more deaths than necessary.
This part is especially doubtful for me, as there are factors moving it in either direction. For one, the pandemic measures also helped a lot for things like the flu, which had less cases and therefore caused less deaths. On the other hand, problems caused by lack of exercise and social interaction have definitely increased. Lastly, I'm quite sure we have a lot of missclassified deaths in either direction.
These are all quite different and I see no reason to assume these factors even out.
Also, suicides aren't significantly up,the physical and psychological effects of lockdown don't happen immediately, while a reduction of car deaths do.
e.g. UK suicides have not significantly changed in 2020:
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...
So overall I think they're pretty safely assume that any excess deaths are coronavirus, especially as flu has all but disappeared too.
People avoiding medical treatment is awkward in the figures, because - medical treatment sometimes kills people. First link I found suggests that medical treatments cause 800,000 deaths per year in the USA.
If medical treatments are really down, I'd guess we might actually expect mortality figures to be temporarily down (but, higher later).
Whenever you take any surgery (for example), the meaningful risk of immediate death is balanced against the benefit of better quality of life later.
If you measure the impact of medical treatments only on the day they are taken, you'll only find evidence that a bunch of people have died who wouldn't have otherwise died on that day.
You can't then observe the benefit until some time has passed.
That number pops up all the time in clickbait headlines, but the study behind it doesn't really support the claim.
There is a pretty substantial difference between "Deaths caused by medical mistakes" and "Deaths that occur in a certain timeframe after a medical mistake occurs" (which is what the study actually looked at) are two very different things.
The sicker someone is, the more likely they are to receive healthcare (so there are more opportunities for mistakes). Also, the sicker someone is, the more likely they are to die. Those two combine to result in a lot of folks that die shortly after a medical mistake, even if the mistake was very minor, and didn't contribute in any way to their death.
Doesn't honestly surprise me that much , I was driving up i95 in late March and people were pulling some really crazy shit in the early pandemic. I also saw a few (looked deadly to me) wrecks on the highway.
You'd think people would chill out because the roads were practically empty, but I guess pandemic stress combined with the immediate rage of "the roads are empty and this asshole camper is only doing 75 mph in left lane" leading to absolute lunacy at very high speeds.
Normal levels of rush hour traffic around here mean nobody can do more than 50 mph at best with an average speed closer to 35, which probably keeps the deaths down.
Second wave was more difficult since it overlapped the normal flu season.
You can see graphs here showing normal flu seasons and where COVID fits in: https://www.euromomo.eu/graphs-and-maps/
This seems reasonable, although I'd suggest it's an underestimate of COVID-19 deaths.
Excess deaths counts have been consistently showing negative in countries during periods of time where they have coronavirus under control.
Other significant causes of death (including suicide, influenza, road traffic accidents) appear to be down.
As such, I'd assume that COVID-19 deaths are likely somewhat higher than excess mortality figures. I'm prepared to accept the assumption that they're approximately the same.
[Edited to note: the linked article discusses this with further detail and evidence]
Edit: data source is cdc total mortality page. Going back to 2014
Here's the sum total of evidence provided:
> An analysis by the Netherlands statistical agency suggested that all excess deaths in the Netherlands were directly due to COVID-19
So they use a single study out of Europe to extrapolate here.
> The second driver of excess mortality is reduced health care utilization for many causes;3 however, the impact of reduced health care use on health outcomes is harder to prove. Many mechanisms have been proposed, including reduced vaccination rates and reduced births in hospital.4 Demonstrated increases in cause-specific mortality related to these causes, however, have not yet been verified. The impact of changes in health care utilization on excess mortality may be observed in later years, rather than in 2020 or the first quarter of 2021.
So they dismiss this.
> Third, convincing evidence has been found that rates of anxiety and depression have increased, which might in turn lead to increases in deaths from suicide.5 To date, the evidence on increased suicide is very limited.6 Opioid deaths, on the other hand, have clearly increased7 in the United States. Compared to past trends, opioid deaths increased by around 15,000 since March 2020. Evidence on whether this has also occurred in other countries awaits further study.
So again, they dismiss this.
> Fourth, we reviewed the evidence on decreases in injuries as a result of reductions in mobility. We analyzed data from 12 countries that provide cause of death data by week or month, which allows us to test whether some causes decreased significantly during 2020 and whether that decrease was related to the decreases in mobility that have been reported. This analysis suggests that globally, injury mortality decreased by 5% in 2020 due to reductions in mobility. At the global level, this translates into a reduction of approximately 215,000 deaths.
Conveniently, when then assumption works out in their favor, they include it in the model.
> Fifth, some infectious causes of death may have declined during the pandemic due to the behavioral changes associated with control of the pandemic, including mask use and reduced contact with others. Causes that have clearly declined are influenza,8,9 respiratory syncytial virus,10 measles,11 and possibly other respiratory viruses and viral diarrheas. For example, influenza cases in the United States declined 99.3% from the winter season of 2019–2020 to the winter season of 2020–2021. Combining the reductions reported in different countries in influenza, respiratory syncytial virus, and measles, the global reduction in mortality from these causes may be larger than 400,000 deaths.
Again, when the assumption works in their favor, they include it.
> Sixth, deaths from some chronic conditions such as ischemic heart disease or chronic respiratory disease declined in some months of 2020, most notably in May and June in Europe. These declines were most likely due to the fact that frail individuals who died from COVID-19 earlier in the year would otherwise likely have died from these chronic conditions. The strongest evidence for this effect is that excess mortality was negative in some countries in Europe in June when the reported COVID-19 death rate was very low. In aggregate, this effect likely reduced mortality by only 2% based on our analysis.
This is so egregious as to be laughable...they find evidence for something, and then "based on their analysis", limit the effects.
> The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude. Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality.
So they didn't even try.
Again...I don't know what the right answer is here, but this is, at best, a biased reading of the available data. All you can do is throw up your hands and go back to first principles: without prospective validation, statistical models are fiction.
I personally wouldn't have excluded these weeks - unless you're going to exclude historical (near-annual) heatwaves from the figures, this should balance out.
> All you can do is throw up your hands and go back to first principles: without prospective validation, statistical models are fiction.
No estimation is perfect, nor expected to be, and so your criticism is unreasonable. You're doing exactly the things that you are criticising the study for, and more so. You provide zero evidence to counter their sourced evidence, and ignore and dismiss points that don't match what you are trying to say.
They have provided no "evidence" -- they made a model. They have provided no validation of that model, so it could be completely incorrect. Nobody knows.
Furthermore, I just showed you that of the sourced evidence they did consider, they dismissed nearly everything that reduced the death rate attributable to Covid, and said it was "too dificult" to quantify.
Mathematical models without prospective validation are not evidence. They are not science. They are bedtime stories.
I wouldn't be completely dismissive. The first attempts at using statistical data to drive medical practice were during the Napoleonic wars, and dramatically improved medicine. I would expect the statistical methods used were pretty crude, as it was a very young discipline.
No matter how crude your methods, if you don't validate your model prospectively, it is a mathematical fairy tale.
Not just a holdout set -- a holdout set of prospective data, where you actually predict the future, blindly, and see how you do.
Obviously, you have to wait a little while to gather such data before you make big claims with your model. Doesn't mean you get to skip it.
It's not even clear to me that the authors did a cross-validation here, or even bothered to fit the free parameters of their model based on any kind of empirical data at all. At least with regard to percentage of excess deaths due to Covid, I'm not sure how they could...the parameters seem to be unrelated to any empirical data.
Also, if I understand correctly, none of the modeling done in standard texts such as Gelman et al.'s Bayesian Data Analysis involves prospective validation under your definition. Should we then classify the examples in that book as "mathematical fairy tales"? This seems like a fairly strict standard!
> Also, if I understand correctly, none of the modeling done in standard texts such as Gelman et al.'s Bayesian Data Analysis involves prospective validation under your definition. Should we then classify the examples in that book as "mathematical fairy tales"? This seems like a fairly strict standard!
It's surprisingly common for models to pass all of the cross-validation you want to throw at them, and fail in the real world. I don't care what statistical techniques you've applied, if you don't conduct blind tests, you don't know how your model performs.
Setting this aside: TFA did nothing you're talking about. Let's be clear about that.
Suppose I blind myself to the holdout set. What's the difference?
> It's surprisingly common for models to pass all of the cross-validation you want to throw at them, and fail in the real world. I don't care what statistical techniques you've applied, if you don't conduct blind tests, you don't know how your model performs.
What exact failure mode is such that a) prospective testing guards against it, and b) traditional validation methods do not?
Take for example distribution shift. Suppose I'm worried the underlying data generating process is going to change between training and deployment. You propose, I guess, that this is fixed by collecting more data prospectively. OK, suppose and I do that and everything checks out. Now what guarantees there is no distribution shift between the time I do the prospective testing and subsequently deploy the model?
To be more direct: one eventually has to make assumptions of statistical regularity and distributional constancy somewhere, at some point, in order to do any statistical inference at all. If you have good reasons to make such an assumption, I don't see why prospective data collection is any different from a regular holdout set. And if you don't, then you're screwed no matter what you do.
> Setting this aside: TFA did nothing you're talking about. Let's be clear about that.
Sure, but strongly held, unorthodox opinions about statistical practice are more interesting to me than tearing down some mediocre article.
Their point is that while in theory you could blind yourself to the holdout set - that rarely REALLY happens. At least in a truly good way. Almost everyone is going to either peek at the data, massage the data, or try the validation and when it fails tweak the model and try again, or any number of shenanigans that no one admits happen - but happen all the time.
The failure mode that a prospective test would guard against in this case is - you can't peek or massage the future (and if you can, you can retire a billionaire pretty easy and stop worrying about this) - so you can't accidentally fool yourself or others by peeking, massaging, etc. And if you tweak your model, then do another prospective test - then you still can't peek at the future, and you'll have a different set of data, so you can't be overfitting to the old data/p-hacking.
You can do it over and over again, and as long as you don't just say 'all good' on a failed test without doing another different prospective test, you either have a predictive model or you clearly do not.
That is something the traditional validation models cannot do, since they aren't looking for truly never before seen data.
It still doesn't tell you if once in production you will stop fitting and fail over, but it does at least tell you that it fit a never been seen, new set of data at least once. Which is better than the other tests can do by their very nature.
> Almost everyone is going to either peek at the data, massage the data, or try the validation and when it fails tweak the model and try again, or any number of shenanigans that no one admits happen - but happen all the time.
While "peeking" at the data is certainly something that happens all the time, usually what happens for even the most rigorous of model-makers is that your model fails "out of domain" -- the past doesn't accurately reflect the future.
Even if you get everything else right, it's incredibly common to fool yourself into believing you're capturing "reality", when in fact you're just making a good fit to past random fluctuations.
I already addressed the point about distribution shift above. You need to assume that the past reflects the future at some point, otherwise you can't justify deploying the model even after the prospective test.
According to your theory, publishing would act as a 'nothing up my sleeve' validation of their model.
Since, you can check this model in the future - you can do it for yourself.
And yet, you seem to be complaining about this publication?
(I still don't agree with this as a principle - since I wouldn't now expect the future to reflect the past, and the authors make no claim to predictive powers when they are identifying that the present is unlike the past)
Wouldn't that still be technically tangentially an after effect of covid? I mean no covid, no reason not to get to the doctor, so if covid didn't exist you might survive those, no?
25-44 year olds don't usually die (typical mortality is approx 0.1%), so +25% represents a relatively small number in absolute terms.
[0]: https://www.destatis.de/DE/Themen/Gesellschaft-Umwelt/Bevoel...
edit: I found no English version unfortunately, but at least the Excel file which is easier to work with.
https://www.statista.com/statistics/1191568/reported-deaths-...
https://www.statista.com/statistics/1105061/coronavirus-deat...
USA has 30 times the deaths among 30-39 year olds but only 5.5 times the population. It isn't just Italy, almost every other country has a distribution similar to Italy.
USA on the other hand has excess obesity across all metrics (I'm one), so if it hit younger ages harder here it's probably due to obesity epidemic raising death chances.
> Other significant causes of death (including suicide, influenza, road traffic accidents) appear to be down.
That's most probably a direct factor of the containment measures. Influenza has been on sometimes historic lows (https://www.who.int/influenza/surveillance_monitoring/update...), and as many people have stayed home streets have been free and people don't drive home from bars totally drunk, both drastically reducing road accidents.
Suicides however? These are going up by some indications (https://www.nature.com/articles/s41562-020-01042-z), as is domestic violence (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195322/).
[0] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0...
[1] https://www.medrxiv.org/content/10.1101/2021.02.13.21251682v...
Can you source your other claims? At least one seems to be wrong. Traffic deaths seem to be up:
https://www.usatoday.com/story/money/cars/2021/03/05/pandemi...
https://www.todayonline.com/singapore/fall-traffic-accidents...
https://www.marketscreener.com/news/latest/Road-Traffic-Acci...
https://www.hindustantimes.com/cities/delhi-news/road-accide...
https://www.destatis.de/EN/Themes/Society-Environment/Traffi...
https://www.gov.uk/government/statistics/reported-road-casua...
https://zambiareports.com/2020/07/22/332-die-road-accidents-...
https://newsbook.com.mt/en/2021-sees-decline-in-road-traffic...
https://www.topgear.com.ph/news/motoring-news/mmda-edsa-road...
These are mostly unchecked secondary sources, of course. But, your secondary source, the "National Safety Council", appears to over-report deaths compared to the Department of Transportation's later figures. In 2019, they over-reported by... 8%.
Suggesting the US had 900k covid deaths is ridiculous. Only 1 of the 6 considered factors lists covid as a direct cause.
Why would there suddenly be an 100% YoY increase in the number of Alzheimers deaths?
https://www.wsj.com/articles/coronavirus-pandemic-led-to-sur...
Also: The author cited the sources for their assumptions, specifically on COVID mortality classification.
The models completely mispredict the actual number of cases since that time:
https://pbs.twimg.com/media/E0qZTvVVkAIs484?format=jpg&name=...
This is a total failure of validation that would make any other practitioner question the whole exercise, but it didn't stop the CDC from publishing them. Nor did it stop the news media from trumpeting the results. The Washington Post and CNBC and others wrote headline articles fawning over them.
Link predicting deaths drop to 0 by June 21, 2020 (i.e. last year). Spoiler: they did not. https://ktla.com/news/nationworld/influential-ihme-model-pro... The original paper https://www.medrxiv.org/content/10.1101/2020.03.27.20043752v...
Note this also means COVID has been the number 1 cause of fatalities in total. The other top killers are heart disease and cancer. Heart disease kills ~660k a year and cancer 600k a year. We're not that much over 1 year now since the first cases in the USA. This means that COVID is absolute top cause of fatalities at the moment. For anyone that may feel the need to mention car crashes, guns or drugs those don't even rank in the top 10 of fatalities in the USA.
Something to consider if you see anyone trying to downplay this.
If you calculate the loss of lifespan, HIV would blow Covid out of the water, because the median age at death would mean ~40 or 50 years of life lost. Covid's median age at death is so high, it's often above a country's life expectancy.
It's also worth noting the US population has more than tripled since 1918 and grown by a third since 1990.
This isn't meant to downplay Covid's impact, but to make a more nuanced comparison with past pandemics.
Hell, even the Flu is a combination of diseases: TypeA, TypeC, etc. etc. Even Flu-TypeA is a combination of different diseases: H3N2 (Bird Flu) and H1N1 (Swine Flu) are both Flu-TypeA.
For a singular disease + minor mutations (COVID19 vs B.1.1.7 vs P.1 extremely similar and covered by the same vaccine) to cause such a death count is pretty remarkable.
Most of the downplaying I've seen has revolved around the idea that those who died would have, "died anyway" from some other ailment or that hospitals are finding any reason they can to attribute deaths to covid.
So, while you have a great argument, I doubt you'll change any minds because those who disagree flat out reject your premise.
That's practically inviting them to cite back the average life lost from the 1918 flu. If you're trying to counter someone who's downplaying Covid that is probably not something you should invite them to do.
I've found it is helpful to count by equivalent number of deaths to something that the person has actually experienced, as it is way too easy to brush away deaths that occurred in 1918.
For instance, it's as if you took the number of years of life lost in 9/11 and multiplied it by 120.
Good example of the asymmetry of bullshit here.
For COVID numbers, even with 1M deaths, that would be 1/330 (US population) losing on average ~15 years vs. everyone losing almost 2 years now. It's emotionally tough to pick a policy when you are condemning one group to statistical death, but you still have to try and be objective. My personal opinion is that we'll be writing books about the "the lost generation" in 10 years about children currently in school.
1. The current death toll is with the existing lockdowns. There are good reasons to think that without (especially the early) lockdowns the death toll could have been way higher.
2. Being dead for 1 year cannot be equivalently compared to being socially distant for 1 year (not 2). Is that not obvious?
3. This is before we get into life long disability, etc. due to covid. I know someone whose parent had a covid caused stroke, essentially ending their existence as the person they were before.
I'm not sure she is going to agree with you when she visits you toward the end of your life.
> For 3. it cuts both ways, how many new alcoholic parents and child abuse that ruins an entire lifetime?
It's far from obvious what the effects of COVID-19 are on child abuse. The data is hard to disaggregate because there are so many conflicting factors, but there isn't obvious reason to believe that child abuse is up during the pandemic given the data we have seen: https://www.ucsf.edu/news/2021/03/419961/child-abuse-surges-...
That sounds like it is not obvious.
> The data is hard to disaggregate because there are so many conflicting factors
Basically sums up COVID policies. The point remains, I have yet to see any clear objective policy making that even tries to estimate impact on life of all citizens. In absence of anything resembling a consideration of all age groups, I just ignore any opinion of lockdown both for and against.
So if you are going by this "differential quality of different years" argument, you have to account for the fact that most of these years actually aren't for really old people.
> It wasn't obvious that applying enough pressure wouldn't have prevented the uncontrolled explosion that we now have to deal with.
I'm not sure exactly what you're saying here, but I think we agree. Nothing about this pandemic has been obvious.
Very little of our COVID infections have been linked to either of the geographic borders in this country. While I understand there are greater risks with those borders, it doesn't make the situation incomparable.
> Also, Australia and New Zealand just broke their travel bubble, I don't know if that still constitutes as a "short lockdown" if you haven't been allowed to leave your country the entire time.
Bars and restaurants and sports have been available the whole time. Even if there wasn't a travel ban from the country, where would people even go? Most other countries aren't allowing visitors.
Except we didn't lose a year. A lot of us actually kind of liked the last year. Many got to work from home and discovered it was a lot less stressful than commuting into an office every day, for example. I have a feeling that some of us are going to recall the last year with a bit of nostalgia in the future.
Imagine trying to learn on an old phone, using a cellular internet connection in a bedroom you share with your sister.
So, while I'm glad you enjoyed your year at home -- the focus here was on the impact on students.
I keep seeing statements like this, and I must disagree. My mom's retired, nearly 80, and having an absolute blast living her life. At her prime, she was the primary wage-earner, had two kids, and never had a moment to herself. Her quality of life now is much better than when she was "in her prime". She's got a bunch of friends in the same boat.
https://www.cdc.gov/obesity/data/obesity-and-covid-19.html
And they also reduce life expectancy on their own even without COVID-19. Being obese cuts life expectancy by about 7 years.
https://pubmed.ncbi.nlm.nih.gov/12513041/
So the actual average YLL is probably a little less than 15.
I don't blame the researchers for this bias. The detailed data to correct for it generally isn't available so they're doing their best with what they have.
Not a lot of young people know a huge amount of people in the risk groups, it's easy to dismiss if it hasn't affected someone you know.
What if there was an epidemic virus, that, within a year +/- a few months of contraction, killed hosts over the age of X (20, 50, 70), regardless of underlying health conditions.
It raises some interesting questions! The three I’ve come up with so far:
(1) what does a society look like, without (mature, older, very old) people? What surprising positive and negative evolutions occur?
(2) how would our current societies react to the gradual onset and eventual global expansion of such a disease?
(3) if we found a cure for the disease a few (now, shorter than previously) generations later, who would take it?
It’s kind of similar Lord of the Flies, except instead of a shipwreck, it’s a disease and it happens gradually, to preexisting societies and cultures.
With Covid it was easy people to think it wasn't really a big deal, it reduced the appetite and compliance necessary to keep the pandemic contained.
The authors of this are doing exactly the same thing, but from the other direction:
> Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality. For the reasons presented in this section, we believe that this is likely an underestimate.
This is all simply noise. The way we'll find out the answer to this question is when someone pulls the death certificates for 2020, and actually tabulates the percentage directly caused by Covid.
It will happen, but this work isn't it.
Moreover, we know that there are examples of the opposite: deaths where Covid was on the certificate as a contributing factor, but not the primary cause. These aren't hard to find.
An 85 year-old with congestive heart failure and late-stage cancer and Covid reflects the modal situation here. It isn't some theoretical event -- it's incredibly common.
Right now, what we have is aggregate death counts (which we know are high), and people speculating that they're elevated because of Covid (or in this case, making models based on speculation).
As well, you get the over-the-top cases where someone that dies of a gunshot is included in the covid death count[0].
Some states have tried to do better by breaking it down a little finer. Like Colorado provides[1] a breakdown down by confirmed vs probable. But the data here is still not great.
[0] https://www.kmov.com/news/colorado-coroner-calling-out-how-s...
? It's incredibly clear by looking at Colorado's numbers, there was no misclassification at all. Definitely mistakes have been made, but this isn't even an example of one.
Your comment is bizarre. The same case you're criticizing is from the state you go on to praise in the next sentence. These, unequivocally, have never been included in "death by covid" counts.
> financial implications for a state saying they have covid deaths
Yes, but there are also immense legal, financial, and political implications for lying about covid deaths. There is no evidence of this happening on a widespread scale.
There are obvious signals in total excess death counts indicating the number of deaths due to covid, we can do retrospective random testing of early classified covid deaths.
There is no evidence of some systematic conspiracy or anything of the sort. I encourage you to consider that you might be engaging in motivated reasoning.
I'm fairly sure there is no tissue available to test from any of those bodies
The situation was ripe for fraud, and there is no way to prove it didn't happen en masse. Human nature suggests it did happen. The evidence of what caused those deaths is destroyed shortly after the paperwork is filled out. The whole thing is set up in such a manner that suggests inflation of the numbers, and to have no way to counter the claims as all evidence is gone
It’s simply incentives, it doesn’t take a top-down conspiracy to have independent actors try to game a system in order to profit financially.
From the CDC:
> Table 3 shows the types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019 (COVID-19). The number of deaths that mention one or more of the conditions indicated is shown for all deaths involving COVID-19 and by age groups. For over 5% of these deaths, COVID-19 was the only cause mentioned on the death certificate. For deaths with conditions or causes in addition to COVID-19, on average, there were 4.0 additional conditions or causes per death...
e.g. per that table, out of 560K deaths coded as COVID-19, 257K were also coded as "influenza or pneumonia". That's because Covid causes pneumonia.
Is this a useful metric, though? If covid is the catalyst to cause death with preexisting conditions, is not covid the actual cause of death?
Covid in these cases is an acute condition that is the direct cause of death.
If the answer to the question of, "Would this person be alive were it not for COVID?" is "Yes", then COVID killed that person.
You should be able to be fragile and still survive, that isn't an excuse to let someone die.
Dying with COVID does not mean you would be alive today if you hadn't contracted COVID.
What I can guarantee is that of those 95% who died with COVID, some percentage of them would have died anyway, under almost identical circumstances, except without COVID.
However, it is also true that some of those people would have lived if they hadn't contracted COVID, even though COVID was not the "direct" cause of death. For how much longer, who knows. But certainly not when they did.
In other words: the people saying we should only be counting the 5% direct deaths are wrong, and the people that say we should be counting all 100% who had COVID as deaths from COVID are... also wrong.
I believe we can be much more precise than you're giving us credit for in determining if contracting COVID was the direct cause of someone's death, even with comorbidities.
To be totally honest, when I see someone say, "we can't ever be totally sure" I nearly wholly discount that opinion, because it's very cheap to proffer, almost always true, and of very little value.
Also one of us is confused, and I don't think it is me. From what I've gleaned from this article, the 900,000 figure is not (as you say) "determining if contracting COVID was the direct cause of someone's death", but rather trying to figure out how many people would have died if this had been a "normal" year, i.e. if we could go to a parallel universe and make COVID never exist. This is absolutely not the same thing, as such a scenario will also count deaths as a result of our response to the virus as a death "due to the virus". This is my impression as they seem to be including things like suicide (criteria "c") and people who died because people with actual COVID were taking up hospital beds (criteria "b").
I think this is the correct way to think about this problem, as it is likely to be an underestimate, rather than an overestimate.
In other words, counting suicides probably doesn't matter, as the number is very low. The paper says as much: "The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude."
The paper overall goes into very great detail about what was and wasn't included and why, which is vastly more rigorous than what you seem to be presenting, which is effectively throwing up your hands and saying, "we'll never know!"
One is the OP's idea, "deaths due to COVID". This idea is "how many people would have died if COVID had never existed". However, what a lot of people hear when you say "deaths due to COVID" is "this is the number of people that died as either a direct or indirect result of having COVID in their system". But that is not the 900,000 number being cited.
It is made even worse by the HN headline, which is "death toll from COVID", which even more strongly implies the above.
And... that's exactly what the linked article is doing. And yeah, it turns out that all these people (on balance) would indeed still be alive had they not been sick with covid.
It is definitely not only looking at whether people would have died sans covid in their system.
As to whether a suicide due to pandemic-induced depression "counts" as being "caused by the pandemic" or not, isn't exactly the kind of confounding effect you railed against above? Isn't the solution, again, to not demand that we micro-classify every death and simply look at the external effects we can measure?
To answer your question though, no, they should not be lumped together because they are not the same thing and so the mitigations would've/could've/should've been different. In other words, lumping all these things together as "caused by COVID" is the opposite of useful. For example, you do better next time with deaths due to COVID in your system (category "a") by ramping up vaccination faster/better facemask policy/earlier lockdowns/etc. You can decrease category "b" by having more hospital beds / more healthcare capacity. You can reduce the deaths in category "c" (seemingly suicides) by having lockdowns that aren't up-and-down rollercoasters / better mental healthcare / etc. All of these, though being "due to COVID" should be handled very differently so it is counterproductive to lump them all together.
Again, I think you might be projecting a bit here, because the only reason I can think of that you would want to lump them together is to push a political agenda. Not for any utilitarian reason.
>"Would this person be alive were it not [for contracting] for COVID?"
Put another way, people in perfect health shouldn't be the only ones whose covid deaths are counted.
If an obese person is in a car accident and immediately dies, we say that they died due to the more immediate health event: the car accident. -- even though we know that obese people are more susceptible to death in car accidents.
This is like saying that 0% of people who have contracted HIV have ever died of HIV, they died of other diseases. Well, sure, but what allowed those other diseases to be contracted?
The top "other factors" are (in order): Pneumonia, "everything else", respiratory failure, high blood pressure, diabetes, cardiac arrest, heart disease, acute respiratory distress syndrome, etc.
It's pretty clear to say that far more than 5% died of Covid induced complications, not that they died of "natural" causes and also tested Covid positive. Saying the 5% number is almost certainly abuse of statistics, especially given the notable uptick in mortality in the US.
I'd consider it playing devil's advocate, depending on the scenario. The problem is, these days I often see a lot of bad faith arguments being passed off as "just playing devil's advocate".
You can be obese and diabetic and still live to be 80+ years old. My grandma is both, and will be turning 81 this year.
But if someone who is only 30, but obese and diabetic dies to COVID, it's a pretty damn bad faith argument to try to claim that COVID was not the cause of death.
Well, I don't even know where to find this kind of data, but your hypothesis could be tested by comparing the number of deaths in 2020 against the number of deaths in 2019, broken down by cause of death.
Or to take me as an example: I have asthma. That probably counts as a comorbidity, so if I die of covid, should that count as a covid death or not? I'm 42, I can reasonably expect another 42 years of life. Most chronic illnesses don't kill you.
I've actually seen some people with Asthma may have possibly survived because of certain Asthma medications that may do something to block covid, I can't remember the study, but if you're on that specific med, maybe that helped?
I'm > 400 lbs (690 in 2012), I'm 41, I survived having it. Except for long-covid which was a bitch.
"cAsE fAtAliTy rAtE iS oNlY 1%" is a horrible metric to base any policy off of.
900,000 death * 15 yll/death [0] = 13.5 million YLL
vs
~63 million YLL for Spanish Flu and 0.5 million YLL for typical flu season [1]
> 900,000 death * 15 yll/death [0] = 13.5 million YLL
Right, so an average American lost 0.03 years of their life due to covid. I guess some thinks everything they did last year to save that 0.02 or so years was worth it. Basically you save a week by social distancing and locking down for a year.
You could make this same argument about anything that causes large amounts of deaths.
In computer terms, it's about launching processes in a controlled manner vs let them run freely and make the system paginate.
You don't let critical systems paginate.
So why did California continue with their measures for a year? They still did among the worst in the world so those measures seems to have had little to no effect at all.
We live in a different planet? I live across the border with North Italy, and it was only 2 weeks what it took for the situation to go from "oops, looks like there's a problem" to "let's mobilize doctors out of retirement and potentially kill them to save people". There have been different levels of restrictions since. Same in France, Spain, Germany, pretty much anywhere in Europe.
> Yes, from time to time not every patient they wanted to put on a ventilator got one, but ventilators doesn't dramatically improve the odds of survival so it wasn't a big deal anyway.
Ventilators were abused at the beginning out of ignorance about the disease, but they're still the best last-resort treatment for critical cases. In my region, during the second wave, most deaths happened to people waiting for a ventilator, or during transfer from oxygen to a ventilator, and those on ventilators generally survived.
That said, now there's a more defined and effective protocol before reaching a ventilator that requires hospitalization nonetheless, and makes you require one if not followed.
> So why did California continue with their measures for a year? They still did among the worst in the world so those measures seems to have had little to no effect at all.
California had terrible numbers despite the fact that measures worked. It's been studied ad nauseam and social restrictions is the among most effective measures to be taken in every study, with a solid interval of confidence. One of my favourite studies is [0] because it shows that some things were done right (lockdowns, closing schools, remote work) but some had little to no effect (surface disinfection).
The cumulative time wasted by humanity each day by putting seatbelts on or by stopping for red lights.
Traffic lights takes more time, but they also allows for more dense traffic so I don't think that removing them would help at all. I doubt San Francisco traffic would get any better if you removed most traffic lights, likely it would get worse in all the chaos, so unless you prove to me that they actually hurt commute time rather than help I put those savings on the seatbelts.
Don’t get me wrong, I wear a seatbelt and stop at lights.
I was just agreeing with the parent comment. There seems a fairly strong vein that wanted no lockdown and for us to just accept any resulting carnage. I’m not part of that group.
80% of the deaths have been from folks aged 65+. So, it is arguable that the Spanish flu would have killed a lot more if the average lifespan was higher.
https://en.wikipedia.org/wiki/Spanish_flu#Patterns_of_fatali...
> The pandemic mostly killed young adults. In 1918–1919, 99% of pandemic influenza deaths in the U.S. occurred in people under 65, and nearly half of deaths were in young adults 20 to 40 years old.
We shouldn't downplay the progress we've made while we're at it. 100 million vaccinations is quite an accomplishment. If we're going to beat ourselves up for having the top total deaths(while not being in the top 20 per capita), we should pat ourselves on the back for that one. Getting 100 million people to do anything is hard.
It's invalid reasoning to use this study to "upplay" the pandemic.
It includes deaths due to depressions and delayed medical interventions, which you could argue isn't the result of COVID directly, but the result of lockdowns.
So when people use this study to claim "see, this many lives were lost, we were right to institute lockdowns" - that's circular reasoning, part of the reason so many lives were lost is because of lockdowns.
Number died due to lock down
Personally I lost access to badly needed medical care due to lockdown. Was quite scary.
Eventually got Covid. Sucked but nothing compared to what else I’ve been through. So initially was dismissive.
However definitely some lasting changes to my clotting levels.
I have to be perfect with blood thinners these days, we’re before covid I could fudge with them.
My nearly 70 year old mother is in the same boat. She recently dealt with breast cancer treatments (a rare form) and thankfully was given the all clear before covid. She still needed to do follow up visits, more testing etc. but due to covid was told to stay away. Even though she was more comfortable with the risk of getting covid vs. ensuring her cancer is in remission they wouldn't see her.
There's a sensible middle ground between life-as-normal and enforced lockdowns.
The articles about "we now know better how to treat patients" was mostly this, don't put them on ventilators unless it gets super critical, most patients got better without one. Also I haven't seen data on this but I strongly suspect the main reason USA lost so many young people to covid compared to other countries is that USA is way more eager to put people on treatment like ventilators, basically blasting bacteria into the lungs of young otherwise mostly healthy people killing them. Those young lives would have been saved if they weren't diagnosed in the first place.
You might consider yourself lucky if they blast air into your lungs. Italian healthcare was using pure oxygen, which, used at prolonged periods of time basically burns your lungs. Some government officials recently admitted that this caused a lot of "COVID" deaths.
Also, you can't quantify the hypothetical death toll in that scenario in any real numbers, to say "would have skyrocketed" is unfounded. I could understand "would've been higher" that sounds reasonable.
I admit I'm the morbid one in the group, memento mori and all. But I think the real stat we should track is years of lost life expectancy. That's the only statistic that makes sense when doing cross disease examinations. Not speaking specifically about covid, but more generally, something which primarily kills young people is much bigger deal than something which primarily kills old people.
It makes sense if we consider the possibility of novel life experiences to be an important value of how we live life. If you've made it to 60 (a not uncommon life expectancy), you've had a chance to travel, have children, live through many different life occasions, etc. If you're 20, you've barely had two years as a legal adult where you could make something of your life. It has little to do with economic productivity.
1. You get killed at 20.
2. You get killed at 60.
Which option would you choose?
Not to my father, who is in his late 60s and the most at-risk member of the family, and who has been more opposed to the lockdowns than any of us.
His calculation is that at some point - for the good of the family, long-term - the economic damage and delayed social development of his grandchildren outweigh his personal safety.
I have encountered very few older people who don't also think this way.
It's not about "usefulness", it's that saving the life of a young person produces a larger benefit in terms of expected future years of life. Take the extreme case: if a building is on fire and you can only rescue one person, would you be indifferent between saving the life of a 10 year old child versus a 90 year old with terminal cancer?
As I understand it this intergenerational contract used to be quite strong as people would see that previous generations invested in them and as a pay it forward sort of mechanism, they would in turn pay it forward to generations that proceed them .
I suppose there was some "take care of me when I'm old" in the intergenerational contract too, but I understood that as secondary to the propagation aspect...
I think that the main obstacle to this approach is that people instinctively think cross-sectionally rather than longitudinally. When you say "kills young people" and "kills old people", listeners focus on 2021. A young person is somebody born in 2000 and an old person is somebody-else, born in 1940. That is cross-sectional thinking, with 2021 as the date of the cross section.
But the real issue is that we nearly all live to grow old and get to experience both sides of the issue. Someone born in 2000 is likely to live until 2080. They will probably see a different respiratory virus going round then; it may even be what kills them.
So what would you personally prefer? The pro-lockdown approach trades losing a year out of your twenties to lock downs, in return for some action (perhaps ineffective, perhaps unnecessary) to ensure that you survive the plague of 2080 and get to live a few years longer.
The anti-lockdown approach makes the opposite trade-off. It is not really young versus old; it is now versus later.
I'm getting old and rather dreading later. I would prefer that society prioritize letting the young get on with their lives, education, dating, etc. and if I lose some poor quality care-home years, well, I've seen my grandparents and parents get old and frail, and I'd rather not dwell on the details of what I'm dreading.
If young people want to argue for the anti-lockdown trade-off, if they claim that in general young people shouldn't be locked down in the hope of protecting the elderly and they will accept their fate gracefully when they get old, well, I would think them wise beyond their years.
In those wars, a huge number of people died from things other than direct combat.
Here are the numbers [1]
[1] https://en.wikipedia.org/wiki/United_States_military_casualt...
He tested negative twice after his month long bought with it, but only lived for another few weeks until dying of respiratory failure. We were told that because he was not testing positive at the time of death, his cause of death could not be recorded as COVID. I thought cause of death was whatever disease or injury started the chain of events that lead to one's death, but it felt like serious statistic manipulation.
(edit - grammar)
My main issue with this criticism is that tallies of other illnesses have the same issues. So if an actual flu season said 20,000 people died, it had the same reporting issues and distribution of reporting issues.
This means a direct comparison to two ailments with the same distribution of reporting issues gives you an accurate view of the affect.
So even without going back and fixing the records - which I'm not sure you or other people even know happened - this means Covid deaths are more accurate and actually proves how it is much much worse.
Anybody see the irony there? Given that the point of bringing attention to this would be to downplay the severity or response (or that there is a 100% correlation between the people that subscribe to these talking points and want a dramatically different response or no mitigation response at all), so, thanks for keeping healthcare authorities accountable, I guess.
[1] https://www.politifact.com/factchecks/2020/apr/21/facebook-p...
> It is standard for Medicare to pay roughly three times more for a patient with a respiratory condition who goes on a ventilator than for one who does not. That has nothing to do with the coronavirus.
> As part of a federal stimulus bill, Medicare is paying hospitals 20% more than standard rates for COVID-19 patients.
> Indications are that due to a lack of testing and other factors, the number of coronavirus cases has been undercounted, not padded.
> For a statement that is partially accurate, our rating is Half True.
https://www.cnet.com/personal-finance/covid-funeral-reimburs...
“Show me the incentive and I'll show you the outcome” - Charlie Munger
The guys mom is there and you're working up her son's case. You have to fill in the blank for cause of death. What are you going to do? Order an autopsy and possibly cut this family out of government aid for COVID-related expenses and deaths?
This isn't really any different than when a person dies some immediate event while also suffering from an underlying illness. If a leukemia patent suffers a an aneurysm, one would expect leukemia to be present on their death certificate.
The answer is the opposite, actually: if it is difficult to disprove any single contributor one way or another it should not be listed as a contributing factor.
https://www.fox35orlando.com/news/fox-35-investigates-questi...
This accusation of fraud and malpractice has been a common talking point amongst those seeking to downplay COVID.
But I've yet to see any evidence that its common or widespread.
This is why excess deaths is the real metric by which the toll of this pandemic will be measured, at least in countries with reliable records about whether deaths happened at all.
I also had zero side-effects from my vaccine, which I understand is supposed to make people feel sick the day after the second dose.
Multiple medical professions felt it was covid and recommended testing.
Some of our symptoms weren't associated with flu, but were with covid.
There are some 20 tracked covid variants spreading in the USA right now.
Tracking of variants didn't begin until Dec. But even in the few months since they began tracking variant proportions, the dominant strains have shifted quite dramatically.
T his is not some wacky conspiracy. Given this evidence, my money is on it was a variant of covid not tested for. You might see things differently, and that's fine.
I'm not certain, but I suspect something was lost in the handoff to the hospice care company where they just didn't have the history and I assume they were the ones that reported the COD. Not certain about this. I plan on looking to see if there's anyway to have this retroactively updated, but I'm not optimistic.
That being said, excess mortality is not purely from COVID. There are widely reported drops in treatment for various cancers [1,2,3]. The link between COVID and diabetes is also very complicated and will take years to figure out what happened. The grim bright side is that we've seemed to hit peak excess deaths and may be dipping below and so the 900k number might decrease a little moving forward [4].
[1] - https://www.breastcancer.org/treatment/covid-19-and-breast-c... [2] - https://ascopubs.org/doi/full/10.1200/CCI.20.00134 [3] - https://jamanetwork.com/journals/jamaoncology/fullarticle/27... [4] - https://www.cdc.gov/nchs/nvss/vsrr/covid19/excess_deaths.htm
> for now we assume that total COVID-19 deaths equal excess mortality
Given how disastrously wrong most modeling/forecasting(1) has been during this pandemic color me a little bit skeptical that their model is somehow better. Models give wide latitude to fiddle with parameters.
Neil Ferguson's earliest models were used to justify no action/herd immunity as the UK's initial strategy.
I recall (but can't find) the Imperial College scientists saying they didn't fully consider any other option at first, because they understood that it would be politically unpalatable.
Best to actually look it up.
(hint: you won't find the 'do nothing for herd immunity' as a stategy, but you will find many newspaper articles speculating about it based on out of context quotes)
History gives a better record than our impressions from the news of the sensational at the time and our faulty memories.
Sure, I will. Here's the original Imperial College Report 9 to which I am referring:
https://www.imperial.ac.uk/media/imperial-college/medicine/m...
which discusses 'mitigation' and 'suppression' as two possible strategies, in March 2020.
The UK government took this report as an endorsement for 'mitigation', which it discusses in more detail, even though the report says "For countries able to achieve it, this leaves suppression as the preferred policy option."
Mitigation is quoted as meaning "reducing peak healthcare demand while protecting those most at risk of severe disease from infection" - I'll admit I extrapolated this into "do nothing".
There are then plenty of articles discussing this, e.g.: https://henrytapper.com/2020/04/04/suppression-vs-mitigation...
How could that be?
Wearing masks on beaches and in restaurants etc may slightly impact the case count but really doesn't impact mortality in the same way that an outbreak in a care home does.
There's limited evidence they work more than a short-term delay tactic and cause tremendous harm.
Not all of those countries are islands (The UK is one, and you may note that it's not on the list.)
But all of those countries instituted short, hard lockdowns, and relaxed them after bringing local cases to zero.
Around here, we institute half-assed lockdowns, that are lifted when enough people complain about them (only to come back, as cases surge). Maybe that's why they don't work for us - because we are politically and socially incapable of dealing with even a few weeks of hardship.
New Zeland, and Australia had few cases when they did lock down, and are islands.
Korea has a very disciplined population compared to the West.
Really you should be comparing the US to Europe. The EU didnt do much better, but was far more draconian. Or within the states.
But anyway, i never know if people are serious when they propose the China or Australian model. Those were brutal and Im glad to be voting for a constitutional amendment next week to limit the governor's lockdown authority.
I never know if people are serious when they suggest that a few hundred thousand dead is a worthwhile footgun-sacrifice to escape the draconian rule to which Australians and New Zealanders were subjected to over the past year. I'm generally a bit leery of ideological arguments that necessitate sacrificing those numbers of people for some intangible, abstract good.
But if we are going to go down that road, can I get a say in which people we will get to sacrifice to meet that ideological objective?
The common denominator in all covid success cases seems to be an effective and strong contract tracing and quarantine protocol. That is the tried and true method used to defeat outbreaks.
If you have a good contract tracing program, a short-hard lockdown can be used to delay the outbreak while your tracers find and isolate the infected.
But without an effective contract tracing program (and I'm not talking about some bullshit smartphone app, but public health contract tracers with the power to actually do something), the lockdown is just a delay tactic.
Even if we got down to 0 cases in April 2020 in the USA, the virus would work its way back in within weeks, if not days. Without a tracing program that works, we'd be back to ten thousand cases in a few months.
All those countries have tight border controls. We get hundreds of thousands of illegal border crosses ever year. We'd have to deploy the military along the Mexican border and probably Canada too.
I don't think a single state has really tried to ramp up contract tracing efforts to the required levels.
And Australia had a several month long lockdown to get defeat a relatively small, isolated breakout. The bigger the outbreak the longer the lockdown is needed. And the longer the lockdown, the less severe it can realistically be. I accepted "don't have any social visits" for 6 weeks, but I wouldn't comply if they asked for 6 months. You can close factories for a couple weeks, but not for 6 months.
They had regional lockdowns early in the pandemic. The US... Had a patchwork of half-assed regional lockdowns, that came weeks late.
> All those countries have tight border controls. We get hundreds of thousands of illegal border crosses ever year. We'd have to deploy the military along the Mexican border and probably Canada too.
The overwhelming majority of border cases in the US did not come from illegal crossings in Mexico. They came from legal crossings through controlled borders, because the US did not implement any quarantine control on inbound travelers. It asked for travelers to self-quarantine as a courtesy, with no verification or enforcement, with predictable results.
It's true that lockdowns without contact tracing just delay the problem. The US has failed at that too. If you caught COVID in April, chances are, you'd have no idea who you caught it from. It would have been difficult to engineer a more spectacular disaster, if we tried.
You need two parts to this equation. Lockdown, and contact tracing. Both are required, and it's disingenuous to say that lockdowns don't work. It's fair to say that they don't work as we implemented them. Our implementation of them is not the only implementation of them.
But in my hypothetical where we got to where NZ and AZ are right now (no covid in the community), and quarantine controlled entries, uncontrolled border crossings would 1000% bring in new cases. My point is you need to seal your borders nearly 100% to pull off what NZ and Az do.
And some of it’s a law of large numbers issue. If there is a 1/10,000 chance covid makes it through border quarantine, then if we have 50X as many crossings, we’ll need 50X as many mini-lockdowns. At some point it becomes impractical.
I don’t think it’s fair to say “lockdowns work” when you really mean “lockdowns work at the very start of an outbreak when paired with a strong contract tracing, quarantine, and border sealing.”
I think there is a point of no return at which you cannot lockdown/trace your way back to zero because the virus is everywhere is large numbers.
Total speculation, but I think the US would have had to implement the NZ plan + military on the borders + internal restrictions on travel to different metro areas in Feb. 2020 to have really successfully avoided Covid.
Well, I was initially responding to a context-free claim about them not working. I agree, my response was also a bit light on context, and it made a stronger claim than was warranted.
> Total speculation, but I think the US would have had to implement the NZ plan + military on the borders + internal restrictions on travel to different metro areas in Feb. 2020 to have really successfully avoided Covid.
That may be true. It might not be. I think we will never know, because official policy at the time was 'don't test sick people [1], sweep everything under the rug to make the numbers look good, don't let private providers test people, institute a delayed travel ban that does not include Europe.'
[1] Unless they recently traveled from a foreign outbreak area. I remember reading about the hoops people had to jump through to get tested - and how many of them just gave up on the whole thing. Official policy was not to test non-travelers, because there was no evidence of community spread. Of course, if you never test anyone, you won't find any...
With China, we don't have enough information to make the claim that they under-reported deaths. If you CTRL-F China in the OP data on them is absent. I'm a bit surprised that the author could extrapolate a gap between reporting and actual deaths for every other country except that one.
As for comparing EU and the UK to Australia and New Zealand, that's more easily explained by the much higher air traffic volume between these countries and covid hotspots early on. In short, the combination of being "islands" with limited ports of entry and smaller passenger volume meant that early border closures could be much more feasible and effective.
Korea for all intents and purposes is an "island" in this comparison as well, in that on 3 sides it's surrounded by water and its northern border has no ports of entry.
A short, early response with entry closures and contact tracing does seem to be key, but I don't agree with the notion that we need to emulate their lockdowns. I'd rather wear a mask forever than be like them. The UK got the worst of both worlds since they got stricter lockdowns than the US without getting it under control. The decision to go for zero and stop all social life in order to get down to zero deaths from all covid is commendable but not our obligation. Our duty was to stop from overwhelming our medical system only, not to go for zero by giving up all social life and the economy.
All the cherry picking data in the world will not help you if you get sick.
I am really sorry that some abstract principal becomes a hill to die on.
I cant speak for the OP, but for those of us who have given life and death some thought, lockdowns are worse than death.
"Lockdowns are a unacceptable imposition on freedom" I can understand. I disagree, but I understand.
"lockdowns are worse than death" strikes me as odd.
What I don't get that people who don't want lockdowns also oppose masking and other measures. Why not try to keep things open but also strongly support masking just to be sure?
Maybe travel in and out of Florida is fluid enough to explain it to some degree.
uh, what? I don't understand why anyone would willingly try to catch a disease...
(get your kids the chickenpox vaccine, don't do those chickenpox parties if those still exist. The vaccine drastically reduces the occurrence shingles later in life. I'm a bit envious that my younger sisters got it, but I got chickenpox as a child. Seeing it flare up in my dad every 18 months doesn't give me hope).
I'm a little surprised that the quoted age of most Americans having it is not less than that. The chickenpox vaccine was only authorized for use in the US in 1995 (I was born a bit before that, my siblings after that). That would make everyone 28 or older at least 2 years old before the vaccine came out in the US, which is the most likely age people got it.
(Assuming that immigrants in the window of 1988 to 1995 from nations who authorized in that period do not make up a substantial fraction of the present US population).
2. There were some "get covid" parties at University of Alabama (probably others): https://abc3340.com/news/local/university-of-alabama-respond...
3. There are shingles vaccines: https://www.cdc.gov/vaccines/vpd/shingles/public/zostavax/in....
https://www.cbsnews.com/news/alabama-covid-19-party-students...
They actually thought risk was lower than it was, went to Florida and unfortunately caught the bug.
Edit made, since all this happened in the window.
Figure 5: The (estimated) ratio of reported versus total deaths. It appears from it that FL was more accurate in their reported numbers than CA. That has absolutely nothing to do with lockdowns.
Figure 7: The cumulative deaths, where FL and CA are the same color (that is, in the same range of cumulative deaths).
Either way, neither indicates that FL's death rate was better than CA's.
https://www.statista.com/statistics/1109011/coronavirus-covi...
Shows that FL has a higher death rate than CA. Though if you take the adjustment from this paper into consideration, then CA's would be worse.
In Florida, where a vast amount of people go to vacation, out of town covid cases were not counted.
Figure 7, the cumulative total death rate, is probably more relevant to the point you’re trying to make, in which case FL and CA are in the same bin.
One conclusion you might draw is that the effectiveness of lockdowns cannot be inferred from this single map.
Maybe your problem is more with the media than any side which they defined.
For deaths it seems by far the most important is not lockdown, but rather protecting elderly. So maybe Florida prioritized that, and didn't spend effort on lockdown, while California prioritized lockdown thinking it would also help elderly.
(I mean, that definitely happened, but I haven’t seen analysis quantifying the significance of the total contribution.)
There’s a whole lot of omitted confounding variables in the “compare aggregate totals and jump to policy conclusions” games people are playing.
Maybe I can find graphs.
Here's a cumulative death per capita graph for 5 states that illustrate 5 different patterns [2]. Most states followed one of these patterns.
There is the "New York" pattern: densely populated states with a large elderly population. Hit very hard very early with a very high death rate, but after a couple of months got a handle on it and from then on was about average.
There is the "Washington" pattern: a fairly steady rise in deaths per capita, never quite under control but never really out of hand either.
The "Florida": like Washington for the first 3 or 4 months, then shifts to a more rapid growth, and pretty much stays there.
The "California": 3 or 4 months like Washington, the starts to Florida but gets the rate back down, then spends another 3 or 4 months like Washington (but shifted up because of the burp at 3 or 4 months), but then loses it in the third wave almost catching up to Florida.
The "South Dakota": low population low density state that with reasonable precautions should do better than Washington, but by working really hard to ignore it manage to end up with high numbers.
Use the drop down to flip that graph from total deaths to total cases, and South Dakota is even more striking.
Flip to new cases or new deaths 1 week averages to compare how they all are doing currently. Florida's currently running about 3-4 times the new cases as California, and about 50% more new deaths. (Change the highlight dropdown from "All Highlight & All Current" to "All Current" to make it easier to see the latest values).
It will be interesting to see how vaccination will affect this. With the more easily transmittable variants becoming more common, which also seem to hit younger people more, I've seen the estimates from what we need for herd immunity go up to 80-90% from the early 70% estimates for the original variant.
Overall, there are enough people who say that they will not get vaccinated to make it unlikely that the US can reach that, especially if it turns out to be 90% needed. However, those people are not uniformly distributed among the states. I would not be surprised if in a half a year we end up with two kinds of states: those where it is fully under control due to herd immunity and life has largely returned to normal, and those where it is still sickening and killing a lot of people.
[1] https://www.usmortality.com/
[2] http://91-divoc.com/pages/covid-visualization/?chart=states-...
Most of California's deaths occurred in a wave from January to March of 2021, while Florida had their first wave in the summer of 2020. (https://linqbymarsh.com/blueicustominsights/covid-insights is good for historical data like this).
There’s a whole lot of omitted confounding variables in the “compare aggregate totals and jump to policy conclusions” games people are playing.
Very true, but the lack of clear correlation between level of restrictions and Covid outcomes is at least some evidence against lockdowns.
https://www.statista.com/statistics/1104709/coronavirus-deat...
We should be concluding that lockdown and masks leads to more deaths, not less (or at the very least that they are an unjustifiably expensive public health intervention), and begin rolling back all restrictions immediately.
It would make more sense to compare similar countries, and Sweden is drastically worse than any its neighbours. Not only that, they changed course and added tougher restrictions than originally, so they themselves realised it doesn't work to fo nothing.
Why do people still ignore that?
[1]: https://mobile.twitter.com/TedPetrou/status/1390340398699192....
If you argue about healthcare reforms overall then sweden does much better than Finland and Denmark, as expected lifespan was still much longer even when covid was at its worst. So a Sweden with covid every single year is still better off than Finland and Denmark without covid. Likely they could do better if they implemented some of Swedens others healthcare reforms rather than fight covid.
It's worth noting that the governments in both Japan and Sweden have very strongly recommended distancing, and probably just as importantly they've provided some funding to allow individuals and businesses to comply. Just paying people to stay home without a compulsory element might have been quite effective in many societies with relatively high civic virtue and social trust, but only Japan and Sweden seem to have actually tried it.
Besides, if we're just cherry-picking examples -- well, Canada is doing much better than Sweden. Or America. And Canada is more comparable to America than Sweden. And Canada has had more drastic shutdowns and restrictions compared to America. So how does that fit into the picture?
So...not as many people died as we thought were going to so we're now just going to arbitrarily say any excess death was a covid death just to make sure the numbers look like what we think they should?
These are the kinds of statistical shenanigans that have been going on all year and people wonder why people question 'the science.'
Just a few sentences later, they break down changes in death rates into 6 categories -- 3 that are increases but also 3 that are decreases.
But in any case, it's a pretty reasonable first-order assumption that excess deaths are from COVID, that can then be analyzed in more detail per-population to see if it continues to be plausible, e.g. whether excess deaths were also correlated in time and place with COVID, etc.
And isn't this precisely the kind of double-checking of official numbers that is valuable? Official statistics don't always tell the truth -- witness Cuomo specifically undercounting nursing home deaths. The shenanigans we should be concerned with aren't this -- it's shenanigans in official reporting. Thank goodness we live in a democracy with free speech where these kinds of things can be questioned.
Challenging findings to produce stronger, more trustworthy final results ultimately increases faith in science, don't you think? It sounds like you're arguing findings should never be challenged, which isn't science at all.
> The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude. Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality
Basically the 6 factor breakdown is a way to decrease the volume of expected deaths to make the excess mortality number larger. 100% of which was attributed to COVID.
My mother-in-law passed last summer, alone in her apartment. She was sick beforehand, quarantined, and living in a senior living community. When she was discovered the coroner did not come and investigate because it appears of natural causes, based on the observations of the local police officer. Her body was transported directly to the funeral home.
I insisted they do a COVID-19 test, which the coroner did at the funeral home. The results came back as positive. Had I not pushed them to actually test, it would have been misreported and her death mis-attributed.
It left me wondering if this was common and how many people may have passed in similar circumstances, without family pushing for testing.
1: https://www.economist.com/graphic-detail/coronavirus-excess-... 2: https://www.medrxiv.org/content/10.1101/2021.01.27.21250604v...
> Overall, the evidence suggests reductions of 615,000 deaths, or potentially more, stemming from behavioral changes at the global level. The main potential increases in excess mortality due to deferred care and increases in drug overdose and depression are hard to quantify at this point or are of a much smaller magnitude. Given that there is insufficient evidence to estimate these contributions to excess mortality, for now we assume that total COVID-19 deaths equal excess mortality
So basically they lowered the expected number of deaths, then claimed all deaths above expectation are COVID.
* 100M people
* Long land borders with Laos, Cambodia, and China
* Virus located in state territory in Jan 2020
* Total number of verified cases: 3,137.
* Total number of deaths: 35
* Current number of daily new cases: ~50.
Multiply the figures by 3.3 or so to normalize with US population.
Forget the quibbling over the statistical model. Maybe it's only 600K. Regardless, it's over _20000 times higher_. And even allowing for, I don't know, different susceptibility to the symptoms, or whatever - the US numbers are just insane.
https://www.vox.com/22346085/covid-19-vietnam-response-trave...
Billions of dollars from organizations that have billions invested in selling vaccines
Look into the criticism of organizations such as Gavi.
"Public-sector workers and academics public health have criticized GAVI, and other global health initiatives (GHIs) with private-sector actors, saying that they have neither the democratic legitimacy nor the capacity to decide on public health agendas. Private donors often find it easier to exert influence through public-private partnerships like GAVI than through the traditional public sector. There is also criticism that staff at GHIs are often recruited directly from elite educational institutions, and have no experience in health care systems, especially those in poorer countries. Some WHO officials have privately criticized GAVI for infringing and weakening the WHO's mandates"
And that is just a small portion of the issues with that organization. GAVI is an organization that promotes sales of the industry's newest vaccines, not promoting vaccination as a whole.
"In 2012, the first MSF "The right shot" report criticized GAVI for focussing on funding expensive new vaccines and neglecting to give children cheap old ones. "Twenty percent of the world’s children aren’t even getting the basic vaccines", MSF's vaccine policy adviser said.[11] MSF criticized the Global Vaccine Action Plan (GVAP), a WHO global collaboration of which GAVI is listed as a leader, as flawed for failing to help those 20%, which is some 19 million children.[28]"
And this is just complaints against one of the organizations.
The implied conclusion is that Covid has been exaggerated to sell vaccines
Cherry picking exapmple: "criticized GAVI for focussing on funding expensive new vaccines and neglecting to give children cheap old ones" Two minutes reading the article on Wiki tells me that the purpose of the organisation is to facilitate access to new vaccines, expensive patented ones. Access to non patented cheap vaccines does not need a group like this.
Hardly worth bothering about, but the question was asked. That is why "conspiracy BS"
- Vietnam[1]: 58 k
- World War Two[2]: 407 k
- World War One[3]: 117 k
and due to the huge numbers of people in the U.S. who are refusing to get vaccinated, wear masks, or participate in social distancing, the U.S. deaths from COVID-19 are probably far from over.
[1] - https://en.wikipedia.org/wiki/Vietnam_war
Looking at Italian data going back to March/April of 2020, we knew that over 50% of deaths, the patient had 3+ serious diseases and had a median age of 79+.
The true death rate is the delta of standard deaths in a “normal” year and the ones recorded now. That and somehow account for some pull-forward that’s clearly happened.
If a person was somehow due to die (assume a God exists and it’s already planned) on January 2021 of terminal cancer, but then covid found him and he died Dec 2020, what’s the real cause of death?
"Please use the original title, unless it is misleading or linkbait; don't editorialize."
Please don't do that!
Which is where the title came from.
At the last minute I remembered there was an actual scientific paper so I changed the URL to that.
So many commenters arguing about the accuracy of the statistical models used to reach the 900,000 dead figure.
Missing the terrible, tragic, point. Too many people have died (and too many been disabled - for each death about 10 get "Long Covid") It did not have to be like this.
This is/was a tragedy. There have been way too many deaths. Some places did much worse than others - perhaps it is time to start thinking about, and discussing that?
Excess deaths should be looked at over a long period of time.
Seems similar to the difference between weather and climate.
If the news were running 24/7 with reels of disaster porn - images of people dying in ICUs, or struggling to breathe and unable to get treatment, we'd have been taking this problem seriously last year. Instead, it's this abstract, sanitized problem that only happens to other people.
What you don't see on the TV isn't real.
For example, if one dies having both advanced cancer and Covid, which one gets tagged as the cause of death?
for starters let’s have WHO investigate it by a team not led by the guy who was a close collaborator with Wuhan lab.
There are metrics all over the place showing some regions with no lockdowns having less excess mortality and mortality due to covid. Some of the lockdown measures in some places were counterproductive. Some people say all of them were, some people say none of them were anywhere (which makes no sense really), but the truth is probably somewhere in the middle: at least some measures taken in some places were the wrong call. This is to be expected, we didn't know what the disease was going to do and lots of us panicked. But conflating deaths from covid with deaths from the response and attributing all of them to the same cause is going to necessarily include deaths that would not have happened even in the pandemic if it weren't for the response. And we can quantify that, as an example, look at the disparity in excess mortality and covid death between California and Florida. California had a higher excess mortality and a higher covid death rate. Was that excess death in California due to covid, or due to a botched response? Again, probably a bit of both, but there's no way to pick the two categories apart, and so this entire methodology is not useful to quantify anything.
For people under 55 the chance of fatility is miniscule.. in the range of choking or car accidents. This age group makes up 80% or so of the population.
For people over 80 this may be the worst disease since the black plague. Millions upon millions of deaths. This age group makes up approximately 10% of the population.
This is an important consideration because the lockdowns effectively trapped mostly working age people who weren't at risk of dying from Covid in the first place.
I think that's where a lot of criticism of Covid policies stems from.
Should we make national health policy based on a disease that effects a minority of the population?
Reference:
https://www.statista.com/statistics/1191568/reported-deaths-...