Per a recent Facebook conversation I offered to post some information on how they are counting cases as the challenge isn’t only in the US. I also encourage all of us toward patience when people are confused as it isn’t black and white. There are many forms of counting and each has it’s own agenda.
My personal opinion, there is SO much information here and bottom line is we may not have the true and useful numbers for a while and we may never have them with the way we are going…so we need to have more useful (that is saying it mildly) planning around this that works for our economic, mental and physical welfare.
Tracking the results has been an enormous issue with three main considerations – and I realize there are many more:
- The timing issue that has (at least) two parts – I am going to address two aspects. Part 1 – How we address deaths that occur well after people heal from Covid-19. Example, if someone dies from a heart attack in June and had covid and healed from it in January these are being labeled in many countries as covid deaths…I don’t feel they should be and that is my opinion. Part 2 – How we address deaths that are not tracked until well after the fact. Example, we don’t often get numbers on someone until much later in their case and how to count that is questionable. Some places are backtracking numbers, others are using numbers from months ago now…it’s very confusing and there are reasons for their choices that not all would agree with.
- The testing problem which has many parts – Part 1 – how we call a case covid when testing is off. Example, if someone shows up with symptoms in an ER that a doctor feels are clearly Covid-19 and they don’t test positive and the doctor knows many covid patients aren’t testing positive. If this person dies, many doctors are putting covid on the death certificate. Part 2 – The tests themselves have accuracy issues (see link to my video explaining this below) which affects numbers. Part 3 – As there are many being tested in various ways and multiple times, how we count has consequences. For example if someone gets tested 6x and one time is positive how do we count that? Also if someone gets tested over time, one month negative, one month positive, then they get tested again to confirm the positive how is that counted?
- The difference between deaths that wouldn’t have occurred soon on their own and deaths that may have been pushed to happen sooner because of covid-19 – For example, an 85 year old woman who dies from COPD and then on autopsy is found she had covid antibodies. These are currently being labeled covid deaths…should they be? I wonder if we should have a different descriptor for these and some statisticians are feeling we should look at life years as a descriptor, ie. how many years are taken away by contracting covid and can we ever know this for certain as some doctors feel depression and other aspects are the precursors here, not covid. Very complicated and heart-breaking conversation.
Additional considerations statisticians are currently investigating:
- The number of ‘other deaths’ – suicides, deaths from those who didn’t get the care they needed due to hospitals dealing with covid, etc. – that weren’t from the individual contracting the virus and are related to the pandemic situation.
- The number of ‘excess deaths’ – i.e. the deaths than normally occur in a similar time period and showing how many additional there are (this is a VERY basic way of explaining this so see videos below for more).
- That case fatality rate is being used improperly as the fatality rate…a lot of differences in meaning and language here (see videos below) – the case fatality rate is created by taking the total number of cases and subtracting those that aren’t resolved yet, and then taking the number of fatalities from only those resolved cases. A challenge is that there are A LOT of unresolved cases and so this in my opinion is not an accurate number for true fatalities, it is most useful in seeing where most fatalities are coming from and shouldn’t be part of economic shutdowns as if there are 200 cases and 10 are resolved and one of those 10 was resolved due to death we are saying there are 1 in 10 case fatalities and this isn’t accurate.
Some reasons real numbers are important:
- Opening economies is dependent on numbers and if the numbers are skewed we are causing economic shutdown without reason ongoing when we could do this differently and reopen the economy rather than continuously closing businesses that will never reopen and changing the economic landscape.
- Understanding what is working and what isn’t in our methodologies around dealing with the virus.
- Understanding if the virus is losing it’s virulence and if so, where and why and what does that mean for opening economies.
Questions many are considering about and beyond the numbers:
- If the number of cases is rising because of testing being widely available and because more people are feeling comfortable going to hospitals now, are we using that number improperly in many of our statistical analyses.
- If the number of deaths is mostly in care homes, have we made the changes we need to to protect that segment of the population. I don’t feel we have in the US. We are still having care workers go between different homes, go home at night to large families, etc. Many other countries have managed this better. Part of this comes down to increasing the pay to these essential care workers to encourage them to stay in the homes for extended periods especially in those homes with an outbreak and recognizing they are putting their welfare at risk as well.
- Should we be discerning between three or more categories of deaths rather than putting all together: Example, those deaths of the elderly who were near death from other diseases prior, those deaths of people with underlying diseases that were clearly affected by covid and those deaths of those who tested positive for covid without underlying conditions or triggering events (an alarmingly low number in my experience).
- Why aren’t we focusing on increasing awareness of alternative methods of empowering individuals through nutrition, supplementation, meditation, stress reduction, etc.
- How are we taking care of our care workers, essential workers and those on the frontline physically, emotionally and ongoing. Are we addressing their needs with social distancing with their families after work, taking care of their psychological needs from trauma, etc.
- Why aren’t we sharing proper treatment options as many doctors around the world have become more confident in effectively treating covid cases.
- What have we learned about the specific underlying conditions that are being triggered by the virus and what can we do about this. Understanding this and treating effectively quickly for those with these specific conditions can save lives.
- What don’t we know yet and how are we sharing information with other countries? (Critical to not shut out other countries during a global pandemic. Sharing information is critical).
- Are hospitals getting paid more for Covid cases and is that affecting both treatment and numbers? (see links below)
- Should we have categories of testing that make sense and make it clear how each is used. For example, those who test positive with no symptoms are a different category than those who test positive and have symptoms and are the latter considered more infectious?
Here are some videos/ articles worth watching/ reading on the above topics – feel free to share more in the comments:
Exploring testing challenges (my video) – there are many links after this video that might be interesting if this is a topic of interest for you.
Why coronavirus rates differ – various types of fatality rates and knowing what the numbers are for and what information they are based on.
Census information and Covid-19
Excess deaths information on Jama (Jeffrey had posted this on Facebook)
Links to excess mortality rate information: https://ourworldindata.org/excess-mortality-covid
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