Today is the fourth of July, 2020. As of this writing, the CDC reports 128,648 cumulative deaths due to COVID-19 in the United States, with over 2.7 million total cases reported. The present trend is rising numbers diagnosed, presently in excess of 50,000 new patients per day and increasing — this compared to 500 in mid-March. Some take comfort in the fact that COVID deaths per day are trending down. This would be a grievous error.
First, let us deal with the more optimistic myths. Remember, there’s some truth to most of these — but not as much as people might expect.
On social media, it’s been suggested that young people are likely to be asymptomatic, and that the recent spike in numbers has been driven largely by the young; hence the decline in mortality. This is certainly a contributor, but the percentage of symptom-free cases among even the young and healthy has been estimated at only around 20%, and the mortality rate remains high among those with symptoms. Thus, it can’t be a large factor.
Likewise, it’s been asserted that treatment methods have improved. Again, there’s a measure of truth to this; respirator protocols for critical patients have been refined, and there are a few positive results from medication studies. However, the first is a minor improvement only, and none of the medicinal protocols have passed the trial stage; there is still no approved treatment. (Remdesivir is on its first widespread trials now — only a few hundred patients — and the first positive reports on Hydroxychloroquine and Azithromycin have only just been released.) Thus, only a handful fewer people are dying.
A third reason commonly mentioned is that, as testing increases, so too do positive results. This is evident on its face; however, that impacts only base numbers. For this to be the driver behind the trend, positive test percentages would need to be declining, and they’re not. In point of fact, as the accuracy of available tests improves and false positives are becoming less common — under 2% now — and profit-driven fraud, among other problems, is being addressed, one would expect the trend to be declining rather sharply. And yet it’s increasing. That’s extremely disconcerting.
Finally, there’s a pervasive belief that COVID-19 simply isn’t as deadly as people think, that early numbers were driven largely by infection of vulnerable elderly populations, and that the summer’s heat will destroy airborne viruses. In the United States, the mortality rate continues at around 1% and severe impact around 7%, presuming healthcare access; this hasn’t changed. Elderly populations are far more likely to die, but nearly one in six Americans is in that vulnerable group; it’s not as though they all caught this back in March. Finally, hot temperatures prevail in Brazil’s jungle areas, where the death toll is catastrophic.
Even the sum total of these causes entirely fails to match the present trend; they are utterly insufficient to explain why so few are dying — if 600 per day is truly “few”.
The problem is, what we all think we know is dead wrong. The numbers we’re getting fed by the media are simplified past the point where they’re meaningful, and the trend lines aren’t remotely representative of actual fact. This isn’t a problem of bad data (though there is some of that) or lag in reporting (we already take that into account). It’s that statistics is complicated, and most people don’t understand it. There is a very good reason analysts and modelers have advanced degrees in mathematics. Chances are, you don’t.
To put this as simply as possible, the basic misunderstanding is that we’re a country in an outbreak. In reality, we’re looking at thousands of local outbreaks, one in every town and neighborhood and school district. Each area has its own data and trend line, and the factors behind local numbers vary from place to place — which only makes sense, if you think about it. Some states, the people don’t wear masks; on the other hand, it’s easier to practice social distancing in Montana, Alaska, and northern Maine. The rates and numbers are different.
When you simply lump together numbers from different data sets without factoring in root causes and local caveats, the picture you’ll end up with is often entirely nonsensical compared to reality. Our specific error at the moment is best-known as the “amalgamation paradox“, which explains why you can’t just add up the raw numbers behind multiple increasing trend lines. (You’re welcome to study the mathematical principles on your own time, but this article stops short of providing an advanced Statistics degree. -Editor)
And that’s what we’ve got right now, is multiple parallel increasing trend lines. Picture it like this: Our early numbers showed a general rise, but most of that was in New York City, but most of the country lagged far behind. Not so today. In the words of Dr. Miles Beckett, “The truth is simple, and horrifying. We are about to have dozens of NYCs around the country.“
If we examine the country state by state — or, better, county by county — we can more readily see the effect — and even major media is beginning to notice. NBC News maintains a daily update that leads the CDC’s numbers by almost a day, and it’s quite accurate — but it’s only available by state. There are over a hundred local hotspots, each with populations over half a million people.
And here’s where the studies stop. We can tell you that published projections show nearly forty thousand more reported deaths will be logged by the end of July, and that most of those have already occurred but that the paperwork takes two weeks (longer in overburdened areas) to arrive. What we can’t tell you is the daily death totals in Florida or Arizona because they’ve stopped reliably reporting them to the public — presumably to avoid panic, but perhaps the relevant offices are just overwhelmed. Both states are among the worst hot spots. The awful truth is, far from being over-reported as some suggest, the CDC numbers are far behind the actual death count.
And trends all around the country are sharply on the rise.
What this means is that, even if we maintain our present precautions, with a large proportion of the populace sheltering in place, schools and many businesses closed, and masks, handwashing, and social distancing being widely practiced, we’re still about to witness a few months with a truly staggering impact. If our hospitals can cope with the new influx of COVID-19 patients, it’s likely that we’ll see only a few hundred thousand dead by the end of September. But that’s the best-case scenario.
If instead our hospitals become overwhelmed, as is presently about to happen in Arizona, local mortality rates can easily double or treble. Treatment options become limited during space and staff shortages; although there’s little chance the ventilator supply will run out at this point, there are only just so many operators. Worse still, once overflow facilities are activated, the chance of outside exposure increases.
Three months ago, The Not Fake News estimated between one and six million Americans would die of this disease, many by autumn. If we’re very fortunate, react promptly, maintain hospital capacity, continue to isolate — and if treatments arrive sooner than expected — we may come in under those numbers by a small percentage. I’m cautiously optimistic; we’ve shown tremendous adaptability thus far.
But the numbers tell us that we’re in for a truly terrible summer.
Stay home when you can. Wash your hands. Wear a mask (and maybe goggles?) and practice social distancing. And, above all: Good luck.
EDITOR’S NOTE: This article has been weeks in the assembling. I’d like to thank all the people that have helped collect studies and sources; I could not have done this alone. As well, I owe a great intellectual debt to Dr. Beckett, who demonstrated that this concept could be cogently expressed in 280 character chunks.
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