An update on SARS-COV-2 mortality

We are now in to the third year of dealing with this virus and pandemic, so we’ve got some long term trend data to digest despite the fact our real time surveillance and monitoring is terrible. It is amazing that in this technically advanced country it takes over a month to collect and collate reliable mortality statistics. But that said, here’s a go at a summary of where we stand. Note that the CDC mortality statistics are compiled on a weekly basis, which makes sense as day to day variations and record keeping anomalies like holidays and weekends get smoothed out. Here I’m looking at “excess mortality” – people who died in any given week who probably would not have if it had not been for COVID. Also note that the typical course of the disease is that death occurs 2-3 weeks or so after infection, so the “death” curve lags the “infection” curve by around three weeks.

First, we have to pick a “start date.” For that we can’t use the calendar year because in the US the pandemic really didn’t get going and become widespread until the end of March or early April. So let’s use the 13th week of the year, March 28 2020 as our reference. That means year one is from March 28 2020 to March 26 2021, and year two is March 27 2021 to March 25 2022, and we are now about 17 weeks into year three. Here is a plot of excess deaths due to the pandemic by week. The blue line is the first year, the orange line the second year, and the yellow line is this year so far. I’ll explain the green line further down.

Click to see full size.

The blue line, 2020, clearly shows the initial wave (with the sharp rise as the disease spread and vulnerable populations fell) as the infection spread across the country. The “summer peak”, which is unusual for a respiratory virus, is also clear, and happened between mid June and early September. Then the big one, the massive winter wave of 2020 between weeks 30 and 52 (early November to early March). Enter 2021 (the orange line). Here we have three factors: first, the various masking and social distancing measures were in full force, and second vaccination was kicking off. By week 1 of year two (first week of April 2021) 25% of Americans were “fully vaccinated” (the initial two dose sequence), and there was no spring wave or early summer peak as seen in 2020. Unfortunately by Summer 2021 restrictions were being lifted, and there was still a significant population that was either not exposed and unvaccinated. So the delayed summer peak hit with almost as many deaths as the initial wave in the spring of 2020. By disease week 40 62% of the population had been vaccinated, so perhaps 80% of the population had some kind of immunity from either having COVID or being vaccinated. So why was there a sharp uptick in the orange line? The third factor: variants like Omicron. While technically not as deadly, the variants spread more easily than COVID Classic. But, as the graph shows, the peak was not as high, and not as many people fell sick and died. So how bad was the first year? We lost 555,242 people who would not have otherwise died. SARS-COV-2 had a whole population mortality rate of 0.168%. The 2017 Flu season had a whole population mortality rate of 0.0187%. So it was far worse than a normal influenza epidemic, almost ten times as bad. However, it wasn’t as bad as the Spanish Flu of 1918, which had a rate of around 0.3%. The two year rate for Spanish Flu was 0.65%, SARS-COV-2 was 0.30%. However, a caution, in that the full story of COVID has yet to be told. Spanish Flu went away, and immunity was long lasting. it doesn’t look like this new virus is going to go so quietly.

Where do we stand? At first things looked pretty good this year. The mortality trend was going down. But the new variant (BA5) is more easily transmitted and appears to be more deadly. Starting at the end of March, the death rate in 2022 became higher than in 2021 – and the trends aren’t good. The yellow line is reported, but as noted above there is a problem. It takes at least a month for all of the mortality data to come in. Even so what we have the line is above 2021, and if we estimate statistically what the line might look like when all the data is in, we get the green line. I sure hope that’s wrong, but in any event it does look like we might be in for another wave.

One last note of interest, the consensus computer models (not the extreme ones that got all the attention in public) at the end of February 2020 estimated the mortality in the US for the first year of the pandemic at 0.1326%. That’s not too bad given what was observed (0.168%).

Caveats: this isn’t a formal scientific study, just a brief overview. I think it’s pretty close, it’s just plotting processed numbers so not terribly complex, but obviously not peer reviewed. The primary reference data for this analysis is the CDC’s Excess Deaths Associated with COVID-19 data set (link to CSV). Vaccination data also from CDC is located here (link). Both are raw data sets, be sure to read and understand the technical notes before you do any number crunching – like hurricane track data, spaghetti must be cooked before consumed πŸ˜› .

Don’t look in the mirror …

Last night we watched the new Netflix movie “Don’t look up.” It was a bit of a surreal experience. It’s billed as a “dark comedy” or “parody”, but to me it was more than that. The critics don’t like it much, I suspect because
a) it hits too close to home; and,
b) the critics probably don’t get it.

Parody or Documentary? Marketing shot for Don’t Look Up by Netflix.

The scariest thing to me is that despite the obvious attempts to be “over the top” it was far too often “close to the mark.” I won’t do any real spoilers here, except this brief note from the first few minutes of the film: the scientists discovering an urgent threat are bundled up and flown to Washington DC to brief government officials (including the President). They they wait outside the oval office, are finally sent to stay in a hotel overnight as political stuff came up, and have to come back the next day. They are then misunderstood and ignored, and go home on the train. Been there, done that. Except I got stuck paying for my own hotel room due to a paperwork screwup.

Pick a topic: foreign policy/nuclear war, climate, resource depletion, economics, pandemic, whatever, and the attitudes in Don’t Look Up are played out in our society every day. Scientists getting hijacked by the DC/Media Culture, ratings driven “news” stories, the “if it didn’t come from the Ivy League it can’t be worth much” worldview, politicians with one eye on the polls and the other on their billionaire backers, it’s all here. And far too real.

Doomwatch give this five stars. It does for the current politics/media/high-tech-billionaire society what Dr. Strangelove did for the Cold War. A lot of people won’t like it, and certain political parties will take offense by thinking it is about them, and the “other side” will smugly make the same assumption, rather than in fact about the whole system. But give it a try, and consider if you too are “feeding the beast” and try to think of ways of changing our society to get away from this train wreck. Because even if you avoid the end of the world, you might be eaten by a Bronteroc.

Here’s DiCaprio discussing the movie …

More pandemic deaths in 2020 than 2021?

So if you’ve been watching the news over the last few days you’ve seen a rash of headlines along the lines of “US COVID-19 deaths in 2021 surpass last year’s toll” (The Hill). Is that true? Let’s see what Dr. House has to say …

I feel his pain.

Even some basic common sense shows comparing year-to-date numbers for 2020 and 2021 is utterly absurd. Let’s take a look at the CDC’s excess death database, using data through the end of October (since US medical statistics reporting is a train wreck and the November data isn’t usable yet due to late reporting). COVID19 wasn’t widespread in the US last year until at least April. There were only five COVID19 excess deaths in the first five weeks of 2020. There were 120,541 in the first five weeks of 2021. So these reports comparing 2020 to 2021 are just typical modern media reporting: simplistic, context free, and melodramatic.

So what if we do a rational comparison. By the first week of April 2020 COVID-19 was widespread in the US and weekly excess deaths were over 10,000. Let’s compare the first week of April through the last week of October in each year. In that period last year (2020) we had 230,240 excess deaths attributed to COVID. 2021? “only” 207,590 – . I say “only” in the sense it’s not as high as 2020, not in the sense that it’s anywhere near a good thing or shouldn’t have been a lot lower. (and, that number may go up some due to the reporting problems, but it’s probably not far off). For reference, using a baseline of that period (April to October) of 1,730,000 deaths (the number of people we would expect to die in the US during those months), over 12% more people died so far this year who wouldn’t have were it not for COVID. Still, put it all together … lower is lower, and you can argue it’s a positive sign given the “Delta Surge” the last couple of months. However, hope doesn’t sell for some reason and there is a lingering fear among officials who certainly know better about the statistics that if the message is “diluted” with hope, people who haven’t been vaccinated will use it as yet another excuse to avoid the jab.

The “Delta Surge” starting in August seems to be waning, but if last year is a guide the winter surge got started about the end of October/Early November. Will we have a similar winter surge this year? Hard to say, but it might be that the Delta surge, combined with vaccination and the sad fact that many vulnerable people have already been lost, it will take the edge off the expected winter peak.

If we use the first week of April as a baseline, the total number of excess deaths (people killed by the SARS-COV-2 virus who wouldn’t have died otherwise) in the first full year of the pandemic, from April 2020 to the end of March 2021, was 556,179. Even if this winter season (Nov to March) is exactly as bad as last year, the total will be 5% less than the first year of the pandemic. For what it’s worth I think this winter won’t be as bad as last year, and I suspect when we look at the number for April 2021 to March 2022 they will be 10% or even 15% lower than the first year. To be clear, that’s not as big a dip as I’d hope, but given the mangled response to the pandemic by all the key players (government, industry, public), sadly not surprising.

Side note: if you’re over 30 or have an underlying vulnerability, just get the stupid shot.

Doomwatch, 26 Sept 2021: Supertyphoon #Mindulle and #Japan, #Gulab and #India, Hurricane #Sam and, well, nobody but fish

There are two major (Saffir Simpson Category 3 or higher) storms stalking the earth this morning, but only one is threatening land. There are also earthquakes, volcanoes, and of course the SARS-COV-2. Here’s the overview …

click any image to embiggen.

One thing that stands out on the dashboard are all the earthquakes. None seems to have caused any significant damage, but there have been a lot of them the last three days. As for tropical cyclones, we have two that are threatening land. Cyclone Gulab is making landfall today as a weak storm hitting the east coast of India. It’s hard for a storm to hit India and not impact millions of people, given the population density. Economic impacts should be in the 10’s of millions of US Dollars of equivalent purchasing power parity damage …

In the western Pacific, Supertyphoon Mindulle is starting to recurve north and is forecast to be just offshore Tokyo in about five days. On this track impacts would be light, but a wobble to the left could be Very Bad, so this needs watching …

In the Atlantic, Major Hurricane Sam is a small but very intense hurricane. Fortunately on the current track there is no one in the way for the next five days according to the official forecast …

The track models are tightly grouped over that period. Longer range, it may be an issue for Bermuda, but that’s at least 7-10 days away. Nobody else needs to worry about this one. For perspective here are the long range track models … and for my Canadian friends, way too early to get excited, 10 day forecasts are really iffy especially for tropical systems that far north.

Elsewhere, Teresa is no more, so all of the telenovela references I had planned will have to wait until 2027 in the hopes a storm more deserving of the name shows up. There’s a couple of waves coming off of Africa the chattering class will likely talk about since Sam isn’t a problem. Feel free to ignore them.

I haven’t said much about the pandemic lately because from a scientific and emergency response standpoint there’s not much to say other than global governance is a (colorful language deleted) mess. Like so many issues, this isn’t a technical problem, it’s a political problem. Pick any aspect – masks, vaccinations (who, with what, and when), movement restrictions, natural immunity, and so forth, the technical aspects of public health and medicine are secondary and even tertiary to the politics. In the US, both political parties are criminally negligent in the matter, and internationally the situation isn’t a lot better (and often worse in developing countries). As long as people keep electing (or tolerating, or having forced on them) incompetent leaders you will get incompetent results.

Scientist or Administrator?

Scientists who move into administrative and policy positions have a very delicate line to walk. At some point, you’re no longer a scientist. Yes, you bring expert knowledge, and are hopefully better at backing policies that are supported by the science, but that doesn’t mean you are still making your judgments based on the scientific method: almost certainly, other factors are weighing in. The move from science to policy is a hard transition, and in my experience many who have done so often don’t internalize that they are no longer practicing scientists and now have a different role, responsibility, and relationship to the scientific endeavor. Perhaps it has something to do with the Peter Principle – that individuals who are competent – especially super-competent – are promoted out of those roles until they are in positions outside their level of comfort, competence, and experience.

It is painful to watch this process play out – and sadly I think we are watching it with Dr. Anthony Fauci. He has become such a lightning rod for both derision and worship it must be incredibly difficult for him personally. While it’s cool to have your own action figure …

You can really buy one of these:

… all the publicity and hate is hard to deal with. While of course not to anywhere near the same degree, having been publicly and very personally attacked over both science and policy (and more rarely praised as a paragon of Scientific and Manly Virtue πŸ˜› ) it’s hard to take, and I really understand his frustration and pain. But he’s not doing himself – or most importantly the scientific enterprise – any favors with comments like these:

Continue reading

Doomwatch, 15 July 2021

There’s lots of doom stalking the earth, but mostly of the “humans are their own worst enemy” variety. There is only one active tropical cyclone – Hurricane Felicia, off the west coast of Mexico and headed out into open water. The invest area in the Atlantic is nothing to worry about, probably just a bored forecaster. There is a more serious threat potentially developing in the West Pacific that some of the models forecast to be a major storm impacting Okinawa in four or five days before heading towards Mainland China. There has been bad flooding in Germany, and in the western US heat and wild fires continue to be a problem. And the usual scattering of earthquakes, including a swarm on the California/Nevada border, and a half dozen or so volcanoes spewing ash, but none causing significant damage. Here’s a map of natural doom:

Hurricanes, Earthquakes, Volcanoes, other severe weather zones (blue/yellow) this morning (15 July)

In the “doing it to ourselves” category the SARS-COV-2 pandemic continues to do a slow burn through the population lacking natural or artificial (vaccinated) antibodies. It’s hard to get a solid handle on just how dangerous some of the new variants are. The majority of infections are now the notorious “Delta” variant (B.1.617.2 – here’s more about variants then you want to know). It does seem to have a much higher transmission rate – the variants making the rounds last year and this spring had an R of around 2, “Delta” is probably well over 3. What that means is that for the original virus, one person would infect on average two other people. “Delta” seems that one infected person can infect between 3 and 4 people. Of course that doesn’t tell you anything about the consequences of being infected – as we know, a lot of people are asymptomatic, others crash. The statistics don’t seem to indicate that conclusively, but the virus seems to be spreading within younger populations. Of course, that can be an artifact of testing bias, and that a lot of older people have had more of an opportunity to be vaccinated (or survived the virus). The research papers I’ve seen are mixed; some indicate that existing antibodies/vaccines aren’t as effective, some say it’s no big deal. The truth is probably both πŸ˜› – there is some reduction, but it’s not increasing mortality.

The media is of course excited about Delta. For Chatham County, Georgia (Savannah Area) a reporter was breathlessly saying the community transmission index “doubled since the end of June!” Technically true, it has gone from 50 to 98 between June 30 and July 14, but let’s put that in perspective: In January it was over 600 … so while the trend isn’t great as “delta” moves into the area with both cases and CTI, this isn’t something to freak out over. If you have natural or artificial antibodies, you’re in good shape. If you don’t and are an adult, you should get vaccinated unless you have a solid health reason that makes it risky. It’s as safe as any other vaccines out there (which are pretty safe all things considered).

There are a lot of unsettling geopolitical developments that do not bode well for the upcoming weeks. The situation in South Africa is out of control. This has huge implications across southern Africa, as some of the logistics and food distribution facilities looted the last few days are essential not just in South Africa but across the region. There is unrest in Cuba – how much is natural, and how much astro-turf from Miami, and where it is going is debatable. Haiti continues to be in turmoil, and the web of involvement in President Moise continues to expand. NATO continues the risky game of “poke the bear”, conducting provocative exercises across the Black Sea at the risk of goading the somewhat unstable Ukrainian regime in to taking another action in Eastern Ukraine that will result in Russia being forced to respond.

But at least Brittany now has her own lawyer now, so that’s nice.

COVID19 excess mortality – reasons for optimism?

For the last few weeks I’ve been watching the COVID-19 excess mortality statistics from NIH/CDC. As I constantly rant, the real time numbers you see on the cable “news” networks are utter rubbish: it takes several weeks for death certificates and reporting to become reliable, and of course just raw daily numbers lack context. So here is the latest reliable data charting excess mortality in the US from all causes since 2016 through late March. Above zero means more than expected; below zero means fewer people died than we would expect. The last data point (well below zero) is likely based on incomplete data, but is probably not drastically wrong. You can clearly see the bad 2017/2018 influenza season as the spike on the left side – and the very obvious and undeniable COVID-19 pandemic on the right (although people do deny it for whatever stupid reasons):

Click to embiggen

So … it is possible that in mid to late March all cause mortality in the US returned to something like statistically normal. I’m using “all cause” because that puts everything in perspective – deaths caused by everything from COVID-19, influenza, traffic accidents, crime, etc. The biggest deviations in this number over the last 20 years or more have been due to Influenza (like the spike in 2017/18), and of course now COVID-19 is the big driver. There are probably a lot of reasons for the big drop in COVID-19 related mortality – first, to be blunt, a lot of the initially vulnerable population has likely succumbed to the virus (many of them probably shouldn’t have, but that’s another rant). Second, the precautions like masking and distancing are helping, third, the vaccination program is likely starting to impact the numbers, and of course we are exiting the winter respiratory virus season.

Even given the case counts over the last couple of weeks (which were trending in the wrong direction) this trend in mortality is likely to be preserved, and the overall mortality in the US to remain in the normal range unless something changes. Have we turned the corner? Maybe … unless the variants are deadlier than expected, people get stupid about precautions too soon, etc. And other parts of the world aren’t doing so well. So don’t start partying yet – but maybe you can smile a little behind your mask …

How dangerous is COVID? How about the COVID Vaccines?

We’re starting to get enough data to draw some conclusions. TLDR: COVID is dangerous – 4.5 times more deadly than the 2017 Influenza strain, which was a bad one. With the caveat that the long term studies are still underway for a lot of at-risk populations, COVID itself is about 215 times more deadly than the vaccine. The COVID vaccine isn’t really significantly more dangerous than the Influenza vaccine. Here’s a bit more detail and context …

You can’t get this vaccine for some reason.

There is a lot of argument and discussion over the relative risk of COVID vaccines, especially in Europe with the reports of the AstraZeneca/Oxford vaccine potentially causing blood clots in some people, and the Polyethylene Glycol (PEG) in the mRNA vaccines causing anaphylaxis (allergic reactions) here in the US. Both are concerning – and there is an urgent need to figure out why certain people are more vulnerable to adverse reactions than others. Certainly those with known allergies should be very careful to check the components of each vaccine before receiving it – the CDC publishes guidelines for this, and if you have sensitivities check with your Doctor before getting a shot (or any) procedure. This is the dilemma of vaccination: it’s best for the vast majority of people, but can be dangerous for a few. But care must be taken not to blow that true statement out of proportion.

What are the overall risks – in context with other risks? Lets take a closer look at the data from the FDA’s Adverse Event Reporting System as well as the CDC’s National Center for Health Statistics data bases and a few other data bases at CDC, NHTSA, and the FBI for context. Here is what your chances of dying this year look like:

  • Chances of dying from COVID: 1 in 163
  • Chances of dying from COVID Vaccine: 1 in 35,000
  • Chances of dying from Influenza (2017 H5N1 strain): 1 in 740
  • Chances of dying from Influenza Vaccine: 1 in 100,000
  • Chances of dying in any Accident: 1 in 1,350
  • Chances of dying from Gun Violence (you are a criminal): 1 in 3,000
  • Chances of dying from Gun Violence (you are not a criminal):1 in 220,000
  • Chances of dying from a Weather or Earthquake Hazard: 1 in 2 million or so

So in context, the vaccines are not risky compared to the disease – and certainly not compared to dying in a car accident (1 in 6000 or so). There has been some reports and talk that the COVID vaccines are significantly more dangerous than the Influenza vaccines. That’s a bit hard to judge. For one thing, the COVID vaccines are being scrutinized in a way the Influenza shots have not been. But even given that, the raw numbers show that the potentially associated mortality rate is about 2.8 times higher. It’s likely that difference would disappear if similar tracking were in place, but even if true isn’t bad. So the “50 times more side effects” stuff you see circulating is overblown.

Hope that helps put things in perspective …

Binary Thinking

In reading “news” stories lately, not to mention various comments in social media about topics ranging from politics to COVID vaccines, I was struck again by the power of binary thinking, as well as how perceptions are manipulated by asking (and answering) the wrong question. Another frequent related problem is making assertions that are perhaps true, but presented out of context in such a way as to create a false perception. This usually results in the two “sides” talking past one another and a shouting match ensues; there is no shared worldview to even begin a discussion.

Here’s a concrete example regarding vaccines: In skimming a discussion about mRNA vaccines it was said by one advocate that there is no evidence or “mechanism” they cause birth defects. The problem is, that’s “true” as far as it goes but also misleading. Pregnancy was a specifically excluded condition during the trails reported so far, and all of the documentation submitted to the FDA said it was not assessed. As for mechanism, there are in fact several potential mechanisms where something could go wrong, given the rapid and complex cell division that occurs during the early stages. Is it rare? Possible or impossible? Probable? Likely? We just don’t know – there is no evidence. Last time I looked at least 18 people had become pregnant during the trials and are being closely monitored, but that’s a very small sample size, and until the children are several years old, it can’t be said for sure that there were not problems. It was also said no long term side effects have been reported. That is true but highly misleading: the vaccines were only developed less than a year ago, so there hasn’t been enough time for any long term effects to develop or reach a statistical threshold. So therein lies the problem – saying “there is no evidence” when there have been very limited (or no) studies is absolutely not the same thing as saying “there have been detailed studies an no problem was found.” That’s a distinction that is lost on many people.

For the record on this subject, here is what CDC says as of 7 January 2021: Based on how mRNA vaccines work, experts believe they are unlikely to pose a specific risk for people who are pregnant. However, the actual risks of mRNA vaccines to the pregnant person and her fetus are unknown because these vaccines have not been studied in pregnant women. We know COVID19 presents risks to pregnant women, so if in a high risk group (like a health care provider) it might make sense to be vaccinated with an mRNA vaccine despite the unknowns. Work from home and sensible about social distancing, etc? Maybe best to wait. It’s not an easy call, based on an objective view of the available data.

Again, this isn’t to be anti-vaccine. There are rational risk-benefit arguments for some, and over time as more data is collected and if the early results hold up, increasingly large segments of the population to take these vaccines. What bothers me is that people present it as a binary, “no brainier” choice. It’s just not that straightforward and it is hubris to assert that it is.

Unfortunately there is no shortage of hubris, exaggeration, and binary thinking in order to sway opinions in our public dialogue these days. I could cite many examples, from election fraud (it probably didn’t impact the results, but that’s not the point: the US election system is broken, with deep structural flaws such that it doesn’t meet standards it imposes on other countries), to social debates like LGBTQ issues or abortion or climate change or …

In short, it takes objectivity and careful analysis to reach good conclusions. This is especially hard given the political parties benefit from a sharply divided electorate, advocates for various issues minimize or are even blind to potentially adverse consequences, and demand you “take a stand”, and of course the media industry profits from the noise and drama all that creates. Please don’t feed that process, and try to understand that many situations are not sound-byte simple.

In short, life is complex. Don’t fall into the trap of absolutes.

Not a big Star Wars fan, but it has its moments.

COVID19 Mortality: A look back

TLDR: The 27 March 2020 forecast all population symptomatic case fatality rate based on the Diamond Princess cruse ship data was 1.71%. The current (20 January 2021) US symptomatic case fatality rate is 1.67%. So while the public perceptions and actions have been shifting, the bottom line hasn’t changed that much, and while there was a lot of uncertainty back then, the early work wasn’t bad. Here’s some more background, including a rant about people who think people aren’t dying from this, and a look back at the mortality forecasts made early last year.

Our first solid look at COVID19 in a controlled environment was the cruse ship “Diamond Princess”. Almost exactly one year ago, on January 20, 2020, the ship departed Yokohama on a three hour tour, um, on a round trip tour of Southeast Asia timed to coincide with the Lunar New Year celebrations. A single passenger from China brought with him a hitchhiker: the SARS-COV-2 virus. Over the ensuing weeks (which included some dumb measures by the Japanese Government that made things worse), something like over a third of the passengers and crew are thought to have contracted the virus. Around 400 of the passengers and crew became sick enough to be classified as symptomatic, nearly 200 of those were hospitalized, and about 10 or 12 had a primary cause of death being from the disease which is now called COVID19.

So where do things stand? I again rant that real time death counters seen on “news” outlets are disgusting displays of much that is wrong with American “Journalism.” Let’s look at the National Center for Health Statistics data, which is probably the most authoritative/reliable source. These statistics are updated weekly; those of you with wonky tendencies may want to read the technical notes, but the bottom line is that mortality statistics take time to compile in the US. Nationally, only 60% of death records are submitted to NCHS within 10 DAYS of death! Lets ltake a look at the week of December 26th. As of the 14th of January (two weeks after), the number of reported deaths were 41,796. As of yesterday that number is up to 72,710 … now, that’s a worse than usual example due to the holidays, but it shows the dangers of relying on the “real time” data. The Johns Hopkins data sets that many in the media are using are quite good, but they are not definitive, and the sensationalist abuse of this data is not helping. Again, pandemics are “slow motion” disasters. They rarely evolve from hour to hour or day to day, it’s more of a week to week process, with the decisions of millions of individuals influencing the course of the outbreak. The hype is stressful, distracting, and given the politics, divisive, as it encourages people who think they are being railroaded to believe there isn’t a problem.

But there is. I’ve posted similar graphics before, but here it is again, updated through yesterday. The blue line is shows total reported deaths. The orange line is expected deaths based on the US population at the time. The yellow line is “non-COVID related deaths” as classified by the ICD–10 codes. The “expected” line is wavy because more people die in winter than summer – usually due to Influenza and Pneumonia. You can very clearly see that the 2017-18 influenza season was bad, and that 2018-19 was mild. The 2019-2020 season was pretty normal – until in early February something drastic happened. That “something” was the SARS-COV-2 virus. Even if the only data you had was the blue line – reported deaths – you’d know that there was a new disease stalking the land. Look carefully at the orange line – non-COVID deaths – and how high it is during the summer. Contrary to what some with an ax to grind are saying, it seems that we were more than likely under-counting COVID deaths rather than over counting them, although it is possible that some people died who would not have otherwise because they did not seek medical care out of fear, or some other indirectly related causes. In any event, reported deaths are obviously well above normal, there is obviously some new disease running through the population, and anyone who is saying otherwise is simply wrong.

Click to embiggen …

Looking back at the early mortality forecasts, my own forecasts were off by a factor of two – the estimates from late March/Early April were on the order of 200,000 by now, but reported US fatalities recently topped 400,000. I had assumed average people would demonstrate more common sense than they did (yeah, you can rarely go wrong assuming people are idiots but despite being on doomwatch I try to be optimistic πŸ˜› ). I also thought the initial reaction would be stronger nationally, and widespread masking start earlier, than how it played out. I never really thought the vaccines would be ready by now – and I’m still rather pessimistic it will have the impacts the vaccine chorus is singing. First, this is a corona virus: other beasties of this type are responsible for about 20-30% common cold cases, and they mutate so rapidly the immune system can’t keep up; it’s unrealistic to expect vaccines to keep up, although it’s also wrong to discount them, as like with influenza vaccines, they can provide some protection even against unrelated strains. Second, despite the PR deluge, the efficacy hasn’t really been statistically demonstrated to the usual standards, and the quality control and massive rollout have created problems that have harmed the process. Cheerleading and glossing over things like adverse reaction rates isn’t really great way to build confidence. As I have said, I am absolutely in favor of vaccines – but I’m also in favor of a careful, “first do no harm” approach to public policy that a rushed “do something NOW” process rarely allows. Appearances do matter, but the data matters more.

When I teach emergency management, the very first thing I try to get decision makers to understand is that no matter what they do, they are going to kill people. There is almost never such a thing as “erring on the side of caution” because all actions have consequences – and as I often point out, economic harm also causes physical harm, a fact that is often overlooked. Ultimately the trick is to figure out policies that will cause the least harm in the long run.

As the COVID19 pandemic shows, that’s a very difficult thing to do.