Epidemiologists as the new gurus: what about the excess death rate?
Epidemiologists deal with dry facts and figures, but the subject matter of those facts and figures can be very dramatic: illness and death, and how best to go about minimizing the former and delaying the latter. Usually we don’t pay all that much attention to them unless we have a particular interest in the subject.
But now epidemiologists are constantly in the news, and anyone with an “epidemiologist” before or after his or her name is now the new authority. We hang on their every word as though our lives depended on it. Governments set policy based on their recommendations and those policies are having extreme effects on our lives.
It is definitely true that epidemiologists have expertise in this arena that most of us lack, and that we can learn things from them. But they disagree with each other in their prognostications. They are good at describing something ex post facto, often with estimates derived from statistics that are far from exact. It often takes years to understand what has happened in an epidemic or pandemic. And that’s understandable.
But their forecasts? They disagree with each other. Well, someone’s correct, but who? The worst doomsayer? The sanguine optimist? The in-betweens?
And I have a question for them all. I know we are missing some important numbers for COVID-19 that can’t be ascertained just yet. For example, to know the all-important case fatality rate of this disease, we have to know the numbers of people infected. As we test more and more of the population we learn more about that, but not even remotely as much as we need to know. And unless we test the entire population, including those with no symptoms, and do it at intervals, we can’t know in real time or perhaps ever.
But we do know another important number: how many people have died so far of COVID-19. Or do we? Is everyone who dies of any respiratory disease being tested for the presence of the virus? And if they are all being tested, do we know that those with a positive COVID-19 test actually died from the virus and not from some other condition they might have? That sort of thing has been described as taking place in Italy, for example:
…Prof Ricciardi added that Italy’s death rate may also appear high because of how doctors record fatalities.
“The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.
“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three,” he says.
This does not mean that Covid-19 did not contribute to a patient’s death, rather it demonstrates that Italy’s fatality toll has surged as a large proportion of patients have underlying health conditions.
To understand the meaning of all the deaths in Italy, it would be extraordinarily helpful to know one figure that I’ve never seen discussed: the number of excess deaths; that is, the number over and above what is usual this time of year in Italy.
I have no doubt the number is higher than usual and that there are excess deaths, particularly in certain regions of the north where the virus has been concentrated. But how much higher? Italy ordinarily has a particularly high rate of death from the flu, which makes the “excess death” figure especially important to know. Are significant numbers of the deaths we’re seeing in Italy deaths that would be taking place anyway from the flu or other illnesses we’re accustomed to? And if so, how many?
One of the huge problems with COVID-19 is that so far it seems to cause localized outbreaks that burden a health system and in particular hospital ICU sections. That in turn results in some people dying who might otherwise be saved but for the sudden influx. That is particularly frightening, and many of the strategies being brought to bear in the US are a result of trying to prevent such a calamity. But in order to know how much we need to do and what we can expect in the worst-case scenario, wouldn’t figures for excess deaths in Italy be especially helpful?
When estimates are made for pandemic death rates (that is, deaths per million in the population, or deaths expressed as a percentage of the population, as opposed to case fatality rates that are deaths among those diagnosed), the “excess deaths” figures are commonly used to arrive at those figures. I would think that epidemiologists would be well aware of the importance of knowing what the excess deaths have been so far.
So why haven’t I yet found anything that discusses it? I realize that, since the disease only began a few months ago, we don’t have figures for total excess deaths. But shouldn’t we have some preliminary figures to compare to average figures per day or per week or per month during a bad flu season and during a good flu season? Aren’t epidemiologists interested in doing this? And why aren’t more people curious about it?
I’m sure we’d be hearing about excess death rates and Italy’s baseline death rate from the flu on the back page of the NY Times weekly Science section to explain away this pesky new flu bug if Obama was still the president. Also, we’d be a week away from the baseball season starting and otherwise be normally living our lives.
The powers that be will miraculously forget about this virus and release us from our constraints the day after the election if Trump is defeated. This election will be a referendum on whether we want to go back to what we consider normal life. Either vote against Trump or live as prisoners indefinitely.
Good points Neo. So many questions, so few definitive answers.
It is curious that people who are sounding the alarms, are so uncurious themselves. This certainly applies to that segment of the media that brings us news, speculation and rumor. For, instance, Riverside County, Ca, my lock down site, is reported to have a large number of deaths compared to the much more populous LA county. These deaths are concentrated in an area south of Palm Springs, called the Coachella Valley. It is not heavily populated. If anyone has investigated the disparity in mortality, it has not been reported; to my knowledge. It might be good to know these characteristics.
It is very frustrating to see decisions made and drastic actions mandated across the country, particularly in certain locales such as California, based on suspect data. One might surmise that hysteria has replaced analysis and judgement. Or that a power grab is in progress. The Mayor of LA, incensed that people ignored his edicts over the weekend, is now threatening fines for people who cluster closer than six feet apart. I have visions of officious functionaries wearing appropriate arm bands and carrying tape measures patrolling popular sites, such as the Santa Monica pier.
What mathane said. The questions Neo asks are not ones the “powers that be” want answered. Just look at what the Dems are doing today to understand that this whole thing has turned political; and maybe was from the start.
At this point I am seriously wondering if our federal government knows a lot more about China’s death numbers than we do and thereby these responses somehow make sense. Now Italy’s deaths exceed China’s per the worldmeter. The worldwide total deaths to date do not even reach our seasonal flu deaths here in the USA. In the meantime, Mexico isn’t responding in any manner close to the upending/life-changing responses that have been foisted upon us by governmental decree and their numbers are super low despite cultural behaviours that are more risky than ours by-and-large. I thought maybe weather might have something to do with it but I checked Tijuana’s weather and it is just like ours here in L.A. This doesn’t add up and it is maddening.
NEO: So why haven’t I yet found anything that discusses it?
Because the only persons that benefit from a lower number and less fear is the common person. Hospitals see their budgets growing if they can overfill their ICU, and you can be that is what they are doing. Politicians, i dont need to mention. Epidemiologists think they might finally have a place at the table. Medical companies can foresee a period of greater money for research or help bringing things to market.
think of another category and you will find that only the poor old sad forgotten persons are the only ones who would be happy with a lower number and certainly a less selfish less self interested set of cohorts in positions of temporary authority having their day in the sun…
Even testing is problematic, because testing can only do one thing… raise the confirmed numbers faster than deaths can keep up and so reveal that this is much less dangerous than supposed and much less than prior things we did NOT wreck the boombers elder age for.
oh, and the boomers? they have every self interest in being bribed to roast the rest on a spit before they walk off to sing in the choir triumphant… ie. they gonna die soon, so why give a crap about other people, and children they never had (due to feminism) and ungrateful nasty young people who treat them crappily?
The Excess Death Rate is a concept that has been nagging at me too, although I didn’t name it that, and certainly had not formulated the question as clearly as you have.
Here is another Excess Rate that I am wondering about: the Excess “Hospital Overwhelmed” Rate. How many hospitals have been overwhelmed, versus how many are occasionally overwhelmed by local conditions anyway? If a hospital is overwhelmed, and sends patients to a nearby hospital that is not overwhelmed, does that count?
Don’t we hear all the time about the problem of hospitals closing, especially in rural locales? Is that going to be factored into the overwhelmed rate?
What about the provision of extra military hospitals or hospital ships? If other existing hospitals are NOT overwhelmed thereafter, will Democrats count them overwhelmed anyway, because even though Trump sent the new hospitals, he sent them more slowly than Joe Biden would have? Or Joe Scarborough? Or Fredo’s smarter brother?
Epidemiology is hard!!
Arnold Kling is an economist who writes a blog that I like. It’s hard to describe his politics–maybe conservative libertarian? Anyway, he recently wrote a post I think is relevant to Neo’s remarks about epidemiologists, bad data, and questionable policy:
“If you and I are not coughing, do we need to socially distance from one another? That is a $64 trillion question. So I propose an experiment.
… [Kling then describes the experiment]
As for the volunteers, I suggest that they come from the upper ranks of the FDA, who seem to be the ones most responsible for resisting testing or trying out drug treatments for the virus. Make them “volunteer.”
…
In fact, while we wait for the results we can do it as a thought experiment. If I could, I would ask leading epidemiologists to predict the outcome of the experiment. One could use their estimates to make better assessments of policy.”
(http://www.arnoldkling.com/blog/the-experiment/)
I recall reading some information about the excess death rate at some location in Italy in a comment somewhere a week or two ago. The numbers that stuck in my mind were ~70 (normal), ~400 (pandemic). Don’t rely on that, though. I thought the comment was from someone on the scene but don’t recall what time period the data was for. The commenter was pretty definite that things were not normal.
Oh? *raised eyebrow* What if they’re all wrong? as I was taught a while back, when you extrapolate off the end of the graph, here be dragons. Too many unknowns, not nearly enough equations to solve for the unknowns.
With more testing, we’ll get better error bounds on the prognostications.
that this is much less dangerous than supposed
Oh, Art, you missed the most import statistics: very, very few infected people in the US have recovered. The obvious conclusion is that we are all going to die.
OK, I’m funning. The point is that the pandemic is in a very early phase and still growing exponentially. I think we will do OK in areas where the facilities are not overrun, and even better if there is a cure. NYC, OTOH, may go into the toilet before we get a grip on things.
The questions Neo poses in her closing paragraph are eminently sensible and should be easily answered.
The wrong people are at the podiums, the FDA head, Hahn, and Fauci, the 79(!) year-old head of the least significant, least productive National Institute (of Infectious Diseases), They babble about vaccines, drugs and clinical trials, with results out in…2 years or so, for our safety, their ultimate concern? You gotta be kidding!
We are now a nation of frightened and confused children, made so by secular progressivism and its bizarre emphasis on individual liberties regardless of societal cost, starting with no-fault divorce, then abortion on demand, gay “marriage”, now transgenders and children choosing their “gender” and parents allowing MDs to administer opposite-sex hormones and mutilate them with needless surgery. This is madness.
No wonder we rabbit-like children, once known as citizens of the planet’s greatest country, are so frightened of the Wuhan virus! Which is not “COVID-19” in my book, any more than Ebola is not Ebola or the Marburg virus is not Marburg.
Nothing there to hold us together, nothing. The “center cannot hold”, as Yeats wrote, without, in all likelihood, a violent, purging defense of conservative values based in reason and Judaeo-Christian faith. In Latin, that’s “Fides et Ratio”, the title of St. Pope John Paul II’s great encyclical, worth reading by non-Catholics even.
Chuck:
Well, without a link to the excess death information there is no way to evaluate it.
As I believe I indicated in the post, there is every reason to believe that in Italy there are excess deaths right now. The question is how many, and why no one seems to be reporting on that.
Neo:
I have also looked for that statistic and haven’t found it. Just throw the numbers into your Bayesian model with an appropriate error bar 🙂
And now this (but is it true?):
https://legalinsurrection.com/2020/03/former-hhs-official-cdc-lied-to-trump-hhs-secretary-about-ability-to-make-wuhan-coronavirus-test/
-Publication of corporate pay statistics by race and race statistics for all corporate boards
-A bail out on all current debt at the Postal Service
-Required early voting
-Required same day voter registration
-Provisions on official time for union collective bargaining
-Full offset of airline emissions by 2025
-Publication and reporting of greenhouse gas statistics for individual flights
-Retirement plans for community newspaper employees
-Federal $15 minimum wage
-Permanent paid leave
-Study on climate change mitigation efforts
The provisions will apply to the companies and business rescued by bill.
Holding America hostage…
Artfldgr:
I say yet again,
Democrats are evil.
They have become a satanic force.
St. Michael the Archangel, defend us in battle. Be our protection against the wickedness and snares of the Devil. May God rebuke him, we humbly pray. And do thou, O prince of the Heavenly Hosts, by the Power of God, cast into hell Satan and all the evil spirits who prowl the world seeking the ruin of souls. Amen
Here’s an interesting “fisking” of a popular post that was pulled from Medium by Medium for being disinformation:
https://twitter.com/CT_Bergstrom/status/1241522140559503360
It’s by one Carl T. Bergstrom Prof. Biol. at the University of Washington
He says he specialize in Information flow in biology, society, & science. I love corvids.
His twitter feed is: https://twitter.com/CT_Bergstrom
Cicero, Amen!
Dr. Birx just spoke about collecting fatality stats globally. She said only one 14 year old died in China, and no one under the age of 15 has died in Europe from coronavirus.
She also said that positive coronavirus test results are blowing out in the NY area (not sure the precise region) at 28% of all recent tests. Nationwide, about 8% of tests are positive now. Does that 8% number include the NY numbers too, or is it excluding NY? Not clear.
The point is that the pandemic is in a very early phase and still growing exponentially.
can we stop saying this?
here are the numbers.. i just downloaded them.
3/10/2020,3/11/2020,3/12/2020,3/13/2020,3/14/2020,3/15/2020,3/16/2020,3/17/2020,3/18/2020,3/19/2020,3/20/2020,3/21/2020,3/22/2020
28,35,39,46,53,62,84,107,117,195,239,299,403
The numbers are cumulative… meaning that 403 included the 299..
IF you recalculate to remove the cumulative and have daily numbers
28,7,4,7,7,9,22,23,10,78,44,60,104
The above numbers in the USA are why we have destroyed businesses,
three years of growth, unfunded retirements, and need a trillion plus bailout
if the daily numbers doubled… 28 the first, 56, and so on..
The deaths would be 114,688
2018 flu killed 300 a day (linearly), and the number would be 3,900
if you want to add todays number 579-403 = 176
28,7,4,7,7,9,22,23,10,78,44,60,104,176
not bad for 14 days of effort..
Look! Numbers!
The Seattle Times just published an article called Go inside the nerve center of a Western Washington hospital system dealing with coronavirus, about the CHI Franciscan hospital system, which runs 11 hospitals and hundreds of other clinics.
Here’s the important bit:
Now, go read the article and notice all the conditional words:
• If a surge of COVID-19 patients arrives
• how many hospital beds, health care workers and medical supplies each hospital could soon require.
• “What we are preparing ourselves for is the experience they had in China,” Ragsdale said, where hospitals saw a sudden, overwhelming spike in visits.
• Triage tents are available, if needed, and there are backup tents if overflow exceeds capacity
• “The models, the data we’re seeing, there is potential for over-capacity to hit,” Ragsdale said. “We need to get ready for that.”
[Emphasis added]
And indirectly speaking to excess deaths:
This does not sound like a hospital system overwhelmed and in crisis, for all that it’s right in the middle of the Seattle hotspot.
Dr. Birx just explained how modelers got the big potential infection percentages that Andrew Cuomo and Gavin Newsom have been using. Were the Cuomo numbers 40 to 70% of the whole population of New York?
Birx said that the model assumes that 1) Officials and citizens do nothing in terms of prevention or mitigation AND 2) the state then goes through 3 whole waves of infection extending out to the end 2022 or beyond. Let’s call this the Malthusian model. Human individuals and society itself are just brainless pinballs rattling around inside the machine. Or as one of the Brian (Bryan?) commenters said I think; GIGO.
From Birx: Average fatality age in Italy = mid 80’s. All coronavirus fatalities?
We don’t get hurricanes in Seattle, but we do occasionally get snowstorms that shut us down. The situation in the previous post sounds like news stories saying “Seattle to get twelve inches tomorrow night!” and everyone runs out and buys toilet paper (?), and then we get half an inch and it all melts before morning.
Bryan Lovely,
Yep, they’ve been predicting this surge in patients for a couple weeks now and it sounds like it’s still if, could ,potential, etc.
Of course, Emperor Jay will probably be locking us down here in a half hour.
Griffin: And the West Seattle Bridge just closed for months of repairs. Looks like I’m not likely to be commuting to work even after the quarantine is eventually lifted, because tens of thousands of cars are going to be trying to cross a 4-lane drawbridge onto a surface street. (My regular route to downtown.)
Bryan,
Yeah I just saw that. How in the world did we all drive on the viaduct for years and now they are closing the West Seattle Bridge like that?
That high rise portion is not that old like 30 years or so I think.
Someone in the Whitehouse briefing referred to the current 20% positive testing rate in the New York area. Either they got it wrong or I did. 20 or 28%, either very high or extremely high. So much better if one could read this stuff.
According to JHU.edu, Germany is up to 123 deaths with 29.06K cases. That’s a 0.42% death rate which is up a little, but very impressive assuming they’re not undercounting or overcounting something. And they achieved this with some of their youth running wild in nightclubs in Berlin. Maybe the young and infected are staying away from the elderly. I wonder if their medical treatment of the seriously ill is just better than everyone else.
Nationwide, about 8% of tests are positive now.
About 5% here in Utah, ~10% seems typical, New York is an outlier.
That’s a 0.42% death rate
That is what I am thinking, that it will end up somewhere around 0.5%. I do have a lot of hope that chloroquinine and hydrochloroquine will make a difference. The MSM hate the possibility with a raging passion, but there you go. They want me to die or, if not that, to run around in circles screaming at Trump 🙂
New York gets all the attention, but the death rate in the other 49 is worse?
Worldometer reports 43,718 cases in United States, 552 deaths.
43718/552 = 0.0126 or 1.26% national death rate
NYTimes reports 20,875 cases in New York, 157 deaths
20875/157 =0.0075 or 0.75% state of New York death rate
Subtract New York from the nationwide data
Rest of country 22,843 cases, 395 deaths
22843/395 = 0.0173 or 1.73% remaining 49 states death rate
Am I making a mathematical mistake?
Yes Chuck, I thought a few days ago we (U.S.) were getting a 5 to 7% positive testing rate.
New York cases are a large fraction of the U.S. total cases, so it matters a lot if the quoted nationwide positive test rate is counted including NY or excluding NY. Either way, it looks bad in NY. Should we just chalk this up to population density or something else?
Between the MSM and the Democrats in congress, we are in deep deep trouble.
Cap’n Rusty,
Your numbers look OK, and are interesting. My quote is from today’s Whitehouse briefing is very late breaking stuff, so maybe it’s wrong, but it suggests a big upsurge in very new infections in NY. Certainly NYC has some very fine hospitals, so possibly the average critical care is excellent.
The other factor is that the early deaths in the U.S. were a bunch of elderly folks who were taken out in a nursing home in Kirkland(?) WA. That may only represent a quarter of a percent at this point or less.
I also recall that anecdotally, the video I saw of NY doctors 5 or 7 days ago, had them jumping all over the hydroxychloroquine + Z-pak treatment.
I’ve been curious about this, too. The comparison I’d like to see is to Italy and the swine flu in 2009, which was judged as possibly very serious at first. Although its impact did turn out to be higher than normal, it was not nearly as serious as feared.
@TommyJay
I’ve been following reports here and making rough mental estimates. Note more current data can be found following some of the links on that page.
Historical NY data here. Cases are increasing rapidly, it is had to know how much comes from increased testing and how much from contagion.
@Cap’n Rusty
Another problem is that the people who died were infected 2-3 weeks earlier and the number infected at that time was much smaller, hence the percentage of that infected population that died is much higher, maybe by 4x or more. One can fine things down when/if the statistics stabilize, there are too many variables in play at the moment to be very certain of anything.
TommyJay, I listened to the presser and think I heard Dr Birx say NYC and close environs were returning 28% positives of tested persons, whereas the whole rest of the country outside that NYC area was returning 8% positives of all persons tested (with results already). Can’t say I’m perfectly certain on those numbers without going back to the video, but they’re what I came away with.
https://www.thelocal.it/20180119/italy-worst-flu-season-in-14-years/amp
Last year 2018 flu season seems like about 50ish died. So so significant increase. That, however, is not evidence that all other places will follow a similar pattern. in fact, other places seem in quite different trajectories.
McAllen:
Died of the flu? Because if Italy is counting heart attack + CV as CV, then we need to know the number of heart attacks last year. And strokes, and kidney failures, and COPD, and…
Bryan Lovely:
Perhaps they could even compare all cause death rate in the month of March 2019 (or an average) to all cause death rate in the month of March 2020. It would at least indicate something.
I’m certainly not an epidemiologist, but I’ve read enough of their papers to know that they have formulas to compare death rates and come up with excess deaths in a certain time period. That’s one of the main tools for estimating deaths from flu, for example, because flu is by no means always tested for.
Thanks sdferr. I like Chuck’s, 10:11pm theory. I was thinking that maybe NY state was holding back death certs. a couple days, but I think Chuck’s idea is better.
COVID-19 deaths and cases: how do sources compare?
https://ourworldindata.org/covid-sources-comparison
in addition to the series of small errors that we found in the WHO dataset – means that we believe it is currently not possible to understand how the pandemic is developing based on the data published by the WHO.
Download today’s data on the geographic distribution of COVID-19 cases worldwide
https://www.ecdc.europa.eu/en/publications-data/download-todays-data-geographic-distribution-covid-19-cases-worldwide
sdferr:
Thanks for that observation. I’ll try to run my numbers each day for a while, to see where they go.
The smartest guy I know maintains that doctors and health care experts are hammers that see Coronaviruses as nails, and probably should not be in charge of making the over-all allocation of the nation’s resources.
Nor should Fredo’s older brother: “If we can save just one life . . .”
Cap’n Rusty,
I heard that quote from Cuomo 2nd or 3rd hand and doubted it could be true. Just wow.
Thanks for the covid tracking website Chuck. I’m too blind to see the links unless they’re long. It looks like the cumulative NY testing is tracking at a 27% positive result rate, not just recent testing.
It could be they are being really restrictive in their testing in an effort to not waste tests, in anticipation of very much worse to come. Alternatively, New Yorkers are much less panicky than everybody else, which seems doubtful but possible.
Referring back to some earlier thoughts, I wish I knew whether the politicians who issue the sweeping edicts, and justify those by scaring the hell out of people, were simply ignorant, or charlatans. The Governor of California actually told the President, in writing, that 56% of the population of California, or about 25 million could be infected. Did he actually believe that? I doubt that he is a complete simpleton. Then, he issued his lock down orders.
I have reported that my daughter is in the LA County Health Care system. For weeks she has been carrying a heavy burden, contingency planning for a projected hopeless situation in her hospital. She is an intelligent person; but, like all of us, is hostage to the apocryphal forecasts from the experts.
I see many parallels to the modeling that created the climate hysteria; only now it is so immediate.
Oldflyer, we shall soon see. Plan for the worst, hope and pray for the best is usually the way to go. Hope your daughter can hang in there, be safe, and ride this out. Not an easy time to be in the hospital field, but may God be with her.
There is a lot of panic and cya mode going on, coupled with stupid public behavior. Here in Puget Sound after all this for the last two months, people excessively partied in the parks last weekend because the sun came out and now we are on a state wide lock down, for better or worse. Gov Inslee woke up and saw the shadow of Gov Newsom and had to do something.
I agree with the climate hysteria and immediacy, hadn’t thought of that but good parallel.
Oldflyer:
The article I read regarding Newsom’s dire prediction is that it would happen in eight weeks; i.e., 56 days.
In other words, 446,000 people per day. About twice the number of cases world-wide at the present time. (I understand about geometric progression, etc., but this is nonetheless absurd.)
Math is hard for Democrats.
Of interest? Or lies?
21 million cell phone accounts closed in China in the past 3 months.
https://www.ntd.com/the-closing-of-21-million-cell-phone-accounts-in-china-may-suggest-a-high-ccp-virus-death-toll_447579.html
“It is definitely true that epidemiologists have expertise in this arena that most of us lack, and that we can learn things from them. But they disagree with each other in their prognostications. ” – Neo
In other words, just like economists.
Barry Meislin on March 23, 2020 at 5:51 pm said:
And now this (but is it true?):
https://legalinsurrection.com/2020/03/former-hhs-official-cdc-lied-to-trump-hhs-secretary-about-ability-to-make-wuhan-coronavirus-test/
* * *
Well, the Democrats have a plan to fix that problem.
They’ll get somebody else in place that won’t have to be lied to, because they are in on the game.
https://www.thegatewaypundit.com/2020/03/obama-national-security-advisor-susan-rice-retweets-call-to-remove-trump-from-office-now-over-coronavirus/
(Actually, I think it looks more like the CDC overpromised and underdelivered as opposed to flat-out lying, but the effect was the same.)
Cornflour on March 23, 2020 at 5:11 pm said:
Arnold Kling is an economist who writes a blog that I like. It’s hard to describe his politics–maybe conservative libertarian? Anyway, he recently wrote a post I think is relevant to Neo’s remarks about epidemiologists, bad data, and questionable policy:
* * *
The comments at Kling’s blog made some interesting points, and linked some other articles of relevance, for anyone who has run out of things to read on the internet.
I do support making FDA and CDC officials and leaders be the guinea pigs for any testing.
And Congress.
I beg your pardon in advance for my sometimes faulty English.
I live in the province of Varese, which is in Lombardy (bordering wit Switzerland) but it’s not heavily impacted by infections or deaths; of course, our local hospitals ARE in critical conditions, because they are receiving all those sick people from other out-of-control provinces, like Bergamo and Brescia.
The health system here is indeed overwhelmed; my brother’s wife is a physicians, a specialist in pulmonary issues: according to my brother, she’s working 14/16 hours each day and she’s physically destroyed (btw: she’s taking chloroquine to protect herself) but morally in full gear; her daughter Erica, herself a young (28 yo) doctor, caught the virus (but withotu serious implications) and is isolated in a room: she’s just complaining she’s useless. The rest of the family – my brother and two male sons – has to be completely separated from mother and sister, so they are living at the upper floor and never go downstairs; consider that males die at twice the rate women do.
However, as I said, life here is quite calm: we are restricted to stay inside our homes, but the basic services are functioning well and the death rate is very low: in my province there are, today, 400 infected and I think 15 victims (there are no exact information about *deaths* in each province, only about people positive and under intensive therapy; death numbers are only given at the regional level). I work as a IT network engineer, so I have the permission to go to office – but I mainly work from home. Supermarket are working without shortages and, after a little confusion at the beginning, people have learnt to stay in queue (a big deal for Italians…) and behave intelligently; garbage collection, electrical power, heating, police: everything is working, even in the critical places.
Of course economy is being hit hard, and it is my personal (and totally disputable) opinion that the restricting measures taken are excessive, especially in regions where the death toll is very low: life could go on almost normally, IF people could respect norms. But the “IF” here is very big, and at so I come to the point of this post.
Why so many deaths? and are these really deaths in excess?
My first observation is that conditions are really critical (and they ARE critical) only in some very circumscribed zones. At the regional level (there are 20 regions, divided in provinces), Lombardy has 3776 victims: 1/6 of the Italian population live in Lombardy, but 62% of the total deaths are happening here. Then comes Emilia-Romagna, just to the south of Lombardy, with 892 deads. Together, the two regions make 76.8% of the total. The rest of Italy is quite another game.
But inside Lombardy only two or three provinces (there are 12) are tragically impacted: Bergamo, Brescia and, to a lesser extent, Cremona; Milano, which is by far the most populous, is much better; my Varese and Sondrio are practically unaffected.
Second point: is Covid19 really causing an excess of deaths? One can have doubt only in regard to what’s happening in the southern regions. As for northern Italy, IN CERTAIN LIMITED ZONES, there is no doubt: we have towns here where the churches are full of coffins (), the crematory can’t stand the number of bodies arriving (I have friends working there) and military trucks had to intervene in order to bring all the corpses away. I have a couple of colleagues, strong guys, living near Bergamo: they tell me “Qui non va bene per niente”, “Here it’s not going well at all”, it’s a continue procession of ambulances and funerals. It’s really tragic.
The worst is happening inside the hospitals, and this is my third point. In my opinion, what’s gone wrong is: infection containment, especially inside the hospitals. At the beginning, the epidemic was faced with some superficiality: even after the alarm, people continued to go to work (workers in Lombardy are famous and proud for their industriousness) and to aggregate; many young people lived the closing of schools as a sort of holiday and met widely. What’s more serious, nurses and doctors in some hospitals got infected ans spread the virus, so that those place (like the hospital of Alzano near Bergamo) became focuses of Covid19: people going there to be cured, with only a minor illness, were dead after a few days.
You can’t imagine how rapidly this virus can spread in the worst cases: according to what my sister-in-law says, hospitals in some zones are the most dangerous place – but where else can an infected person go, when all the system is overwhelmed? It’s a terribly vicious circle.
My final consideration here is that control, testing and isolation are of the utmost importance. Only a few Km from Bergamo, there’s a town named Vò Euganeo in Veneto, which was one of the first where several serious cases emerged: the local authorities immediately screened all suspect cases (fever, coughs, …) and isolated them completely. Veneto, which borders with Bergamo and Brescia, today has only 192 deads.
I’m not saying that everything has to be shut down everywhere, has politicians decided to do here – but, even if I was very skeptic in the beginning, I admit that I had to change my attitude.
If you let this virus spread unchecked, in a crowded place with lot of irresponsible people (like New York or any heavily populated place) the situation can **easily** go really out of control.
I beg you to be intelligent and prudent.
Please, remember my people in your prayers.
As Regard professor Ricciardi’s interview, I have to say that it’s being misunderstood in America.
He’s not saying that, after all, Covid19 is not serious and people is dying for other causes. He’s part of the government staff, and one of the people who decided for the total shut down in Italy, in the first place.
He’s saying that people who die overwhelmingly have pre-existing conditions; but here, and in previous interviews, he was pretty clear that those people would not have died without Covid19.
What he’s saying is that Italy is more “honest” than other countries which ascribe deaths to the pre-existing conditions, hiding in this way the real situation. Strangely, he’s being interpreted the other way around.
I repeat my opinion that the epidemic is not alarming in most of Italy – hence my skepticism about the total shut down of the nation – but it is certainly so in some areas. Realistic (if you want: pessimistic) diagnoses are better, in order to control the infection.
Paolo,
Thank you for taking the time to share your first hand account of conditions in Italy.
Molte grazie e Dio ti benedica. Tu rimani in salute!
@Artfldgr on March 23, 2020 at 6:01 pm
Incredible. What a bunch of scoundrels.
Paolo,
Do you notice any patterns in Italy based on weather? Was winter colder/warmer/wetter/dryer than normal? Do warmer or colder regions have more or fewer infections?
@Bryan Lovely on March 23, 2020 at 10:30 pm
You can find useful numbers related to different causes of death on the site of the ISTAT (Istituto nazionale di STATistica):
http://http://dati.istat.it/
Of course it’s in Italian, and it’s updated till 2017.
On the left, choose the section “Salute e sanità” (“Health and Healthcare”), then “Cause di morte” (“Causes of death”); here you find several tables, even at the regional and provincial level: in order to choose a particular region/province, use the pull-down menu to the right of the label “Territorio” (second red row, from the top).
For instance, deaths for cancer (“tumore”) in Lombardy have been 31,691 in 2017.
On average, we have around 600,000 deaths each year – 1650 each day.
If, by hypothesis, deaths caused by Covid19 were all in excess, they would currently be adding 600 people to 1650, each day.
Hello Rufus,
Winter has been mildly cold here in Lombardy, perhaps a little dryer than usual.
Central and Southern Italy are much warmer than here, they also have the Mediterranean sea which mitigates the climate, while we are just under the (wonderful!) Alps: for sure they had far less infections and deaths than us and weather could certainly be a reason.
Thanks for your blessing. Your Italian is perfect.
Paolo,
Thanks for the information. I’ve been reading your reports at Instapundit too. It’s good to see you over here and I hope you stick around. Lots of smart people commenting and lots of good information.
There’s food commentary at Instapundit too but sometimes it gets drowned out by the trolls.
Thank you Paolo for this insight. God bless you, your family and all who are suffering.
I believe this post addresses the question of excess deaths in Italy. Some of the comments are also informative.
https://reason.com/2020/03/17/italian-daily-death-rate-up-20-because-of-coronavirus-lombardy-up-about-80/#comments
Hello Fractal Rabbit
nice to meet you here as well, then. I’ve tried to inform you Americans as honestly as I can; I’m deeply attached to your country. Hope I’ve been helpful in some way.
I use to read this blog frequently, even if I didn’t comment till today. I like what the host, Neo, thinks and I also find her writing elegant and intelligent. She’s in the Top List of the blogs I read almost daily.
Thank you Sharon, you are very kind.
Morning update: not much has changed except worldometer has changed their website making it much harder to navigate to find the information. It’s like am MS OS update. They claim they are tweaking their reporting, so expect discontinuities in the data as they do those adjustments.
I wish I could report anything different, but all data still following exponential tracks except for Connecticut which is still linear. For you own state, at least the state data is still on the front page for the US data. I had to really dig around to find the US serious cases number. They took that off the front page and buried in a table that was a bit hard to find…..sigh….
If trend continues expect around 55000 cases by tomorrow. They report 295 recovered cases, while I predict 920 with two week recovery, and 6100 with 1 week recovery. The recovery case number still seems way too low.
Yesterday or so i put up the US death numbers..
Todays are very very interesting!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
28,35,39,46,53,62,84,107,117,195,239,299,403,579,593
28,7,4,7,7,9,22,23,10,78,44,60,104,176,14
yes.. 14…
that (probably) wont change till new numbers tomorrow…
IF this was continuing on its progression, the number should be more than 100 (minimum) to keep the curve going over time…
if this is just a stumble, then the next number would have to continue AND make up for the stumble… that probably would make the news go nutty saying its the worst increase yet…
A perhaps unrelated post …
Senior Grocery Shopping in Northeastern Illinois … we went out this morning to our local chain food store.
Fresh fruit and vegetables were fully stocked as far as we could tell.
More bread than before but still some empty shelves.
Milk was limited to two gallons per shopper. We only use about 1/2 a gallon per week maximum. Unless something SWMBO needs it for baking.
Lots of toilet paper but fewer paper towels available.
Fragranced soaps abound. Very limited non-fragranced liquid or bar soap.
Perhaps 10% of the shoppers were wearing masks.
Checkout lines had tapes marking 6 foot separation spaces.
Seems like, for the most part, the grocery supply chain is back to normal.
No line at ATM machine and it had cash.
Stay safe and no fighting. Back to my self-imposed “news” moratorium.
—
And now the rumors behind the news.
– Firesign Theater
The recovery case number still seems way too low.
Up to six weeks to recover. The Seattle nursing home outbreak was reported about the first of March, it is easy to forget that three weeks ago almost nothing was happening in the US.
Tuvea,
Thanks for that report. I’m in the Adirondacks of NYS and our grocery stores haven’t returned to normal yet. Or even close to what you describe. TP is still out. As is any kind of beef, especially ground hamburger. We’ve never been out of dairy but that’s because we live close to the source of that. We’ve got dairy farms everywhere up here.
I’ve got a nice supply of frozen beef I bought off a farmer I know. He had to kill a couple of cows back in December and the timing worked out.
No soap except dove bar soap. No bleach or cleaning supplies.
“Unless something SWMBO needs it for baking.”
Are you a fan of Haggard or Rumpole?
“Up to six weeks to recover. ”
Many mild cases have reported feeling totally fine after 1 week. Usual recovery from most viruses is two weeks, so that is what I’m basing it on
“…except worldometer has changed their website making it much harder to navigate to find the information” physicsguy
Is this intentional, that we no longer have that succinct, easy-to-read assessment of Current Active Cases worldwide and how many, a steady 95% for the last 12 days are mild and how many, 5% are serious? Now we have to go digging for information in order to draw our own conclusions and not just depend on the “experts”. Hmmmm. From where I sit (my desk since our business is deemed “essential”) this is a concern. Somehow here in the state of California where marijuana dispensaries were determined “essential” but my Realtor son can’t conduct an Open House and provide for his family I don’t feel protected or watched-out for.
Thanks, Paolo!!!
Then need to do quantitative viral load studies on districts and regions and in office buildings and hotels by sampling sewage and recirculating air.
This will happen, but it takes time to design a plan.
Many mild cases have reported feeling totally fine after 1 week.
Note that testing kicked into high gear about a week ago. Here in Utah it went to over a 1000/day almost overnight.
Sharon W: Is this intentional, that we no longer have that succinct, easy-to-read assessment of Current Active Cases worldwide and how many, a steady 95% for the last 12 days are mild and how many, 5% are serious?
Actually its NOT intentional… several places have determined that the data from the WHO is not reliable, and so they have started reworking their data from more reliable sources… so now there is less of it, but its of better quality…
i put up a mention of this happening, and why the people like me who put up websites with charts and my friend, and others have issues… over time, the datasets change, they do not stay the same… they break out more data, so the total you had yesterday is not there any more, and there are 5 locations to aggregate…
So is the Worldometer Coronavirus site currently displaying this considered inaccurate data:
287,310
Currently Infected Patients
274,322 (95%)
in Mild Condition
12,988 (5%)
Serious or Critical
You’re welcome, Ira, I’m glad to meet you.
Unfortunately, today’s been another grim one: 743 dead people. The only promising sign is that new cases in most Lombard provinces are decreasing, but for those already under intensive therapy the future is dark.
Artfldgr on March 23, 2020 at 10:52 pm said: https://www.thenewneo.com/2020/03/23/epidemiologists-as-the-new-gurus-what-about-the-excess-death-rate/#comment-2485837
in addition to the series of small errors that we found in the WHO dataset – means that we believe it is currently not possible to understand how the pandemic is developing based on the data published by the WHO.
Johns hopkins says 674…
just 19,000 more and some to match the flu
New epidemiological model shows vast majority of people suffer little or no illness The new coronavirus may already have infected far more people in the UK than scientists had previously estimated — perhaps as much as half the population — according to modelling by researchers at the University of Oxford. If the results are confirmed, they imply that fewer than one in a thousand of those infected with Covid-19 become ill enough to need hospital treatment, said Sunetra Gupta, professor of theoretical epidemiology, who led the study. The vast majority develop very mild symptoms or none at all. – Oxford study
US doctors are hoarding two rumored “anti-coronavirus” drugs for themselves and their families, helping to drive a nationwide shortage, a report said Tuesday. The doctors are prescribing chloroquine and hydroxychloroquine for themselves and their loved ones even though there is no scientific proof that the pharmaceuticals combat the contagion — and as lupus and arthritis sufferers who use the medicine go without, according to pharmacists and state regulators who talked to ProPublica. “It’s disgraceful, is what it is,” said Garth Reynolds, head of the Illinois Pharmacists Association, which was alerted to the situation through calls and emails from concerned members.
Paolo Pagliaro:
Thank you so much for coming here and letting us know how it looks from northern Italy. Your comments are invaluable (and your English is great, by the way).
Marjorie M:
Thanks. That’s definitely an article that tries to deal with the question.
But average death rates in Italy as a whole aren’t telling us much. Death rates from flu are seasonal, for example. We need to know death rates from this time of year in that area of Italy in a low flu year, an average year, and a high year, and compare them to now. This was already a high flu year, by the way, if I’m not mistaken – even before COVID.
Yesterday I posted:
New York gets all the attention, while the death rate in the other 49 is worse.
Worldometer reports 43,718 cases in United States, 552 deaths.
43718/552 = 0.0126 or 1.26% national death rate
NYTimes reports 20,875 cases in New York, 157 deaths
20875/157 =0.0075 or 0.75% state of New York death rate
Subtract New York from the nationwide data
Rest of country 22,843 cases, 395 deaths
22843/395 = 0.0173 or 1.73% remaining 49 states death rate
Following up those calculations today:
Worldometer reports 52,878 cases in United States, 684 deaths.
52878/684 = 0.0129 or 1.29% national death rate
NYTimes reports 25,665 cases in New York, 184 deaths
25665/184 =0.0072 or 0.72% state of New York death rate
Subtract New York from the nationwide data
Rest of country 27,213 cases, 500 deaths
27213/500 = 0.0184 or 1.84% remaining 49 states death rate
Again, if my math is wrong, correct me.
Vitoria Colizza models infectious disease at the Pierre Louis Institute of Epidemiology and Public Health in Paris and is a co-author of an African study about its susceptibility to the virus.
She is concerned about seven African nations that have a moderate risk of importing the virus ( from Chinese connections and workers), but whose weak health care systems, low economic status or unstable political situations make them highly vulnerable. These are Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana and Kenya.
It would be interesting to see excess deaths in these countries.
Here is my question on that New York death rate: if you look at the us average ‘tests per million people’ (1094) and the New York rate of tests per thousand (4692) there is a massive disparity. With that large gap of increased testing in New York does that mean they are just picking up more marginal and mild covid cases that don’t result in death and driving down their death rate?
Rdm:
I had that thought as well. Maybe they’re just picking up the milder cases because they’re doing so much testing.
Or, to look on the gloomier side, maybe the deaths are just lagging a sudden boom in infections. There is a time lag between infection and death for those unfortunate enough to die.
Rdm,
That was my guess also, but all we can do is guess. There is so much additional data necessary to test hypotheses.
Dnaxy:
Nigeria, Ethiopia, Sudan, Angola, Tanzania, Ghana, and Kenya are reporting a total of 152 cases (as of right now on Worldometers). So either they’re totally underreporting (possible), or the disease hasn’t really arrived there (but there’s lot of Chinese workers going to and fro), or maybe they’re not really very vulnerable after all and we need to figure out why.
Artfldgr on March 24, 2020 at 2:33 pm said:
…… several places have determined that the data from the WHO is not reliable, and so they have started reworking their data from more reliable sources… so now there is less of it, but its of better quality…
* * *
Thanks – that’s good to know.
And for all you hoarders out there – they know who you are….
https://pjmedia.com/lifestyle/costco-just-told-hoarders-what-they-can-do-with-all-their-excess-toilet-paper/
Paolo, I used to see your comments some years ago on a small blog which dealt with mostly religious matters. Thank you for your comments here. My husband has many friends in Italy, from his years of working based in Europe. I am glad to know you are well. You and your country have my prayers.
Will do.
First of all, 52,878 / 684 is 77.3, not .0129. Second, to calculate a fatality rate, you need to divide the number of deaths into the number of closed cases. For the United States, that’s 698 / (698 + 378) = .649 = 64.9% fatality rate.
I expect that to come down as the disease progresses, but that’s the rate in the United States right now. Your attempted calculation (684 / 52,878) assumes that each and every active case will recover. That’s highly unlikely based on what we’re seeing. It’s not a good assumption.
“Your attempted calculation (684 / 52,878) assumes that each and every active case will recover.” — mkent
No. Those 684 dead people were once active cases and therefore contained in the 52,868 cumulative active case number. You can calculate your 64.9% number with your definition, if you care to. I don’t think it is a very informative number.
We have numbers from S. Korea where the first wave is mostly finished and that mortality rate was around 0.6% and the WHO number from China and elsewhere that is around 3.4% and is likely on the high side.
If medical people are functioning in a crisis mode, they are no doubt thrilled when numbers of patients recover, but they probably aren’t going to waste time counting and keeping track of them precisely. That has been born out by others who have concluded that recovered numbers in various coronavirus listings are absurdly low.
That’s one of the reasons for Neo’s post on excess death numbers. Deaths are usually counted quite carefully. I wondered if excess death numbers are terribly useful if flu case numbers changed dramatically from one year to the next.
Japan had perhaps 85K fewer flu cases this year compared to last year. But a 0.1% mortality rate reduces that down to 85 flu deaths eliminated this year. Not a big deal if many hundreds are dying because of something else like coronavirus.
No, the numbers from South Korea are as follows:
126 deaths / 3856 closed cases = 3.3% fatality rate
I don’t know from where you’re getting a 0.6% fatality rate for South Korea, but it’s off by a factor of 5-1/2.
Well, since you are using a completely different method of calculating fatality rate than pretty much everyone else uses …
mkent:
Perhaps this will be helpful . . . especially the part where it provides an example:
If you are given a fraction, convert it to a percentage by dividing the top number by the bottom number. If you are given 13/100, you would divide 13 by 100.
13 ÷ 100 = .13
mkent,
You are correct that I’ve been sloppy and not getting some of this through my thick skull. The data descriptors I’ve been looking at are of a variety. Confirmed cases, Active cases+Recoveries (deaths removed). Somebody even listed suspected cases, sheesh.
A correct counting of active cases should follow something like a bell curve in the long term, whereas a running sum of confirmed cases should look something like a rounded step function. Wikipedia has a chart of the latter for S. Korea, except the top of the step isn’t flat because new cases keep coming in.
This from Wikipedia
Whether one uses confirmed cases or closed cases for the denominator of the fatality rate, the result is that they both are timed skewed during the spread, but in opposite directions. I have more confidence that people are counting confirmed cases correctly than closed cases, but that’s just a guess.
As far as I can see, the relevant numbers are fatalities/total cases, fatalities/total population, and excess cases. And since we can’t believe anything the Chinese government says — note that they expelled most US reporters, I wonder why! — I don’t think we will ever know the true worldwide numbers. I just hope the US numbers are honest. If worldometers is correct, NY has one of the lowest rates of fatalities/total cases of only 0.92%, and except for Washington (4.62%), Louisiana the highest at 3.62%. So either worldometers is way off, or Cuomo is just a crybaby.
Worldometers right now is reporting 64,107 total cases in the US, with 893 deaths and 393 recovered.
That would imply that the health authorities are tracking 62,821 currently active cases over the last five weeks, for a disease that for most people seems to have a two-week course. Right. Pull the other one.
Or maybe hospitals are only reporting cases as “recovered” who were hospitalized and in the “serious/critical” category. And therefore we can’t use the recovered/dead or recovered/total ratio as meaningful information at all.
It’s already been 2 weeks. And China had this back in December and January. And flights were going all over. So why isn’t the entire world sick by now? It’s too slow. Something else is going on.
China had mandatory vaccines last year. And Wuhan has 5g activated by December 2019. Look in that and you will see.
Neo, take a look at euromomo.EU
This graphs in detail baseline mortality and excess mortality in all EU countries over the last 4 years. Tells us everything we need to know. The only country showing excess mortality is Italy, but only in 65+ age group. And even then, the excess is less than 2017 and 2018 flu. In 2019, Italy also had a really mild flu season, so less 65+ passed away earlier in the winter. The figures don’t lie.
You may also find this interesting
https://swprs.org/a-swiss-doctor-on-covid-19/