Tuesday, August 18, 2020

Counting Counts

 Environmental & Science Education, STEM, Health, Medicine--Ed Hessler

You'd think that reporting the actual number of COVID-19 deaths would be straightforward until you consider some of the impediments. 

Writing for STAT, Philip Setel, a vice president and director of civil registration and vital statistics at the organization Vital Strategies, writes that limited testing, inconsistencies in assigning the cause of death, and even political influence (imagine that!)" contribute to the uncertainty. He notes that a metric urged by other health professionals and scientists should be used. It measures "the total number of lives lost n excess of historically expected levels." (added)

There are indirect effects of COVID-19, for example "when health systems are strained or overwhelmed and unable to provide...quality care (insufficient ICU beds is an example),,,delays in going to the hospital (arising out of fear)...and "COVID-19's interactions with noncommunicable diseases such as diabetes, heart disease, cancer, kidney disease, and others." COVID-19 has been a surprise in terms of these deaths.

So how does one measure "'excess mortality'"? The basic formula is supplied by Setel. You measure "the difference between the total number (of) deaths from all causes during a specified period of time and expected number of deaths for the same place and time of year, on an historical average."  We know that testing is limited in spite of claims by the President that it isn't. Setel writes that the need for testing" in a variety of communities "greatly excess the number of tests available."

And consider this factor, testing.  Setel notes, it "tends to occur almost exclusively in hospitals, leaving uncounted the deaths related to Covid-19 outside these facilities. This heavy reliance on hospital data excludes the tremendous number of deaths that occur at home in low- and middle-income countries. Even in the absence of a public health emergency, for example, some governments have estimated in unpublished reports that up to 80% of deaths happen outside of hospitals, with no doctor in attendance."'  

Accurate data allow analysts to pinpoint peaks. Setel draws our attention to a single city. "'Cumulatively, between March 16 and June 6, Manaus (Brazil) registered 3,549 excess deaths and a 153% increase in expected mortality. By contrast, only 1,462 confirmed Covid-19 deaths were reported during this period." (added). This is huge; the implications of undercounting are well known in terms of treating, deploying resources and using the wisely, making investments, in decision making about easing rules, and opening local economies.

And again, he reminds, urges, pleas with political authorities to  "rely on epidemiological evidence and data to guide the return of open societies, economies, and a new normal for all." 

So far the science has been downplayed, even damned when even the faintest praise is given.

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