Overcount? Undercount?

How many people in the U.S. have died of the coronavirus? According to the official U.S. death toll as I write, this, the number is 76,600. Today the Christian Science Monitor reported that, according to the latest Axios-Ipsos poll, 63% of Democrats say that number is an undercount, while a plurality of Republicans (40%) believes the figure is inflated.

Yet a wide range of studies and reports conclude that undercounting coronavirus deaths is widespread.

A New York Times study concluded that in just nine states, in March and April alone, the death undercount was close to 9,000. A study by the Yale Medical School reported in the Washington Post came to a similar conclusion.

Reports from numerous sources indicate that both the number of covid cases and deaths in Texas have been significantly under-reported, particularly among prison inmates and people in nursing homes, and Governor Abbott has refused to address the discrepancies.

According to the CDC and other health organizations, virtually all pandemics have been initially undercounted, for various reasons, partly because not all health workers recognize the signs of a new disease and then because record-keeping suffers when the health system gets overwhelmed.

So why the wide discrepancy between Democrats and Republicans?

One reason for that discrepancy is obvious. All of us tend to believe what we see around us. I live in an overwhelming Republican state with only one moderately large city and a whole lot of space elsewhere. The entire state has less than 6,000 cases, and less than 70 deaths. Needless to say, most Republicans here think the problem is overstated. Republicans tend to predominate in rural areas, and those areas generally, like Utah, are spread out more. Republicans also tend to have a greater percentage of those well-off who live in less crowded and more sanitary areas – which means they don’t see the deaths and the suffering to the same degree.

And it doesn’t help when the Republican President downplays the severity of the situation.

Democrats, on the other hand, are more likely to see the deaths or be personally affected. The coronavirus thrives best in densely populated and connected areas, which is why New York City, New Jersey, and Connecticut, as well as Detroit and Chicago and other dense urban areas, are getting hammered by the virus. In those locales, health professionals and others have been storing bodies in refrigerated trucks and makeshift morgues. New York has discovered funeral homes overwhelmed with bodies. Under those conditions, undercounts are far more likely than overcounts. And those areas are also highly Democratic in their voting allegiance.

No… the coronavirus hasn’t taken a strong hold here, and it may not, given the more rural nature of Cedar City, which so far has only had 30 cases and one death, and the folks here have a tendency to discount just how bad it can be elsewhere. But we have a daughter who’s a doctor at a major medical center in Virginia, and grown children in New York City, Boston, and the Washington, D.C., area, and everything they’re telling me is a far different story than what’s happening in Cedar City.

While we’d like to believe what we see is what the rest of the country is like…sometimes, it just isn’t, and, if you don’t see this, you should consider giving more credence to those media reports you distrust than to your own pleasant surroundings.

5 thoughts on “Overcount? Undercount?”

  1. Grey says:

    This essay has sought a delicate touch, so I’ll try to restrain myself.

    COIVD sceptics should read up on ‘excess deaths’ – something historians use to calculate the number of deaths from historical megadeath events like the black plague. You compare the deaths from England year over year in the mid-1340’s to create a baseline of anticipated deaths per year. Then compare your baseline to the plague years of 1348-49, with the deaths above the baseline – “excess deaths” – being attributed to the plague.

    We can do that in modern Italy, Spain, Belgium, New York, etc. The offical “COVID” death counts include those where a person tested positive. If they died of COVID, but weren’t tested, they aren’t included: They just ‘died’. But when the ‘excess’ deaths for these areas is calculated month by month, and the number of official COVID deaths is subtracted, there are still colossal numbers of ‘excess’ deaths. Right now, it looks like the actual death toll from COVID is 2x the offical total.[1]

    It seems like Trump and the GOP are doubling-down on the idea that it won’t spread into rural areas as they push for reopening without adequate (really, any) test/trace plans in place. But COVID talks, and BS walks, and I bet we’ll see a lot of walking when this roars into rural areas (spoiler: it will be the blue states’ fault for ‘not doing enough’).

    [1] https://talkingpointsmemo.com/muckraker/how-many-people-have-died-in-nyc-during-the-covid-pandemic

  2. Michael Creek says:

    It seems to me that the concept of excess deaths would have some relevance in that it would measure statistically and broadly, Covid related deaths. But related is not direct causation. We know that Covid can exacerbate pre-existing conditions such as heart disease. We know that economic dislocation will result in increased suicide, domestic violence, alcoholism and drug abuse. Did Covid cause these deaths?

    1. From the comments of doctors and epidemiologists, it’s clear that most of them regard the deaths of individuals with pre-existing conditions who die when infected with Covid as caused by Covid. Deaths resulting from conditions exacerbated by Covid or by regulations/orders used to combat it won’t be in the official death tolls.

  3. Michael Creek says:

    When reflecting on the Australian Covid experience and as we are starting to come out of the social and economic lock down (which reached Stage 3 and never Stage 4), it is apparent that there are great risks in opening up an economy without having in place some critical backup.
    Firstly, is the ability to find cases in the least possible time. This depends on self reporting disease symptoms, no matter how mild, rapid and trustworthy testing, and, critically, contact tracing. This latter is very difficult and labor intensive. We have had a cluster of over 80 cases in a meat packing yard. The first case was diagnosed on April 24 and, within 3 weeks, 88 cases have resulted. Luckily, the Covid situation here is largely contained, and the state has the capacity to track, test and isolate the contacts. If the outbreak goes to another generation, it becomes less and less containable.
    Secondly, it is very important to protect vulnerable populations, such as old people in group situations and hospital staff.
    As our Prime Minister said on May 8
    “There have been 6,899 confirmed cases in Australia and sadly 97 people have died. There are now only around 1,000 active cases in Australia, and over the past week, daily infection rates have remained low. Testing remains high, with more than 730,000 tests undertaken in Australia.

    We need to continue to have the right controls in place to test more people, trace those who test positive and respond to local outbreaks when they occur. These are precedent conditions to enable Australia to relax baseline restrictions and enable Australians to live and work in a COVID-19 safe economy.

  4. Given COVID 19’s effect nation wide and existing statistics, Fairly rational thought would suggest a higher number of deaths than is reported. Common questions that have arisen are why different political parties may under or over report it. It is strongly suggestive that any existing party in power may under report a situation to suggest better performance and control and encourage re-election while parties not in dominant position may exaggerate the negatives to dislodge the existing party. With that said, I am more concerned with reduced numbers of medical doctors that are present to help counter COVID 19. Insurance plays a considerable part in medical treatment and over the last 20 years patterns suggest increasing attempts at not covering existing problems by reducing the number of medical doctors on insurance panels as well as reducing financial earning of primary care doctors by over 60% in some cases almost removing categories of doctors from the medical pool altogether. Family practice, the primary care givers that would have been the first defenders against COVID 19 for the population have been significantly reduced in numbers due to insurance manipulations. With that being stated, some doctors are being brought out of retirement to help address the communities’ medical needs. If there is a silver lining here it may be a forced change in the medical community that mandated better and faster care and helps bring some of our most needed doctors back into service and or brings more medical doctors in fields such as family practice back into productive service.

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