Give Him A Break by Chip ProserIf you've been visiting this blog with any regularity since the beginning of 2020, you probably know that we started covering the coronavirus intensely by early February. And we were quick to point out that China was feeding international organizations fake COVID-statistics pretty early on-- as they have continued to do right up until this day. Yesterday, for example, they reported just 2 new cases and no new deaths. Look at this chart of the countries with similar overall numbers of confirmed COVID-19 infections:China claims 58 cases per million people. Even just marginally and relatively less dishonest countries are reporting astronomically higher numbers of cases per million:
• U.S.- 5,326 cases per million• Brazil- 1,974• Russia- 2,598• Spain- 6,096• U.K.- 3,966• Italy- 3,832• France- 2,854• Germany- 2,178
And Iran, which was the first country to get the pandemic in a big way after China, reported 2,258 new cases and 63 new deaths yesterday. Their caseload per million is 1,715.Does it matter that China-- and other countries-- fudge their numbers. Of course it does... at least to anyone trying to figure out what the contours of this pandemic and this disease really are-- and how to fight it effectively. But it isn't just China. Trump-allied governors, particularly Florida's Ron DeSantis, are also giving misleading numbers that are far below what it really happening there. As you may have noticed, when we list Florida numbers, we usually not that they are fake. Texas' numbers appear to be as well. Florida, for example, has reported a gigantic spike in flu and pneumonia deaths that are certainly deaths that should be attributed to COVID-19. Does this look suspicious to anyone:Florida is reporting just 2,481 cases per million and just 110 deaths per million. No one believes these statistics-- and Texas' are even more bogus-- 2,045 cases per million and 55 deaths per million. Yesterday, writing for Politico, Darius Tahir and Adam Cancryn noted that "Federal and state officials across the country have altered or hidden public health data crucial to tracking the coronavirus' spread, hindering the ability to detect a surge of infections as President Donald Trump pushes the nation to reopen rapidly."China or Florida... which is worse? Hard to say, but Floridians in Miami-Dady, Broward, Palm Beach, Hillsborough, Orange, Lee, Duval, Collier, Pnellas, Manatee and Polk counties are being hit a lot harder than DeSantis' phony figures indicate-- as he pushes to reopen willy-nilly and fast. Tahir and Cancryn reported that "In at least a dozen states, health departments have inflated testing numbers or deflated death tallies by changing criteria for who counts as a coronavirus victim and what counts as a coronavirus test, according to reporting from Politico, other news outlets and the states' own admissions. Some states have shifted the metrics for a “safe” reopening; Arizona sought to clamp down on bad news at one point by simply shuttering its pandemic modeling. About a third of the states aren’t even reporting hospital admission data-- a big red flag for the resurgence of the virus. The spotty data flow is particularly worrisome to public health officials trying to help Americans make decisions about safely venturing out. The lack of accurate and consistent Covid-19 data, coupled with the fact that the White House no longer has regular briefings where officials reinforce the need for ongoing social distancing, makes that task even harder.COVID-Kim
Iowa Gov. Kim Reynolds told reporters that the state will share information about outbreaks at meatpacking plants only upon request. And Georgia has only just begun to differentiate between the two types of coronavirus tests it's been adding into its testing totals for weeks.“All these stories about undercounts, overcounts, miscounts, are undermining our ability to deal with the pandemic,” said Irwin Redlener, a public health expert at Columbia University. The country, he said, is confronting an “unheard of level of chaos in the data, the protocols, the information.”The problems are widespread and have infiltrated federal health agencies as well. The Centers for Disease Control and Prevention blended diagnostic and antibody tests, boosting the nation's overall testing numbers.The Department of Health and Human Services took out of context data on the danger of “deaths of despair” from overdoses and suicides amid an economic debacle, according to the authors of the report in question. On Tuesday, an ethics center at Harvard rebuked the White House for misleadingly citing numbers from one of its studies to buttress the administration's national testing report.Nearly half the U.S., meanwhile, has registered rising caseloads as states press ahead with reopening the economy. While some of that reflects increased testing, an accompanying uptick in hospitalizations is worrying experts, including former FDA commissioner Scott Gottlieb.The White House, which has insisted it's following a “data-driven path” to reopening, did not respond to questions about the data that it’s relying on.But within the Trump administration, some officials aren’t merely ignoring the warning signs. They’re also selectively using scientific advice and models in their quest for a swift reopening. For instance, HHS Secretary Alex Azar warned during a recent Cabinet meeting that the U.S. could see 65,000 additional “deaths of despair” if the country does not get back on track to normalcy soon.In reality, the study he cited explicitly warned against lifting lockdowns before health data showed it was safe to do so.“Some might use this report to argue that this is why our economy needs to open up fast. But that’s NOT what we are saying,” wrote the authors of the report, which was published by the American Academy of Family Physicians and Well Being Trust. “Even as of today parts of the country are opening, data suggest that this is premature due to a lack of consistent testing, which allows public health authorities to trace, treat and isolate to prevent further spread.”Harvard University’s Safra Center for Ethics similarly publicly chastised the administration. HHS used one of the center’s testing models to suggest the U.S. was already testing enough people to contain the virus-- when the center was arguing that testing is woefully inadequate to ensure a safe reemergence from “stay at home.”“The Department’s Report does not provide an accurate summary of the modeling supporting our recommendations,” said the center’s director, adding that HHS had cited a “nonprimary” model in the study’s appendix and then adjusted the assumptions underpinning it.The data challenges are making it even harder for the states to balance health and economic imperatives. In addition to pulling back from its historic role as the central health authority during public health crises, the Centers for Disease Control and Prevention has established few firm standards for how states should monitor Covid-19 and made little overt effort to coordinate its messaging with state and local health departments.That’s created a patchwork system where key health information is collected and communicated with little uniformity, and amid rising concern over whether Americans are receiving reliable reports about the pandemic fight.At least a half-dozen states have admitted to inflating their testing figures by mixing two different types of tests into its totals, a practice widely derided as scientifically unsound.In Georgia, where Gov. Brian Kemp has been among the strongest proponents of reopening, the inclusion of antibody tests inflated the state’s overall testing count by nearly 78,000-- a disclosure that came a few weeks after officials posted a chart of new confirmed cases in Georgia with the dates jumbled out of order, showing a downward trajectory.Like several other states, Georgia's health department began listing separate totals for its antibody and diagnostic test counts only after reporters discovered it had been quietly combining the two. Georgia's count of hospitalized coronavirus patients also includes only those who were already in the hospital when their diagnosis was reported to the state, a limitation that the state has openly admitted likely creates “an underestimation of actual hospitalizations.”“It’s going through political filters there in the same way that maybe we’re seeing some information go through political filters at the federal level,” said Harry Heiman, a professor at Georgia State University’s School of Public Health, of the state’s coronavirus data. “It makes it really hard to know what’s going on.”Florida has weathered a string of controversies over its evidence to support GOP Gov. Ron DeSantis’ boasts that the state is faring better than most, including an attempt to block access to information on nursing home deaths and the firing of a health department official who now alleges she was pushed out for refusing to manipulate the state’s data.A separate dispute involved the health department’s attempt to suppress the coronavirus death count published by Florida’s medical examiners-- a figure that was initially higher than health officials’ tally.“Never, before today, has the Department of Health raised an eyebrow that this information is confidential and privileged,” said Stephen Nelson, the district medical examiner for Polk County, Florida.By the time the examiners’ death toll was finally released almost two weeks later amid public pressure, the number was lower than the one published by the health department.States led by Democratic governors haven’t been immune from transparency questions either. New Jersey revised down its nursing home coronavirus death count by about 1,400 after concluding it would only count those with a lab-confirmed diagnosis of the disease, a move a GOP state legislator called a “whitewash.”...Yet unlike in past public health emergencies, the Trump administration has signaled little interest in overseeing how states combat the pandemic in this next phase, and what evidence they rely on to do it.In response to questions about states manipulating and altering their coronavirus data, an HHS spokesperson told Politico that “state leaders have the clearest insights into the situation on the ground in their states, and we stand ready to provide support as states begin to reopen safely.”As for the CDC, the vaunted public health agency spent the past week under fire for its own data issues, after confirming it, too, was combining different types of tests in calculating the nation’s testing totals. The CDC, which blamed the lapse on combined testing numbers reported by individual states, said it will break out figures for the different tests “in the coming weeks.”It’s an environment that threatens to erode public trust, experts warn. “You want people to trust what authorities are telling them,” said Jennifer Kates of the Kaiser Family Foundation, and that trust is going to be difficult to earn.
Yesterday, German Lopez reported at Vox that Just 3 states meet these basic criteria to reopen and stay safe and that "most states still need to reduce coronavirus cases and build up their testing capacity... [and] haven’t made the preparations needed to contain future waves of the pandemic-- putting themselves at risk for a rise in Covid-19 cases and deaths should they continue to reopen." These are the 3 most fundamental criteria needed to reopen relatively safely:
• The coronavirus is no longer spreading unabated.• The states need the testing capacity to track and isolate the sick and their contacts• The states need the hospital capacity to handle a potential surge in Covid-19 cases.
Personally I would go much further and add that the states' populations are observing social distancing protocols and that everyone is wearing a mask and that the states are taking it seriously enough so that non-mask wearers are fined enough to hurt-- like 1% of their 2018 reported gross income-- or imprisoned. Experts who spoke with Vox said that states "should see a two-week drop in coronavirus cases, indicating that the virus is actually abating. They should have fewer than four daily new cases per 100,000 people per day-- to show that cases aren’t just dropping, but also below dangerous levels. They need at least 150 new tests per 100,000 people per day, letting them quickly track and contain outbreaks. They need an overall positive rate for tests below 5 percent-- another critical indicator for testing capacity. And states should have more than 40 percent of their ICU beds free to actually treat an influx of people stricken with Covid-19 should it be necessary... [W]ith these metrics, states can gauge if they have repressed the coronavirus while building the capacity to contain future outbreaks should they come. In other words, the benchmarks show how ready states are for the next phase of the fight. So far, most states are not there. As of May 27, just three states-- Alaska, Kentucky, and New York-- met four or five of the goals, which demonstrates strong progress. Thirty states hit two or three of the benchmarks. The other 17, along with Washington, DC, achieved zero or one."
Very few states hit all the marks recommended by experts. But even those that do shouldn’t consider the pandemic over. They should continue to improve-- for example, getting the positive rate below even 1 percent, as in New Zealand-- and look at even more granular metrics, such as at the city or county level.Meeting the benchmarks, however, indicates a state is better equipped to contain future coronavirus outbreaks as it eases previous restrictions.Experts emphasized that states have to keep hitting all these goals week after week and day after day-- Covid-19 cases must remain low, testing ability needs to stay high, and hospital capacity should be good enough for an influx of patients-- until the pandemic is truly over, whether thanks to a vaccine or other means. Otherwise, a future wave of coronavirus cases, as seen in past pandemics, could kill many more people.“You need to have all the metrics met,” Popescu said. “This needs to be a very incremental, slow process to ensure success.”And if the numbers do start trending in the wrong direction, states should be ready to shut down at least some parts of the economy again. Maybe not as much as before, as we learn which places are truly at risk of increasing spread. But experts caution that future shutdowns will likely be necessary to some extent.“I do worry we’re going to see surges of cases and hot spots,” Watson said. “We do need to keep pushing on building those capacities... Otherwise, we’re just rolling the dice on the spread of the virus. It’s better if we have more control of the spread.”That’s another reason these metrics, along with broader coronavirus surveillance, are so important: They not only help show how far along states are in dealing with their current Covid-19 outbreaks, but will help track progress to stop and prevent future crises as well.
