Debating Deaths Does Nothing

Terry H. Schwadron

May 14, 2020

Really? With coronavirus deaths spiraling toward 86,000, now we have to debate whether the death count is exact?

Rather than focus our various efforts on providing testing, contact tracing, protective gear and protecting supply lines for food and medicine, our government leaders have to spend their time looking to shave a few victims off the total death count, presumably for political purposes?

This, as I find I am saying way too often, is nuts.

There are growing accounts out of the White House that Donald Trump and members of the coronavirus task force are pushing the Centers for Disease Control to get states to be precise in counting coronavirus deaths. At the same time, states are noting that death counts, particularly in New York and New Jersey, may be understating the death totals because people are dying at home or in nursing homes rather than in hospitals where the death reports are funneled to state health departments.

And on top of all this, there is a rear-guard action among some right-leaning political interests to base death counts solely on medical examiner records that usually lag behind the health department counts, and do not represent deaths that never come to coroner attention.

Apart from record-keeping, the goal of slowing the count seems to be justification for re-opening economies — as if whether it is 85,000 deaths or 79,500 deaths would make a difference to your decision about whether to enter into a workplace lacking protective steps or to mix unmasked on public transportation.

It may be the final victory of symbolism over reality.

Bending the Numbers

Dr. Deborah Birx, coordinator of the task force, has urged CDC officials to exclude from coronavirus death count reporting individuals who either do not have confirmed lab results and are presumed positive or who have the virus and may not have died as a direct result of it, three unnamed senior administration officials told The Daily Beast, for example.

The news outlet quotes five officials in the CDC that the agency has been forced to push back against Trump suspicions about the death totals — which he thinks are being inflated by the methodologies being used. At the same time, Scientists and doctors working with the task force, including Dr. Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, have said the U.S. death toll count is likely higher than is being reflected in government data.

Bob Anderson, chief of the Mortality Statistics Branch at the CDC said, “We’re almost certainly underestimating the number of deaths.”

Besides being practically irrelevant, this debate over the actual count is just the latest front in tensions between the White House and the CDC, typified by the recent decision to shelve CDC guidelines for re-opening businesses as overly aggressive and detailed. The guidelines covered such things as summer camp set-ups and religious services as well as workplaces.

Basically, the White House argument is that mortality rates lag behind hospitalizations as a current, real-time indicator for disease.

But rejecting high death numbers may help justify ignoring contagion for politics, and divert from Trump’s chaotic handling of testing issues, of lags in providing ventilators, protective gear and in failing to speed supplies needed both on the medical and economic fronts.

Information Does Lag

It is a strange fight for a White House that ought to be a lot more concerned about ensuring that food is getting to market rather than spilled unused and unsold on the farm, or whether labs have enough chemical reagents to process the rising number of tests, or whether businesses have sufficient guidance on how to operate or whether OSHA plans anytime soon to actually supervise worker safety issues.

Can’t we all just agree, for example, that the feds did not think early enough about nursing homes to ensure that all the deaths were counted as the virus spread? Or now that these strange child deaths may be virus-related? In the small town in upstate New York where we spend time, we’re only hearing this week about nursing home deaths among the county totals, and the state is saying that death totals are shy of of upwards of 5,000 deaths. Florida, one of the last states to issue a shelter-in-place order and one of the first to reopen, has stopped releasing medical examiners’ statistics on numbers of coronavirus victims because the numbers are higher than the state’s official count.

Birx has said she does not trust the CDC’s numbers for case and death counts. She thinks the reporting system is flawed because it does not always certify correct hospital death codes, resulting in possible overcount. The CDC notes that local officials are reporting that patients arrive at hospitals already dead, for example, or that overwhelmed doctors may not stop to encode the deaths properly. To account for that in New York, the medical examiner runs a computer program of records looking for mention of COVID-19.

One of the sources with knowledge of Trump’s private remarks said he would he’d like a “review” of how the coronavirus deaths are counted, citing hypothetical cases in which a person has the virus but is killed by other unnatural means, such as falling down a flight of stairs.

What we don’t need right now are arguments about precision. A pandemic means a whole lot of death, and we should be focusing on safe ways to get through it.