{"id":5986,"date":"2020-09-23T19:28:30","date_gmt":"2020-09-23T19:28:30","guid":{"rendered":"https:\/\/adhc.lib.ua.edu\/pandemicbook\/?page_id=5986"},"modified":"2021-11-13T18:52:08","modified_gmt":"2021-11-13T18:52:08","slug":"09-23","status":"publish","type":"page","link":"https:\/\/adhc.lib.ua.edu\/pandemicbook\/09-23\/","title":{"rendered":"09-23"},"content":{"rendered":"\t\t
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Wednesday, September 23<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t
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\n\t\t\t\t\t\n\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\tUS Cases 6.94 million
US Deaths 202,148<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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Sep 22: Over 200,000 people are dead<\/a> from COVID-19. The Washington Post<\/i> reports that the Pentagon\u00a0used $1 billion Congress allocated for medical equipment to pay defense contractors<\/a>\u00a0instead for such things as jet engine parts, body armor, and dress uniforms.<\/p>

Sep 23: A study conducted at Houston Methodist Hospital finds\u00a0a more contagious strain<\/a> of COVID-19 in a large portion of recent patient samples. A grand jury does not charge<\/a> ex-Louisville, Kentucky officers for shooting Breonna Taylor. The Republican-led Senate Homeland Security Committee<\/a> says in a report that it found no improper influence or wrongdoing by Joe Biden in his Ukraine dealings as vice president. Chad Wolf<\/a>, acting Homeland Security secretary, tells senators that white supremacists have become the “most persistent and lethal” domestic security threat in the United States. President Trump refuses to commit to a peaceful transition of power\u00a0<\/a>if he loses the November election. “We’re going to have to see what happens,” Trump said.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t

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\n\t\t\t\n\t\t\t\t\t\t\t\n\t\t\t\tFrom the cutting room floor ...\t\t\t\t<\/span>\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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I had initially reached out to a Food Systems Planner in Franklin County, Ohio, to discuss his work addressing the \u201cfood desert\u201d phenomenon in a metropolitan area of 1.3 million people, with a larger minority population than the surrounding areas in Ohio. But it\u2019s his personal perspective (he stresses that he\u2019s not speaking as a government representative) that jumps out at me today.<\/span><\/p>\n

Looking back on this moment from fifty years in the future, he imagines people will marvel at the \u201cwanton disregard\u201d for the degree to which the tragedy of this year fell upon those already pushed to the margins:<\/span><\/p>\n

\n

\u2026 and how seemingly invisible that suffering and death has been for the whiter and wealthier and more powerful. This invisibility is a function of how segregated we are in terms of housing, education, workplace, healthcare, and much more. We live, work, and play in completely different worlds. This allows the whiter, wealthier, and more powerful to easily ignore suffering and death in normal<\/span> times and continue in their ignorance during a crisis.<\/span><\/p>\n

I invite you to imagine what our societal and governmental response would be if COVID-19 was causing suffering and death at proportionate or higher rates in these whiter, wealthier, and more powerful suburban communities. It\u2019s easy to imagine a World War II scale response that reoriented our entire economy and cultural norms in service of defeating the virus and stabilizing the economy. Instead, the United States still has no national plan to fight rising infections, expand and improve testing, facilitate effective quarantine, or stabilize and support the people and communities most impacted.<\/span><\/p>\n<\/blockquote>\n

[read_more id=”1″ more=”Read more” less=”Read less”]<\/p>\n

His point is a good one. And it prompts me to spend much of the day digging into data that, unexpectedly, highlights exactly this point.<\/span><\/p>\n

Per capita, the worst spots have remained the places with some of the highest percentages of African Americans\u2014namely the Gulf South and the Mississippi River Valley\u2014and Latinx populations\u2014namely Texas through southern California. As we\u2019ve already shown throughout our pandemic year, these are largely poor areas ruled over by a Republican elite without much access to healthcare or employment that stresses workplace safety. Over the last half-year, there has been little improvement in these areas at all; high caseloads per capita in early May, high caseloads per capita in late September. America may have moved on from their interest in these areas, but coronavirus has not. <\/span><\/p>\n

There\u2019s another unwelcome indicator to add to the story this week. The New York Times<\/em> recently tabulated \u201cexcess deaths\u201d through the first five months of the pandemic. It\u2019s especially important to reveal this statistic now, since right-wing conspiracy mongers seized on the statistic released by the CDC last month that \u201conly\u201d 6% of COVID-related deaths listed coronavirus as the exclusive cause of death.[1]<\/a> Ninety-four percent of the 200,000 deaths by coronavirus, in other words, listed more than one condition or co-morbidity contributing to death\u2014something we\u2019ve known since the first public reports on coronavirus patients out of China in January. This string of co-morbidities is not suspicious at all; it\u2019s actually the standard death certificate coding procedure mandated by the WHO and the CDC throughout this pandemic.[2]<\/a> But those searching for reasons to disbelieve the severity of COVID in order to dispense with mask mandates, business closures, or stay-at-home orders are hyping this 6% as a secret admission by Fauci and his supposed left-winged minions.<\/span><\/p>\n

As we already saw in April, the measurement of excess deaths bypasses one of the weak links in any public health system: the improper coding of death certificates. Even if a physician, coroner, or medical scribe is reluctant to place the \u201cU07.1\u201d indicating SARS-CoV-2 on the death certificate, every<\/em> death counts toward the total of excess deaths no matter the cause.[3]<\/a> \u201cExcess death\u201d could potentially stand for three different things, however. Mid-nineteenth century statisticians and public health officials compared deaths from one year to the year before it or, alternatively, used a multi-year \u201caverage expected mortality\u201d and compared actually counted deaths against that number to measure the impact of diseases, accidents, wars, and other tragedies.[4]<\/a> In the last few decades, British public health statisticians attempted to account for under- and over-counting by formulating an \u201cupper bound\u201d threshold.[5]<\/a> The CDC uses this upper bound algorithm to warn of impending outbreaks instead of merely reporting a difference between tabulated deaths and the expected average mortality because, they say, \u201cThe upper bound more readily identifies areas experiencing statistically significantly<\/em> higher than normal mortality.\u201d[6]<\/a> The<\/em> New York Times<\/em> chose to use the expected average mortality instead of the typical upper bound threshold, however. That turned out to be a significant decision. Unlike the more conservative estimate usually adopted by the CDC, yesterday\u2019s New York Times<\/em> article identifies 257,900 deaths above the expected average mortality from the second week of March through the final week of August.[7]<\/a> (I did my own count using National Center for Health data and beginning the count two weeks earlier\u2014when the first deaths started. My count comes out only slightly higher.[8]<\/a>) That excess death count reveals that over one quarter of a million people more than expected have died in America this year. That\u2019s the equivalent of a Madison, Wisconsin, a Buffalo, New York, or a St. Petersburg, Florida exterminated in under a half-year. Whatever<\/em> is killing Americans this year, it\u2019s bad in an unprecedented, once-in-a-century sort of way.<\/span><\/p>\n

Those on the political right might proclaim the \u201ccure\u201d of shutdowns and masks is worse than the coronavirus disease. Fortunately, there\u2019s a long-practiced method by which to assess the stringency of our nation\u2019s response to coronavirus. National \u201cp-scores\u201d rank excess mortality by the difference between the weekly deaths as actually counted and the average number of deaths in that same week averaged over the previous five years. Compared to Italy, which suffered a p-score more than double<\/em> their yearly average in February and March, the USA appeared to weather the first wave proportionally better. By April, while the USA was more or less in lockdown, we averaged only 30%-40% over the ordinary number of deaths. But, unlike Italy, whose p-scores dropped precipitously given their own quarantines, the level of death in the United States persisted in that 30% range for weeks, then months. In fact, America\u2019 p-score over these last few months appears similar to Sweden\u2019s. But Sweden elected not to shut down its schools, restaurants, and other drivers of the economy at first and, buffered by its quasi-socialistic system, suffered comparatively less economic damage than Germany, Italy, or the UK. In other words, the USA suffered the negative economic consequences of closing most businesses, but because we didn\u2019t follow through with truly restrictive lockdown measures, we suffered the worst long-term epidemiological consequences in tandem with the economic problems. The United States suffered the worst effects of both<\/em> Italy and Sweden.<\/span><\/p>\n


<\/span><\/p>\n

Notes<\/p>\n

[1]<\/a> BMartin1776, \u201cUpdated CDC Covid Numbers Show Only 6% of Total US Deaths Actually Died Solely From Virus,\u201d SavingtheRepublic.Com: Video News & Opinion<\/em> (blog), August 30, 2020, http:\/\/savingtherepublic.com\/blog\/2020\/08\/updated-cdc-covid-numbers\/.<\/span><\/p>\n

[2]<\/a> National Vital Statistics System, \u201cGuidance for Certifying Deaths Due to Coronavirus Disease 2019 (COVID-19),\u201d Vital Statistics Reporting Guide (U.S. Department of Health and Human Services, April 2020), https:\/\/www.cdc.gov\/nchs\/data\/nvss\/vsrg\/vsrg03-508.pdf; WHO, \u201cInternational Guidelines for Certification and Classification (Coding) of COVID-19 as Cause of Death\u201d (Geneva, Switzerland: World Health Organization, April 16, 2020), https:\/\/www.who.int\/classifications\/icd\/Guidelines_Cause_of_Death_COVID-19.pdf?ua=1.<\/span><\/p>\n

[3]<\/a> Steven Schwartz, \u201cNew ICD Code Introduced for COVID-19 Deaths,\u201d COVID-19 Alert (Washington, DC: Division of Vital Statistics, National Center for Health Statistics, March 24, 2020).<\/span><\/p>\n

[4]<\/a> \u201cMortality From London Fogs,\u201d The British Medical Journal<\/em> 1, no. 1103 (February 18, 1882): 235\u201336, http:\/\/www.jstor.org\/stable\/25258965.<\/span><\/p>\n

[5]<\/a> Angela Noufaily et al., \u201cAn Improved Algorithm for Outbreak Detection in Multiple Surveillance Systems,\u201d Online Journal of Public Health Informatics<\/em> 5, no. 1 (April 4, 2013), https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3692796\/.<\/span><\/p>\n

[6]<\/a> National Center for Health Statistics, \u201cExcess Deaths Associated with COVID-19,\u201d Centers for Disease Control and Prevention, September 9, 2020, https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/covid19\/excess_deaths.htm. Emphasis in original.<\/span><\/p>\n

[7]<\/a> Josh Katz, Denise Lu, and Margot Sanger-Katz, \u201cThe Toll Since Coronavirus Struck: 250,000 More Deaths Than Normal,\u201d The New York Times<\/em>, September 22, 2020, sec. U.S., https:\/\/www.nytimes.com\/interactive\/2020\/05\/05\/us\/coronavirus-death-toll-us.html.<\/span><\/p>\n

[8]<\/a> https:\/\/www.cdc.gov\/nchs\/nvss\/vsrr\/covid19\/excess_deaths.htm<\/span>
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tTrump refuses to commit to a peaceful transfer of power\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t
\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tNBC News. \u201cReporter: \u2018Win, Lose or Draw in This Election, Will You Commit Here Today for a Peaceful Transferal of Power after the Election?\u2019 President Trump: \u2018We\u2019re Going to Have to See What Happens.\u2019 Https:\/\/T.Co\/H5RF3dKPD1.\u201d Tweet. @NBCNews (blog), September 23, 2020. https:\/\/twitter.com\/NBCNews\/status\/1308902276187262978.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\n\t\t\t\t\t
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\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tBranco, AF. \u201cBiden SCOTUS List.\u201d Townhall, September 22, 2020. http:\/\/townhall.com\/political-cartoons\/2020\/09\/22\/176894.\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t
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