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Not-that-bad or not-that-high: How advocates of a return to normal misrepresent coronavirus deaths

Medical personnel move a deceased patient to a refrigerated truck serving as a makeshift morgue at Brooklyn Hospital Center on Thursday in New York City. (Angela Weiss/AFP via Getty Images)

To advocate for a quick or immediate return to America as normal, one must figure out how to rationalize the fact that this week alone, tens of thousands of people have died of covid-19, the disease caused by the coronavirus that emerged in China last year. You can’t simply say, “open up the economy and let the bodies fall where they may.” Instead, we get two different arguments: “open up the economy because the number of deaths is comparable to other causes,” or “open up the economy because the number of deaths isn’t a high as suggested.”

Both of those arguments, though, have significant flaws.

The death toll isn’t demonstrably inflated.

The second argument has been fairly common recently, advocated by people such as former Fox News host Bill O’Reilly and current Fox News personality Brit Hume. Hume in particular has repeatedly suggested that the number of covid-19 deaths being recorded is inflated because people who have preexisting conditions such as cancer are dying and having their deaths attributed to the virus.

Anthony S. Fauci, a leading member of the White House coronavirus task force, was asked about this claim on the “Today” show Thursday morning.

“There is absolutely no evidence that that’s the case at all,” Fauci said. “I think it falls under the category of something that’s very unfortunate, these conspiracy theories that we hear about. Every time we have a crisis of any sort, there’s always this popping up of conspiracy theories. I think the deaths we’re seeing are coronavirus deaths, and the other deaths are not being counted as coronavirus deaths.”

Asked if there was, perhaps, an undercount of coronavirus deaths, Fauci said he thought there was “more of a chance of missing some that are really coronavirus deaths that are not being counted,” but added that the undercount was probably not “significant enough to really substantially modify the trends that we’re seeing at all.”

Fauci’s expert analysis aside, skeptics of the number of coronavirus deaths often point to assertions that the number of pneumonia deaths in the country is substantially lower this year than in years past — attributable, they claim, to pneumonia deaths being categorized instead as deaths due to covid-19.

The Centers for Disease Control and Prevention collects weekly data on pneumonia and influenza deaths. Since the beginning of the year, the number of weekly pneumonia deaths in the United States has, in fact, been lower than in the past two years.

The CDC data is current as of about three weeks ago, after the increase in covid-19 deaths began. More on that in a second.

It’s worth noting that the number of deaths from pneumonia this flu season has been consistently lower than in years past, which helps explain why the number of deaths in recent weeks has been below the figures from 2018 or 2019. As a percentage of recorded deaths, the number of pneumonia deaths this flu season doesn’t stand out, nor is there a detectable shift in the new year, after the coronavirus began to spread.

What’s more, the number of recorded pneumonia and flu deaths is significantly lower than the number of weekly coronavirus deaths. If we considered the peak number of pneumonia deaths in 2018 — 5,583 deaths in the second week of that year — the figure would constitute less than two-thirds of the deaths from coronavirus in the 14th week of this year. (Data on coronavirus deaths is from the Johns Hopkins University tally.)

If we consider those numbers as a daily average, allowing us to capture the most recent daily data, it’s obvious that covid-19 mortality is not simply a function of diverted pneumonia deaths.

Regardless, it’s faulty to argue that conditions which might themselves lead to a patient’s death should be necessarily considered as the causes of death. If someone is teetering on the edge of a cliff and you push them, it was your push that caused their death, even if they may have fallen anyway. It’s been known since the outset of the pandemic that those with underlying conditions were at more risk from the coronavirus. It can give sick patients that additional push which leads to their deaths.

Testing for the novel coronavirus is a crucial part of slowing the disease's spread. Here’s how the United States failed to provide tests that worked quickly. (Video: The Washington Post)

The coronavirus isn’t simply a run-of-the-mill cause of death.

On Wednesday, Fox News’s Tucker Carlson presented a case for getting the country back to normal.

“Here are a few numbers,” Carlson said. “An estimated 60,000 Americans will die from the coronavirus. According to the CDC, in 2018, 61,000 Americans died of the annual flu. That same year, more than 67,000 died from drug overdoses. Nearly 50,000 died from suicide. About 88,000 Americans died from alcohol abuse. Eighty-three thousand died from diabetes. More than 606,000 died from cancer.”

“For the sake of argument, let’s assume the real number is twice that, and 120,000 Americans will die in this outbreak,” he continued. “That would still be around as many people as die from overdoses and suicides — both of which our leaders essentially ignore. Deaths like those aren’t considered a government problem.”

“We’re not going to tell you that what our leaders have done in the last month is disproportionate,” Carlson added a bit later. “You can decide that for yourself. But it’s definitely something to think about."

His argument was largely predicated on a downward revision of a leading model of how many people might die of the virus. That model, from the University of Washington’s Institute for Health Metrics and Evaluation, had predicted more than 90,000 deaths by August. This week, after considering new data including the effectiveness of social distancing efforts, the likely toll fell to 60,414.

That 60,000 figure, though, was the most likely outcome in a broad range of possibilities — from as few as 30,000 deaths to as many as 130,000. (The 60,000 figure was also in the original range of possibilities compiled by the IHME, something critics of the model tend to ignore.)

The IHME estimate of 60,000 deaths (1) is only through August and (2) assumes that full social-distancing measures remain in effect through May — something that Carlson seems to think is not warranted. So even with the stay-at-home orders remaining in place, the IHME model suggests that the toll by late summer could be tens of thousands of deaths higher. And that’s before we enter the next flu season in the fall, when many experts expect a resurgence of the virus.

For the sake of argument, let’s nonetheless assume that Carlson’s numbers are right. He’s correct that the current tally of deaths from coronavirus — 16,478 — is far below the number of annual deaths seen from other causes. It’s also true that even the 120,000-death figure is lower than causes such as stroke, accidents or cancer.

The point, though — the entire point, start to finish — is that those deaths are uniquely preventable. There is no cure for cancer and, for many cancers, no way to prevent someone from developing the disease. There is a way to prevent people from getting covid-19: keep them from contracting the coronavirus. The toll by August may be the equivalent of a bad seasonal flu such as the one we saw in 2017-2018, but that’s because of the stay-at-home orders, according to government experts. It’s because we limited the extent to which the virus could spread. And, again, the estimate that the toll by August could be as low as 60,000 depends on the distancing measures Carlson and others are eager to revoke.

Based on the most recent Johns Hopkins data, the coronavirus is killing more people each day than die, on average, of heart disease and cancer.

This is an unfair comparison in its own right, since the daily coronavirus death toll is a function of the current spike in deaths. Cancer kills that many people every day for 365 days a year; coronavirus is very unlikely to see such a high average through the end of 2020. Unless, of course, it’s allowed to spread unchecked.

The point is entirely that we have more control over the height of the spike in coronavirus deaths — and over the number of spikes — than we do with illnesses such as heart disease. Yes, there is a severe economic toll and, yes, we will need to figure out a system that allows the virus to be contained while the economy slowly gears back up.

What Carlson and others suggest is that the success of the containment measures is an argument to scale back those measures.