Tag: Accurate Coronavirus Data

Our COVID Data Is Inaccurate, And It’s Going to be Spun

The Daily Escape:

Sand Harbor State Park, Lake Tahoe, CA – 2020 photo by debarnec

Happy belated tax day! Two disturbing articles about both the accuracy and reliability of COVID-19 data were in the NYT yesterday.

First, the collection and reporting of data is increasingly reliant on outdated technology to deliver test results:

“Health departments track the virus’s spread with a distinctly American patchwork: a reporting system in which some test results arrive via smooth data feeds but others come by phone, email, physical mail or fax, a technology retained because it complies with digital privacy standards for health information.”

The problems are compounded by human error:

“These reports often come in duplicate, go to the wrong health department, or are missing crucial information such as a patient’s phone number or address.”

Before the pandemic, nearly 90% of laboratory test results for diseases tracked by public health departments were transmitted digitally. But the need for substantially greater Coronavirus testing has brought many more players into the public health arena, including companies that usually run employment screening tests, and small clinics that usually test for diseases like the flu and strep throat.

This has increased the share of lab tests coming to public health departments via fax and phone.

The result is unreliable information. The Times quotes Janet Hamilton, executive director of the Council of State and Territorial Epidemiologists: (emphasis by Wrongo)

“Nationally, about 80% percent of coronavirus test results are missing demographic information, and half do not have addresses…”

Hard to trace an infected person without an address. America’s health system is a jumble of old and new technology that make it difficult to track what’s really going on with the COVID pandemic.

Also, the Trump administration’s guidelines on demographic data haven’t taken effect yet. In June, they required laboratories to report a patients’ age, race and ethnicity, so public health officials could better understand the demographics of the Coronavirus pandemic. But, those rules won’t take effect until August, and they only state that laboratories “should” provide patients’ addresses and phone numbers. They do not mandate it.

Dr. Frieden, former CDC director says:

 “You’ve got hundreds of laboratories and thousands of tests. Nothing is interoperable because they haven’t been mandated to do that.”

Other countries have a unique number identifier for each patient, something that Congress refuses to provide in the US. Instead, data often come to public health authorities using only the information that laboratories need to track the record, not the details that public health officials need to help manage the disease.

Anyone who has healthcare knows that patients routinely fill out the same information on multiple forms in multiple offices. The need for doctors and testing services to use fax machines betrays the fundamental lack of modern technology in some health care settings.

And remember, it’s not for lack of money: There’s plenty of money in the US health care system.

The second item regarding COVID data is more troubling. The NYT reports that: (emphasis by Wrongo)

“The Trump administration has ordered hospitals to bypass the Centers for Disease Control and Prevention and, beginning on Wednesday, send all coronavirus patient information to a central database in Washington — a move that has alarmed public health experts who fear the data will be distorted for political gain.”

From now on, HHS, and not the CDC, will collect daily reports about the patients that each hospital is treating, how many beds and ventilators are available, and other information vital to tracking the pandemic.

This is seen as an inherently political move by outside public health experts. The NYT quotes Nicole Lurie, who served as assistant secretary for preparedness and response under former President Obama:

“Centralizing control of all data under the umbrella of an inherently political apparatus is dangerous and breeds distrust….It appears to cut off the ability of agencies like C.D.C. to do its basic job.”

This is more disturbing than finding out that the data are terrible. Alex Azar, who runs HHS, is a Trump crony and has clearly used his position to be helpful to Trump’s re-election campaign.

If there ever was any hope for a dispassionate, reasoned, and scientific FEDERAL response from Trump, it is certain that these two problems, one with the quality of the data, and the second with how it will be spun as it is reported, show we’re doomed.

How many health care workers will have to die? How many people living in states run by Trump’s personal bootlickers will get the treatment that they need?

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Monday Wake Up Call, Memorial Day – May 25, 2020

The Daily Escape:

Reflection of sunrise at Vietnam Veterans Memorial – 2012 photo by Angela B. Pan

(There will be no column on Tuesday, 5/26. We will resume on Wednesday.)

Most years, today is about honoring those who have died in America’s wars. But this year, we should also be honoring all of those who have died from COVID-19. In the 80+ days since the first American death from the virus, around 100,000 people have died from it.

Let that sink in. The 2020 virus toll is now greater than America’s combined combat deaths in Korea, Vietnam, Afghanistan and Iraq. Yet, many people think that concern about the virus is simply a political move designed to keep Trump from being reelected.

Let’s take a look back at the Tomb of the Unknown Soldier in Arlington National Cemetery. It is dedicated to deceased US service members whose remains were never identified. On March 4, 1921 Congress approved the first burial of an unidentified American serviceman from World War I in the plaza of the new Memorial Amphitheater.

Then on November 11, 1921, another unknown WWI soldier was brought back from France and interred in the tomb. President Warren G. Harding officiated at the interment ceremonies. During his remarks at the ceremony, Harding said this:

“Our part is to atone for the losses of the heroic dead by making a better Republic for the living”.

Harding was president from 1921 to 1923, when he died, apparently of a heart attack. Despite his being in office only two years, Harding managed to appoint four justices to the Supreme Court.

We see Harding as a failed president, but if all presidents made “making a better Republic for the living” their highest objective, America would likely be a much better place today.

The AP reports that, according to the Department of Veterans Affairs, more than 1,000 veterans have been killed by the Coronavirus, but that number does not include hundreds more who have died in state-run veterans homes. Most people know someone who died.

Despite that, Coronavirus deaths are being politicized. Trump says the numbers are exaggerated. Many Republicans say that masks and social distancing aren’t necessary. Some still compare the rate of deaths from the yearly flu to COVID-19 and say “what’s the big deal?”

On this Memorial Day, we seem to be hopelessly divided. Polls show that just 53% of Democrats have a great deal of confidence that medical scientists are acting in the public interest. But among Republicans, just 31% express the same “great deal” of confidence in them, a 22 percentage point difference.

Perhaps looking at a little more history would help. America was founded on principles of mutual help, compromise, and provision for the common defense in a hostile world. Ben Franklin said at the signing of the Declaration of Independence, that “We must all hang together, or surely we will all hang, separately.” What he meant was that unity was essential to achieving victory in the Revolutionary War.

Our Constitution codifies the golden rule into civic responsibility for finding solutions to shared problems. The expectation is that will be accomplished through reasoned debate as a part of the legislative process.

But our infatuation with neoliberal economics has brought us unregulated greed. That has led to failures of the commons. Management of health care by MBAs means we can’t provide our own medicines, or our own PPE. We can’t even maintain enough ICU beds on standby for peak needs.

The pandemic has shown us that we’re poorly equipped to handle both a humanitarian disaster and an economic crisis at the same time. What’s far worse is that those existential threats didn’t unite us.

If these twin threats weren’t enough, what possible threat will it take to unite us?

What may finish off America as a global power is our failure to learn from our mistakes. We live in a time of black or white answers, of friends versus enemies. We’ve forgotten how very useful understanding what is happening in the grey areas can be.

The virus isn’t going away with words or photo ops. And propping up the Dow Jones isn’t going save us either.

American Exceptionalism is over. We’re finding out that in most of the ways that count (healthcare, employment security, and unity) we’re performing at a mediocre standard.

Do we still have what it takes to correct our slide?

Time to wake up America. On this Memorial Day, we need to remember our dead, but we also need to remember what it takes to live and work together for a common cause.

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Sunday Cartoon Blogging – May 10, 2020

The National Bureau of Economic Research (NBER) has an interesting new report showing that New York City’s subway system was a major disseminator of COVID-19 during the coronavirus’ initial infection of the city during March 2020.

They show that subway ridership correlates directly with new cases, particularly in Queens. The near-shutdown of subway ridership in Manhattan (down by 90%) at the end of March correlates strongly with the reduction in the rate of increase in new cases in Queens thereafter.

They superimposed maps of subway station turnstile entries with zip code-level maps of reported coronavirus incidence. That showed Coronavirus propagation followed a process strongly consistent with subway riding. Moreover, local trains appeared to have a higher propensity to transmit infection than express trains, perhaps because people spent longer on those trains. Bus hubs served as secondary transmission routes out to the periphery of the city.

The subway was shut down because of staffing issues on March 25, not because the mayor or governor thought it was an important disease vector. Since then, at least 98 transit workers have died from coronavirus. On to cartoons.

Jogging in Georgia requires evasive tactics:

Trump did it again:

It never ends. On Fox and Friends, Trump said there is “no question” the video of the Ahmaud Arbery shooting is troubling. But, he hinted that further evidence might emerge that could possibly exculpate the shooters:

 “You know, it could be something that we didn’t see on tape. There could be a lot of — you know, if you saw things went off tape and then back on tape”

BTW, the NY Daily News reported that no burglaries had been reported for seven weeks before the shooting.

Small man sits near a great man:

America grows smaller as the president tries to make himself bigger, all the while failing at the actual mission of leading the Republic.

Pro-life doesn’t get in the way of reopening:

The only animal Trump wants at the White House:

Dropping charges against Flynn looks partisan:

Another reason to stay indoors:

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Problems With The COVID-19 Data

The Daily Escape:

Sunrise in Monument Valley, UT – photo by therealmindzeye. Note the sun star!

Happy tax day! Here are the updated COVID-19 seven-day results as of 4/13:

  • The number of new cases has plateaued. The average rate of increase for the past seven days is 6.88% vs. 5.00% on 4/13. But, this is a function of how many tests are conducted.
  • The number of deaths is increasing more slowly, averaging 11.94% for the past seven days vs. 7.35% on 4/13.
  • More people were tested on 4/13 than on any day in the past seven days, but we still lag April 4th, which was the country’s high point in tests at 229,268.

We all hear the daily recitation of new cases, deaths and tests, but as Wrongo said last week, there are multiple issues with the data that politicians and public health officials are relying on for decision-making.

Cathy O’Neil, who writes at Bloomberg and blogs as the Mathbabe, has a column addressing reasons to doubt the COVID-19 data. Here are a few of her points: (emphasis and brackets by Wrongo)

“1. The number of infected is close to meaningless. Only people who get tested can be counted, and there still aren’t enough tests…anecdotal evidence suggests that people need to be ill enough to be hospitalized [to get tested]. About 10% of cases merit hospitalization, so the actual number of infected might be about ten times larger than what’s reported.

2. The tests aren’t accurate and the inaccuracies aren’t symmetric. In particular, they produce many more false negatives than false positives….Some research suggests that the false negative rate could exceed 30%.

3. The number of tests doesn’t equal the number of people tested. Because the tests are so inaccurate, some people get tested twice….This means that the share of the population tested compared to the number of people found to be infected paints a rosier picture than reality…another reason to believe that the actual number of infected is higher.

4. The numbers aren’t in sync. People sometimes die weeks after being hospitalized, and they get hospitalized a week or more after testing positive for the virus. So we shouldn’t expect the “number of deaths” curve to flatten until pretty long after the “number of cases” curve does.

5. The meaning of hospitalization is changing. Officials have recently presented flattening hospital admissions as a positive sign. But it takes a lot more to get somebody to the hospital these days. Hotlines are jammed, ambulances are scarce, standards for who gets hospitalized have drastically changed, and people are avoiding overwhelmed emergency rooms. So fewer hospitalizations doesn’t necessarily mean that the situation is getting better.

6. Deaths aren’t reported immediately or consistently. Various operational issues, such as paper filing and notifying next of kin, determine when a death actually gets registered. This might help explain why the most deaths tend to get reported on Tuesdays.

7. Deaths outside hospitals aren’t being reported. When people die at home or in nursing facilities, veteran homes, or prisons, they’re not always counted…..When France started reporting fatalities in nursing homes, their death count increased by 40%. Belgium reports nursing home deaths pretty well, and they’re finding 40% of deaths occur there.

8. The policy for attributing deaths isn’t consistent. Once somebody is gone, why waste a valuable test? So doctors might not mention Covid-19 as a contributing cause. It’s a judgment call, especially when someone was sick already. This might have a very large effect on the data in certain environments like rehab facilities and nursing homes.

9. Officials may have incentives to hide coronavirus cases. China, Indonesia and Iran have all come under scrutiny for their statistics…..So don’t assume that officials are above…manipulation.

10. What happens in one place, or on average, might not be applicable everywhere. Some small studies suggest that the Covid-19 mortality rate is about 1% of the infected population. But that doesn’t mean it will be the same in the US, or in New York City….As we’ve seen in recent days, such disparities are disproportionately affecting people of color.”

You should follow the Mathbabe. We all rely on the count, but as Cathy says, we may not know the true numbers for some time. Testing needs to be done systematically, particularly on asymptomatic people, once we decide to end the lockdowns.

For deaths, accurate numbers may never be available. It’s possible to estimate using the number of unexpected deaths compared to a year earlier. But even that’s not ideal, because lockdowns might suppress other kinds of deaths — traffic accidents, for example — since people are forced to stay at home.

Despite flaws in the data reporting, we’re all obsessed with learning how America is responding to the pandemic. And the daily updates on tests, cases, and deaths gives us a reasonable clue about what to expect, when things might get better, or how our leaders are doing with the response to the virus.

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