Epidemiologists deal with dry facts and figures, but the subject matter of those facts and figures can be very dramatic: illness and death, and how best to go about minimizing the former and delaying the latter. Usually we don’t pay all that much attention to epidemiologists unless we have a particular interest in the subject.
But during this pandemic epidemiologists have been constantly in the news, and anyone with an “epidemiologist” before or after his or her name is the new authority. We hang on their every word as though our lives depended on it – and perhaps they do. Governments set policy based on their recommendations and those policies are having extreme effects on our lives.
It is definitely true that epidemiologists have expertise in this arena that most of us lack, and that we can learn things from them. They are good at describing something ex post facto, often with estimates derived from statistics that are far from exact. It often takes years to understand what has happened in an epidemic or pandemic. And that’s understandable.
But their forecasts often disagree with each other. Well, someone’s probably correct, but who is it? The worst doomsayer? The sanguine optimist? The in-betweens?
And I have a question for them all. I know we are missing some important numbers for COVID-19 that can’t be ascertained just yet. For example, to know the all-important case fatality rate of this disease, we have to know the numbers of people infected. As we test more and more of the population we learn more about that, but not nearly as much as we need to know. And unless we test the entire population, including those with no symptoms, and do it at intervals, we can’t know for sure.
But we do know another important number: how many people have died so far of COVID-19. Or do we? Is everyone who dies of respiratory disease being tested for the presence of the virus? And if they are all being tested, do we know that those with a positive COVID-19 test actually died from the virus and not from some other condition they might have? That sort of thing has been described as taking place in Italy, for example:
…Prof Ricciardi added that Italy’s death rate may also appear high because of how doctors record fatalities. “The way in which we code deaths in our country is very generous in the sense that all the people who die in hospitals with the coronavirus are deemed to be dying of the coronavirus.“On re-evaluation by the National Institute of Health, only 12 per cent of death certificates have shown a direct causality from coronavirus, while 88 per cent of patients who have died have at least one pre-morbidity – many had two or three,” he says. This does not mean that Covid-19 did not contribute to a patient’s death, rather it demonstrates that Italy’s fatality toll has surged as a large proportion of patients have underlying health conditions.
I have no idea if other doctors in Italy would agree with that assessment or not. But to understand the meaning of all the deaths in Italy, it could be helpful to know one figure that I’ve never seen discussed: the number of excess deaths; that is, the number over and above what is usual this time of year in Italy, in the same locations where most of the dying is taking place.
I have no doubt the number of deaths there now is higher than usual and that there are excess deaths, perhaps a huge number, particularly in certain regions of the north where the virus has been concentrated. But how much higher? Italy ordinarily has a particularly high rate of death from the flu, for example, which might make the “excess death” figure especially important to know. Are significant numbers of the deaths we’re seeing in Italy deaths that would be taking place anyway from the flu or other illnesses we’re accustomed to and which sometimes cause the death of elderly people who are already ill? And if so, how many?
One of the huge problems with COVID-19 is that so far it seems to have caused localized outbreaks that burden a health system and in particular hospital ICU resources. That in turn results in some people dying who might otherwise be saved but for the sudden influx. That is particularly frightening, and many of the strategies being brought to bear in the US are a result of trying to prevent such a calamity. But in order to know how much we need to do and what we can expect in the worst-case scenario, wouldn’t figures for excess deaths in Italy be helpful?
But so far I haven’t found anything written for the public discussing that issue. I realize that, since the disease only began a few months ago, we don’t have figures for total excess deaths. But shouldn’t we have some preliminary figures to compare to average figures per day or per week or per month during a bad flu season and during a good flu season in the localities involved?
I’m neither a scientist nor an epidemiologist. But those are my questions.
[Neo is a writer with degrees in law and family therapy, who blogs at the new neo.]
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