I was updating my post from twelve days ago on the upward trend in new coronavirus cases when I came across a great tabular summary of a phenomenon that’s been underway since early April: significant delays in reporting deaths from COVID-19 (C19). Before I get to that, a quick word on what’s happened over the past 12 days. New coronavirus cases keep climbing in a number of states, and it’s been a grisly waiting game to see whether the severity and lethality of infections will follow the case counts upward. The following chart provides a very preliminary answer. It’s taken from Our World In Data, and it shows the seven-day moving average of C19 deaths in the U.S.
There has indeed been an upturn in reported deaths over the past week. Just prior to that, a temporary plateau in late June was caused by a set of “reclassifications” of earlier deaths in New Jersey (the “plateau effect is caused by seven-day averaging). These kinds of changes in reporting make it rather difficult to interpret trends accurately. Unfortunately, the reporting of deaths has been subject to continuing distortions that are even more difficult to discern than New Jersey’s spike.
Kyle Lamb provides the interesting table below, which might be difficult to read without either clicking on it or going to the link at Twitter. Here is another link to an annotated version of the table. The top row labeled “CTP Total” is the C19 death toll reported each week by the COVID Tracking Project. This is generally what the public sees. These reports show that deaths reached their highest levels during the weeks of April 11th through May 9th. However, the second column shows C19 deaths by their actual week of occurrence. This series shows a more distinct peak on April 18th with steady declines thereafter.
The weekly totals in the second column are not final, however. Take a look at the last reporting week in the far right column (July 11th). The CTP reported 4,286 deaths, an increase over the prior week consistent with the upturn in the first chart above. But the table shows that over half of that week’s reported deaths actually occurred in late April and early May! So the upturn in deaths is something of a mirage.
We won’t have a reasonable approximation of the death totals for the past several weeks (or how they compare) for at least several more weeks. In fact, one can argue that it might be a matter of months before we have a reasonable approximation of those deaths, but it’s worth noting that the vast bulk of “actual” C19 deaths tend to be reported within four weeks of the initial reporting week, and the additions or revisions to the two weeks in late April and early May in the last column were exceptionally large. Chances are we won’t see many more that big…. Or will we?
Aspects of this process hint at the ease with which the C19 death totals could be manipulated. The reported totals for all-cause mortality in the first column are incomplete; more recent weeks, especially, are not fully settled as to causes of death. Some of those fatalities are certain to be attributed to C19. Others might be reclassified as C19. And here is the scary part: the all-cause totals are certain to include a significant number of lockdown-related or COVID-phobic deaths: individuals who were unable or unwilling to seek medical care for urgent needs due to lockdowns or fears of rampant spread of C19 infections within hospital environments. To anyone with an interest in manipulating the C19 death toll, whether hospital officials seeking higher reimbursements, local or state officials seeking federal funds, or public officials at any level seeking to promote pandemic fears and/or political discord, these “extra” deaths might be tempting marks for reclassification.
I’m fairly confident that the uptrend of new cases will be far less severe than early in the pandemic. I believe much of the alarm I see on social and mainstream media is misplaced. More on that in a subsequent post, but for now I’ll simply note that those testing positive are concentrated in much lower ranges of the age distribution, and treatment has improved in a variety of ways. The table above shows that the downtrend in actual weekly C19 deaths is intact as of the admittedly incomplete July 11th reporting week. We won’t know the “actual” pattern of early-July C19 fatalities for another month or more. Even then, one might harbor suspicions that the totals are manipulated for economic or political reasons, but we can hope the reporting authorities are exercising the utmost objectivity in assigning cause of death.