”No country counts virus deaths like the others. We just have the most detailed method.” — Belgium’s Public Health Minister Maggie De Block
Axios reports that “a senior administration official said he expects Trump to begin publicly questioning the COVID-19 death toll as it closes in on his predictions for the final death count and damages him politically.”
Sources indicate that President Donald Trump will charge that hospitals, because they get higher Medicare payments, are lying about their virus mortality rate. It is true that they, on the direction of the Centers for Disease Control and Prevention, are now reporting presumed deaths — those untested patients who had all the symptoms of the coronavirus.
Belgians angry at Trump’s ignorance
In a White House briefing on April 18, Trump bragged about our low COVID-19 virus death rate compared to Western European nations, notably Belgium. Reporting virus deaths on a per capita basis is misleading, primarily because countries with dense populations will generally have higher infection rates.
Belgium has 307 more people per square mile than the U.S., and its government has responded angrily to Trump’s reference to its virus death count. One minister called it “level zero” politics. He claimed that Belgium’s “method of counting [COVID-19 deaths] is the most exhaustive possible.”
Belgian nursing home deaths are 52 percent of the total, but only 4.5 percent of these were confirmed virus fatalities and the rest are now being reported as “suspected, based on symptoms.” The Netherlands (even more dense in population than Belgium) and France have now joined Belgium in this more accurate reporting.
Sweden’s virus deaths undercounted
Some have suggested that we should have followed Sweden’s decision not to issue stay-at-home orders. They argue that the Netherlands, the United Kingdom, France, Italy and Belgium all have higher virus death rates than the Swedes. I will show that these rates are not accurate, but even as they stand, no one would want to accept Sweden’s putative 12.3 percent mortality rate.
Misleading method to count virus deaths
Sweden’s population is even less dense than ours and its three largest cities total only 2 million out of 10.1 million Swedes. More decisive, however, is the misleading method many have used to calculate coronavirus deaths. Even Swedish epidemiologist Anders Tegnell, who has led his nation’s “light touch” response to the virus, admits that citing infection rates based on limited tests is “an unreliable measure.”
Many commentators have divided the number of reported deaths by the number of virus cases confirmed by testing.
The problem with this method is that Italy is testing three times more people than Sweden is, and Sweden is counting only the hospital deaths of patients who tested positive.
Therefore, both the numerators and the denominators of this calculation may be way off.
Paul Franks, a genetic epidemiology professor at Sweden’s Lund University states: “The existing data suggest that the infection rates are probably much higher in Stockholm than in London and a little higher across Sweden than across the United Kingdom.”
Sweden’s nursing homes a ‘big problem’
Sweden finally banned visits to its nursing homes on April 3, after it realized that a third of its total virus fatalities (not counted in the national tally) were occurring there. Even so, the nursing home rules are lax: Staff are required to wear masks and gloves only if the resident is suspected of having the virus.
Swedish epidemiologist Anders Tegnell now admits that nursing homes “are our big problem area.” One of his staff stated that nursing home deaths are “probably underestimated, as regional health infectious diseases units were reporting that many elderly who died were not being tested.” Sweden’s Prime Minister Stefan Löfven confessed that nursing home deaths was a “serious situation.”
Sweden’s ‘huge failure’
Writing for London’s Observer, virologist Lena Einhorn contends that Swedish officials “have to admit that it’s a huge failure, since they have said that their main aim has been to protect the elderly, but what is really strange is that they still do not acknowledge presymptomatic or asymptomatic spread is a factor.”
In early May epidemiologist Anders Tegnell found himself rethinking his position. Admitting that 3,000 virus deaths is a “horrifyingly large number,” he admitted that he is “not convinced” the unconventional anti-lockdown strategy was the best option to take. He also previously assured Swedes that child and teen infections would be rare, but now, as primary and secondary schools have not been closed, there are now 400 virus cases in the 0-19 age range.
Sweden’s anti-lockdown no help to economy
One would think that Sweden’s anti-lockdown policy would help the economy, but predictions do not support this view. The European Central Bank calculates that Sweden will suffer a recession in the 6.9-9.7 percent range, just where the rest of Europe is expected to be.
European workers will be much better off because of generous paycheck protection programs, unemployment insurance, and sick leave. Primarily because of the GOP tax cut, our budget deficit will be 44 percent higher than the European average, as many countries in the EU entered the pandemic era with budget surpluses, even Greece, surprisingly enough.
Britain: Most virus deaths in Europe
British health authorities initially followed Sweden in attempting to establish “herd immunity,” but with a rapid rise in mortality, they wisely chose lockdown instead. Imperial College London estimated that 250,000 Brits would lose their lives, and health authorities took note, especially after their prime minister came down with the virus. This delay is the main reason why the United Kingdom now has the highest number of putative deaths in Europe.
Michael Head, global health specialist at the University of Southampton, maintains “that care home residents may account for around half of COVID-19 deaths in five European countries.” The British government has finally included presumed deaths in nursing homes, and the number of national virus deaths went up significantly. In England and Wales the uncounted fatalities were twice as much as the hospital deaths.
COVID-19 deaths may be 60 percent higher
In an analysis of excess deaths (those higher than normal times) in 14 countries, London’s Financial Times concluded that the COVID-19 death toll may be 60 percent higher than reported. Its reporters found 122,000 excess deaths in these countries, but only 77,000 confirmed virus mortality. The most extreme disparity was found in one of Ecuador’s provinces: excess mortality was 10,200 but COVID-19 deaths were only 245.
Coronavirus deaths in New York City rose by 3,700 when probable as well as confirmed cases were added to the toll. (Trump objected to this valid correction.) In the early stages of the pandemic as many as 180 to 195 patients a day, even though they showed symptoms of the virus, were turned away from overwhelmed city hospitals and many died at home. Researchers at the Yale School of Public Health calculated that the number of U.S. deaths “may be off by 50 percent or more.”
CDC looking at ‘excess deaths’
Trump will not be pleased by the CDC’s decision to start counting presumed deaths as well as those confirmed by testing. CDC officials have noted thousands of excess deaths in March and April. The New York Times reported that New Jersey had “about 5,200 excess deaths in the month ending April 11,” but only 2,200 COVID-19 fatalities. Those who die in nursing homes are often “cremated with no autopsy or death investigation.”
Some U.S. death certificates revised
American public health officials are now finding that “acute respiratory failure” was a frequent diagnosis on death certificates during the pandemic. Heart disease and kidney failure were also mistakenly listed as the cause of virus deaths. Dr. James Gill, Connecticut’s chief medical examiner, was suspicious of one certificate that indicated “acute respiratory failure.” He ordered a post-mortem and the true cause was COVID-19.
The case of New York musician Charlie Terhune is illustrative. His wife was sure that he had the coronavirus and his doctor confirm her suspicions. The ambulance medics were certain as well as the hospice nurses. His death certificate, however, stated “acute respiratory failure.”
Suspicious virus deaths in Alabama
Under the new CDC guidelines for recording virus deaths, the states are allowed, consistent the Trump administration’s fatal hands-off policy, to set their own criteria for this reporting. This means, as Debbie Koenig of WebMD reports, “Alabama, for example, may continue to exclude patients who tested positive, if a doctor’s review determines they may have died from another cause. As of April 16, the state had 133 reported deaths with positive tests, but only 82 had been attributed to COVID-19.” That is absurd.
Florida hiding its virus deaths
In Florida there is a tug-of-war between state health officials and state medical examiners, who claim that the former are not reporting all the coronavirus deaths they send them. One of the examiners, Dr. Stephen Nelson, said that state officials told him they also plan to remove causes of death and case descriptions. “Without that information, the list is meaningless,” he said.
In late April, Florida’s Congressional Democrats sent Gov. Ron DeSantis a letter demanding an explanation for “inconsistencies between COVID-19 death tracking methods used by the Florida Department of Health and county medical examiners.” They have not yet received a reply.
The Chinese government is now adjusting upwards the COVID-19 death toll in Wuhan, but residents are complaining that even more transparency is needed. If the Chinese can do it, then Florida’s health officials should do the same.
Nick Gier of Moscow taught philosophy at the University of Idaho for 31 years. Read all his columns at nfgier.com.