Mark Twain nailed it: "It isn't what people don't know that's the problem. It's what they know that just isn't so."
Taking that as a starting point, let's consider Trump's recent interview with Chris Wallace of Fox News. Anything involving Trump is political, but I will stick to just comments about the pandemic that are entirely relevant to this thread.
First, they got into an argument about mortality rate. Wallace said America’s was one of the highest in the world; Trump said it was one of the lowest. Neither seemed to understand (and Wallace should have) that there are several different mortality rates. There is the case fatality rate, CFR, deaths/confirmed cases, which Trump mentioned, but shouldn’t have, because it’s the wrong one to support his argument. America’s CFR is lower than that of most European countries, but not as low as that of many other countries. And it’s not a good figure to compare, anyway, because cases are very dependent on how much testing is carried out, which I will return to later.
Second, there is the infection fatality rate, IFR, infections/cases, which appears to be fairly low in the U.S. This is why Trump keeps saying that 99% of the cases are harmless. It’s true that 99% or more of cases do not result in death, though if we add in hospitalizations and long-haulers, we could say that at least 2-3% of cases are not harmless. But this rate seems to be about the same in most other countries, so it’s not one that likely reflects major differences among nations. Furthermore, since it’s based on antibody tests, which aren’t always accurate, and which haven’t been carried out comprehensively in the U.S., it would be purely speculative to compare America’s IFR with that of other countries.
Then there is the overall mortality rate, deaths/millions of population. This is the best indicator to use, because it’s not dependent on testing at all, or on any estimates of the number of infected. This is the one Wallace was referring to, and he was correct, America’s overall rate is one of the highest in the world. As we have discussed here before, it’s only lower than that of about half a dozen European countries, which suffered massive numbers of deaths early in the pandemic, when they were caught unprepared (their death rates have dropped considerably since then, and the U.S. may very well overtake some of them in a few months). And these countries have much higher population densities than the U.S., except Sweden, which didn’t lock down. There are probably some third world countries that have higher rates, but have under-reported deaths, but comparing the U.S. to them (as Trump did, saying we’re better than Mexico), is hardly a point in America’s favor.
Then there’s testing. When Wallace pointed out the recent spike in confirmed cases, Trump argued, as he has before, that this is because of increased testing. He claimed the U.S. tests more than any other nation in the world. That’s not quite true. China has tested more. More to the point, a number of countries have tested more per millions of population than the U.S. America is up there in tests, but it’s not the leader, and even if it were, it would not be a point in its favor. A lot of countries that tested a lot more earlier in the pandemic have greatly reduced their testing because they have the virus under control, or cases down to very low levels. The high levels of testing in the U.S. actually mostly reflect the fact that America has not brought the virus under control. It’s not something to brag about.
But what about Trump’s claim that the U.S. has more cases because we test more? Almost every epidemiologist in the world will point to the increased positivity rate as evidence that more positive tests are mostly the result of more infections, not the result of simply testing more. However, while this is almost certainly the case, arguments based on positivity are complex, because in theory, there could be other ways to explain increases in this value. These alternatives are very unlikely, particularly when we see enormous increases in positivity in a relatively short time in many communities, but the complexity allows people like Trump to muddy the waters, and argue a different cause. It’s very difficult to provide a slamdunk, air-tight argument based on positivity.
Fortunately, we don’t have to. There is a very simple way to avoid it. We can just look at deaths. If the number of infected individuals were constant, i.e., the number of people getting infected every day were the same, the number of deaths every day should also be the same. But that isn’t the case. Deaths are increasing. Not as much, relative to new cases, as occurred last April, and that’s a puzzle I mentioned here recently—the CFR is decreasing. But the number of deaths are going up. That has to reflect an increase in the number of infected individuals, unless the IFR has gone up. But it would be highly unlikely that the IFR went up while the CFR went down. On the one hand, you would have to argue that people most at risk, such as those in nursing homes, were infected more often than before. This seems very unlikely by itself. But you would simultaneously have to argue that these people were less likely to be tested than before. That again strains credibility.
In any case, the increase in deaths stands by itself as an indictment of the system. It’s evidence that the effect of the virus is increasing. And remember, the goal is not stasis. Simply holding the number of deaths constant would not be controlling the virus. The idea is to reduce them, and eventually eliminate them. So when we see deaths increasing, we see an approach, or approaches, that are failing.
Facebook
Twitter
Instagram