Death Is a Trailing Indicator

 

Every time I see one of these apocalyptic exponential projections based on a “doubling of the death rate every two days,” or whatever the current numbers suggest, I want to slap someone. At the moment, and for the next week or so at least, the death count is a trailing indicator of contagion.

It appears to take, on average, from about ten days to two weeks between infection with the Wuhan virus and subsequent death. That suggests that today’s death figures are a proxy for the rate of infection ten days to two weeks ago.

Ten days ago the schools were open, businesses were open, theaters were open, bars were open, colleges were open, and America was going about its business with little concern of infection. Unless one believes that our subsequent efforts have had little effect, one must assume that the rate of new infection has dropped off substantially. It’s hard to imagine a scenario in which it hasn’t, outside of one or two super-dense metropolitan areas.

Today’s death figures are an echo of conditions that no longer exist. This will be true for another few days, after which time the death figures will begin to reflect actions begun ten days ago.

I am pretty sure that the nation has never shifted its approach to interpersonal contact as profoundly and abruptly as it did last week. Today’s death figures can barely reflect that. Look at the numbers toward the end of this week. I’m expecting a good Friday report.

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  1. CB Toder aka Mama Toad Member
    CB Toder aka Mama Toad
    @CBToderakaMamaToad

    My college students were sent home March 9, actually, so it’s been longer than 10 days for them. 

    • #1
  2. Henry Racette Member
    Henry Racette
    @HenryRacette

    CB Toder aka Mama Toad (View Comment):

    My college students were sent home March 9, actually, so it’s been longer than 10 days for them.

    Fair enough. Mine came home the 14th, and her school was a little slow to close. It’s probably been about 12 days since most college kids got sent home. I don’t know how long it actually took most of them to come home, with packing, spring break, etc.

    • #2
  3. CB Toder aka Mama Toad Member
    CB Toder aka Mama Toad
    @CBToderakaMamaToad

    Also my kids’ colleges are in the Bronx and Orange County, so near the City and New Rochelle.

    • #3
  4. Phil Turmel Inactive
    Phil Turmel
    @PhilTurmel

    @DocJay made an appearance on the Dave Carter podcast.  He said he’d be astonished if the current government clampdown didn’t work.  (But go listen to the whole show…)

    • #4
  5. Matt Bartle Member
    Matt Bartle
    @MattBartle

    For the past couple of days US deaths are down.

    • #5
  6. Matt Bartle Member
    Matt Bartle
    @MattBartle

    But it looks like they are up again today.

    • #6
  7. Henry Racette Member
    Henry Racette
    @HenryRacette

    Matt Bartle (View Comment):

    But it looks like they are up again today.

    I think the statistical noise caused by our rapidly escalating testing profile make any short-term fluctuations in infection rates suspect. As long as the rate of testing is increasing quickly, anything other than a significant increase in the rate of new cases suggests, I think, a general slowing of infection.

    Last I checked, new cases were doubling more slowly than deaths were doubling. I think the rate of new infection is slowing.

    • #7
  8. E. Kent Golding Moderator
    E. Kent Golding
    @EKentGolding

    It is time for primaries to be over.   Rather,  we need a Full Democratic Convention,  with full press coverage,  Next Week.    In New York,  New York.   Good Ole’ Joe deserves his coronation.

    • #8
  9. Mendel Inactive
    Mendel
    @Mendel

    Death is indeed a very lagging indicator, but it’s also the one that is most likely the most accurate between all countries reporting. Each country is testing a different percentage of their patients (which probably explains most of the extreme variation in nominal case fatality rates), and some countries even use different case definitions. Reporting procedures for deaths are probably also slightly inconsistent, but almost certainly much more uniform and thorough than total cases.

    It’s all a matter about what you use the numbers for. Case numbers are probably best for determining growth rates, at least within individual countries. But the other very pressing question we want to answer is “how high will the burden of this virus be on our healthcare system?” And death is probably the best reflector of that.

    And the statistic I keep bringing up is that in Lombardy, Covid-19 has now killed the same number of patients in two weeks as the flu kills in one year. That makes the death count a very useful tool in describing the potential havoc this virus is capable of wreaking.

    • #9
  10. Henry Racette Member
    Henry Racette
    @HenryRacette

    Mendel (View Comment):

    Death is indeed a very lagging indicator, but it’s also the one that is most likely the most accurate between all countries reporting. Each country is testing a different percentage of their patients (which probably explains most of the extreme variation in nominal case fatality rates), and some countries even use different case definitions. Deaths are probably also not defined or reported perfectly, but almost certainly much more accurately than total cases.

    It’s all a matter about what you use the numbers for. Case numbers are probably best for determining growth rates, at least within individual countries. But the other very pressing question we want to answer is “how high will the burden of this virus be on our healthcare system?” And death is probably the best reflector of that.

    And the statistic I keep bringing up is that in Lombardy, Covid-19 has now killed the same number of patients in two weeks as the flu kills in one year. That makes the death count a very useful tool in describing the potential havoc this virus is capable of wreaking.

    None of which addresses the fundamental point of the post, which is that the current death rate reflects the infection rate prior to our current radical transformation.

    The “potential havoc” is vast and horrific. I think the likely havoc, however, is relatively small.

    • #10
  11. James Gawron Inactive
    James Gawron
    @JamesGawron

    Henry,

    We are being influenced by the Chinese. They started out lying and they still are.

    The death rate in China is way down because they have been using the crude anti-viral drugs big-time. They don’t give a damn what the American FDA says or the danger of side effects. Their new case numbers are also down because they have invented a new category “mild case of Coronavirus” which they aren’t counting. Probably 95% of their new cases that aren’t in the high risk demographic aren’t being counted.

    They are lying and we are attributing their great numbers to “curve flattening and suppression”. This is like believing all of the Chinese simultaneously held their breath for two months. It’s nonsense and we will screw ourselves up bigtime believing this nonsense.

    Regards,

    Jimn

    • #11
  12. GrannyDude Member
    GrannyDude
    @GrannyDude

    My daughter, an ICU nurse, has said that the next couple of weeks are going to be critical to evaluating both the threat and the response;  this (death as a trailing indicator)  must be what she’s referring to?

    I find this somewhat comforting, Henry!  Thank you! 

     

    Mendel (View Comment):

     

    And the statistic I keep bringing up is that in Lombardy, Covid-19 has now killed the same number of patients in two weeks as the flu kills in one year. That makes the death count a very useful tool in describing the potential havoc this virus is capable of wreaking.

    That is a pretty frickin’ impressive statistic, Mendel.

    • #12
  13. Jim McConnell Member
    Jim McConnell
    @JimMcConnell

    James Gawron (View Comment):

    Henry,

    We are being influenced by the Chinese. They started out lying and they still are.

    The death rate in China is way down because they have been using the crude anti-viral drugs big-time. They don’t give a damn what the American FDA says or the danger of side effects. Their new case numbers are also down because they have invented a new category “mild case of Coronavirus” which they aren’t counting. Probably 95% of their new cases that aren’t in the high risk demographic aren’t being counted.

    They are lying and we are attributing their great numbers to “curve flattening and suppression”. This is like believing all of the Chinese simultaneously held their breath for two months. It’s nonsense and we will screw ourselves up bigtime believing this nonsense.

    Regards,

    Jimn

    Jim, with respect, I think Henry was referring specifically to the U.S. death rate from the virus. I agree with you that anything coming out of China is suspect, including their medicines.

    • #13
  14. Misthiocracy ingeniously Member
    Misthiocracy ingeniously
    @Misthiocracy

    Mendel (View Comment):
    And the statistic I keep bringing up is that in Lombardy, Covid-19 has now killed the same number of patients in two weeks as the flu kills in one year.

    Quibble: The majority of those flu deaths occur during the winter months and are not spread out over an entire year.  They don’t all occur in a two week period of course, but they do occur in a compressed period of time, thereby putting a temporary strain on health care systems.

    • #14
  15. James Gawron Inactive
    James Gawron
    @JamesGawron

    Jim McConnell (View Comment):
    Jim, with respect, I think Henry was referring specifically to the U.S. death rate from the virus. I agree with you that anything coming out of China is suspect, including their medicines.

    Jim,

    The Chinese experience is very important psychologically. They are selling that their magical Marxist system worked because they suppressed the disease with their draconian social control measures. We are believing this crap and subconsciously altering our approach because of it.

    They are using the crude anti-virals big time and they don’t give a damn about side effects. If you die from a heart attack because of an anti-viral they are just counting that as death from a heart attack and not relating it to Corona. They have altered the accounting procedures big-time to produce the no case growth scenario. They created a new category called “mild case of Coronavirus”. We continue to count every positive test for the virus as a new case. They are simply using the threat statistics by demographic category to put those at lower risk into the “mild case” and then they don’t report them as new cases.

    None of this is about flattening the curve. We are basing our approach on a Chinese model that never existed.

    Regards,

    Jim

    • #15
  16. James Gawron Inactive
    James Gawron
    @JamesGawron

    GrannyDude (View Comment):

    And the statistic I keep bringing up is that in Lombardy, Covid-19 has now killed the same number of patients in two weeks as the flu kills in one year. That makes the death count a very useful tool in describing the potential havoc this virus is capable of wreaking.

    That is a pretty frickin’ impressive statistic, Mendel.

    Granny,

    You are being set up. Lombardy like Wuhan were complete black swan areas. The rest of the world didn’t experience anything like that and still hasn’t. I think Mendel’s flu estimate is also suspect.

    23,000 – 59,000 Flu Deaths 2019-2020 (5 1/2 months)

    https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

    According to Rodin’s post total deaths for all of Italy is 4,825 (Lombardy is part of Italy)

    http://ricochet.com/734243/day-62-covid-19-shelter-in-place/

    Granny you are being gas-lighted.

    Regards,

    Jim

     

     

     

     

    • #16
  17. DonG (skeptic) Coolidge
    DonG (skeptic)
    @DonG

    Why are we not ramping up 200 million bottles of cloroquine? 

    • #17
  18. Joshua Bissey Inactive
    Joshua Bissey
    @TheSockMonkey

    For what it’s worth, nothing really changed in my life until about the middle of last week.

    • #18
  19. Henry Racette Member
    Henry Racette
    @HenryRacette

    Joshua Bissey (View Comment):

    For what it’s worth, nothing really changed in my life until about the middle of last week.

    I hear you. I resolved to stop touching other people’s faces on Wednesday.

    (It’s harder than I expected.)

    • #19
  20. Aaron Miller Inactive
    Aaron Miller
    @AaronMiller

    Misthiocracy ingeniously (View Comment):

    Mendel (View Comment):
    And the statistic I keep bringing up is that in Lombardy, Covid-19 has now killed the same number of patients in two weeks as the flu kills in one year.

    Quibble: The majority of those flu deaths occur during the winter months and are not spread out over an entire year. They don’t all occur in a two week period of course, but they do occur in a compressed period of time, thereby putting a temporary strain on health care systems.

    For economics, there is an urgency to clarifying whether or not COVID-19 is much worse than a common flu virus. But it seems from my uneducated view that we have weeks yet before that determination can be definitely made.

    Wherever the correct data points today, people in my area are still sharply divided about whether or not COVID-19 is dangerous enough to justify the bans. Those opinions will have consequences, greater with each passing day, regardless of the reality. The upheaval is too great to bear uncertainty.

    • #20
  21. Misthiocracy ingeniously Member
    Misthiocracy ingeniously
    @Misthiocracy

    Henry Racette (View Comment):

    Joshua Bissey (View Comment):

    For what it’s worth, nothing really changed in my life until about the middle of last week.

    I hear you. I resolved to stop touching other people’s faces on Wednesday.

    (It’s harder than I expected.)

    The people I really worry about are the strippers.

    ;-)

    • #21
  22. CB Toder aka Mama Toad Member
    CB Toder aka Mama Toad
    @CBToderakaMamaToad

    Misthiocracy ingeniously (View Comment):

    The people I really worry about are the strippers.

     

    There was a headline in the Daily Mail or the NY Post about lap dancers telling their customers, “No touching!” because of corona virus…

    • #22
  23. Doctor Robert Member
    Doctor Robert
    @DoctorRobert

    James Gawron (View Comment):

    Henry,

    We are being influenced by the Chinese. They started out lying and they still are.

    The death rate in China is way down because they have been using the crude anti-viral drugs big-time. They don’t give a damn what the American FDA says or the danger of side effects. Their new case numbers are also down because they have invented a new category “mild case of Coronavirus” which they aren’t counting. Probably 95% of their new cases that aren’t in the high risk demographic aren’t being counted.

    They are lying and we are attributing their great numbers to “curve flattening and suppression”. This is like believing all of the Chinese simultaneously held their breath for two months. It’s nonsense and we will screw ourselves up bigtime believing this nonsense.

    Regards,

    Jimn

    Can you document these claims?

    • #23
  24. James Gawron Inactive
    James Gawron
    @JamesGawron

    Doctor Robert (View Comment):

    James Gawron (View Comment):

    Henry,

    We are being influenced by the Chinese. They started out lying and they still are.

    The death rate in China is way down because they have been using the crude anti-viral drugs big-time. They don’t give a damn what the American FDA says or the danger of side effects. Their new case numbers are also down because they have invented a new category “mild case of Coronavirus” which they aren’t counting. Probably 95% of their new cases that aren’t in the high risk demographic aren’t being counted.

    They are lying and we are attributing their great numbers to “curve flattening and suppression”. This is like believing all of the Chinese simultaneously held their breath for two months. It’s nonsense and we will screw ourselves up bigtime believing this nonsense.

    Regards,

    Jim

    Can you document these claims?

    Doc Robert,

    All I can tell you is that I don’t believe in the curve flattening fairy. I do believe in drugs that kill the virus. I don’t believe in every hypochondriac who probably will increase his risk of dying by forcing his way into the hospital with mild symptoms. I do believe in marshalling resources and aiming those resources at the most likely victims. I don’t believe in relentless worry about offending specially oppressed groups who are bothered by names when serious illness is threatening all of us. I do believe in specific places of origin that have served as a breeding ground for the virus. Thus barring travel from the breeding ground or anyplace that hasn’t also barred travel from the breeding ground is the right policy.

    Regards,

    Jim

    • #24
  25. danok1 Member
    danok1
    @danok1

    James Gawron (View Comment):

    Granny,

    You are being set up. Lombardy like Wuhan were complete black swan areas. The rest of the world didn’t experience anything like that and still hasn’t. I think Mendel’s flu estimate is also suspect.

    23,000 – 59,000 Flu Deaths 2019-2020 (5 1/2 months)

    https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

    According to Rodin’s post total deaths for all of Italy is 4,825 (Lombardy is part of Italy)

    http://ricochet.com/734243/day-62-covid-19-shelter-in-place/

    Granny you are being gas-lighted.

    Jim,

    The CDC data is for the U.S., not Lombardy. I believe Mendel’s point is that in Lombardy, the flu killed fewer people during the current flu season than the Kung Flu has killed there in two weeks.

    @mendel, can you please post links to your sources?

    • #25
  26. James Gawron Inactive
    James Gawron
    @JamesGawron

    danok1 (View Comment):

    James Gawron (View Comment):

    Granny,

    You are being set up. Lombardy like Wuhan were complete black swan areas. The rest of the world didn’t experience anything like that and still hasn’t. I think Mendel’s flu estimate is also suspect.

    23,000 – 59,000 Flu Deaths 2019-2020 (5 1/2 months)

    https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

    According to Rodin’s post total deaths for all of Italy is 4,825 (Lombardy is part of Italy)

    http://ricochet.com/734243/day-62-covid-19-shelter-in-place/

    Granny you are being gas-lighted.

    Jim,

    The CDC data is for the U.S., not Lombardy. I believe Mendel’s point is that in Lombardy, the flu killed fewer people during the current flu season than the Kung Flu has killed there in two weeks.

    @mendel, can you please post links to your sources?

    dan,

    Lombardy and Wuhan are the total outliers. I don’t have stats on Lombardy’s flu season but I really wonder what he is talking about. If anything it is probably a black swan.

    Regards,

    Jim

    • #26
  27. danok1 Member
    danok1
    @danok1

    James Gawron (View Comment):

    danok1 (View Comment):

    James Gawron (View Comment):

    Granny,

    You are being set up. Lombardy like Wuhan were complete black swan areas. The rest of the world didn’t experience anything like that and still hasn’t. I think Mendel’s flu estimate is also suspect.

    23,000 – 59,000 Flu Deaths 2019-2020 (5 1/2 months)

    https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

    According to Rodin’s post total deaths for all of Italy is 4,825 (Lombardy is part of Italy)

    http://ricochet.com/734243/day-62-covid-19-shelter-in-place/

    Granny you are being gas-lighted.

    Jim,

    The CDC data is for the U.S., not Lombardy. I believe Mendel’s point is that in Lombardy, the flu killed fewer people during the current flu season than the Kung Flu has killed there in two weeks.

    @mendel, can you please post links to your sources?

    dan,

    Lombardy and Wuhan are the total outliers. I don’t have stats on Lombardy’s flu season but I really wonder what he is talking about. If anything it is probably a black swan.

    Regards,

    Jim

    Probably a black swan, but that’s why I asked him for links to the source.

    • #27
  28. Aaron Miller Inactive
    Aaron Miller
    @AaronMiller

    James Gawron (View Comment):
    Lombardy and Wuhan are the total outliers.

    But why? If it’s because temperature and humidity are key factors, then should we expect America’s most populous city — New York, governed by sense-hating Democrats — to similarly succumb? Is that, and not just the city’s population density, the reason NYC already stands out in the stats?

    • #28
  29. James Lileks Contributor
    James Lileks
    @jameslileks

    I’m still stunned that the 2009 coverage of pig-flu in our paper didn’t announce the 1000th death until it was a sidetone in a piece about President Obama declaring a national emergency. I told my daughter tonight: this is the second of the three bad weeks. Bad news is a lagging indicator. Anecdotes are not trends. 

     

    • #29
  30. Mendel Inactive
    Mendel
    @Mendel

    danok1 (View Comment):
    @mendel, can you please post links to your sources?

    Average estimated number of flu deaths in all of Italy over a 4-year period (using standardized estimation tools that are also used in the US) is 18,000 deaths/per flu season (27 weeks) for all of Italy:

    https://www.sciencedirect.com/science/article/pii/S1201971219303285#bib0050

    Lombardy has roughly one-sixth of the total population of Italy (10 mil./60 mil.). So using a very simplified assumption (yes, assumption) that flu deaths are roughly equally distributed across the country gives us an average of 3,000 flu deaths in Lombardy per flu season.

    Deaths in Lombardy can be found on the Wikipedia page which sources them from the official Italian Civil Protection website. Over the past 14 days about 3,200 Covid-19 deaths have been reported. https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_in_Italy

    Now: this comparison is something of an apples-to-pears comparison, because not every country reports individual flu-related deaths in the same manner that coronavirus-related deaths are currently being reported, so this is comparing an estimate to a directly-reported number. However, if anything this discrepancy likely understates the coronavirus threat, since the flu statistic includes many people who weren’t diagnosed with the flu, and we don’t know how many people have died with undiagnosed coronavirus who weren’t included in the coronavirus statistics.

    Moreover, we need to remember that all of these deaths occurred after Lombardy went into full lockdown. For that reason, we can’t know what the figures would have been without these draconian measures, but it seems very reasonable to imagine they would be even higher.

    The final piece of evidence is from the doctors themselves. We now have multiple reports in media ranging from nightly news to medical journals in which the local doctors say this is like nothing they’ve ever experienced before. That’s not hard data obviously, but it’s a decent plausibility check for the data that exists.

    P.S. There is another graph going around by the Italian Association of Biotechnologists purporting that Covid-19 has already caused 20 times as many deaths as the flu in all of Italy combined, but I don’t trust those figures at all without a greater explanation into their methodology.

    • #30
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