By Kent R. Kroeger (NuQum.com, March 11, 2020)
Try to avoid news coverage of the coronavirus (2019-nCoV). It is everywhere, and rightfully so. This is a serious worldwide health crisis.
And it is far from over.
In the midst of this global turmoil, an unmistakable narrative has dominated the mainstream news media in the U.S. — President Donald Trump and his administration (but mostly Trump himself) are mismanaging the containment of the coronavirus.
Politico’s Dan Diamond sums up the charge against Trump:
“For six weeks behind the scenes, and now increasingly in public, Trump has undermined his administration’s own efforts to fight the coronavirus outbreak — resisting attempts to plan for worst-case scenarios, overturning a public-health plan upon request from political allies and repeating only the warnings that he chose to hear. Members of Congress have grilled top officials like Health and Human Services Secretary Alex Azar and Centers for Disease Control Director Robert Redfield over the government’s biggest mistake: failing to secure enough testing to head off a coronavirus outbreak in the United States. But many current and former Trump administration officials say the true management failure was Trump’s.”
Assuming these allegations are true, did this mismanagement impact the U.S. response to the coronavirus? How would we know if it did?
The current worldwide numbers (as of 11 March) for the coronavirus are dispiriting:
121,564 confirmed cases.
In contrast, the U.S. the numbers (as of 11 March) are more subdued:
1,050 confirmed cases.
While all deaths are tragic, at a 2.8 percent mortality among confirmed cases, the U.S. looks somewhat better than the world-at-large (3.6% mortality rate).
But this highly-aggregated evidence does not address Politico’s accusations about Trump.
Are the confirmed cases in the U.S. a significant undercount of the true number?
If, in fact, there has been a shortage of coronavirus test kits for the limited number of labs capable of testing for the virus, how can we trust the reported number of confirmed cases?
The worldwide reported numbers are known to be an undercount as people with mild (or no) symptoms may not necessarily have gone to a health clinic to get tested for the coronavirus. It will be months, maybe years, after the crisis is over when epidemiologists will be able to estimate the “true” number of people infected by the coronavirus.
As of now, we know the current confirmed numbers are an undercount.
Even so, we do have a more reliable number that is less susceptible to under-counting: Coronavirus deaths.
The U.S. has 29 such deaths.
In the U.S. context, it is unlikely someone in the past two months could die from a respiratory disease and not at least be checked for the presence of the coronavirus. And while the chances are good there have been respiratory-related deaths in the U.S. since January that were not tested for the coronavirus, it is a reasonable hypothesis that this number is relatively small.
If we accept this assumption, we have the basis for assessing the performance of the Trump administration, also assuming we now the true mortality rate (risk) of the coronavirus.
“Folks want to be able to understand what the true risk is. They want to know just how deadly is it, how deadly is it to me? The challenge is, we don’t totally know,” Dr. Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University, told The Hill this week.
While that number is also unknown, epidemiologists are able to make estimates.
“The best estimates now of the overall mortality rate for COVID-19 is somewhere between 0.1 percent and 1 percent,” Assistant Secretary of Health Brett Giroir said last week during a U.S. congressional hearing.
If Giroir’s estimate range is accurate, we can derive an estimate of the range of U.S. citizens currently infected with the coronavirus.
The U.S. has 29 coronavirus deaths and 1,050 confirmed cases. At a 0.1 percent mortality rate, the number of infected Americans would be 29,000. Whereas, at a 1 percent mortality rate, that number would be 2,900.
Given there are only 1,050 confirmed coronavirus cases in the U.S., according to the World Health Organization (WHO), the reported number is, at best, a third of the actual number of cases.
Compare the U.S. numbers to Spain, where the coronavirus is particularly prevalent. Spain reports 49 deaths against 2,174 confirmed cases. Assuming a mortality rate ranging from 0.1 to 1 percent, Spain probably has between 4,900 and 49,000 actual cases of the coronavirus. At best, Spain’s reported number of cases is just under half of the true number.
Likewise, in Italy, another European country hard hit by the coronavirus, there are a reported 631 deaths and 10,149 confirmed cases. With a mortality rate between 0.1 and 1 percent, there must be between 63,100 and 631,100 actual cases.
Contrast the U.S., Italy and Spain to South Korea, where they have 54 deaths against 7,755 confirmed cases. Assuming a mortality rate between 0.1 and 1 percent, South Korea probably has between 5,400 and 54,000 actual cases. Their confirmed cases, therefore, fall within the estimated range of actual cases.
Even more distinctive is Germany, with only 3 deaths and 1,629 confirmed cases. In Germany’s case, the true range of coronavirus cases is most likely between 300 and 3,000, with the reported number of cases landing well within the likely true range of cases.
Germany, of course, may stand in contradistinction to other countries as it has a comprehensive universal health care where citizens are more likely to get early diagnoses of the coronavirus and therefore increase their chances of survival.
Nonetheless, if we accept the WHO’s reported case numbers and the scientific communities’ estimate of the true mortality rate for COVID-19, some countries are clearly doing better than others at identifying those with this virus.
The U.S. is not the worst at this task, but the country is far from the best.
As more test kits have been distributed in the U.S. and more non-CDC labs are doing the actual testing, the number of confirmed cases has spiked accordingly.
It is clear the U.S. was behind the curve in being prepared to identify and contain the coronavirus. At the same time, it is also clear that situation is improving.
Whether or not the U.S. news media will acknowledge this improvement is to be seen. That this improvement is occurring is not. That there is far more work to do be done should be equally indisputable.
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