How Many People in the U.S. Are Hospitalized With COVID-19? Who Knows?

https://www.propublica.org/article/how-many-people-in-the-us-are-hospitalized-with-covid-19-who-knows?utm_source=sailthru&utm_medium=email&utm_campaign=dailynewsletter&utm_content=feature

 

The Trump administration told hospitals to stop reporting data to the CDC, and report it to HHS instead. Vice President Mike Pence said the information would continue to be released publicly. It hasn’t worked out as promised.

In mid-July, the Trump administration instructed hospitals to change the way they reported data on their coronavirus patients, promising the new approach would provide better, more up-to-the-minute information about the virus’s toll and allow resources and supplies to be quickly dispatched across the country.

Instead, the move has created widespread confusion, leaving some states in the dark about their hospitals’ remaining bed and intensive care capacity and, at least temporarily, removing this information from public view. As a result, it has been unclear how many people are in hospitals being treated for COVID-19 at a time when the number of infected patients nationally has been soaring.

Hospitalizations for COVID-19 have been seen as a key metric of both the coronavirus’s toll and the health care system’s ability to deal with it.

Since early in the pandemic, hospitals had been reporting data on COVID-19 patients to the U.S. Centers for Disease Control and Prevention through its National Healthcare Safety Network, which traditionally tracks hospital-acquired infections.

In a memo dated July 10, the U.S. Department of Health and Human Services told hospitals to abruptly change course — to stop reporting their data to the CDC and instead to submit it to HHS through a new portal run by a company called TeleTracking. The change took effect within days. Vice President Mike Pence said the administration would continue releasing the data publicly, as the CDC had done.

Almost immediately, the CDC pulled its historical data offline, only to repost it under pressure a couple days later. Meanwhile the website for the administration’s new portal promised to update numbers on a daily basis, but, as of Friday morning, the site hadn’t been updated since July 23. (HHS is posting some data daily on a different federal website but not representative estimates for each state.)

“The most pernicious portion of it is that at the state level and at the regional level we lost our situational awareness,” said Dave Dillon, spokesman for the Missouri Hospital Association. “At the end of this, we may have a fantastic data product out of HHS. I will not beat them up for trying to do something positive about the data, but the rollout of this has been absolutely a catastrophe.”

The Missouri Hospital Association had taken the daily data submitted by its hospitals to the CDC and created a state dashboard. The transition knocked that offline. The dashboard came back online this week, but Dillon said in a follow-up email, “the data is only as good as our ability to know that everyone is reporting the same data, in the correct way, for tracking and comparison purposes at the state level.”

Other states, including Idaho and South Carolina, also experienced temporary information blackouts. And The COVID Tracking Project, which has been following the pandemic’s toll across the country based on state data, noted issues with its figures. “These problems mean that our hospitalization data — a crucial metric of the COVID-19 pandemic — is, for now, unreliable, and likely an undercount. We do not think that either the state-level hospitalization data or the new federal data is reliable in isolation,” according to a blog post Tuesday on the group’s website.

Making matters more complicated, the administration has changed the information that it is requiring hospitals to report, adding many elements, such as the age range of admitted COVID-19 patients, and removing others. As of this week, for instance, HHS told hospitals to stop reporting the total number of deaths they’ve had since Jan. 1, the total number of COVID-19 deaths and the total number of COVID-19 admissions. (Hospitals still report daily figures, just not historical ones.)

“Massachusetts hospitals are continuing to navigate the dramatic increase of daily data requirements,” the Massachusetts Health and Hospital Association said in a newsletter on Monday. “MHA and other state health officials continue to raise concerns about the administrative burden and questionable usefulness of some of the data.”

“Hospitals across the country were given little time to adjust to the unnecessary and seismic changes put forth by the U.S. Department of Health and Human Services, which fundamentally shift both the volume of data and the platforms through which data is submitted,” the association’s CEO, Steve Walsh, said in the newsletter.

A number of state websites also noted problems with hospital data. For days, the Texas Department of State Health Services included a note on its dashboard that it was “reporting incomplete hospitalization numbers … due to a transition in reporting to comply with new federal requirements.” That came just as the state was experiencing a peak in COVID-19 hospitalizations.

California likewise noted problems.

A spokesperson for HHS acknowledged some bumps in the transition but said in an email: “We are pleased with the progress we have made during this transition and the actionable data it is providing. We have had some states and hospital associations report difficulty with the new collection system. When HHS identifies errors in the data submissions, we work directly with the state or hospital association to quickly resolve them.

“Our objective with this new approach is to collaborate with the states and the healthcare system. The goal of full transparency is to acknowledge when we find discrepancies in the data and correct them.”

Last week, HHS noted, 93% of its prioritized list of hospitals, excluding psychiatric, rehabilitation and religious nonmedical facilities, reported data at least once during the week. (The guidance to hospitals asks them to report every day.)

Asked about the lack of timely data on its public website, HHS said it will update the site to “make it clear that the estimates are only updated weekly.” HHS is now posting a date file each day on healthdata.gov with aggregate information on hospitalizations by state.

But unlike the prior releases from CDC, which provided estimates on hospital capacity based on the responses, this file only gives totals for the hospitals that reported data. It’s unclear which hospitals did not report, how large they are, or whether the reported data is representative.

It’s also unclear if it’s accurate. New York state, for instance, reported that fewer than 600 people were currently hospitalized with COVID-19, as of Friday. Federal data released the same day pegged the number of suspected and confirmed COVID-19 hospitalizations at around 1,800.

Louisiana says more than 1,500 people are currently hospitalized with COVID-19. The federal data puts the figure at fewer than 700.

Nationally, The COVID Tracking Project reports that more than 56,000 people were hospitalized around the country with the virus, as of Thursday.

The data released by HHS on Friday puts the figure at more than 70,000.

NPR reported this week that it had found irregularities in the process used by the Trump administration to award the contract to manage the hospital data. Among other things, HHS directly contacted TeleTracking about the contract and the agency used a process that is more often used for innovative scientific research, NPR reported.

An HHS spokesperson told NPR that the contract process it used is a “common mechanism … for areas of research interest,” and said that the system used by the CDC was “fraught with challenges.”

Ryan Panchadsaram, co-founder of the tracking website CovidExitStrategy.org, has been critical of the problems created by the hospital data changeover.

“Without real-time accurate monitoring, you can’t make quick and fast and accurate decisions in a crisis,” he said in an interview. “This is just so important. This indicator that’s gone shows how the health system in a state is doing.”

Dillon of the Missouri Hospital Association said the administration could have handled this differently. For big technology projects, he noted, there is often a well-publicized transition with information sessions, an educational program and, perhaps, running the old system and the new one in parallel.

This “was extremely abrupt,” he said. “That is not akin to anything you would expect from HHS about how you would implement a program.”

 

Misinformation on coronavirus is proving highly contagious

https://apnews.com/86f61f3ffb6173c29bc7db201c10f141?utm_source=Sailthru&utm_medium=email&utm_campaign=Newsletter%20Weekly%20Roundup:%20Healthcare%20Dive:%20Daily%20Dive%2008-01-2020&utm_term=Healthcare%20Dive%20Weekender

Misinformation on the coronavirus is proving highly contagious ...

As the world races to find a vaccine and a treatment for COVID-19, there is seemingly no antidote in sight for the burgeoning outbreak of coronavirus conspiracy theories, hoaxes, anti-mask myths and sham cures.

The phenomenon, unfolding largely on social media, escalated this week when President Donald Trump retweeted a false video about an anti-malaria drug being a cure for the virus and it was revealed that Russian intelligence is spreading disinformation about the crisis through English-language websites.

Experts worry the torrent of bad information is dangerously undermining efforts to slow the virus, whose death toll in the U.S. hit 150,000 Wednesday, by far the highest in the world, according to the tally kept by Johns Hopkins University. Over a half-million people have died in the rest of the world.

For most people, the virus causes only mild or moderate symptoms, such as fever and cough. For some older adults and people with existing health problems, it can cause more severe illness, including pneumonia.

Hard-hit Florida reported 216 deaths, breaking the single-day record it set a day earlier. Texas confirmed 313 additional deaths, pushing its total to 6,190, while South Carolina’s death toll passed 1,500 this week, more than doubling over the past month. In Georgia, hospitalizations have more than doubled since July 1.

“It is a real challenge in terms of trying to get the message to the public about what they can really do to protect themselves and what the facts are behind the problem,” said Michael Osterholm, head of the University of Minnesota’s Center for Infectious Disease Research and Policy.

He said the fear is that “people are putting themselves in harm’s way because they don’t believe the virus is something they have to deal with.”

Rather than fade away in the face of new evidence, the claims have flourished, fed by mixed messages from officials, transmitted by social media, amplified by leaders like Trump and mutating when confronted with contradictory facts.

“You don’t need masks. There is a cure,” Dr. Stella Immanuel promised in a video that promoted hydroxychloroquine. “You don’t need people to be locked down.”

The truth: Federal regulators last month revoked their authorization of the drug as an emergency treatment amid growing evidence it doesn’t work and can have deadly side effects. Even if it were effective, it wouldn’t negate the need for masks and other measures to contain the outbreak.

None of that stopped Trump, who has repeatedly praised the drug, from retweeting the video. Twitter and Facebook began removing the video Monday for violating policies on COVID-19 misinformation, but it had already been seen more than 20 million times.

Many of the claims in Immanuel’s video are widely disputed by medical experts. She has made even more bizarre pronouncements in the past, saying that cysts, fibroids and some other conditions can be caused by having sex with demons, that McDonald’s and Pokemon promote witchcraft, that alien DNA is used in medical treatments, and that half-human “reptilians” work in the government.

Other baseless theories and hoaxes have alleged that the virus isn’t real or that it’s a bioweapon created by the U.S. or its adversaries. One hoax from the outbreak’s early months claimed new 5G towers were spreading the virus through microwaves. Another popular story held that Microsoft founder Bill Gates plans to use COVID-19 vaccines to implant microchips in all 7 billion people on the planet.

Then there are the political theories — that doctors, journalists and federal officials are conspiring to lie about the threat of the virus to hurt Trump politically.

Social media has amplified the claims and helped believers find each other. The flood of misinformation has posed a challenge for Facebook, Twitter and other platforms, which have found themselves accused of censorship for taking down virus misinformation.

Facebook CEO Mark Zuckerberg was questioned about Immanuel’s video during an often-contentious congressional hearing Wednesday.

“We did take it down because it violates our policies,” Zuckerberg said.

U.S. Rep. David Cicilline, a Rhode Island Democrat leading the hearing, responded by noting that 20 million people saw the video before Facebook acted.

“Doesn’t that suggest that your platform is so big, that even with the right policies in place, you can’t contain deadly content?” Cicilline asked Zuckerberg.

It wasn’t the first video containing misinformation about the virus, and experts say it’s not likely to be the last.

A professionally made 26-minute video that alleges the government’s top infectious-disease expert, Dr. Anthony Fauci, manufactured the virus and shipped it to China was watched more than 8 million times before the platforms took action. The video, titled “Plandemic,” also warned that masks could make you sick — the false claim Facebook cited when it removed the video down from its site.

Judy Mikovits, the discredited doctor behind “Plandemic,” had been set to appear on the show “America This Week” on the Sinclair Broadcast Group. But the company, which operates TV stations in 81 U.S. markets, canned the segment, saying it was “not appropriate” to air.

This week, U.S. government officials speaking on condition of anonymity cited what they said was a clear link between Russian intelligence and websites with stories designed to spread disinformation on the coronavirus in the West. Russian officials rejected the accusations.

Of all the bizarre and myriad claims about the virus, those regarding masks are proving to be among the most stubborn.

New York City resident Carlos Lopez said he wears a mask when required to do so but doesn’t believe it is necessary.

“They’re politicizing it as a tool,” he said. “I think it’s more to try to get Trump to lose. It’s more a scare tactic.”

He is in the minority. A recent AP/NORC poll said 3 in 4 Americans — Democrats and Republicans alike — support a national mask mandate.

Still, mask skeptics are a vocal minority and have come together to create social media pages where many false claims about mask safety are shared. Facebook has removed some of the pages — such as the group Unmasking America!, which had nearly 10,000 members — but others remain.

Early in the pandemic, medical authorities themselves were the source of much confusion regarding masks. In February, officials like the U.S. surgeon general urged Americans not to stockpile masks because they were needed by medical personnel and might not be effective in everyday situations.

Public health officials changed their tune when it became apparent that the virus could spread among people showing no symptoms.

Yet Trump remained reluctant to use a mask, mocked his rival Joe Biden for wearing one and suggested people might be covering their faces just to hurt him politically. He did an abrupt about-face this month, claiming that he had always supported masks — then later retweeted Immanuel’s video against masks.

The mixed signals hurt, Fauci acknowledged in an interview with NPR this month.

“The message early on became confusing,” he said.

Many of the claims around masks allege harmful effects, such as blocked oxygen flow or even a greater chance of infection. The claims have been widely debunked by doctors.

Dr. Maitiu O Tuathail of Ireland grew so concerned about mask misinformation he posted an online video of himself comfortably wearing a mask while measuring his oxygen levels. The video has been viewed more than 20 million times.

“While face masks don’t lower your oxygen levels. COVID definitely does,” he warned.

Yet trusted medical authorities are often being dismissed by those who say requiring people to wear masks is a step toward authoritarianism.

“Unless you make a stand, you will be wearing a mask for the rest of your life,” tweeted Simon Dolan, a British businessman who has sued the government over its COVID-19 restrictions.

Trump’s reluctant, ambivalent and late embrace of masks hasn’t convinced some of his strongest supporters, who have concocted ever more elaborate theories to explain his change of heart. Some say he was actually speaking in code and doesn’t really support masks.

O Tuathail witnessed just how unshakable COVID-19 misinformation can be when, after broadcasting his video, he received emails from people who said he cheated or didn’t wear the mask long enough to feel the negative effects.

That’s not surprising, according to University of Central Florida psychology professor Chrysalis Wright, who studies misinformation. She said conspiracy theory believers often engage in mental gymnastics to make their beliefs conform with reality.

“People only want to hear what they already think they know,” she said. 

 

 

 

US coronavirus data will now go straight to the White House. Here’s what this means for the world

https://theconversation.com/us-coronavirus-data-will-now-go-straight-to-the-white-house-heres-what-this-means-for-the-world-142814?utm_medium=email&utm_campaign=Latest%20from%20The%20Conversation%20for%20July%2028%202020%20-%201689316298&utm_content=Latest%20from%20The%20Conversation%20for%20July%2028%202020%20-%201689316298+Version+A+CID_abf5f3d50179e225ba3e81ad0fbb430c&utm_source=campaign_monitor_us&utm_term=US%20coronavirus%20data%20will%20now%20go%20straight%20to%20the%20White%20House%20Heres%20what%20this%20means%20for%20the%20world

US coronavirus data will now go straight to the White House ...

Led by physicians, scientists and epidemiologists, the US Centers for Disease Control and Prevention (CDC) is one of the most reliable sources of knowledge during disease outbreaks. But now, with the world in desperate need of authoritative information, one of the foremost agencies for fighting infectious disease has gone conspicuously silent.

For the first time since 1946, when the CDC came to life in a cramped Atlanta office to fight malaria, the agency is not at the front line of a public health emergency.

On April 22, CDC director Robert Redfield stood at the White House briefing room lectern and conceded that the coronavirus pandemic had “overwhelmed” the United States. Following Redfield at the podium, President Donald Trump said the CDC director had been “totally misquoted” in his warning that COVID-19 would continue to pose serious difficulties as the US moved into its winter ‘flu season in late 2020.

Invited to clarify, Redfield confirmed he had been quoted correctly in giving his opinion that there were potentially “difficult and complicated” times ahead.

Trump tried a different tack. “You may not even have corona coming back,” the president said, once again contradicting the career virologist. “Just so you understand.”

The exchange was interpreted by some pundits as confirmation that the CDC’s venerated expertise had been sidelined as the coronavirus continued to ravage the US.

In the latest development, the New York Times reported this week the CDC has even been bypassed in its data collection, with the Trump administration ordering hospitals to send COVID-19 data directly to the White House.

Diminished role

When facing previous public health emergencies the CDC was a hive of activity, holding regular press briefings and developing guidance that was followed by governments around the world. But during the greatest public health emergency in a century, it appears the CDC has been almost entirely erased by the White House as the public face of the COVID-19 pandemic response.

This diminished role is obvious to former leaders of the CDC, who say their scientific advice has never before been politicised to this extent.

As the COVID-19 crisis was unfolding, several CDC officials issued warnings, only to promptly disappear from public view. Nancy Messonnier, director of the CDC’s National Center for Immunization and Respiratory Diseases, predicted on February 25 that the virus was not contained and would grow into a pandemic.

The stock market plunged and Messonnier was removed from future White House press briefings. Between March 9 and June 12 there was no CDC presence at White House press briefings on COVID-19.

The CDC has erred during the pandemic, most significantly in its initial efforts to develop a test for COVID-19. The testing kits proved to be faulty – a problem compounded by sluggish efforts to rectify the situation – and then by severe delays in distributing enough tests to the public.

But many public health specialists are nevertheless baffled by the CDC’s low profile as the pandemic continues to sweep the globe.

“They have been sidelined,” said Howard Koh, former US assistant secretary for health. “We need their scientific leadership right now.”

What does it mean for the world?

The CDC being bypassed in the collection of COVID-19 data is another body blow to the agency’s standing.

Hospitals have instead been ordered to send all COVID-19 patient information to a central database in Washington DC.

This will have a range of likely knock-on effects. For starters, the new database will not be available to the public, prompting inevitable questions over the accuracy and transparency of data which will now be interpreted and shared by the White House.

The Department of Health and Human Services, which issued the new order, says the change will help the White House’s coronavirus task force allocate resources. But epidemiologists and public health experts around the world fear the new system will make it harder for people outside the White House to track the pandemic or access information.

This affects all nations, because one of the CDC’s roles is to provide sound, independent public health guidance on issues such as infectious diseases, healthy living, travel health, emergency and disaster preparedness, and drug efficacy. Other jurisdictions can then adapt this information to their local context — expertise that has become even more essential during a pandemic, when uncertainty is the norm.

It is difficult to recall a previous public health emergency when political pressure led to a change in the interpretation of scientific evidence.

What happens next?

Despite the inevitable challenges that come with tackling a pandemic in real time, the CDC remains the best-positioned agency – not just in the US but the entire world – to help us manage this crisis as safely as possible.

In the absence of US leadership, nations should start thinking about developing their own national centres for disease control. In Australia’s case, these discussions have been ongoing since the 1990s, stymied by cost and lack of political will.

COVID-19, and the current sidelining of the CDC, may be the impetus needed to finally dust off those plans and make them a reality.

 

 

 

Cartoon – Under Control

Coronavirus | The Manchester Journal | Manchester Breaking News ...

How deadly is COVID-19? A biostatistician explores the question

https://theconversation.com/how-deadly-is-covid-19-a-biostatistician-explores-the-question-142253?utm_medium=email&utm_campaign=The%20Weekend%20Conversation%20-%201680716207&utm_content=The%20Weekend%20Conversation%20-%201680716207+Version+A+CID_c211e1b0b6c4b69b3a29a9d1624a2ab6&utm_source=campaign_monitor_us&utm_term=How%20deadly%20is%20COVID-19%20A%20biostatistician%20explores%20the%20question

How deadly is COVID-19? A biostatistician explores the question

The latest statistics, as of July 10, show COVID-19-related deaths in U.S. are just under 1,000 per day nationally, which is down from a peak average of about 2,000 deaths per day in April. However, cases are once again rising very substantially, which is worrisome as it may indicate that substantial increases in COVID-19 deaths could follow. How do these numbers compare to deaths of other causes? Ron Fricker, statistician and disease surveillance expert from Virginia Tech, explains how to understand the magnitude of deaths from COVID-19.

As a disease surveillance expert, what are some of the tools you have to understand the deaths caused by a disease?

Disease surveillance is the process by which we try to understand the incidence and prevalence of diseases across the country, often with the particular goal of looking for increases in disease incidence. The challenge is separating signal from noise, by which I mean trying to discern an increase in disease incidence (the signal) from the day-to-day fluctuations in that disease (the noise). The hope is to identify any increase as quickly as possible so that medical and public health professionals can intervene and try to mitigate the disease’s effects on the population.

A critical tool in this effort is data. Often disease data is collected and aggregated by local and state public health departments and the Centers for Disease Control and Prevention from data that is reported by doctors and medical facilities. Surveillance systems then use this data and a variety of algorithms to attempt to find a signal amidst the noise.

Early on, many people pointed out that the flu has tens of thousands of deaths a year, and so COVID-19 didn’t seem so bad. What’s wrong with that comparison?

The CDC estimates the average number of flu-related deaths since 2010-11 is around 36,000 per year. This varies from a low of 12,000 deaths in 2011-12 to a high of 61,000 deaths in 2017-18. Thus, the number of COVID-19 deaths to date is three to four times greater than the annual average number of flu-related deaths over the past decade; it is 10 times larger when compared to the 2010-11 flu season but only about twice as large compared to 2017-18.

To make this a fair comparison, note that seasonal influenza mostly occurs over a few months, usually in late fall or early winter. So, the time periods are roughly comparable, with most of the COVID-19-related deaths occurring since late March. However, COVID-19 does not appear to be seasonal, and fatalities are a lagging measure because the time from infection to death is weeks if not months in duration, so the multiples in the previous paragraph will be greater by the end of the year.

Furthermore, while death rates have been coming down from a peak of more than 2,700 on April 21, 2020, the United States is now averaging just under 1,000 deaths per day as of July 10, and given the dramatic increase in cases of late, we should expect the fatality rate to further rise. For example, the University of Washington’s IHME model currently predicts slightly more than 208,000 COVID-19-related deaths by November 1.

So, by any comparison, the COVID-19 death rate is significantly higher than the seasonal influenza death rate.

What are some comparisons that could provide some context in understanding the scale of deaths caused by COVID-19?

As of this writing, more than 130,000 people have died of COVID-19, and that total could grow to 200,000 or more by fall. Those numbers are so big, they’re hard to grasp.

Michigan Stadium in Ann Arbor is the largest football stadium in the United States. It holds 107,420 people, so no football stadium in the country is large enough to hold everyone who has died from COVID-19 thus far. By the time bowl season comes along, assuming we have a football season this year, the number of COVID-19 fatalities will likely exceed the capacity of the Rose and Cotton bowl stadiums combined.

The state of Wyoming has a population of slightly less than 600,000 people, so it’s the equivalent of one out of every five people in that state dying in the last four months. By this fall, the COVID-19 death total will be the equivalent of fully one-third of the people in Wyoming dying.

The populations of Grand Rapids, Michigan; Huntsville, Alabama; and Salt Lake City, Utah are each just over 200,000 people. Imagine if everyone in one of those cities died over the course of six months. That’s what COVID-19 may look like by fall.

How do COVID-19 deaths compare to chronic diseases like cancer or heart disease?

Today, COVID-19 ranks as the sixth leading cause of death in the United States, following heart disease, cancer, accidents, lower chronic respiratory diseases and stroke. Heart disease is the leading cause, with just over 647,000 Americans dying from it each year. Alzheimer’s disease, formerly the sixth largest cause of death, kills just over 121,000 people per year. If the University of Washington IHME model’s current prediction of COVID-19-related deaths comes to pass, COVID-19 will be the third leading cause of death in the United States by the end of the year.

The American Cancer Society estimates that in 2020 there will be an estimated 1.8 million new cancer cases diagnosed and 606,520 cancer deaths in the United States. Lung cancer is estimated to kill about 135,000 people in the US in 2020, so the number of COVID-19 deaths is currently equivalent and will exceed it soon. Of course, it is important to note that the COVID-19 deaths have occurred in about the past four months while the number of lung cancer deaths is for a year. So, COVID-19 deaths are occurring at roughly three times the rate of lung cancer deaths.

What are some historical comparisons that you think are useful in understanding the scale of deaths from COVID-19?

The 1918 influenza pandemic was similar in some ways to the current pandemic and different in other ways. One key difference is the age distribution of deaths, where COVID-19 is concentrated among older adults while the the 1918 pandemic affected all ages. In my state of Virginia, only 8% of the people who died in the 1918 pandemic were more than 50 years old, compared to more than 97% for COVID-19.

The CDC estimates that the 1918 pandemic resulted in about 675,000 deaths in the United States, so slightly more than five times the current number of COVID-19 deaths. In October of 1918, the worst month for the influenza pandemic, about 195,000 people died – well more than all who have died so far from COVID-19.

As with any historical comparison, there are important qualifiers. In this case, the influenza pandemic started in early 1918 and continued well into 1919, whereas COVID-19 deaths are for about one-third of a year (March through June). However, today the United States’ population is about three times the size of the population in 1918. These two factors roughly “cancel out,” and so it is reasonable to think about the 1918 epidemic being about five times worse than COVID-19, at least thus far.

In comparison to past wars, the U.S. has now had more deaths from COVID-19 than all the combat-related deaths in all the wars since the Korean War, including the Vietnam War and Operations Desert Shield and Desert Storm. In World War II there were 291,557 combat casualties. So the number of people who have died from COVID-19 thus far is about 45% of the WWII combat casualties. By the fall, it could be more than 70%.

Finally, note that the number of confirmed and probable deaths from COVID-19 in New York City (23,247 on July 10, 2020) is more than eight times the number who died in the 9/11 attack (2,753).

 

 

 

 

Covid-19 data is a public good. The US government must start treating it like one.

https://www.technologyreview.com/2020/07/17/1005391/covid-coronavirus-hospitalizations-data-access-cdc/

Data for the public good - O'Reilly Radar

The US has failed to prioritize a highly effective and economical intervention—providing quick and easy access to coronavirus data.

Earlier this week as a pandemic raged across the United States, residents were cut off from the only publicly available source of aggregated data on the nation’s intensive care and hospital bed capacity. When the Trump administration stripped the Centers for Disease Control and Prevention (CDC) of control over coronavirus data, it also took that information away from the public.

 

I run a nonpartisan project called covidexitstrategy.org, which tracks how well states are fighting this virus. Our team is made up of public health and crisis experts with previous experience in the Trump and Obama administrations. We grade states on such critical measures as disease spread, hospital load, and the robustness of their testing. 

 

Why does this work matter? In a crisis, data informs good decision-making. Along with businesses, federal, state, and local public health officials and other agencies rely on us to help them decide which interventions to deploy and when workplaces and public spaces can safely reopen. Almost a million people have used our dashboards, with thousands coming back more than 200 times each.

To create our dashboards, we rely on multiple sources. One is the National Healthcare Safety Network (NHSN), run by the CDC. Prior to July 14, hospitals reported the utilization and availability of intensive care and inpatient beds to the NHSN. This information, updated three times a week, was the only publicly available source of aggregated state-level hospital capacity data in the US.

With 31 states currently reporting increases in the number of hospitalized covid-19 patients, these utilization rates show how well their health systems will handle the surge of cases.

 

Having this information in real time is essential; the administration said the CDC’s system was insufficiently responsive and data collection needed to be streamlined. The US Department of Health and Human Services (HHS) directed hospitals (pdf) to report their data to a new system called HHS Protect.

Unfortunately, by redirecting hospitals to a new system, it left everyone else in the dark. On July 14, the CDC removed the most recent data from its website. As we made our nightly update, we found it was missing. After significant public pressure, the existing maps and data are back—but the agency has added a disclaimer that the data will not be updated going forward.

 

This is unacceptable. This critical indicator was being shared multiple times a week, and now updates have been halted. US residents need a federal commitment that this data will continue to be refreshed and shared.

The public is being told that a lot of effort is going into the new system. An HHS spokesman told CNBC that the new database will deliver “more powerful insights” on the coronavirus. But the switch has rightly been criticized because this new data source is not yet available to the public. Our concerns are amplified by the fact that responsibility for the data has shifted from a known entity in the CDC to a new, as-yet-unnamed team within HHS.

I was part of the team that helped fix Healthcare.gov after the failed launch in 2013. One thing I learned was that the people who make their careers in the federal government—and especially those working at the center of a crisis—are almost universally well intentioned. They seek to do the right thing for the public they serve.

 

In the same spirit, and to build trust with the American people, this is an opportunity for HHS to make the same data it’s sharing with federal and state agencies available to the public. The system that HHS is using helps inform the vital work of the White House Coronavirus Task Force. From leaked documents, we know that reports for the task force are painstakingly detailed. They include county-level maps, indicators on testing robustness, and specific recommendations. All of this information belongs in the public domain.

This is also an opportunity for HHS to make this data machine readable and thereby more accessible to data scientists and data journalists. The Open Government Data Act, signed into law by President Trump, treats data as a strategic asset and makes it open by default. This act builds upon the Open Data Executive Order, which recognized that the data sets collected by the government are paid for by taxpayers and must be made available to them. 

As a country, the United States has lagged behind in so many dimensions of response to this crisis, from the availability of PPE to testing to statewide mask orders. Its treatment of data has lagged as well. On March 7, as this crisis was unfolding, there was no national testing data. Alexis Madrigal, Jeff Hammerbacher, and a group of volunteers started the COVID Tracking Project to aggregate coronavirus information from all 50 state websites into a single Google spreadsheet. For two months, until the CDC began to share data through its own dashboard, this volunteer project was the sole national public source of information on cases and testing.

With more than 150 volunteers contributing to the effort, the COVID Tracking Project sets the bar for how to treat data as an asset. I serve on the advisory board and am awed by what this group has accomplished. With daily updates, an API, and multiple download formats, they’ve made their data extraordinarily useful. Where the CDC’s data is cited 30 times in Google Scholar and approximately 10,000 times in Google search results, the COVID Tracking Project data is cited 299 times in Google Scholar and roughly 2 million times in Google search results.

 

Sharing reliable data is one of the most economical and effective interventions the United States has to confront this pandemic. With the Coronavirus Task Force daily briefings a thing of the past, it’s more necessary than ever for all covid-related data to be shared with the public. The effort required to defeat the pandemic is not just a federal response. It is a federal, state, local, and community response. Everyone needs to work from the same trusted source of facts about the situation on the ground.

Data is not a partisan affair or a bureaucratic preserve. It is a public trust—and a public resource.

 

 

 

 

Unpublished White House Coronavirus Task Force Report – 18 States in Red Zone

https://mailchi.mp/publicintegrity/exclusive-white-house-docs-shows-18-states-in-coronavirus-red-zone?e=4539e77864

An unpublished document prepared for the White House Coronavirus Task Force and obtained by the Center for Public Integrity suggests more than a dozen states should revert to more stringent protective measures, limiting social gatherings to 10 people or fewer, closing bars and gyms and asking residents to wear masks at all times.

The document, dated July 14, says 18 states are in the “red zone” for COVID-19 cases, meaning they had more than 100 new cases per 100,000 population last week. Eleven states are in the “red zone” for test positivity, meaning more than 10 percent of diagnostic test results came back positive. 

It includes county-level data and reflects the insistence of the Trump administration that states and counties should take the lead in responding to the coronavirus. The document has been shared within the federal government but does not appear to be posted publicly.

It’s clear some states are not following the task force’s advice. For instance, the document recommends that Georgia, in the red zone for both cases and test positivity, “mandate statewide wearing of cloth face coverings outside the home.” But Gov. Brian Kemp signed an order Wednesday banning localities from requiring masks.

 

 

 

 

The U.S. is way behind on coronavirus contact tracing. Here’s how we can catch up.

The U.S. is way behind on coronavirus contact tracing. Here’s how we can catch up.

The US is amassing an army of contact tracers to contain the covid ...

Get this: Vietnam, a country of 97 million people, has reported zero deaths from only 372 cases of coronavirus.

Theories abound about how they pulled it off. But public health experts chalk it up to swift action by the Vietnamese government, including contact tracing, mass testing, lockdowns, and compulsory wearing of masks.

Here, masks have become a political landmine. And despite President Trump claiming, “We have the greatest testing program anywhere in the world,” some states with surging infections have testing shortages—like Arizona.

But what about contact tracing, the process of calling potentially exposed people and persuading them to quarantine?

“I don’t think we’re doing very well,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, when asked in June about contact tracing nationwide. Most states haven’t even made public how fast or well they’re implementing the process, if at all.

Florida, the nation’s current No. 1 hotspot for the virus, is often failing to trace positive cases. This, despite the state spending over $27 million on a contract with Maximus, a company notorious for underbidding, understaffing, and performing poorly on government services contracts in multiple states.

Yet, there are bright spots elsewhere. California allocated 5 percent of staff across 90 state government departments to contact trace. North Carolina’s Wake County trained 110 librarians. In Massachusetts, counties have used state pandemic funds to hire more nurses.

There are three reasons why state and local governments should reassign public employees or hire new staff outright as the country—finally—ramps up contact tracing.

One, outsourcing what should be a public job to for-profit companies like Maximus reduces transparencylimits democratic decision-makinglowers service quality, and increases inequality, all while rarely saving public dollars. Public control is particularly important when it comes to contact tracing, which involves personal health data.

Two, this is a chance to begin to reverse decades of cuts to public health budgets, which have made the worst public health crisis in a century even worse. Almost a quarter of the local public health workforce has been let go since 2008. Federal spending on nondefense discretionary programs like public health is now at a historic low.

The Trump administration, as expected, is headed in the wrong direction. On Tuesday, it stripped the Centers for Disease Control and Prevention (CDC) of control over coronavirus data. State and local governments must do all they can to right the ship.

And three, contact tracing is an opportunity to chip away at systemic racism. Since World War II, public sector employment has helped equalize American society by offering workers of color stable, well-paid employment. The median wage earned by Black employees is significantly higher in the public sector than in private industries.

Privatizing public work like contact tracing contributes to racial and gender income disparities. Workers at federal call centers operated by Maximus, for example, are predominately women and people of color paid poverty wages as low as $10.80 an hour with unaffordable health care.

If #BlackLivesMatter—as many governors and mayors across the country have proclaimed in recent weeks—then contact tracing should be treated as what it is: a public good.

To catch up to other countries like Vietnam, the U.S. needs to get contact tracing right—and that means doing it with public workers.

 

 

 

 

Administration’s war on the public health experts

https://www.axios.com/trump-public-health-experts-cdc-fauci-e1509d14-0cf1-4b1c-b107-7753bf95395d.html

Trump's war on the public health experts - Axios

A pandemic would normally be a time when public health expertise and data are in urgent demand — yet President Trump and his administration have been going all out to undermine them.

Why it matters: There’s a new example almost every day of this administration trying to marginalize the experts and data that most administrations lean on and defer to in the middle of a global crisis.

Here’s how it has been happening just in the past few weeks:

  • The administration has repeatedly undermined the Centers for Disease Control and Prevention. Most recently, Trump has criticized the CDC’s school reopening guidelines, Education Secretary Betsy DeVos declared that “kids need to be in school,” and the administration has reportedly ordered hospitals to bypass the CDC in reporting coronavirus patient information.
  • It has repeatedly undermined Anthony Fauci. Trump distanced himself on Wednesday from an op-ed attack by White House trade adviser Peter Navarro, but longtime Trump aide Dan Scavino also called the infectious diseases specialist “Dr. Faucet” in a Facebook post accusing him of leaking his disagreements. And the White House gave a opposition research-style list of the times Fauci “has been wrong” to the Washington Post and other media outlets.
  • Trump himself undermined public health experts generally with his retweet of former game show host Chuck Woolery’s “everyone is lying” tweet — which blamed “The CDC, Media, Democrats, our Doctors, not all but most, that we are told to trust.”
  • Trump has made numerous statements suggesting, over and over again, that we wouldn’t have as many COVID cases if we just tested less. (From his Tuesday press conference at the White House: “If we did half the testing we would have half the cases.”)

The impact: The result is that the CDC — which is supposed to be the go-to agency in a public health crisis — is distracted by constant public critiques from the highest levels. And Fauci, “America’s Doctor,” is the subject of yet another round of stories about whether Trump is freezing him out.

  • “The way to make Americans safer is to build on, not bypass, our public health system,” Tom Frieden, a former CDC director under Barack Obama, said in a statement to Axios about the efforts to sideline the agency.
  • “Unfortunately, as with mask-up recommendations and schools reopening guidance, the administration has chosen to sideline and undermine our nation’s premier disease fighting agency in the middle of the worst pandemic in 100 years,” Frieden said.
  • And Fauci, in an interview with The Atlantic, said of the efforts to discredit him: “Ultimately, it hurts the president to do that … It doesn’t do anything but reflect poorly on them.”

The other side: The White House insists there’s no problem. “President Trump has always acted on the science and valued the input of public health experts throughout this crisis,” said White House deputy press secretary Sarah Matthews.

  • Trump campaign communications director Tim Murtaugh closed ranks with the experts as well. “President Trump has said repeatedly that he has a strong relationship with Dr. Fauci, and Dr. Fauci has always said that the President listens to his advice,” he said.
  • And Department of Health and Human Services spokesman Michael Caputo declared that “the scientists and doctors speak openly, they are listened to closely, and their advice and counsel helps guide the response.”
  • “Frankly, when it comes to this tempest in a teapot over Dr. Fauci, I blame the media and their unending search for a ‘Resistance’ hero, for turning half a century of a brilliant scientist’s hard work into a clickbait headline that helps reporters undermine the president’s coronavirus response,” Caputo said.

Between the lines: Murtaugh deflected several times when asked whether there was a deliberate strategy to marginalize the CDC and the experts: “The President and the White House have consistently advised Americans to follow CDC guidelines. The President also believes we can open schools safely on time and that we must do so.”

  • However, one administration official said there were parts of the CDC school reopening guidelines that were impractical, and noted that kids can also suffer long-term harm by staying out of school too long.

Our thought bubble, by Axios White House reporter Alayna Treene: The responses make it clear that the White House and the Trump campaign don’t want to advance the narrative that they’re deliberately battling with America’s health experts, or that there’s any kind of strategy behind it.

The bottom line: When the history of this pandemic is written, it will show that the public health experts who were trying to fight it also had to deal with political fights that made their jobs harder.

 

 

 

 

 

COVID-19 and the End of Individualism

https://www.project-syndicate.org/commentary/covid19-economic-interdependence-waning-individualism-by-diane-coyle-2020-05?utm_source=Project+Syndicate+Newsletter&utm_campaign=1cfd702284-covid_newsletter_07_05_2020&utm_medium=email&utm_term=0_73bad5b7d8-1cfd702284-105592221&mc_cid=1cfd702284&mc_eid=5f214075f8

Daniel Innerarity - Project Syndicate

The pandemic has shown that it is not existential dangers, but rather everyday economic activities, that reveal the collective, connected character of modern life. Just as a spider’s web crumples when a few strands are broken, so the coronavirus has highlighted the risks arising from our economic interdependence.

CAMBRIDGE – Aristotle was right. Humans have never been atomized individuals, but rather social beings whose every decision affects other people. And now the COVID-19 pandemic is driving home this fundamental point: each of us is morally responsible for the infection risks we pose to others through our own behavior.

In fact, this pandemic is just one of many collective-action problems facing humankind, including climate change, catastrophic biodiversity loss, antimicrobial resistance, nuclear tensions fueled by escalating geopolitical uncertainty, and even potential threats such as a collision with an asteroid.

As the pandemic has demonstrated, however, it is not these existential dangers, but rather everyday economic activities, that reveal the collective, connected character of modern life beneath the individualist façade of rights and contracts.

Those of us in white-collar jobs who are able to work from home and swap sourdough tips are more dependent than we perhaps realized on previously invisible essential workers, such as hospital cleaners and medics, supermarket staff, parcel couriers, and telecoms technicians who maintain our connectivity.

Similarly, manufacturers of new essentials such as face masks and chemical reagents depend on imports from the other side of the world. And many people who are ill, self-isolating, or suddenly unemployed depend on the kindness of neighbors, friends, and strangers to get by.

The sudden stop to economic activity underscores a truth about the modern, interconnected economy: what affects some parts substantially affects the whole. This web of linkages is therefore a vulnerability when disrupted. But it is also a strength, because it shows once again how the division of labor makes everyone better off, exactly as Adam Smith pointed out over two centuries ago.

Today’s transformative digital technologies are dramatically increasing such social spillovers, and not only because they underpin sophisticated logistics networks and just-in-time supply chains. The very nature of the digital economy means that each of our individual choices will affect many other people.

Consider the question of data, which has become even more salient today because of the policy debate about whether digital contact-tracing apps can help the economy to emerge from lockdown faster.

This approach will be effective only if a high enough proportion of the population uses the same app and shares the data it gathers. And, as the Ada Lovelace Institute points out in a thoughtful report, that will depend on whether people regard the app as trustworthy and are sure that using it will help them. No app will be effective if people are unwilling to provide “their” data to governments rolling out the system. If I decide to withhold information about my movements and contacts, this would adversely affect everyone.

Yet, while much information certainly should remain private, data about individuals is only rarely “personal,” in the sense that it is only about them. Indeed, very little data with useful information content concerns a single individual; it is the context – whether population data, location, or the activities of others – that gives it value.

Most commentators recognize that privacy and trust must be balanced with the need to fill the huge gaps in our knowledge about COVID-19. But the balance is tipping toward the latter. In the current circumstances, the collective goal outweighs individual preferences.

But the current emergency is only an acute symptom of increasing interdependence. Underlying it is the steady shift from an economy in which the classical assumptions of diminishing or constant returns to scale hold true to one in which there are increasing returns to scale almost everywhere.

In the conventional framework, adding a unit of input (capital and labor) produces a smaller or (at best) the same increment to output. For an economy based on agriculture and manufacturing, this was a reasonable assumption.

But much of today’s economy is characterized by increasing returns, with bigger firms doing ever better. The network effects that drive the growth of digital platforms are one example of this. And because most sectors of the economy have high upfront costs, bigger producers face lower unit costs.

One important source of increasing returns is the extensive experience-based know-how needed in high-value activities such as software design, architecture, and advanced manufacturing. Such returns not only favor incumbents, but also mean that choices by individual producers and consumers have spillover effects on others.

The pervasiveness of increasing returns to scale, and spillovers more generally, has been surprisingly slow to influence policy choices, even though economists have been focusing on the phenomenon for many years now. The COVID-19 pandemic may make it harder to ignore.

Just as a spider’s web crumples when a few strands are broken, so the pandemic has highlighted the risks arising from our economic interdependence. And now California and Georgia, Germany and Italy, and China and the United States need each other to recover and rebuild. No one should waste time yearning for an unsustainable fantasy.