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Editor's Note: John D. Sutter is a contributor to CNN and the National Geographic Explorer. He is the director of the Baseline series, which will visit four locations on the front lines of the climate crisis every five years until 2050. Visit the project's website or follow it on Instagram. The opinions expressed in this comment are yours. See more opinion at CNNE.com/opinion
(CNN) - After Hurricane Maria in Puerto Rico, many journalists, community leaders and activists had the same suspicion. More people were dying than the United States government said.
In October 2017, President Donald Trump arrived on that island, which in many ways is a de facto colony of the United States, to throw paper towels at the victims of the storm and praise what he called a low death toll.
"You can be very proud that all of your people and all of our people are working together," Trump said at a press conference at the time, citing a death toll of 16. The storm in Puerto Rico was not a "true catastrophe." like Hurricane Katrina in 2005, the president said.
Along with many other journalists, including those from the Center for Investigative Journalism, I helped expose the count of large-scale deaths in Puerto Rico. A year later, after a successful open records lawsuit and dozens of investigative stories, the government admitted the truth, which is that approximately 3,000 people, not 16, died in the storm and its chaotic aftermath, which included months without electricity and other life support services.
I was reminded of that disconnect between truth and reality, and the difficulties of explaining the disaster-related deaths, this week, when researchers from the Yale School of Public Health and the Washington Post released a report analyzing "excess deaths ”by covid-19.
Yale's findings indicate that officials are greatly underestimating the cost of the pandemic.
"It is still unclear what the actual count of fatalities from covid is," Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University, and professor of public health, told me. "We are in a confusion of numbers, which is a problem."
It may seem like a callous term, but "excess deaths" is essential to understanding this pandemic. The term refers to the number of deaths that are in “excess” of the normal mortality rate for a particular place during a certain period of time.
This is a statistical estimate, not a case-by-case accounting. However, it is considered by many epidemiologists and medical examiners to be the best measure of deaths related to pandemics and disasters. It is not difficult to see why. It is easier to measure the total number of deaths and compare them to a past baseline than to evaluate each victim, review their medical records, interview family members, and arrive at an objective evaluation. Such a case-by-case methodology is extremely difficult to implement and will often fall short.
"Cause of death mapping is more of an art than a science," said Daniel Weinberger, an associate professor of epidemiology at the Yale School of Public Health and principal investigator on the report. The assignment could change from one doctor to another, he said.
The official death toll from Hurricane Maria in Puerto Rico - 2,975 - was not, in fact, a list of precise names and causes of death. It was an "excess of deaths," calculated by a team of researchers from George Washington University, which the island's administration hired as the controversy increased. Other estimates placed the number as possibly even higher.
Yale's figures work like this too. The researchers found 15,400 "excess deaths" in the United States from March 1 to April 4, the first weeks of the coronavirus rampage in this country. During that time, only about half of those deaths, 8,128, were attributed to covid-19, according to the report.
The figures suggest that the pandemic has been much worse than reported.
Explanations for the discrepancy range from lack of testing capabilities to various methods of deciding which deaths should be classified as caused by the coronavirus.
“Not everyone who dies from covid-19 will have 'covid' on their death certificate or be counted in those official statistics; therefore, there will be some level of low count, ”said Weinberger of the Yale School of Public Health. “Due to delays in (mortality) data and the time it takes to report and fill them in, it will be some time before we have an idea of how much is under-reported. A conservative estimate is that the actual number (of deaths from covid-19) is perhaps 1 ½ or two times greater than the reported numbers. "
The "excess death" figures are also not perfect, Weinberger said. Did the deaths decrease because there are fewer traffic accidents with fewer people on the road? Did some people avoid seeking medical attention because they were afraid of contracting covid-19 in a hospital and therefore died of treatable infections or diseases? It is difficult to count. But measurement remains a critical method of understanding the broad impact of the coronavirus, according to experts.
I asked Aaron Bernstein, acting director of the Center for Climate, Health and Global Environment (C-Change) at the Harvard TH Chan School of Public Health, if "excess deaths" was the best measure of the number of victims of a pandemic. Yes, he said. "For sure."
The point, for me and for the experts I contacted by phone this week, is that we know much less about the real cost of covid-19 in the United States than officials and the media tell us.
It is impossible to turn to cable news, public radio, or online news sites and not be bombarded with the latest issue of the pandemic: X people have died, Y are positive, and so on. These numbers fly to us through push notifications and take up considerable space on television. Press conferences with politicians and health officials often begin with them. Single digits are often quoted, giving the impression that we know exactly who is dying and where and when. However, these figures do not represent a real reality on the ground.
That's a problem, Columbia's Redlener noted, in part because governors and other public officials rely on these numbers, along with the models used to project how the coronavirus will spread among populations, to decide how and when to “open up” to quarantine.
Governors have to ask themselves questions like: “Has (the burden of disease) been alleviated long enough? Has there been a persistent 14-day drop in hospital admissions? ” Redlener said: "He's taking a lot of risk (by easing stay-at-home orders to control the spread of the virus), and he's trying to rationalize it based on the numbers, but the numbers aren't necessarily accurate, reliable, or predictable." .
What is at stake is unthinkably high, he said, and these officials are in an unenviable position. "There will be people who will die if we open too early. And there will be people who go bankrupt if we open too late, ”he said.
Given such uncertainty, it would be wise for them to proceed with caution. However, states from Georgia to Utah, where I live, are reopening restaurants, gyms, and lounges.
In Puerto Rico, while officials were busy minimizing the severity of the hurricane, the victims struggled without electricity or medical attention, and many of them died in that wait.
Hopefully that is not the case with the covid-19. Because, by any assessment, this is a deadly historical pandemic, and one that, in Redlener's words, is "very, very far from over."
coronavirus