The above was my partner’s belated response to a story told us by a friend during a FaceTime happy hour yesterday evening. Someone our friend knows lost her husband. He’d refused to go to the hospital even though his wife works at one. In the evening, she urged him to go to the emergency room; the next morning, she woke up and he was dead beside her in bed.
In confronting the grief that is now ubiquitous in New York City, I agree with my partner’s assessment – sometimes: “Words mean nothing.”
But for confronting the social and political dynamics underlying that grief, words are essential, which is why I keep on writing. Picking up where we left off yesterday, the Mayor acknowledged (actually, to his credit, before I wrote the piece, though I only came to reportage on his comments after the fact) that – in addition to the confirmed deaths that the City has been counting for weeks (~7,600 according to the City; nearly 9,000 according to the State); and the probable deaths that the City began to include in the COVID-19 death toll a few days ago (~4,000 at present) – the 3,000+ additional deaths above baseline since the pandemic’s onset in NYC that, so far, are being categorized as “not known to be confirmed or probable COVID-19” (and which I’m calling “Still-ignored deaths“) should also be considered COVID-19 deaths. As the Mayor put it, this seems like “obvious truth,” and, on that point, I agree with him.
Let’s say that – adding up the State’s updated figure of ~9,000 deaths, with the ~4,000 probable deaths the City is acknowledging, and the ~3,000 unaccounted for deaths that both City and State continue, for now, to ignore – that the total NYC COVID-19 death toll to date has been ~16,000. The current population of NYC is ~8.5 million, though – with all the rich people who have decamped for the Hamptons, the Berkshires, Florida, Maine, etc. to wait out the pandemic and, having inadvertently vectorized themselves, spread the disease – the number of people actually resident in NYC at the moment is likely appreciably lower. I’m going to use 8 million for mathematical convenience given that plenty of uncertainty and rounding are already baked into these numbers.
To put things really simply, 1/1000th of 8 million is 8,000, and 1/1000th is equivalent to 0.1%, which is also approximately the case fatality rate for the seasonal flu. That doesn’t mean that 8,000 people die in New York City each year from the flu though, because not everyone gets the flu. In fact, the City estimates that roughly 2,000 people die each year from the flu in NYC, which suggests that ~25% or 1 in 4 New Yorkers have symptomatic cases of the flu each flu season. (I bring up influenza because of all the lies we were told comparing COVID-19 to the seasonal flu.) To put things in perspective, the seasonal flu kills approximately 1 out of 1,000 people who suffer symptomatic infections each year in NYC, and seems to infect, on average, perhaps 1 out of every 4 New Yorkers, so ~1 out of every 4,000 New Yorkers dies each year from the seasonal flu. Just to show that math:
1/1000 x 1/4 x 8,000,000 = 2,000
which obviously involved a lot of rounding and simplification, but gives us the ~2,000 seasonal flu deaths per year figure that the City points to.
Okay, so if 16,000 people have already died in NYC thus far from COVID-19 – with the daily death rate still plateauing at a rate near 500 deaths per day – we can see that ~8x as many City residents have died already, in about one month, from this disease as die, on average from the seasonal flu per year; however, we also have no real idea, as yet, what fraction of the City’s population has been infected by SARS-CoV-2. I’ve recently pointed to data on infection rates in birthing people in NYC to suggest that perhaps the cumulative infection rate to date among NYC residents is ~15-20%, but that’s highly conjectural.
Still, using the 20% figure, we could work backwards and say that if 16,000 people have already died, and 1 out of 5 New Yorkers has been infected, that means that (still using 8 million for convenience), 1.6 million people have been infected out of whom 16,000 died, which gives a 1% infection fatality rate:
8,000,000 x 1/5 x 1/100 = 16,000.
(The difference between case fatality rate and infection fatality rate is that the former only counts symptomatic cases, which is how the CDC seems to approach their seasonal flu data, while the latter includes all people who have been infected, even those who were asymptomatic; in the case of our current COVID-19 predicament, infection fatality rate may be the more meaningful figure, as we work towards getting out of this shutdown, but there remain many unknowns, including if reinfection is possible in general, and if those who have been asymptomatically infected will have sufficient antibodies to protect them from reinfection in particular. I learned all this at COVID University!)
To the extent that some people experience asymptomatic infection, infection fatality rate should always be lower for a given disease than case fatality rate (because you’re dividing the same number of fatalities by a larger denominator of people), so if these back-of-the-envelope numbers give an infection fatality rate of ~1% for COVID-19 as compared to a case fatality rate of ~0.1% for the seasonal flu, we could guess that the former is at least 10x more deadly than the latter; however, lack of adequate testing capacity and, hence, our utter lack of knowledge about the total number of infections to date in NYC makes it next to impossible to have any faith in these numbers. What if it turns out I’m badly wrong, and fully 50% of New Yorkers have already been infected with SARS-CoV-2? Paradoxically, if it turns out that those of us who have been infected have some degree immunity, a 50% cumulative infection rate to date would be good news and bode well for the “reopening” of the City. It would also yield a significantly lower infection fatality rate.
Even with all that said, though, now that we can say relatively conclusively that at least 16,000 NYC residents have already died from COVID-19, even if the entire population of the City had already been infected with SARS-CoV-2, that would still yield a 0.2% infection fatality rate, and a case fatality rate significantly higher, given that studies are increasingly suggesting that perhaps as many as 4 out of 5 SARS-CoV-2 infections are asymptomatic.
(Eg, even if the entire population had been infected already, and 16,000 people have died, with only 1 out of every 5 cases symptomatic, that would actually still yield a case fatality rate of 1% – that is 1 out of 100 people with symptomatic cases dying – even though the infection fatality rate would be 0.2% because:
8,000,000 x 1/5 x 1/100 = 16,000.)
All to say, analyses like this one from John P. Ioannidis of Stanford have not aged particularly well. I agree with Ioannidis’ assessment from mid-March that: “If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.” But the dismissive angle he took (his title begins: “A fiasco in the making?”) now seems rather foolish. Such is the risk of being contrarian and being wrong. Or, at least, not very right.
To Ioannidis’ credit though, had we had proper data in March, we could have acted more properly, and had our elected executives acted on the sound data that we did have in January and February, we wouldn’t be here today. As we’ve know learned the hard and deadly way, this disease is not very much like the seasonal flu. Words aren’t good for expressing the grief and suffering that have accompanied the verification – in bodies – of that hum-drum fact, but they can serve us in speaking truth to power in the names of the dead.