A Pandemic of Innumeracy (and Bad Metaphors)

On Friday, I concluded that we’ve entered The First Climate Decade. Meanwhile, the COVID-19 pandemic rages on.

I’ll be the first to agree that the handling of the pandemic has been disastrous in the United States – where things continue to go badly, after millions of residents ignored public health guidance and common sense to travel and congregate over the holidays – but does the US really have “the worst epidemic in the world” as is so often repeated by commentators and everyday people alike?

As of this writing (January 1st, 2020 at 5 PM EST), the US has roughly 20 million confirmed COVID-19 cases and 350,000 deaths. (I wrote a few weeks ago, in predicting that the pandemic will end in the US early in the spring, about how ridiculous these numbers are, given that the IFR for COVID-19 seems to be somewhere between 0.5 and 1%.) Russia is only reporting ~60,000 COVID-19 deaths, but that number tripled in a single day recently. Our political culture – flawed as it is – would not permit such a massive deceit to be perpetrated, at least not domestically. (It has certainly permitted us to largely forget the crime of the invasions of Iraq and Afghanistan and our ongoing so-called Global War on Terror, but that is another issue.)

India is only reporting ~10 million confirmed cases and ~150,000 deaths (and, of course, has four times the population of the US), but then, no informed person in India believes the official numbers, and serious policy and public health experts have speculated that the death toll may be as much as a 5x undercount. For comparison, I speculate that the US death toll has been undercounted by ~10% (with recent data showing 2020 excess mortality of 400,000+ deaths – ~20% above the official COVID-19 death toll, but with the excess likely explained in roughly equal parts by uncounted COVID-19 deaths and an increase in suicides, drug overdoses, deaths from avoidable but untreated causes, etc. during the pandemic). If that 5x figure happens to be roughly correct, that would put the actual Indian death toll closer to 750,000 – still lower than the US death toll per capita, but roughly double even the actual US figure.

Of course, that 5x figure is speculative and out-of-date, but the case remains that the US is a rich country with well-resourced healthcare institutions and near universal access to emergency care. (What you pay for that care is, again, another issue.) In at least some poor countries, the governments of which lack both resources and incentives to accurately test at a population-level for prevalence of a disease which they cannot hope to control, and where large majorities of the population have limited or no access to healthcare, it may be easier to simply ignore a pandemic from which the rich, and relatively so, are relatively able to insulate themselves.

Layer on top of that failing of public health the fact that COVID-19 mortality skews very sharply to the right based on age, and it is easy to imagine that – whereas in the US and Europe, the aging populations of which have been hammered by the pandemic, hiding the death toll is impossible – in countries like India – where something like 1 out of every 6 deaths is not registered at all, and another 4 out of 6 deaths is not registered with an official cause of death – a young population, radical economic inequality (and concomitant disparities in healthcare access), and lack of robust public oversight might make it more viable to simply make the true toll of the pandemic disappear from public view.

This certainly isn’t a defense of the dismal US response, as rich countries with aging populations (like Japan, South Korea, and New Zealand) have shown that humane, rational, and effective responses to this pandemic are very much possible – setting aside the fact that not-so-rich (but incidentally nominally socialist) countries like Cuba, Vietnam, and China have all fared much much better than we have here in the US – but it can, at least, be helpful to temper our hot takes with data and numerical scrutiny lest we perpetuate false narratives, exceptionalism, and US/Euro-centrism.

Postscript: One might wish that ex post antigen testing might, in the future, shed light on the true extent of COVID-19 spread around the globe; given that SARS-CoV-2 antibodies seem to fade quite rapidly, that prospect will depend on as-yet-undiscovered means of accurately ascertaining past infection.