What Could’ve Been: Population Adjusted Covid-19 Fatality Rate

Question: Shouldn’t we be doing a lot better than Italy and Spain? Could we have implemented a system of social-distancing combined with testing and tracking that would not have entailed an economic shutdown of the current magnitude (i.e., could we have implemented something closer to  what S. Korea did, had we had a competent administration and leader not-in-denial?).

Source: Ravikumar and Vandenbrouke, St. Louis Fed, accessed 4/23/2020. Note: Drawn on a log scale.

Source: Ravikumar and Vandenbrouke, St. Louis Fed, accessed 4/23/2020. Note: Drawn on a log scale.

 

62 thoughts on “What Could’ve Been: Population Adjusted Covid-19 Fatality Rate

  1. Bruce Hall

    https://www.nytimes.com/2020/04/17/us/coronavirus-death-rate.html

    An interesting read discussing the complexity of getting accurate data within the U.S. Then comparing U.S. data to other nations becomes even more problematic.

    Without question, the infections are very serious among the older population with underlying health problems. However, it appears that New York may have encouraged the spread of the disease among its oldest residents. https://paltc.org/sites/default/files/AMDA-AHCA-NCAL%20Statement%20on%20State%20Advisories%20FINAL.pdf?

    We are deeply concerned with the recent New York State order, which states:

    “No resident shall be denied re-admission or admission to the NH [nursing home] solely based on a confirmed or suspected diagnosis of COVID-19. NHs are prohibited from requiring a hospitalized resident who is determined medically stable to be tested for COVID-19 prior to admission or readmission.”

    1. Menzie Chinn Post author

      Bruce Hall: And you don’t think other countries have difficulty compiling data? Suppose reporting problems are worse in the US. Then presumably we’re under-counting, so we are in actuality doing worse than what is presented in the graph.

      But I thank you for stopping the hype on hydroxychloriquine.

      1. pgl

        We know for a fact that people are dying in their own houses. We know for a fact that the shortage of medical care in New York City is leading to deaths from other causes. But Bruce Hall is wearing his MAGA hat so he cannot be bothered with these realities.

      2. Bruce Hall

        Menzie, I think your statement can be changed to this: “so we are in actuality doing better than what is presented in the graph”. It all depends on your perspective.

        If the virus is more widespread than counted, then the death rate may be significantly less than that calculated on known/counted cases. https://www.mercurynews.com/2020/04/17/coronavirus-2-5-to-4-2-of-santa-clara-county-residents-infected-stanford-estimates/. That’s simply a case of the denominator being a magnitude or two more than is being calculated. Aside from the lower death rate, the real good news is that there may be far more immunity than previously suggested.

        Regarding HCQ, the VA has already stated that their data were not controlled for any factors and may be essentially worthless. hhttps://twitter.com/tomselliott/status/1252964789816643584

        Has Trump been perfect in his response to Covid-19? Well, hindsight tells us “no”. But I think Teddy Roosevelt’s words to the French at the Sorbonne in Paris in 1910 are relevant:

        Let the man of learning, the man of lettered leisure, beware of that queer and cheap temptation to pose to himself and to others as a cynic, as the man who has outgrown emotions and beliefs, the man to whom good and evil are as one. The poorest way to face life is to face it with a sneer. There are many men who feel a kind of twisted pride in cynicism; there are many who confine themselves to criticism of the way others do what they themselves dare not even attempt. There is no more unhealthy being, no man less worthy of respect, than he who either really holds, or feigns to hold, an attitude of sneering disbelief toward all that is great and lofty, whether in achievement or in that noble effort which, even if it fails, comes second to achievement. A cynical habit of thought and speech, a readiness to criticize work which the critic himself never tries to perform, an intellectual aloofness which will not accept contact with life’s realities—all these are marks, not as the possessor would fain to think, of superiority, but of weakness. They mark the men unfit to bear their part painfully in the stern strife of living, who seek, in the affectation of contempt for the achievement of others, to hide from others and from themselves their own weakness. The role is easy; there is none easier, save only the role of the man who sneers alike at both criticism and performance.

        It is not the critic who counts; not the man who points out how the strong man stumbles or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows the great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.

        1. not_really

          Incompetence is success now?

          Your absurdly long quote would work just as well if there was a competent team in the White House instead of the hucksters and hustlers in there now.

          For all your hard work pretending, I have a fabulous money-making opportunity for you. Once you join and then get 10 friends to join, the money just rolls in!

        2. Dave

          “It is not the critic who counts; not the man who points out how the strong man stumbles or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows the great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly”

          Wait. Do you HONESTLY believe Trump is striving “valiantly” with a face “marred by dust and sweat and blood”? Really? If so, you are a delusional moron.

        3. 2slugbaits

          Bruce Hall Donald Trump is no Teddy Roosevelt. Trump is not being criticized for failing to foresee the unforeseeable. Trump is being criticized for refusing to accept what other leaders in other countries clearly recognized. Trump is being criticized for ignoring the warnings of experts and instead relying upon his uninformed bluster, intuition and outright lies. Trump’s actions were not the the actions of a brave leader making difficult choices; they were the actions of a political coward who was more concerned about offending his base than in protecting the country. For precious weeks Trump dithered and denied and pretended that it would all just “miraculously disappear.” And then he started pushing some fantasy about hydroxychloroquine being some kind of silver bullet despite the lack of any reliable testing. And he conned you…yet again.

        4. pgl

          We are doing 10 times worse than Korea. Let that sink in Brucie as I know basic arithmetic eludes you. Yes two other nations were even more incompetent than we were. BFD! BTW the right answer to Menzie’s question is no we should not expect to do much better than those other 2 nations for a simple reason. We have a moron for a President. But I guess for someone like you – the Moron in Chief looks like a genius.

        5. pgl

          “If the virus is more widespread than counted, then the death rate may be significantly less than that calculated on known/counted cases.”

          This is really dumb even for you. Let’s model this out. Let x = probability of getting a bad event such as this disease. Let y = your version of the death rate (deaths on the condition of getting this disease. z is the probability of dying which equal x times y.

          OK read this 100 times as it is very basic arithmetic and we do not want to lose you.

          If x = 10% and y = 10%, then the probability of dying is 1%.

          But as you celebrate x turns out to be 25% so let’s recalculate y as 4%. Again we don’t want to lose you with basic arithmetic but the probability of dying is still 1%.

          I bet if some Russian asked you to play his version of roulette and gave you a choice: (a) use a pistol that can hold 6 bullets but put in only 3 versus (b) use a pistol with 12 bullets but put in 4 – you would be dumb enough to take option (a).

          Come on Brucie – we all have already noted you prove yourself to be the dumbest person on the planet. So relax – you do not have to prove the point over and over.

        6. Ulenspiegel

          ” I think your statement can be changed to this: “so we are in actuality doing better than what is presented in the graph”. It all depends on your perspective.”

          Irony? Stupidity?

    2. pgl

      You are not in jail for pushing this snake oil?

      https://apnews.com/a5077c7227b8eb8b0dc23423c0bbe2b2

      More deaths, no benefit from malaria drug in VA virus study

      I bet others will demand that you apologize for your lies on this topic and your demeaning of those who told the truth about this fraud of yours. I will not make such demands as I have long realized you are comfortable being a lying snake.

        1. 2slugbaits

          Bruce Hall Please pay attention to the kinds of arguments used to discredit the VA findings. If you’ll recall the initial claim from the French doctors was that hydroxychloroquine was supposedly effective in those patients who were in the most critical condition. Now the VA study is being criticized because it obtained bad results when used on the most critical patients. Now the argument is that hydroxychloroquine should be used when patients are not in bad shape. Of course, other studies have been unable to find a statistically significant difference in patient outcomes when hydroxychloroquine is used on patients who aren’t knocking on death’s door. You’re trying to have your cake and eat it too. The truth is that we don’t have any…repeat ANY solid conclusions about the effectiveness of hydroxychloroquine. It might be effective in some limited cases under special circumstances for a specific group of patients. Or it might not. We just don’t know. Which is exactly why Dr. Donald Trump should keep his mouth shut and not make unsubstantiated claims about its effectiveness. One thing from the VA study is very clear…some patients have a lot to lose by using hydroxychloroquine. But I suppose you’ll just keep watching those quacks and frauds that Lauran Ingraham and Sean Hannity keep trotting out. Don’t you ever get tired of being suckered?

          1. pgl

            It does seem that Bruce Hall has no clue what real biopharmas do in their clinical trials. Throwing darts over beer is more scientific than Brucie’s desperate search for anything that would help him sell his snake oil.

        2. pgl

          You are still selling this snake oil? Seriously? That desperate to make ends meet? I guess being totally incompetent at everything really sucks during a pandemic.

          1. Edward Kokkelenberg

            Do you people simply want a forum to attack each other or do you want to discuss economic and health scenarios?
            This problem from hell might be a problem for integrated dynamic models. Has any one a reference to these being used?

    3. pgl

      Blame New York (the real victims) again? Of course MAGA hat wearing sycophants like you would never blame Trump. At least this organization gets the enormous strain the medical professionals in my city are under:

      ‘We understand the need for public health and elected officials to weigh the risks and benefits of their decisions. Without doubt, in the face of a significant surge in the number of people who need hospital care, difficult decisions must be made. However, a blanket order for every nursing home in the state to accept all admissions from hospitals is not sound policy.’

      That kind of clarity is just the opposite of the lies and contradicting BS we are getting from the White House. Capacity is the issue and the White House delayed and denied over and over when our Governor was literally begging from more capacity and supplies. So no you little Trumpian Minnie me – it is not New York’s fault. The blame rests with that incompetent President you adore.

      1. Bruce Hall

        If the government within New York has a policy leading to more infections in nursing homes, it is not the victims being blamed.

        1. not_really

          What’s the alternative to New York’s policy? Don’t stop now, policy genius. Or, cut and run.

          1. pgl

            Here is the Trump plan. Convince the governor of Georgia to open up tomorrow. And then we he does – attack the Governor of Georgia. No blame for the White House regardless. What a guy!

        2. pgl

          Listen dumbass. If you took off that stupid MAGA hat and listened, you would see that the citizens of my state really love the efforts of both our medical professionals and our governor. Of course our governor knows how to listen to our heroes. A skill that you will never have and you refuse to try.

  2. pgl

    https://www.usatoday.com/story/news/nation/2020/04/23/coronavirus-new-york-millions-residents-may-have-been-infected-antibody-test/3012920001/

    2.7 million New Yorkers may have this damn virus. That is 14% of the state’s population. I guess Trump needs to stop patting himself on the back for what Kudlow called an effective containment. Oh wait – no shut down of European travelers and over 40,000 people from China since his ineffective shut down. Heck of a job Donnie!

    On the bright side – New York will reach herd immunity sooner than those hicks in Kentucky who want our government to go bankrupt because McConnell must bail out his rich buddies.

    1. Barkley Rosser

      pgl,

      See 2slug’s point from preious thread followed up by me. It is not clear that there is a meaningful such thing as “herd immunity” for this virus.

      1. pgl

        I sort of get that which is why I have not been on a subway since March 11. But at least my state is trying to ramp up testing.

      2. Ulenspiegel

        “See 2slug’s point from preious thread followed up by me. It is not clear that there is a meaningful such thing as “herd immunity” for this virus.”

        According to an expert on corona virus (Christian Drostern, Charite Berlin) herd immunity would be very useful, however, natural herd immunity comse with many deaths, vaccination would be better.

        1. baffling

          what barkley is saying is that there is limited evidence that people develop long term immunity after exposure to the virus. this is an unknown at this point in time, and it is foolish to base policy decisions on this unknown. if people do not truly develop immunity, then you cannot achieve herd immunity. what you get is darwin immunity.

          1. Barkley Rosser

            I shall grant in this case that Ulenspiegel’s point that getting a good vaccine would solve this problem.

  3. Barkley Rosser

    Oh dear, I posted a comment on the prvious thread before I read this one and went on about the successful programin South Korea that kept deaths low without shutting down the economy. I shall only note that some other nations have also done it, especially New Zealand and Taiwan, both led by women.

    Again, all three of those did exactly what Trump did not do: act quickly to carry out large-scale fosuced testing with apprpopriate followup tracing and isolation. It is possible to keep SARS-Cov-2 at bay without a total death of the economy, but not by doing what Trump has been doing, which makes a complete farce of the idea that somehow he is defending the economy against the disease.

  4. Edward Hanson

    Difficult to determine could a been outcome. I’ll add another could of been. What if the New York State and City had read readily available studies of the spread of a pandemic due to mass transportation and had shut down the MTA early. No o0ne knows.

    Again speculation is just that, speculative.

    And BTW, it is something to see how your charts, which do show how much better the US did than Spain or Italy.

    And finally. It is certainly good to see how transparent the US is with its disease data. And I notice that you, Menzie, carefully do not use Communist Chinese Government public data. Just wish you would add that no one, no where, no how, should seriously use their data.

    Ed

    1. 2slugbaits

      Edward Hanson how much better the US did than Spain or Italy

      I’m not sure that’s true if you control for population density. The population density for Spain is 239/sq mile and for Italy it’s 529/sq mile and for the US it’s 91/sq mile. If we expect social distancing to be an effective way to control spread, then we shouldn’t be surprised that the vast physical distances in the middle parts of the country provide some relief as well. OTOH, NYC has a population density of 27,000/sq mile, so maybe we could say that NYC is doing better than Spain or Italy.

      1. pgl

        I shudder to think about places like Tokyo that has a subway system that makes the MTA at rush hour look like social distancing. And they are supposed to host the next Olympics?

    2. pgl

      Uh Ed – I live in NYC and a lot of us were not taking the subway before the Idiot in Chief you adore decided to go 180 and say there is a problem. I did have to take it on March 11 and it was not crowded in the least. Yes most residents of my city get it even that that Real Estate con artist from Manhattan who occupies the White House either does not or lied to us for months. MAGA!

    3. Barkley Rosser

      Ed,

      I for one am perfectly willing to say Cuomo should have moved sooner. He does not look all that wise compared o say Newsom or Inslee, much less leaders in South Koria, Taiwan, and New Zealand. But he moved sooner than “dust and sweat” Trump, and he is certainly more consistent coherent than Trump is in his regular briefings.

  5. Not Trampis

    you could have copies us except your president has obvious cognitive problems and simply did not understand the problem. Still doesn’t.

  6. Moses Herzog

    ttps://www.youtube.com/watch?v=AGPx-ekqZEo

    “Didn’t stay very long”. “Aaaaaaaaaaaaaaahhhhhhhley’s the roughest place I ever been….. ”

    “Before the break of day. before she can wash her face and hands, you know she really go away…….. ”

    really classic lyrics

  7. Grunschev

    I think the graphs should be something like “days after 10 deaths” or similar, rather than using the calendar date on the x-axis.

    And, as the disease strikes the elderly much harder than the young, we need to normalize based on population age in some way. In Italy, about a quarter of the population is over 60 while in the USA it’s more like a sixth.

    I don’t think any country is doing a great job counting cases and deaths. We’ll have a better idea when we can look at excess mortality. Somebody who dies of a stroke because they couldn’t get an ambulance in a timely manner due to COVID should be counted as a COVID death (if there was no COVID, an ambulance would have been available).

    Of course, we won’t know who really did better or worse for a while. Because of our impatience to open the economy, we’ll almost certainly have a much larger second wave than the more patient nations. That is, those countries who don’t worship Capitalism to the extent we do, where it seems the entire GOP is willing to sacrifice my life so they can go get a haircut.

    1. Menzie Chinn Post author

      Grunschev: Those are not calendar dates at bottom of graphs. Please note legend on below the graphs at original St. Louis Fed website: “The right axis gives the total number of deaths, the left axis gives the death rates per 1 million people, and the x axis tracks the number of days since the death rate was 0.05 per 1 million people for all the listed countries.”

      1. Grunschev

        The first graph, the x-axis legend is “calendar date” and the values are dates. And the starting points on the pretty colored lines are at different places on the x-axis, which would fit with deaths starting at different times. Are we not looking at the same graphs?

        1. Menzie Chinn Post author

          Grunschev: Sorry, I was referring to second graph, which is more relevant for comparisons of death rates. You are right, first graph has calendar dates.

  8. Ulenspiegel

    “Could we have implemented a system of social-distancing combined with testing and tracking that would not have entailed an economic shutdown of the current magnitude (i.e., could we have implemented something closer to what S. Korea did, had we had a competent administration and leader not-in-denial?).”

    1) Do western countries have the same number of health care workers as South Korea? Conventional tracking requires substantial man power.

    2) Are western socienties willing to accept severe reductions of privacy like mobile phaone apps which are not anonymous?

    Austriai and Germany are somewhere inbetween, not as good as South Korea, but much better than most of the rest. Even with very early testing the virus could spread. As around 45% of the transmissions are presymptomatic or asymptomatic ( ->R0 ~1) , it is not possible to reduce the rate with conventional tracking without social distancing.

    My takehome massage is that only a combination of digital tracking and early testing makes the difference.

    1. pgl

      “1) Do western countries have the same number of health care workers as South Korea? Conventional tracking requires substantial man power.”

      Interesting question – we are told we have the best health care system in the world but I want to see the per capita comparisons. We should have been gearing up this capacity starting back in 2014 but the Tea Party crowd refused to fund these efforts. After all tax cuts for rich people is their only priority.

      “2) Are western socienties willing to accept severe reductions of privacy like mobile phaone apps which are not anonymous?”

      Trump’s MAGA wearing hat libertarians are all up in arms over this app issue but I suspect most Americans get we need to do this.

  9. pgl

    Trump and his sycophants want us to believe he did a great thing with that travel ban from China. Never mind it was a porous ban allowing over 40,000 people to fly here from China after the ban was imposed. The real problem is that he choose not to ban travel from Europe. I guess that is because he thought this was a China virus where white people could not transmit it. But there is more – it seems the virus was here well before this ban was imposed.

    https://talkingpointsmemo.com/muckraker/newly-revealed-covid-death-is-last-nail-in-coffin-of-trumps-failed-china-ban

  10. baffling

    i have a recommendation for bruce, ed, sammy and rick:
    please follow trumps advice and sit in your tanning bed while enjoying a cocktail of CHLOROXOquine. after all, what could it hurt?

  11. 2slugbaits

    Edward Kokkelenberg This problem from hell might be a problem for integrated dynamic models. Has any one a reference to these being used?

    Could you be more specific? By “integrated” did you mean some model that integrated health strategies and economic policies? Or did you have in mind some model that simulated at the regional level and then integrated those regional outcomes to a global level along the lines of Nordhaus’ RICE & DICE models? Or were you thinking of some DSGE model? Or if the emphasis is on “dynamic” were you thinking in terms of some flavor of a Hamiltonian? The term “integrated dynamic model” can be interpreted in any number of different ways.

  12. Edward Hanson

    Menzie

    This is a nice initial study, albeit, small in breadth. I suggest a next study would acknowledge the different style of government the US has. The state governments have have considerable power. I would be interested in the following for comparison to Italy and Spain; the states of California, Texas, Florida, and New York. Each of these states are comparable in population of Italy and Spain. Each, as said, have considerable power in regard to reaction to the pandemic.

    Ed

  13. pgl

    What is more open to Lawrence Kudlow: doing the right thing regarding social distancing or getting a haircut so he can look good when interviewed on Faux News? Yep – you guessed it:
    https://talkingpointsmemo.com/news/white-house-adviser-got-special-deal-haircut-to-look-good-on-fox-news
    A member of the White House’s Coronavirus Task Force bragged Friday night about violating the “stay-at-home” rules that his public health colleagues have said are crucial to slowing the spread of the novel coronavirus. Larry Kudlow, the White House economic adviser, let the story slip during an interview with Fox News’ Laura Ingraham. “I’m also going to confess, I had a hair trim yesterday,” Kudlow told Ingraham … “It was kind of a special deal,” Kudlow told Ingraham. “Friends of ours — you know this person, but I’m not gonna mention any names. She got her hairdresser to come in and open up her barbershop, and the guy gave me a pretty good trim.”
    “I don’t have much to work with,” the White House adviser acknowledged. “But it looks much better because I wanted it to look good on the Laura Ingraham Show. That was the key point and here I am. I had no temperature this morning coming into the White House, I tested negative last week, I feel fine.”
    “You’re special, you got a haircut,” Ingraham snarked at the White House adviser, who mouthed “I’m sorry,” before the Fox News host moved on with the interview.

    But Laura – he is special as he kisses Trump’s rear end on a daily basis!

  14. pgl

    Trump’s incompetence is costing countless lives and causing us to do a nose dive economically. But of course Republicans like Mitch McConnell could care less about that if they get to hold onto power. Oh wait – this incompetence may cost Republicans both the White House and the Senate. Oh my!

    https://www.msn.com/en-us/news/elections-2020-us/nervous-republicans-see-trump-sinking-and-taking-senate-with-him/ar-BB13bhRy?ocid=spartandhp

    Nervous Republicans See Trump Sinking, and Taking Senate With Him

    “President Trump’s erratic handling of the coronavirus outbreak, the worsening economy and a cascade of ominous public and private polling have Republicans increasingly nervous that they are at risk of losing the presidency and the Senate if Mr. Trump does not put the nation on a radically improved course.”

    Look – we all want this virus to dissipate. We all want the economy to quickly recover. But it ain’t happening as long as Trump cares only about what people think about Trump. The man has always been a self-centered lying scum with zero competence at governing. And McConnell has backed this scum at every step which means the Senate will not miss him a bit.

  15. Lynn

    1. My first time on this website – was hoping to see respectful, thoughtful discussion.
    2. I’m confused by the premise because I’d heard we were doing better than Spain and Italy and the graph seems to show this unless I’m reading the graph wrong (entirely possible)? The Y-axis is logarithmic so I see the US to be sitting at 150 deaths per million while Italy and Spain are between 400 and 500 deaths per million.
    3. It has been my experience while traveling in Asian countries to see people commonly wearing masks, much more so than in Europe or the US. Perhaps this has also affected the morbidity numbers due to fewer patients per doctor/hospital thus resulting in a less stressed healthcare system and hence better care and lower death rates?

    Thanks, enjoy your day.

    1. Barkley Rosser

      Lynn,
      Yes, Asians in some countries have long worn masks in public. Another factor in the better performance on cases and deaths by several Asian nations has been their rapid respoinse to the very earliest news, espeially among those with close Chinese ethnic connections or phsical closeness, e.g. Taiwan, Hong Kong, Singapore, and South Korea. For them they suffered badly in a way the US did not remotely do in the SARS epidemic a decade and a half ago, recently enough they have fresh memory of it. So they were quick to act in some cases even before when the Chinese Government was recognizing what was going on. Timing on epidemics, like in love and war, is very important.

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