Today, we present a guest post written by Jeffrey Frankel, Harpel Professor at Harvard’s Kennedy School of Government, and formerly a member of the White House Council of Economic Advisers. A shorter version appeared at Project Syndicate.
Mark Twain said, “There are three kinds of lies: lies, damned lies, and statistics.” Too often, the pandemic has unnecessarily allowed scope for the sort of popular suspicions reflected in Twain’s bon mot.
Statistics are in fact a critical component of the fight against Covid-19. Their use ranges from judging the efficacy of different vaccines to judging the performance of different governments.
But throughout the pandemic, comparisons across countries have focused too much on the wrong statistics. The problem is worse than impeding the evaluation of governments’ performance. The focus on the wrong metrics gives has given some political leaders a strong incentive to under-react to the pandemic, to suppress testing for example, and thus has arguably contributed to the loss of millions of lives.
Per capita cases
The official global death toll from Covid-19 stands at 3.3 million. One sees tendentious media reports comparing fatalities across countries or states.
For professionals analyzing the data, the more information the better. But for the purposes of the general conversation, the choice of which sort of statistics to emphasize is consequential. Everyone has limited bandwidth and in this age of mistrust of experts and mainstream media, it is important that prominence be given to statistics that are as informative and reliable as possible.
Counts of countries’ officially recorded infections and deaths have been the most prominently featured. The first thing one needs to do is pretty obvious: divide cases and deaths by population, to express them in per capita form. It is not very enlightening to hear that the United States has suffered more cases, in absolute terms, than the Netherlands. Or India than Peru.
But even reported on a per capita basis, official counts of infections and deaths are tremendously inaccurate. Specifically, they are usually gross under-estimates of the true numbers. Carriers of the virus are not counted as infected unless they are tested or even hospitalized. Victims are not counted as Covid-19 deaths unless a doctor puts that on their death certificates.
Estimates of the extent of the undercount of infections vary. The same with deaths. The World Health Organization this week reported an official mortality under-count of 50 % in the European Region and 60% in the Americas. The Economist magazine’s model of excess mortality calculates that the true number of deaths attributable to Covid-19 globally is currently in the range of 7 – 13 million, that is, about three times the standardly reported official account.
The estimated undercount varies widely across countries. It is often greater under autocracies — a factor of 5 in Russia, for example.
The undercount also tends to be more extreme in lower-income countries. Egypt, for example, has 13 times as many excess deaths as the number officially attributed to Covid-19. The lowest-income countries may not even be able to count total deaths. In that case, estimates of excess deaths can only be inferred. The Economist’s model shows an undercount factor of 14 in Sub-Saharan Africa.
For richer countries, the overall undercount is smaller, estimated at 17 % for OECD members. In the US, the estimated undercount was running at only 7 % in March-April. The American undercount is much smaller in 2021 than it was last year. In the early days of the pandemic, President Trump said there were only 15 American casualties and congratulated himself for doing such a good job (February 26, 2020). As late as July 2020, the professional estimates of true infections ran 2-to-6 times higher than the official US count.
Of course, even accurate measures of infections or deaths would be just the starting point for evaluating the effectiveness of public measures to combat the virus. One would need to control for other determinants, such as population density and age distribution, before passing judgment on the quality of government crisis management.
That official reports of cases and attributed deaths understate the true count is no secret. But the focus on official reports, which only count infections according to positive coronavirus tests or deaths according to what is on the death certificate, does more damage than merely understating the gravity of the problem. Worse, it gives politicians an incentive to reduce testing and suppress bad news, e.g., by encouraging doctors to list co-morbidities (diabetes) or complications (pneumonia) as the cause of death rather than Covid-19. Since testing, social distancing, and vaccination — most of it voluntary — have been so necessary for fighting the coronavirus, whatever undermines them causes deaths.
Some statistics that are more informative
It would be better if the media and popular discussion paid more attention to some other measures that are more informative and also less vulnerable to political influence.
The positive coronavirus test rate as a percentage of all tests administered is much more instructive, compared to positive results as a percentage of the entire population. India’s current positivity rate is a very alarming one in four. (It is as high as one in two in West Bengal. In contrast, the US positivity rate has recently fallen below 3 %.) If President Modi had focused on the positivity rate a few months ago, perhaps he would have known not to prematurely declare victory against the virus. As it was, he facilitated super-spreading mass political rallies and religious celebrations.
If the positivity rate had received more attention than the reported infection rate, it would have constructively given governments an incentive to increase testing. Instead, the focus on verified infections as a percentage of the population gave governments a dangerous incentive to reduce the extent of testing. When Donald Trump was president, he was acutely sensitive to this incentive: “When you test, you find something is wrong with people. If we didn’t do any testing, we would have very few cases” (May 14, 2020). He claimed that the US was doing more testing than most others, but the claim was completely false.
Trump was not alone among leaders. Brazilian President Jair Bolsonaro limited testing for the sake of appearances and actually cut back when Covid-19 cases accelerated sharply. Others who have sought to downplay the seriousness of the virus include Mexican President Andrés Manuel López Obrador, Russian President Vladimir Putin, U.K. Prime Minister Boris Johnson, and now-deceased Tanzanian President John Mugufuli.
In the current phase, the vaccination rate can be a revealing measure of government progress. Israel has now vaccinated 57 % of its population, Chile 41 %, the US 39 % and the U.K. 34 %, whereas most EU countries have only vaccinated around 15 % of their populations, Brazil and Mexico 9 %, and India 3 %. Within the US, the vaccination rate ranges from above 60 % in New England states to a low of 33 % in Mississippi.
Positivity rates, vaccination records, and excess mortality calculations have their own limitations as criteria of how bad things are. But they are generally more illuminating than the statistics that are most widely cited.
Epidemiological models often focus on the parameter R, the rate of exponential spread of the virus (or, after turning the corner, the rate of exponential decline). Unfortunately, data availability does not allow reliable estimation of R.
Historical comparison of death rates
To recognize the undercounts is to realize that the pandemic is even worse than one thought. But the news is already too depressing as it is. An historical perspective allows us to end on a more encouraging note — provided we handle the statistics properly.
A recent newspaper headline proclaimed that the 2020 jump in the US death rate (essentially what we have been calling excess deaths) not only was the worst in the last century, but supposedly surpassed even the global influenza of 1918: “Record Jump in the US Death Rate Last Year” (NYT, 4/25/2021). “The U.S. death rate in 2020 was the highest above normal since the early 1900s — even surpassing the calamity of the 1918 flu pandemic.”
It would seem surprising if, with all the advantages of modern medical science and greater economic resources, Americans did worse in 2020 than in 1918. The truth is, they didn’t. It is true that the federal and state governments could have done far better. But the outcome wasn’t worse than the so-called Spanish flu. The New York Times article was misleading in its description of the comparison of excess deaths between 1918 and 2020. (The mortality rate in 2020 “increased 16 percent from 2019, even more than the 12 percent jump during the 1918 flu pandemic.”)
According to the CDC, “from 2019 to 2020, the estimated age-adjusted death rate increased from 715.2 to 828.7 deaths per 100,000 population.” (Unadjusted for age, 3.4 million Americans died last year, out of a population of 330 million.) That was an increase in mortality of 0.114 percentage points [from 0.715% to 0.829%]. To be sure, the rise in 2020 was tragically large, reflecting the pandemic. But why describe the result as an increase in the death rate of 16% [calculated as .114%/.715%]?
If one compares the 2020 crisis to the rise in the age-adjusted death rate from 2,278 per 100,000 in 1917 to 2,542 per 100,000 in 1918, an increase in mortality of 0.264 percentage points [from 2.278% to 2.542%], one learns that the earlier episode was more than twice as deadly. It is misleading to describe the 1918 jump in mortality as 12 % [calculated as 2.542%/2.278 %] and therefore less severe than the recent experience.
The point is that the 2020 hit only looks worse than the 1918 hit when compared to other causes of death, which have declined by much more over the last century.
What is most striking in a graph of the death rate in the US over time – even more striking than the exceptional leaps of 1918 and 2020 – is the otherwise gradual but strong downward trend from 1910 to the present. Even the awful reversal of 2020, from 0.7% to 0.8%, still leaves the death rate below what it was as recently as in 2000.
Steven Pinker’s book Enlightenment Now is a good antidote to the impression we all get that the world is generally going to hell. Favorable long-term trends show up in statistics on life span, health, literacy, safety from violent death, escape from poverty, and more other criteria than one would have thought possible. But such historical progress is not automatic and we should not take it for granted, as the pandemic illustrates. Faith in “science, reason, and humanism,” have made it possible. So has holding leaders accountable. Good statistics help.
This post written by Jeffrey Frankel.
It is interesting to note, Steven Pinker, who I am pretty sure is a former professor of James Kwak’s, has been labeled a “racist” by some. I have no issue with Pinker, and basically think it’s hilarious he would be labeled a “racist”. It is a common trait among our young people, and even some older folks, poor at formulating their own losing arguments to label someone, and yell out “racist!!!” “misogynist!!!!” as a reflexive self-defense mechanism when the quicksand of logic hits their knees. Now, if people want to go after Pinker for going through wives quicker than some people go through Heath ice cream bars, that might be a valid point.
I would add Pinker’s “Better Angels of Our Nature” as well worth reading.
He buries the notion that our era is more violent, more homicidal than the past, when in fact the opposite is true.
But of course, the narrative is more important than the data.
Always has been.
January 15, 2018
Life Expectancy at Birth for China, United States, India, Japan and Germany, 1977-2019
January 30, 2018
Infant Mortality Rate for China, United States, India, Japan and Germany, 1977-2019
Does that infant mortality rate include female babies put in rock filled bags in a nearby river or a nearby commercial dumpster because they couldn’t carry on the father’s family name (among other negative stigmas attached to female babies)?? Please keep in mind this question was asked by an American “misogynist” before formulating your answer. pgl and “FemaleNoSpeak” blog wouldn’t want it any other way.
Let us know how many mainland theater screens this film, written and directed by two Chinese women, gets on release. It was shown in Taiwan and won multiple Taiwanese film awards when it was released—23 years ago. I think they’re still waiting for the wide release on the mainland. Too much realism???
Yep time to ignore the serial irrelevance from our wine infested Uncle Moses. Dude – you need to get your own blog so the rest of us can just skip it.
Gosh, pgl, at least this comment by Moses did follow up on ltr’s comments on lifr expectancy and infant mortality rates in various countries somewhat with its implication that the Chinese infant mortality rates might need some adjusting. Hers comment is already somewhat off topic, although I grant that the main post does deal with measuring death rates in connection with how to measure coronvirus rates, so not totally off.
As it is, you are completely right that our good friend very frequently posts stuff that is just nowhere near either the original topic of the thread or anything anybody else has said along the way, and he even occasionally recognizes that he does this., with only the slightest amount of embarrassment, and with Menzie apparently tolerating it, although he does not tolerate overly racist or sexist comments apparently.
You and Barkley have your own blog, and most people DO skip it. But at least you and Barkley aren’t petty types, and people on this blog appreciate that. Like telling people to “cite” graphs with plainly labeled footnotes of the source, or bashing very good forecasts of 2nd Quarter headline GDP inside of 3% close, while getting it over 30% off. But why would people skip reading a blog written by the two people doing such things?? Weird……
Keep fighting for women on “FemaleNoSpeak” blog, ok?? Update us all on Andrew Cuomo’s future, the man you said was “Our nation’s leader in Covid-19 response” How anyone could skip this type of wisdom to read Chinn and Hamilton is a strange enigma to unlock, aye pgl???
Moses – for the 100th time, Econospeak is not my blog or Barkley’s blog. Barkley may have even told you who is the administer of the blog (I won’t as I respect why the administer does not blog). We may have the privilege of posting there but we do not control who else does. And you should know that by now assuming the wine has not given you dementia.
The many times you have accused us of not allowing women to blog is beyond dishonest of you. It is by now carnival barker stoopid. Learn to read moron.
“Keep fighting for women on “FemaleNoSpeak” blog, ok??”
I checked Angrybear where Barkley’s and mine posts are featured and there are three – count them three – women contributors. OK we are not the administers there no more than we are at Econospeak. But neither one of us are excluding women from blogging.
Unless you have the worst case of dementia ever – you are nothing more than a pointless liar Sarah Palin style.
Thought this was an interesting story:
Again, I am still leaning to this coming from some animal to animal cross-contamination (bat being the most likely candidate), and then probably a human not washing their hands and putting their hand up to their mouth or nose. I still put it at a good 85%. But when you have 3 or so folks at a lab coming down ill not a long time before the breakout, and then add in a well credentialed person saying there’s a possibility, it’s hard to say it’s an impossibility:
I would need very hard proof to change my stance on this, but it’s not out of the question. This isn’t enough for me, but it’s enough to keep the door open half an inch. I’ve basically changed my thoughts on it from being about a 0.5% chance, up to maybe a 15% chance.
I have argued all along that it is a possibility that should be investigated. What i have argued against is people making such an accusation with no evidence, only suspicion. This is too big of an accusation to make without evidence. I certainly hope we continue to investigate and accumulate information, so we have confidence in how it started as a means to prevent a repeat. I still think it was a natural exposure. But as i told my wife a year ago, the fact the origin was near a lab means that issue needs to be examined clearly.
We probably had a better chance at getting to the bottom of this investigation in china had the trump administration not been so adversarial with them early on. That was not constructive in obtaining reliable information on the origins.
There is the third sort of intermediate possibility that I have pointed out numerous times, animal to human but in a lab or brought into a lab and then out from there, as opposed to “cooked up in a lab.” Along with finding about these apparent three early cases in one of the labs, it is increasingly looking like whatever the transmission path or origin, it did not initially get out from the wet market, with quite a few early cases not connected to it, but certainly the major public outbreak coming from there, But it increasingly looks like how it got there was from a person coming in from somewhere else, not all that likely from some animal brought there that was the original source of the animal to human transmission, if indeed that is what happened.
“There is the third sort of intermediate possibility that I have pointed out numerous times, animal to human but in a lab or brought into a lab and then out from there, as opposed to “cooked up in a lab.”
The first hypothesis by Prof. Drosten, expert for corona virus, in spring 2020 was that the Chinese fur industry is the most likely source, Wuhan with its markets was only the catalyst. This thesis got IMHO a lot of support by the fact that in Europe a number of mink to human infections were confirmed in summer 2020.
The lab thesis is IMHO only a tool to increase pressure on China; as the Chinese government did not provide good data but tried to sweep the affair under the carpet by blaming others it makes sense as political tool, not as scientifically correct explanation.
What our resident narcissist of Shenandoah Gutterflush has yet to figure out, is that the lab in question had no animals inside it, or none of the nature that would have spread the virus, But he’s so desperate to cook up ANY theory that has the virus originating from the Wuhan lab, he pulls that one out of his A$$. Not to mention the other ungodly dumb theory that where it would be much easier to do contact tracing of those employed in a lab (and finding nothing legit there), that the only PhD holder I would basically describe as “the dumbest guy in the room” believes he’s going to be able to get reliable contact tracing from a largely informal “wet market” weeks/months later. This is what narcissists do who cannot emit these words: “I was/am wrong” “This was/is a very dumb theory of mine, which the only reason I articulated it in the first place was another sad attempt to differentiate myself as something other than a run of the mill egghead, if that”
“About half the early cases, in December, had a link to the Huanan Wholesale Seafood Market, a maze of stalls selling frozen fish and some wild animals. That’s why animal markets are under suspicion.”
I guess the moment well-educated lab scientists get off work, they head down to the local meat market to consume the exotic/filthy animals they know to be a great danger to humanity~~~this is our Harrisonburg PhD’s genius theory for the year 2020. I guess if you have zero shot for a Nobel Prize, you try for the “Hail Mary” of wives’ tales.
You have been told this numerous times, but there are two labs in Wuhan studying viruses. Most of the focus has been on the Wuhan Virology lab with the higher level of security that is quite some distance from the wet market. Apparently there were no bats there (although how do know given the limited access to it?), but that is where allegations have been made of there being “gain of function” research that might have generated the virus. If indeed the virus was lab-generated, that is where it would have happened, and I gather that is where these early cases were, although I am not sure.
But the other lab, a lower security one, is around the corner from where the wet market was. It was the one pinpointed by an early paper in China by Chinese that got suppressed by the government, blocked from being published, and the authors of that one claimed that there were bats in that lab. So, I am afraid you just have not kept up with this stuff, and I posted on this particular point last year when you were just dismissing all this in a very stupid and ignorant way.
I have a rather naive question – how does figuring out where this virus originated back in late 2019 do a damn thing to bring anyone’s life back, increase vaccinations, or otherwise contain the damage from this pandemic? It doesn’t. But yea – let’s keep throwing rocks at each other rather than work together to move forward. After all – we all must behave like Trumpian morons.
Presumably if we can determine how it got going actions can be taken both in China and elsewhere to tighten conduct both in the wild and in labs to make it less likely for another such virus to create a pandemic. Really. I understand that you were on the bandwagon simply denying any chance it came from a lab along with Moses last spring. But that looks more likely now, however it got into one of those labs maybe. I do not think saying that we all must behave “like Trumpian morons” helps here. I do not see the people raising these issues now engaging in the blatantly racist and lying way that he did last spring, which I understand led lots of people to simply dismiss the possibility of any lab involvement however.
Again, I fear we are too late, and that it will be impossible to determine the ultimate origin and pathway to a pandemic, with the Chinese government at various levels having simply destroyed too much crucial data, and very unlikely to aid in discovering any that still remains not completely destroyed, such as the details of the reported early cases of some people working in one of the labs.
As it is, if the origin really was a simple animal-to-human-in-the-wild event that ended up at the wet market or some other one, I do not see why the PRC? government is so unwilling to open things up for closer study and has so vigorously shut down internal reports that suggest problems. Indeed, the govbernment’s credibility is even worse because it seems to be trying to push various theories that somehow suggest it did not originate in China, which pretty much evderybody outside of China except perhaps our very own ltr, do not take remotely seriously, with one of these theories being that it was US soldiers who brought it to Wuhan in October, 2109, and the theory they keep pushing harder, with the WHO at least keeping the door open to it, that it entered China on some frozen food from who knows where.
“how does figuring out where this virus originated back in late 2019 do a damn thing to bring anyone’s life back”
This would of course not bring back any lifes, however, it may in furture reduce the chance that another virus is produced and released.
I do not like the fact that in China conditions exist that facilitate the “breeding” of new viruses that can hop from one species to another, I actually expect that the Chines government admits the issue and takes action, this face saving game is BS.
I’ll tell you something, You can agree or disagree, actually I have the weird tangent in my mind that you miight agree with me. HERE IS THE HARD FACT, ON THE GROUND, REALITY: “If the three facets of China’s big brother government ever got their act together–i.e. Beijing, province level, and municipal level—and decided that they actually wanted to ENFORCE a zero-tolerance policy on the non-sale of exotic animals and the hygiene rules of outdoor food markets/ “wet markets”—–SARS, Covid-19, and the next one which is certain to come along in the next 15-20 year time frame, will become a joke of backwards cultures of yesteryears’ past.
Then the next goal will be getting rid of American Uni Profs with harebrained and absurdist theories on well-educated scientists smearing bat feces on their lamb soup lunch.
Yes, with all your inane capitalizing it is true that if they really wanted to, the multiple levels of Chinese government could probably ban wet markets.
But, despite your rantings to the contrary, it is quite possible that the virus did not come from the wet market originally, although it is clear that is played a substantial role in its spread at a certain point. But the hard fact, since you are so into those, is that a lot of the early cases now known about involved people having nothing to do with the market and getting it before it appears to have come out of there as perhaps the first superspreader event of the pandemic. You really need to calm down and get it more together here, seriously losing it.
if the pandemic came from a lab, then the world needs to really reconsider how and what we do in those labs. safety protocols need to be standardized and enforced. we may need to examine these types of labs in the same way we monitor nuclear facilities. and a framework for accountability can be created.
on the other hand, if it did come from a natural source, this emphasizes the need of the type of lab research that was being done in the wuhan lab. so while the statement above would still apply, we would work to make sure we do not stifle this type of research. the russians were able to develop a vaccine very quickly because they were also studying the sars virus in great detail-and working on a vaccine.
knowing how the virus emerged does not change the past. but it certainly gives credibility to which path we choose to follow going forward. this will not be the last pandemic i see in my lifetime. we need to learn how to respond much better for the next one. this one was tame compared to what we could face.
It doesn’t bring anybody back. It might shed light on how the virus evolved and give some ideas about how to catch the next pandemic earlier on. Finding the origin is about two things: 1. scientific inquiry, and 2. having more information and ideas to apply to the next pandemic. There will be a next pandemic.
Good piece by Jeff. Now I’d like to see a serious piece about the risks vaccinated and not of going into groups of different kinds.
Remember. the cross individual probabilities are NOT independent – indeed that is the whole point of an epidemic.
I use Bayes thm to get the conditional probabilities and a made up measure of outcome correlation to do the updating.
My wife and I, for example, are perfectly outcome correlated.If she has it I have it and vice versa.
So cond prob = independent prob + (1 – independent prob)*correlation.
The equation is made up but it works well for zero and one correlation
The essay is excellent, but I would question the blanket criticism of the mentioned national leaders in focusing on the spread of the coronavirus. After all, the structure of the British economy differs vastly from that of Tanzania. The situation confronting the prime minister of Britain and president of Tanzania were in no way that I can understand similar. Criticism of the President of Tanzania as though John Mugufuli were Boris Johnson clouds the problems each confronted.
Trump was not alone among leaders. Brazilian President Jair Bolsonaro limited testing for the sake of appearances and actually cut back when Covid-19 cases accelerated sharply. Others who have sought to downplay the seriousness of the virus include Mexican President Andrés Manuel López Obrador, Russian President Vladimir Putin, U.K. Prime Minister Boris Johnson, and now-deceased Tanzanian President John Mugufuli….
— Jeffrey Frankel
[ This passage is importantly lacking, as though the presidents of the United States and Mexico or Tanzania could have pursued similar paths in limiting the spread and effects of the coronavirus. Just what sort of infrastructure is Tanzania lacking to adopt US style healthcare policy? ]
its not just infrastructure. leaders set the tone for how a nation responds, or does not respond, to a threat. at the same time, it is clear that while china responded internally one way, they presented a different tone with the international community. they were not transparent. how leaders respond matters.
May 30, 2021
Over 620 mln COVID-19 vaccine doses administered across China
BEIJING — Nearly 621 million doses of COVID-19 vaccines had been administered across China as of Saturday, the National Health Commission said Sunday.
[ There are 5 Chinese vaccines being used, with from 18 to 20 million doses being administered daily. ]
As for the severity of the epidemic in India, this work is revealing:
May 13, 2009
Is India a Flailing State? Detours on the Four Lane Highway to Modernization
By Lant Pritchett
India is an emerging global superpower as its rapid growth has transformed its economy and has maintained itself as the world’s largest democracy. But at the same time India lags in many dimensions—its malnutrition rate is one of the highest in the world, its immunization rates are lower than most African countries, and Bangladesh has a better infant mortality rate. I argue that this is in part because the Indian state is “flailing”—its very capable head is no longer reliably connected to the arms and legs of implementation. In the four-fold transition of economy, polity, administration, and society the administrative capability of the state is lagging. I use examples from services like health, education, and routine transactions like issuing driver’s licenses to show that the agents of the state routinely do not implement the tasks they are assigned—causing a massive divergence between de jure and de facto reality. The paper concludes with speculations about the causes of flailing and possible future trajectories.
May 26, 2021
The New York Times Says 200,000,000 People Have Been Infected with Covid in the United States (sort of)
By DEAN BAKER
This is the implication of its analysis * of likely Covid deaths and infections in India. Its central estimate assumes a case fatality rate of 0.3. This means that for every thousand people who get infected, three will die.
There have been roughly 600,000 reported deaths from Covid, since the pandemic began. If this is 0.3 percent of the people who contracted the disease, then 200,000,000 people in the United States have been infected.
May 25, 2021
Just How Big Could India’s True Covid Toll Be?
By Lazaro Gamio and James Glanz
Data as of May 24
26.9 million Reported cases
307,231 Reported deaths
A conservative scenario
404.2 million Estimated infections
600,000 Estimated deaths
15 infections per reported case with an infection fatality rate of 0.15%
A more likely scenario
539.0 million Estimated infections
1.6 million Estimated deaths
20 infections per reported case with an infection fatality rate of 0.30%
A worse scenario
700.7 million Estimated infections
4.2 million Estimated deaths
26 infections per reported case with an infection fatality rate of 0.60%