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Politics Trump Suggests Virus Death Count Is Inflated. Most Experts Doubt It

01:53  23 may  2020
01:53  23 may  2020 Source:   nytimes.com

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Stelter: Trump is talking more than his experts . That 's a problem. Indeed, they're suggesting the numbers might be inflated in an effort to paint President Trump and/or the crisis in the Trump was asked on Tuesday at the White House briefing about the accuracy of the death count , with a reporter

Other experts noted that the White House didn’t even explain the time period the death estimate Almost the entirety of what the public knows about the death projection was presented on a single slide at a At Tuesday’s briefing, Trump unveiled the government’s projected death count , saying it was

WASHINGTON — President Trump, eager to reopen the economy, has begun questioning the official coronavirus death toll, suggesting the numbers, which have hobbled his approval ratings and harmed his re-election prospects, are inflated.

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Public health experts say that an accurate count of deaths is an essential tool to understand a disease outbreak as it unfolds: The more deadly a disease, the more aggressively the authorities are willing to disrupt normal life. Precise death counts can also inform the federal government on how to

Claims involving inflated death counts also circulated widely on social media. The CDC's changes come as experts say statistics confirmed by positive tests haven't been capturing the full Experts say that COVID-19 deaths are likely not being overinflated. That list includes by Dr. Anthony Fauci

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In coronavirus task force and other White House meetings, conversations with health officials have returned to similar suspicions: that the data compiled by state health departments and the Centers for Disease Control and Prevention include people who have died with the coronavirus but of other conditions. The numbers, some say, include too many “presumed” cases of Covid-19 and too many Americans who were never tested for the disease.

Bing COVID-19 tracker: Latest numbers by country and state

Last Friday, Mr. Trump told reporters that he accepted the current death toll, but that the figures could be “lower than” the official count, which now totals nearly 95,000.

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Behind the scenes: The official said Trump has vented that the numbers seem inflated and has brought up New York’s addition of more than 3,000 unconfirmed but suspected COVID-19 cases to its death toll. What they’re saying: Experts believe the formal death count is inaccurately low because

The death toll passed 67,000 on Sunday, more than the total American deaths in the Vietnam War and already higher than the president’s earlier prediction. While he has previously expressed doubt about a second wave in the fall anticipated by public health experts , he conceded that it could happen.

Most statisticians and public health experts say he is wrong; the death toll is probably far higher than what is publicly known. People are dying at their houses and nursing homes without ever being tested, and deaths early this year were likely misidentified as influenza or described only as pneumonia.

Dr. Anthony S. Fauci, the nation’s top infectious disease expert, told lawmakers this month that the overall toll was likely an undercount. “I don’t know exactly what percent higher but almost certainly it is higher,” he said at a Senate health committee hearing.


Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, which is closely tracking the coronavirus pandemic, said that “the officially reported numbers don’t reflect the true level of illness and death that have occurred.”

“We very much feel the reported numbers reflect an undercount,” she said.

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“We currently do have some deaths that are being reported that are clearly from other causes. There are a number of nuances to the data that we report and often it is very difficult – especially quickly – to make an assessment on the cause of death .

That is 9,000 more deaths than were reported as of April 11 in official counts of deaths from the In Michigan, the partial death count is 121 percent of the count in a normal year, the equivalent of It is possible that those reductions could cancel out coronavirus deaths in places where the virus is not

Inside the White House, doubts about the official numbers are pervasive, though they come in different forms. Mr. Trump is in search of good news to promote his administration’s response to the pandemic and to press states to reopen. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, is a numbers obsessive and wants her own data to supplement information coming in from the states and the C.D.C. One official has even accused hospitals of potentially exaggerating their coronavirus patient counts to milk money from Medicare.

Top White House officials have even discussed appointing a “forensic” team to audit how some hospital systems and state health departments have been tallying infections and deaths, according to one senior administration official. Multiple senior White House officials said they were unaware of such conversations.

In a brief interview Thursday, Dr. Birx stressed that there had been no pressure to alter data. “I’ve never been in a meeting where anyone has discussed changing the death numbers,” she said.

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Health experts are warning that the national count of Covid-19 deaths in the United States could be underestimated as the coronavirus Unlike most coronavirus tests, which generally require a swab and look for signs of the virus itself, antibody tests look instead for the body's response to a virus .

Mr. Trump suggested he was speaking on gut instinct, and acknowledged he had no expertise on the subject. Even under typical circumstances, public health experts say that it takes months or years to But they also say that an accurate count of deaths is an essential tool to understand a disease

And she disputed that the White House was debating the C.D.C.’s counting of probable infections. “There is no tension about their presumed cases,” she said.

But she herself has said publicly that the American health care system incorporates a generous definition of a death caused by Covid-19, the disease caused by the coronavirus.

“In this country we’ve taken a very liberal approach to mortality,” Dr. Birx said at a White House news conference last month. “There are other countries that if you had a pre-existing condition, and let’s say the virus caused you to go to the I.C.U., and then have a heart or kidney problem — some countries are recording that as a heart issue or a kidney issue and not a Covid-19 death.”

Robert Anderson, who runs the mortality statistics branch of the C.D.C.’s National Center for Health Statistics, said the federal government deployed two parallel, related systems to tally deaths, one based on case reports and one on death certificates. He said it was unlikely that there was any kind of overcount.

“The case reporting system asks: Did the patient die from this illness?” he said. “It’s not asking if the patient with Covid-19 died. It’s asking if they died from Covid-19.”

A death certificate, Mr. Anderson said, clearly establishes a cause of death or a contributing factor.

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That has not deterred some at the White House to search for new data. Dr. Birx often begins her days before 5 a.m. examining fresh numbers from a small group of Trump administration officials who work late nights in the White House complex.

Detailed to Dr. Birx from the C.D.C., the State Department, the White House budget office and a technology agency called the U.S. Digital Service, the employees compile their own information about the pandemic from state and local health departments in hard-hit parts of the country. That data is then shared with the White House’s coronavirus task force.

White House officials say skepticism in the Trump administration over C.D.C. data, including for opioid use, long predates the coronavirus outbreak. But new reasons have cropped up.

At least one senior White House official has mentioned that hospitals could be inflating their coronavirus patient counts, responding to financial incentives — Medicare offers higher payments to providers for treating coronavirus patients. Several senior officials said they were unaware of such talk.

An official with the American Hospital Association disputed that idea.

“There’s guidance around what you have to do, and the clinician has to say, ‘This is the diagnosis,’” said Nancy Foster, the association’s vice president for quality and patient safety policy. “They’re putting their professional reputation on the line to say that.”

Without doubt, the C.D.C., which collects data from states, has been hampered during the pandemic by inconsistent protocols and limited resources at a local level. How deaths are tallied often varies from one state or county to the next and involves a chaotic mix of health care providers, medical examiners, coroners, funeral homes and local health departments that fill out death certificates, often without official test results.

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White House officials have also wanted the C.D.C. to standardize how states report cases to the federal government, a role that now belongs in part to a professional organization, the Council of State and Territorial Epidemiologists.

“There is no organization on earth better at standardizing surveillance than the C.D.C.,” said Dr. Thomas R. Frieden, the agency’s former director. “Could it be better? Absolutely. It could be more timely. It could be more complete.”

Dr. Birx was caught off guard in April when states began incorporating both confirmed and “probable” cases and deaths, senior administration officials said, a change that encouraged a deeper suspicion among those who have doubted the overall mortality figures.

Dr. Birx was again angered by news reports divulging drastic projections she had never seen, the officials said, including those laid out in an internal document obtained by The New York Times that forecast about 200,000 new cases each day by the end of May. The data, which had not been vetted by the White House, came from the Johns Hopkins Bloomberg School of Public Health, which said it was preliminary and should not have been released. It has also proved false.

The Trump administration has looked to the outside to get its numbers. The Department of Health and Human Services has used a technology program devised by Palantir to track numbers gathered by federal agencies, states, private health providers and universities. The administration also signed a $10 million deal with a tracking contractor — first reported by The Washington Post — that monitors hospital capacity and Covid-19 deaths, essentially repeating and privatizing the work of the C.D.C.’s National Healthcare Safety Network.

“If you set up parallel tracks, you will get inconsistent information,” Dr. Frieden said. “You can ask different questions at different times and get different answers.”

Coronavirus: the death toll could be largely underestimated in Italy

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Mr. Anderson of the C.D.C. said in an interview that the agency was looking at new systems, including artificial intelligence, to get a better grip on coronavirus trends. “We are in the process of exploring some machine learning and A.I. techniques to try to make the coding more efficient and make the system more nimble,” he said.

Epidemiologists are also rethinking their tabulations, but not in ways the White House would like. They have increasingly compared recent totals of deaths from all causes, which provide a more complete picture of the pandemic’s impact than tracking only deaths of people with confirmed diagnoses. Fatalities in the gap between the observed and normal numbers of deaths are called “excess deaths.” A study of mortality statistics in New York City showed more than 24,000 excess deaths from March 11 to May 2.

Mr. Trump is hardly the only politician uncomfortable with the official coronavirus counts. Jared Polis, Colorado’s liberal Democratic governor, said on “Fox News Sunday” that “the C.D.C. criteria include anybody who has died with Covid-19, but what the people of Colorado and the people of the country want to know is how many people died of Covid-19.”

Last Friday, Colorado’s health department revised its death toll downward, forming two categories to account for what it said were patients who had Covid-19 but died from other causes.

Trying to separate the cause of death in coronavirus-infected patients is “ludicrous,” said Dr. Alicia Skarimbas, a physician in Bergen County, N.J., who has treated around 75 Covid-19 patients.

“I have yet to have anyone infected with Covid die from anything else,” she said.

Noah Weiland and Abby Goodnough reported from Washington, and Maggie Haberman from New York.

Coronavirus: the death toll could be largely underestimated in Italy .
© REUTERS / Flavio Lo Scalzo Medical check at the entrance of the Spedali Civili hospital in Brescia, Italy, March 3, 2020. How many victims did the Covid-19 really do in Italy? No doubt much more than the official figures indicate. For civil protection, a total of 32,330 people are said to have died from the coronavirus on the peninsula. Unreliable data, according to social security which announces, it, nearly 20,000 more victims for the months of March and April.

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