How the U.S. Messed Up Covid-19 So Badly – Elemental – Elemental

Elemental: You report that the United States, which is responsible for 4% of the global population, has seen 22% of the Covid-19 deathsand of course that only accounts for numbers through September 2020. Apart from being incredibly sobering, what do these numbers tell us?

Nancy Krieger: I think a very important thing to point out is that with a lot of the Covid-19 data, people have resorted to counting cases and then looking at what percentage of the population they are. So, when you come up with statistics like 4% of the population and 22% of the deaths, it tells you something but it doesnt tell you enough. The better data, to really compare countries accurately, that isnt compromised by variables like how many people have access to testing, how accurate the testing is, how Covid-19 deaths are being defined, etc., is the data around excess deaths.

We calculated something on the order of 260,000 excess deaths for the United States for the period of January 1 through September 12, 2020. Soon after we published our findings, the Morbidity and Mortality Weekly Report (the main journal of the CDC) came out with its analysis showing upwards of 300,000 excess deaths in the United States.

So, the disproportion4% of the population responsible for 22% of the deathsis one part of understanding what were seeing in the United States during this pandemic. Another part is just how many excess deaths were seeing.

If you look at the excess death numbers by race/ethnicity, the percent increase has been 54% for Hispanics, 37% for Asian Americans, 33% for Black Americans, 29% for American Indians, and only 12% for white Americans.

For those unfamiliar with this measure, how do you define excess deaths?

You consider the number of deaths that occurred within the last two weeks of March 2020, for example, regardless of cause. Once you know how big the population is, you compute how many deaths per 100,000 people there were in that two-week interval. Then you compute the same thing for the same two weeks over the past five years and take the average. The final step is to determine if the number of deaths for the two-week period in 2020 is larger, the same as, or smaller than the number of deaths for the corresponding two-week period for the average of 20152019, and if it is larger, thats the excess number of deaths.

The value of this approach is that it immediately takes into account seasonality of deathsdeaths from the flu in winter, for instance. We measure excess deaths to understand not just the impact of epidemics, but of natural disasters as well.

Of the 300,000 deaths the CDC reported, about 100,000 dont show up as Covid-19 deaths. These are deaths that reflect the impact of the pandemic regardless of whether you were infected with the virus deaths from delayed surgeries or interrupted chemotherapy, for example. The data also shows that the percent increase of excess deaths is particularly high for people ages 25 to 44, which probably reflects workplace exposure. Even as a lot of elderly people have died from Covid-19, elderly people by definition die at higher rates to begin with.

If you look at the excess death numbers by race/ethnicity, the percent increase has been 54% for Hispanics, 37% for Asian Americans, 33% for Black Americans, 29% for American Indians, and only 12% for white Americans. The social patterning of this excess is incredibly stark in terms of the inequities that are revealed. Each and every death matters, period. And each one has enormous ripple effects. What is the impact on families? What is the impact of so much concentrated death on neighborhoods?

The other thing to remember here is that deaths are just one part of the picture. The work is only now underway looking at what happens if you have a serious case and survive, but then continue on with potentially debilitating symptoms as a long-hauler. If youre 25 years old and you recover from the virus, we have no idea how you will be impacted when youre 50 years old. If 8 million people are affected by the virus and 20% go on to be long-haulers, thats on par with the number of new cancer cases we see every year in our country (1.76 million). If only 7% become long-haulers, thats still on par with the number of cancer deaths per year (606,880), and cancer is the second leading cause of death in the United States.

How do we swallow what were seeing in America when it comes to Covid-19 alongside the idea that the United States is a supposed world leader in medicine?

The United States has phenomenal resources available to some people with regard to biomedical advances, but the U.S. also leads, among industrialized nations, in the number of people who are uninsured. We can say the U.S. leads in terms of biomedical technology and expertise, but in terms of actual access of the population to health care itself, the U.S. does not leadit falls way, way behind.

Public health and clinical care should be complementary partners. In the United States, clinical care has gotten a lot more attention in terms of health dollars. Privatization has a lot to do with this. In the U.S., public health has long been underfunded. After the 2008 economic debacle, lots of public health was cut and then never recovered. And, of course, the functions of public health departments are very different from the functions of medical entities providing care to patients. The fact that there are some public health agencies across this country that still rely on pen and paper and fax machines is an indicator.

The other thing is that public health is a very fragmented system. The federal government has some responsibility, but the state and local governments have a lot of responsibility. And, of course, the virus couldnt care less about the fact that we have state boundaries, different jurisdictions, and various levels of government.

Thats why we needed to have a federal response that coordinated what the national response would be to set the tone and the rules and the protocol that would apply everywhere. Because thats how a virus works.

The virus couldnt care less about the fact that we have state boundaries, different jurisdictions, and various levels of government.

What are some specific things that we could be doing in the United States to curb the spread of the virus that we arent yet doing or arent doing enough?

The data shows that there is lack of sufficient attention to how transmission is happening because people have to work. We should have a national standard for OSHA around Covid-19. Some states, California in particular, are setting up stricter rules around workplace complaints and conditions and safety that ought to be followed up with serious fines. A big issue is paid sick leave. People need both social protection and physical protection in the workplace. Both matter, and both ought be mandated.

When we analyzed the relationship between the frequency of workplace safety complaints and the occurrence of Covid-19 cases and Covid-19 deaths, we found a strong correlation of a lag time of 16 to 17 days between time of complaint and time of death. This proved to be true across the country. In other words, worker complaints preceded deaths. People werent complaining because deaths were happening around them. They were complaining and then the deaths happened. This speaks to the importance of paying attention when workers speak up about things not being safe. That is the proverbial canary in the coal mine and you dont wait until the canary dies.

For the virus to wreak havoc, it needs to be transmitted. To stop the spread, we cant just give people advicewear masks, wash your hands. We need to also give people resources. If people cannot afford masks or cant access them at work, thats a problem. If people are worried about being evicted, thats a problem. Because where, then, are they going to wash their hands, protect themselves, and be safe? These are the questions that need to be addressed.

Visit link:
How the U.S. Messed Up Covid-19 So Badly - Elemental - Elemental

Reviewed and Recommended by Erik Baquero