
The elephant in the room: covid deaths are undercounted - k0stas
https://pandemic.substack.com/p/the-elephant-in-the-room-undercounting
======
btilly
This is strongly reminiscent of
[https://www.buzzfeednews.com/article/nidhiprakash/coronaviru...](https://www.buzzfeednews.com/article/nidhiprakash/coronavirus-
update-dead-covid19-doctors-hospitals) that anecdotally reported that COVID
deaths are being severely underreported in the USA because doctors were told
to only test if it would change the care given because tests were in short
supply. But that means that if the person goes on to die, they are not
actually counted as a case.

~~~
nkurz
The article doesn't explicitly make the point, I think a lot of the relevance
of this potential undercounting is how it relates to assessing preventative
measures. Many people have argued (correctly) that "confirmed cases" should be
ignored, as the numbers produced are so dependent on non-random sampling. But
they often followup by arguing that we should focus on COVID deaths, because
those are (usually) too hard to hide. Potential undercounts of this sort call
that conclusion into question.

Perhaps paradoxically, going up another level and looking at "all deaths
regardless of cause" doesn't necessarily improve the quality of the decision
making. If anti-COVID measures also serve to decrease flu deaths and traffic
accidents, it's possible that the total numbers might show a drop even if
those same measures are inadequate for reducing COVID deaths. It's hard to get
anything right!

~~~
btilly
_But they often followup by arguing that we should focus on COVID deaths,
because those are (usually) too hard to hide. Potential undercounts of this
sort call that conclusion into question._

Which was the point of both the OP and the buzzfeed article that I pointed.

We only count someone as a case when they get tested and are positive. However
we don't test someone simply because they are really sick and it looks like
COVID-19. Which means that nobody has to hide the body - it simply isn't
counted in the COVID-19 numbers.

This systemic source of error seems to be common across many regions and
countries. And it throws all quoted statistics into question. And not by a
handful, but by a significant factor.

Of course at the moment preventing bodies is more important than counting
them. But knowing that we can't trust the counts either, matters.

 _Perhaps paradoxically, going up another level and looking at "all deaths
regardless of cause" doesn't necessarily improve the quality of the decision
making. If anti-COVID measures also serve to decrease flu deaths and traffic
accidents, it's possible that the total numbers might show a drop even if
those same measures are inadequate for reducing COVID deaths. It's hard to get
anything right!_

True. But if the systemic undercounting of COVID-19 deaths is a reasonably
large factor and the death rate is a significant fraction of the total death
rate, it can become a more accurate estimate than the official numbers.

And yes. Accurate decision making with unreliable numbers is impossible. The
best we can do is heuristics.

~~~
nkurz
> Which was the point of both the OP and the buzzfeed article that I pointed.

Sorry if my comment was clumsy. I realize that you are aware of everything I
said. I didn't intend it to be novel. Trying again:

On a superficial level, there's been a lot of media coverage of the number of
confirmed infections (the denominator). On a slightly more advanced level,
there have been calls to pay more attention to the actual number of deaths
(the numerator). These discussions properly point out that deaths (which can
theoretically be counted) are likely to be more accurate than infection
numbers (which can only be estimated).

This article (and the one you linked) are pointing out that that the number of
deaths due to COVID-19 also has significant uncertainty. My comment was trying
to make clear why this matters: not for you, but for others who have been
paying attention mostly to the media coverage. Perhaps this 538 article makes
the point better: [https://fivethirtyeight.com/features/why-its-so-freaking-
har...](https://fivethirtyeight.com/features/why-its-so-freaking-hard-to-make-
a-good-covid-19-model/)
([https://news.ycombinator.com/item?id=22746780](https://news.ycombinator.com/item?id=22746780)).

------
rurban
But still vastly over reacted.

A pneumonia death as just far more spectacular than a normal flu death. Look
at the Italy numbers eg. with about 18.000 COVID-19 deaths this season, which
is much lower than a typical flu season of about 25.000. Or look at a bad flu
year like 2014 with 54.000 flu deaths. With an IFR of 1%.

That's far higher than with this Corona virus. The COVID-19 IFR is below 1%.
So what do we wreck our economy for? Flatten the curve, OK. But not much more
than for 5 weeks.

[https://www.ijidonline.com/article/S1201-9712(19)30328-5/ful...](https://www.ijidonline.com/article/S1201-9712\(19\)30328-5/fulltext)

------
hindsightbias
Fascinating that China’s accounting was vilified every day for weeks and how
western media will probably do little better than rote state stenography and
rationalizations.

Such freedom, we will have years of COVID trutherism to look forward to.

