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Trump Suggests Virus Death Count Is Inflated. Most Experts Doubt It Trump Suggests Virus Death Count Is Inflated. Most Experts Doubt It
(1 day later)
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.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.
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.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.
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.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.
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.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.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.”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.“We very much feel the reported numbers reflect an undercount,” she said.
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.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.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.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.
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.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.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.”“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.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.”“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.A death certificate, Mr. Anderson said, clearly establishes a cause of death or a contributing factor.
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.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.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.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.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.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.”“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.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.
Updated June 22, 2020 Updated June 24, 2020
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
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.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.”“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 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.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.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.”“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.”
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.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.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.”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.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.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.“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.Noah Weiland and Abby Goodnough reported from Washington, and Maggie Haberman from New York.