WEBVTT - Why Deaths Seem to Drop as Cases Rise 0:00:04.280 --> 0:00:09.719 Welcome to Prognosis. I'm Laura Carlson. It's day one, twelve 0:00:10.080 --> 0:00:14.720 since coronavirus was declared a global pandemic. Our main story. 0:00:15.960 --> 0:00:18.960 Even as the infection rates surges around the United States, 0:00:19.560 --> 0:00:22.520 some have pointed to lower death rates as proof that 0:00:22.640 --> 0:00:26.040 this stage of the outbreak isn't as bad as it seems. 0:00:27.200 --> 0:00:29.840 But a close look at the numbers shows it may 0:00:29.880 --> 0:00:34.120 be too early to declare that fatalities are really declining. 0:00:35.320 --> 0:00:47.920 But first, here's what happened in virus news today. As 0:00:47.960 --> 0:00:52.400 the alarming coronavirus surge continues in dozens of U S states, 0:00:52.880 --> 0:00:56.920 New York City postponed a planned return to indoor dining 0:00:57.000 --> 0:01:02.800 next week. Mayor Build a Blasio side rising cases in Florida, California, 0:01:02.920 --> 0:01:08.120 and Texas after some of those states reopened restaurants. The 0:01:08.200 --> 0:01:11.560 city had planned to allow restaurants to have a limited 0:01:11.640 --> 0:01:17.080 number of available tables indoors starting this Sunday. Instead, it 0:01:17.120 --> 0:01:22.280 will now help restaurants expand operations outdoors on sidewalks and 0:01:22.400 --> 0:01:27.240 in curbside parking spaces. He said. Some large US companies 0:01:27.280 --> 0:01:31.360 are also reevaluating their plans to ramp up normal operations. 0:01:32.120 --> 0:01:34.760 Google is pushing back a plan to reopen its u 0:01:34.880 --> 0:01:38.920 S offices. In a memo to employees, the company said 0:01:39.160 --> 0:01:44.240 all US offices will remain closed until September seven, at 0:01:44.280 --> 0:01:50.160 the earliest. An experimental coronavirus vaccine is showing promise. In 0:01:50.200 --> 0:01:54.720 an early trial, fiser and bio n text treatment has 0:01:54.760 --> 0:01:58.760 been shown to be safe. It also successfully prompted patients 0:01:58.880 --> 0:02:03.520 to produce and bodies against the virus that has kept 0:02:03.520 --> 0:02:05.480 it at the front of the pack in the race 0:02:05.560 --> 0:02:11.120 to develop a vaccine. Finally, Europe may be starting to 0:02:11.160 --> 0:02:16.600 see a tenuous economic recovery following months of coronavirus shutdowns, 0:02:17.280 --> 0:02:21.679 but the road ahead will be long. European Central Bank 0:02:21.760 --> 0:02:25.560 President Christine Lagarde renewed her warning at a United Nations 0:02:25.600 --> 0:02:30.200 event that the hardest times are yet to come. She 0:02:30.360 --> 0:02:34.840 said the recovery would be uncertain and uneven, and would 0:02:34.960 --> 0:02:39.320 lead to arise in inequality and unemployment that will leave 0:02:39.360 --> 0:02:50.400 the most vulnerable in difficult conditions. And now for our 0:02:50.440 --> 0:02:55.920 main story, the coronavirus continues it's terrifying rampage of large 0:02:55.919 --> 0:02:59.519 swaths of the country, but the Trump administration has made 0:02:59.520 --> 0:03:03.080 a point of mentioning that even while cases are rising 0:03:03.800 --> 0:03:09.280 deaths are declining. That disconnect is Trump says, proof that 0:03:09.320 --> 0:03:14.760 the COVID nineteen pandemic is under control. But the mismatch 0:03:14.840 --> 0:03:18.200 could be an anomaly caused by quirks in how death 0:03:18.360 --> 0:03:22.320 data is collected and reported. It could also be that 0:03:22.360 --> 0:03:25.000 a greater number of younger people are catching the virus 0:03:25.600 --> 0:03:30.120 not necessarily assigned. The coronavirus is becoming less lethal or 0:03:30.320 --> 0:03:34.960 easier to treat. Robert Langre and Emma Court report that 0:03:35.160 --> 0:03:38.120 medical experts say it's too soon to know for sure 0:03:38.600 --> 0:03:46.520 that deaths are still declining in recent days. In recent 0:03:46.560 --> 0:03:49.800 weeks here in the US, we have been seeing case 0:03:49.880 --> 0:03:53.960 counts rise pretty much across the board, particularly in the 0:03:54.000 --> 0:03:56.600 sun belt in the South and the West. And yet 0:03:56.800 --> 0:04:00.240 one interesting thing about these developments we've been seeing is 0:04:00.280 --> 0:04:05.240 that even as the case counts rise, the corresponding mortality rate, 0:04:05.320 --> 0:04:07.960 the death rate does not seem to be climbing with 0:04:08.000 --> 0:04:11.440 the same rates. And I was wondering if you could 0:04:11.520 --> 0:04:15.640 unpack that for us, what are we seeing here? One 0:04:15.680 --> 0:04:17.640 thing to be really aware of it is sort of 0:04:17.680 --> 0:04:20.440 that that death rates in this for COVID are kind 0:04:20.440 --> 0:04:24.000 of the ultimate lacking indicator. We don't really know yet 0:04:24.080 --> 0:04:25.680 what the death rate is going to be for this 0:04:26.040 --> 0:04:28.760 current rise in case counts. And that's because some of 0:04:28.839 --> 0:04:31.560 the cases in the States are reported rather quickly. But 0:04:31.680 --> 0:04:33.640 you know, deaths really do take a while to come 0:04:33.880 --> 0:04:37.960 roll in. Once you diagnose with COVID, even a bad case, 0:04:38.000 --> 0:04:40.080 it may take the people that do die, it may take, 0:04:40.120 --> 0:04:42.320 you know, two or three weeks for them to die, 0:04:42.680 --> 0:04:45.719 if you're going to die. And then these these death 0:04:45.800 --> 0:04:48.880 numbers that come in, they aren't the deaths that occurred yesterday. 0:04:48.920 --> 0:04:52.560 These are deaths that may have been occurred a week 0:04:52.640 --> 0:04:54.720 or two weeks or even three weeks ago. That that is, 0:04:54.880 --> 0:04:58.119 after once someone dies, it can take a while days, 0:04:58.240 --> 0:05:02.039 even weeks or dr filling the death certificate, turn it 0:05:02.040 --> 0:05:05.479 in for the state authorities to kind of adjudicate and 0:05:05.560 --> 0:05:08.680 verify it, and then reported out to two people so 0:05:09.279 --> 0:05:10.800 to the rest of the world. To some of these 0:05:11.080 --> 0:05:14.160 these death numbers coming are quite you know, quite delayed, 0:05:14.200 --> 0:05:17.360 and it just takes several weeks corresponding to the cases 0:05:17.400 --> 0:05:19.680 we're still seeing now. Is the first thing to be 0:05:19.800 --> 0:05:22.160 very aware of. We don't really know yet, you know, 0:05:22.240 --> 0:05:24.600 what the death rate is going to be for this 0:05:24.960 --> 0:05:29.320 current wave of cases. But there are several reasons also 0:05:29.480 --> 0:05:32.840 to believe to suspect that the death rate, you know, 0:05:32.960 --> 0:05:36.800 when we have the numbers will actually be lower. We're 0:05:36.839 --> 0:05:40.479 now six months into this into this pandemic. I mean, 0:05:40.600 --> 0:05:42.960 is it a question with regards to the death rates 0:05:43.040 --> 0:05:48.679 that were simply treating COVID nineteen more successfully. For months, 0:05:48.720 --> 0:05:51.160 medical providers have been you know, learning about how to 0:05:51.200 --> 0:05:53.880 treat this virus, sharing best practices. And I think the 0:05:53.880 --> 0:05:56.520 answer is yes. You know, we still don't have all 0:05:56.560 --> 0:05:59.760 the information we'd like to have. Doctors still don't have 0:06:00.120 --> 0:06:03.080 like a you know, a perfect treatment for this condition. 0:06:03.120 --> 0:06:06.480 We definitely don't have any vaccines right now, except experimental 0:06:06.520 --> 0:06:09.320 ones that are still being tested. You know, It's true 0:06:09.320 --> 0:06:11.960 that we've learned a lot and doctors have better practices 0:06:12.000 --> 0:06:14.360 now and um, and you know, I think we are 0:06:14.440 --> 0:06:17.440 seeing that payoff. But it's not totally clear how all 0:06:17.480 --> 0:06:19.520 of these factors break down in terms of what we're 0:06:19.520 --> 0:06:22.599 seeing right We think, you know, the death rate lagging 0:06:22.640 --> 0:06:26.239 maybe one factor. Another factor is this friend towards younger patients, 0:06:26.279 --> 0:06:29.919 you know, better treatments. Another potential factor is maybe the 0:06:29.960 --> 0:06:32.839 virus is just not transmitting as well in the summer. 0:06:32.920 --> 0:06:36.280 You know, it was sort of hypothesized that the summer 0:06:36.920 --> 0:06:41.640 might make for less virus transmission because that hot air, 0:06:41.760 --> 0:06:44.599 you know, pushing the virus kind of down out out 0:06:44.600 --> 0:06:47.080 of kind of the path of transmission. But you know, 0:06:47.120 --> 0:06:49.640 it's not clear that that's happening. But it's possible that 0:06:49.680 --> 0:06:52.200 perhaps a weaker form of the virus is being transmitted 0:06:52.200 --> 0:06:54.479 people aren't getting as sick. There's also been a pretty 0:06:54.520 --> 0:06:57.760 high profile theory that the virus is getting sort of 0:06:57.839 --> 0:07:01.280 weaker in and of itself as it applicates around the world, 0:07:01.320 --> 0:07:04.799 and that's been pretty roundly criticized. It's not totally clear 0:07:05.200 --> 0:07:09.240 that's what's happening, but there's a variety of explanations here. 0:07:09.360 --> 0:07:13.320 We just we just don't really know. Unfortunately, it does 0:07:13.360 --> 0:07:17.040 seem to be a lot more complicated or perhaps even 0:07:17.080 --> 0:07:21.240 a lengthy process in recording the death count. And I 0:07:21.280 --> 0:07:23.040 was wondering if maybe you could go into some of 0:07:23.040 --> 0:07:27.760 the different kinds of factors that go into potentially delaying 0:07:28.360 --> 0:07:32.360 the recording of a death due to COVID nineteen. If 0:07:32.360 --> 0:07:34.400 you look a few days ago, there's a huge spike 0:07:34.440 --> 0:07:36.680 of death just like three or four days ago, and 0:07:36.760 --> 0:07:39.400 almost all of that was new to New Jersey suddenly 0:07:39.400 --> 0:07:43.760 adding probable COVID nineteen deaths and we're in its account before. 0:07:44.120 --> 0:07:46.160 And those weren't deaths that occurred in the last few days. 0:07:46.200 --> 0:07:48.640 There was their deaths that went way back this you know, 0:07:48.760 --> 0:07:52.560 county of deak Is a is. It just takes a 0:07:52.600 --> 0:07:55.400 while for the death to roll in. Often, for example, 0:07:55.840 --> 0:07:59.600 in Arizona, one of the researchers of follows Is showed 0:07:59.680 --> 0:08:02.960 me when some of the deaths occurred. And so for 0:08:03.080 --> 0:08:06.720 the deaths reported in the weekending June fourteenth in Arizona 0:08:06.760 --> 0:08:09.200 due to COVID, So it turns out only half of 0:08:09.240 --> 0:08:12.000 those deaths reported that week we're from that week, and 0:08:12.080 --> 0:08:15.040 fully fifty were from two or three or even more 0:08:15.280 --> 0:08:17.960 weeks before. That's when they actually happens. That that's an 0:08:18.000 --> 0:08:20.920 example just how the lag can be. And that's from 0:08:20.960 --> 0:08:24.240 when the death actually happens to whether it's reported as 0:08:24.280 --> 0:08:26.240 a death due to COVID. That doesn't even count the 0:08:26.320 --> 0:08:29.000 fact that you know, you get sick, you got a 0:08:29.080 --> 0:08:31.080 case so to take, you know, and it takes two 0:08:31.160 --> 0:08:33.120 to three weeks for that to play out, and you 0:08:33.280 --> 0:08:37.400 either to get better or not. Deaths lag not just 0:08:37.520 --> 0:08:41.800 because It takes time when someone gets COVID to die, um, 0:08:42.200 --> 0:08:44.560 you know, from the disease, to succumb to the disease. 0:08:44.679 --> 0:08:47.960 But but then afterwards there's these official processes that takes 0:08:48.000 --> 0:08:49.800 some time. Right. It takes time for you know, the 0:08:49.880 --> 0:08:52.920 health officials to adjudicate the death. It takes time, you know, 0:08:53.000 --> 0:08:56.079 doctors have to decide did this person die of COVID nineteen. 0:08:56.120 --> 0:08:58.360 You know, if they you know, had COVID nineteen and 0:08:58.440 --> 0:09:01.560 then seemed to recover a little bit and then ended 0:09:01.679 --> 0:09:03.800 up dying, you know, was that a death from COVID 0:09:03.880 --> 0:09:06.520 nineteen or not? There there are some questions about you know, 0:09:06.559 --> 0:09:09.520 the squish nous of of these subjects, right, And during 0:09:09.559 --> 0:09:12.360 this time, everyone wants to rely on the data, right. 0:09:12.400 --> 0:09:14.520 They put all this trust in the numbers that are 0:09:14.559 --> 0:09:16.079 coming out of the states and the numbers that we 0:09:16.120 --> 0:09:19.439 see about testing on the federal level too. But you know, 0:09:19.640 --> 0:09:25.480 importantly this data is not infallible, right, I mean, especially 0:09:25.520 --> 0:09:27.120 when you think about the fact that you know, in 0:09:27.280 --> 0:09:30.160 terms of diagnoses, the only cases that we know we 0:09:30.240 --> 0:09:32.720 only know about cases that actually get diagnosed. We only 0:09:32.760 --> 0:09:35.800 know about people who test positive because they got a test. 0:09:35.880 --> 0:09:38.520 There are likely many more people who are not getting 0:09:38.559 --> 0:09:41.000 tested for these symptoms, for instance. So you know, these 0:09:41.040 --> 0:09:43.400 are official counts, but that's important to remember. These are 0:09:43.480 --> 0:09:46.120 the official numbers, right and there are probably a lot 0:09:46.160 --> 0:09:49.480 of numbers that aren't getting captured in these data even now. 0:09:49.840 --> 0:09:52.199 So I think that's also important when you think about deaths. 0:09:52.280 --> 0:09:54.559 You know, there has been some back and forth even 0:09:54.640 --> 0:09:56.839 earlier in the pandemic about whether all of the death 0:09:56.920 --> 0:09:59.600 from COVID nineteen were actually being counted, you know, as 0:09:59.640 --> 0:10:01.959 health to partments got overwhelmed and things like that. So 0:10:02.400 --> 0:10:04.319 these are the official numbers, but do they tell the 0:10:04.520 --> 0:10:07.920 complete and full and completely thorough story, Like we probably 0:10:08.000 --> 0:10:10.600 won't know that for some time, you know, if at all. 0:10:11.320 --> 0:10:14.000 What should we be looking at or taking away from 0:10:14.040 --> 0:10:16.280 the numbers as they stand right now, and what should 0:10:16.320 --> 0:10:19.280 we be preparing for. You know, we don't know exactly 0:10:19.360 --> 0:10:21.720 what's going to happen in two or three weeks from now, 0:10:21.760 --> 0:10:23.760 and that would be very very interesting to watch because 0:10:23.960 --> 0:10:27.679 we do have in some of these southern states increased hospitalizations, 0:10:28.120 --> 0:10:30.079 increased numbers of people in I c u s. You know, 0:10:30.200 --> 0:10:33.720 what does that translate into. So some of the research 0:10:33.760 --> 0:10:35.880 we talked to in Arizona said that what they would 0:10:35.880 --> 0:10:39.120 expect might be, you know, leveling off of this decline 0:10:39.160 --> 0:10:41.760 in depths and you know, somewhat at an increase again, 0:10:42.120 --> 0:10:44.079 you know, and maybe not a huge spike like we 0:10:44.160 --> 0:10:46.320 had before in April when the in New York, when 0:10:46.400 --> 0:10:49.359 this disease is totally new, when we were kind of unprepared. 0:10:49.520 --> 0:10:52.000 Hospitals are better prepared and there are some treatments and 0:10:52.040 --> 0:10:54.679 they have some better strategies. So be very very interesting, 0:10:54.720 --> 0:10:56.719 you know, to watch. And then I have four or 0:10:56.760 --> 0:10:59.079 five or six weeks from now, the deaths, you know, 0:10:59.200 --> 0:11:02.840 haven't gone up at all, and despite lots of people 0:11:02.880 --> 0:11:04.679 in the hospital of I see you, that will be 0:11:04.720 --> 0:11:07.520 an indication you know, we've gotten there's something's changed a 0:11:07.559 --> 0:11:10.559 little about the the the virus, or you've gotten better 0:11:10.760 --> 0:11:13.240 treating it, or somehow you know, we've kept it out 0:11:13.400 --> 0:11:15.439 of the older, most vulnerable people. One of those you 0:11:15.520 --> 0:11:18.599 know three things. I think also an important part of 0:11:18.679 --> 0:11:21.199 this is to understand the different kinds of data and 0:11:21.320 --> 0:11:24.480 how they trickle in, right, I mean, public health officials 0:11:24.800 --> 0:11:27.559 can't wait for deaths to spike to take action to 0:11:27.640 --> 0:11:30.360 control an outbreak, right, they have to start relying on 0:11:30.520 --> 0:11:35.199 earlier forms of data like case counts and especially hospitalizations. 0:11:35.480 --> 0:11:37.800 The problem is the earliest data that we have coming 0:11:37.840 --> 0:11:40.520 in our case counts, and that doesn't present the fullest 0:11:40.600 --> 0:11:43.959 possible picture of an outbreak, but it is the earliest 0:11:44.000 --> 0:11:46.280 indicator we have. And an expert I spoke with at 0:11:46.320 --> 0:11:49.160 Johns Hopkins put this really well. He said, Basically, you know, 0:11:49.240 --> 0:11:51.760 a couple of weeks ago when the case cases were 0:11:51.800 --> 0:11:54.640 spiking in some of these states like Arizona and Texas 0:11:54.679 --> 0:11:56.880 and Florida, which we now know, you know, are having 0:11:57.200 --> 0:11:59.920 problems in terms of the outbreak in their communities. He's 0:12:00.200 --> 0:12:02.319 you know, this is early data in terms of the 0:12:02.440 --> 0:12:05.520 case counts rising, but it's important to act on early 0:12:05.679 --> 0:12:08.680 data because by the time you get more thorough data, 0:12:08.800 --> 0:12:12.000 more final data, you get hospitalization spiking, you get death 0:12:12.120 --> 0:12:15.200 god forbid spiking. You know, that may be too late, 0:12:15.520 --> 0:12:19.719 and I think that sensitivity towards the mechanism of these 0:12:19.800 --> 0:12:22.520 numbers is important for public health officials to be eyeing. 0:12:22.600 --> 0:12:25.360 You know, waiting for the deaths to rise is not 0:12:25.920 --> 0:12:29.280 the most productive tack here. Right by the time deaths rise, 0:12:29.520 --> 0:12:32.920 you maybe four or five weeks behind something that's happening 0:12:33.240 --> 0:12:41.839 in a state or a local area. That was Robert 0:12:41.920 --> 0:12:44.920 Lang and Emma Cord. And that's it for our show today. 0:12:45.679 --> 0:12:49.040 For coverage of the outbreak from one bureaus around the world, 0:12:49.559 --> 0:12:54.079 visit Bloomberg dot com slash Coronavirus and if you like 0:12:54.240 --> 0:12:57.000 the show, please leave us a review and a rating 0:12:57.200 --> 0:13:00.559 on Apple Podcasts or Spotify. It's the best way to 0:13:00.640 --> 0:13:05.600 help more listeners find our global reporting. The Prognosis Daily 0:13:05.760 --> 0:13:09.120 edition is produced by Top for foreheads Jordan gas Pure, 0:13:09.559 --> 0:13:14.400 Magnus Hendrickson and me Laura Carlson. Today's main story was 0:13:14.480 --> 0:13:18.679 reported by Robert Langrath and Emma Court. Original music by 0:13:18.800 --> 0:13:23.120 Leo Sidran. Our editors are Rick Shine and Francesco Levi. 0:13:24.000 --> 0:13:28.440 Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.