WEBVTT - How Many People Have Really Died? 0:00:07.800 --> 0:00:13.000 Welcome to Prognosis. I'm Laura Carlson. It's day seventy seven 0:00:13.280 --> 0:00:18.200 since coronavirus was declared a global pandemic. Our main story. 0:00:19.200 --> 0:00:22.760 Hundreds of thousands of people around the world are reported 0:00:22.800 --> 0:00:27.440 to have died from COVID nineteen, and yet we don't 0:00:27.440 --> 0:00:32.720 know the true number of virus deaths. Experts widely agree 0:00:32.800 --> 0:00:36.400 that the three hundred thousand deaths from the virus is 0:00:36.440 --> 0:00:40.199 an undercount, but there are ways to get closer to 0:00:40.240 --> 0:00:44.520 the real number. And without knowing that number, we're only 0:00:44.640 --> 0:00:49.120 guessing at how well our disease fighting measures are really working. 0:00:50.640 --> 0:01:02.120 But first, here's what happened today. Germany wants to test 0:01:02.280 --> 0:01:06.200 more people who don't show symptoms for the coronavirus. The 0:01:06.240 --> 0:01:09.319 country's health ministry put out a proposal that would expand 0:01:09.360 --> 0:01:13.440 screening to close contacts of sick people, workers at nursing 0:01:13.480 --> 0:01:16.800 homes and meat packing plants, as well as schools and 0:01:16.880 --> 0:01:21.680 restaurants where cases emerge. Chancellor Angela Merkel and the country 0:01:21.840 --> 0:01:25.760 States have agreed to keep contact restrictions in place until 0:01:25.880 --> 0:01:29.760 June twenty ninth. We may get a new test of 0:01:29.800 --> 0:01:33.280 the international air travel system in the time of coronavirus 0:01:33.880 --> 0:01:38.760 within weeks. Australia and New Zealand could open an air 0:01:38.800 --> 0:01:42.959 corridor between the two countries for quarantine free flights if 0:01:43.000 --> 0:01:46.360 guidelines that will be released in early June are approved. 0:01:47.240 --> 0:01:49.840 The group drawing up the guidelines for safe travel are 0:01:49.840 --> 0:01:54.440 considering every stage of the journey, including how passengers move 0:01:54.480 --> 0:01:59.960 through airports and contact tracing requirements at their destination. Travel 0:02:00.000 --> 0:02:02.800 oilers will have to declare their healthy before they fly, 0:02:03.640 --> 0:02:08.799 and might sacrifice their fare if they're ill. Tightly controlled 0:02:08.960 --> 0:02:12.519 flight bubbles, which can be enlarged to include other countries, 0:02:12.800 --> 0:02:16.760 have emerged as potential models for the global travel industry. 0:02:17.440 --> 0:02:21.160 China and South Korea opened a narrow travel corridor with 0:02:21.360 --> 0:02:27.680 onerous restrictions this month. Finally, Dr Anthony Fauci, the top 0:02:27.880 --> 0:02:31.560 us infectious disease expert, said in an interview on CNN 0:02:32.040 --> 0:02:34.760 he believes a vaccine could be ready to be deployed 0:02:34.960 --> 0:02:37.880 as early as late this year, but a group of 0:02:37.919 --> 0:02:41.760 people who get paid to make forecasts are far more pessimistic. 0:02:42.720 --> 0:02:46.640 Good Judgment Incorporated, a company that maintains a global network 0:02:46.639 --> 0:02:50.200 of forecasters who scour public data, say there's only a 0:02:50.320 --> 0:02:53.240 nine percent chance that there will be a widely available 0:02:53.320 --> 0:03:10.320 vaccine before next April, and now our main story. So far, 0:03:10.720 --> 0:03:13.960 more than three hundred thousand people globally are known to 0:03:14.040 --> 0:03:18.040 have died because of the coronavirus. The US is fast 0:03:18.040 --> 0:03:23.240 approaching the grim milestone of one hundred thousand fatalities, and 0:03:23.320 --> 0:03:27.400 as shocking as those numbers are, experts believe there are 0:03:27.440 --> 0:03:33.680 actually many more deaths were not counting. It might sound macabre, 0:03:33.919 --> 0:03:37.480 but in order to save lives, you need to count deaths. 0:03:38.520 --> 0:03:41.839 Knowing how many have died and the context around their 0:03:41.840 --> 0:03:46.960 deaths is crucial for understanding and fighting the virus. That's 0:03:47.040 --> 0:03:49.960 because we need to understand how fast and in what 0:03:50.080 --> 0:03:54.200 groups mortality is rising in order to fine tune the 0:03:54.280 --> 0:03:59.120 policies that govern our response to the virus. So experts 0:03:59.120 --> 0:04:02.480 are looking past the official count to find other ways 0:04:02.520 --> 0:04:07.320 to investigate just how many people are dying. Bloomberg Senior 0:04:07.400 --> 0:04:16.680 editor Jason Gale has more. Alan Lopez is a laureate 0:04:16.680 --> 0:04:19.719 professor of Global health at the University of Melbourne. He 0:04:19.839 --> 0:04:21.760 spent a lot of his life counting the dead and 0:04:21.920 --> 0:04:25.720 figuring out why people die. Now his efforts have turned 0:04:25.760 --> 0:04:29.880 to COVID nineteen. He says Monitoring mortality right now is 0:04:29.920 --> 0:04:33.560 critical for striking the optimal balance between saving people from 0:04:33.600 --> 0:04:37.880 the pandemic and worsening other health threats. We need to 0:04:37.960 --> 0:04:43.000 understand how bad these are deaths are increasing in order 0:04:43.000 --> 0:04:46.240 for us to turn those policy leavers and knobs at 0:04:46.240 --> 0:04:49.840 the right speed in the right direction. So if mortality 0:04:49.880 --> 0:04:54.000 is still increasing, then we absolutely need to keep doing 0:04:54.040 --> 0:04:56.800 what we're doing to prevent that. But in order for 0:04:56.839 --> 0:04:59.840 us to do that, we need to understand reliably u 0:05:00.000 --> 0:05:02.120 how many people are dying as a result of the 0:05:02.120 --> 0:05:05.359 COVID nineteen academic and at what time and at what 0:05:05.480 --> 0:05:08.760 age they're dying. There's no point making policy now on 0:05:08.920 --> 0:05:11.800 COVID nineteen mortality data four or five or six weeks ago. 0:05:12.160 --> 0:05:14.680 You need mortality data from the last week, and you 0:05:14.760 --> 0:05:17.200 need it by age, need it by sex, and you 0:05:17.240 --> 0:05:27.000 need it to be reliable. Alan and his partner, Professor 0:05:27.120 --> 0:05:30.440 Christopher Murray at the University of Washington and Seattle, have 0:05:30.560 --> 0:05:34.080 spent more than two decades studying mortality rates, and he 0:05:34.120 --> 0:05:37.960 says getting that reliable data can be tricky. The World 0:05:38.040 --> 0:05:41.599 Health Organization, as of Tuesday, said more than five point 0:05:41.760 --> 0:05:45.160 three million people are known to have caught the novel coronavirus, 0:05:45.720 --> 0:05:49.000 and of those more than six percent of died. But 0:05:49.120 --> 0:05:53.839 those numbers aren't reliable. Many people got COVID and weren't tested, 0:05:54.360 --> 0:05:58.120 so their infection wasn't recorded. Some people died at home, 0:05:58.760 --> 0:06:03.000 especially when hospitals were overwhelmed. Some people died too because 0:06:03.160 --> 0:06:07.040 they couldn't get treated for another life threatening condition. So 0:06:07.200 --> 0:06:10.719 how do your factor in those unreported cases and deaths 0:06:10.760 --> 0:06:15.160 to get a more realistic number, Alan says, you ask 0:06:15.240 --> 0:06:18.960 a simple question and go from there. What if COVID 0:06:19.000 --> 0:06:22.440 nineteen never happened, what would we expect to see in 0:06:22.520 --> 0:06:25.040 terms of numbers of deaths by age and sex? And 0:06:25.080 --> 0:06:28.200 then what do we see And in the absence of 0:06:28.200 --> 0:06:31.120 any major shock to the system, like an earthquake or 0:06:31.160 --> 0:06:35.360 a flood or some catastrophic event that causes a lot 0:06:35.360 --> 0:06:37.919 of deaths, all of those deaths must be due to 0:06:38.320 --> 0:06:41.080 the only other thing that's happened that's different but this 0:06:41.160 --> 0:06:45.920 year from last year, and that is COVID nineteen. And 0:06:45.960 --> 0:06:48.840 then there's the matter of figuring out which deaths were 0:06:48.880 --> 0:06:52.560 the direct result of COVID nineteen and which ones were 0:06:52.720 --> 0:06:57.080 caused by some other interrect factor. How many more deaths 0:06:57.120 --> 0:07:00.120 are there by age and sex this year then there 0:07:00.160 --> 0:07:03.840 were last year or the year before, some some comparable basedline. 0:07:04.080 --> 0:07:07.360 In other words, we need to understand fully the impact 0:07:07.360 --> 0:07:10.720 of COVID nineteen, not just as an underlying cause of 0:07:10.760 --> 0:07:14.760 death in hospitals where there's confirmed COVID nineteen cases, but 0:07:14.840 --> 0:07:18.360 also the what we call the multiplier effects of COVID nineteen. 0:07:18.840 --> 0:07:22.360 The fact that it's likely to increase the risk of 0:07:22.360 --> 0:07:25.560 of major vascular diseases heart fare, there, schemic card disease, 0:07:25.600 --> 0:07:29.800 stroke been seeming. We're seeing increasing evidence of that. The 0:07:29.800 --> 0:07:32.680 fact that it's likely to increase death rates from chronic 0:07:32.720 --> 0:07:37.000 obstructive lung disease, so I caually increase death rates among smokers. 0:07:37.040 --> 0:07:39.600 So it's doing a lot of things that are multiplying 0:07:39.680 --> 0:07:42.720 up the risks of other causes of death, leading to 0:07:43.200 --> 0:07:47.880 a much bigger, often to two times higher overall impact 0:07:48.040 --> 0:07:52.120 than what we're measuring in the specific hospital mortality rates. 0:07:53.080 --> 0:07:56.200 The Centers for Disease Control and Prevention estimates that there 0:07:56.200 --> 0:08:00.160 have been as many as one thousand excess death in 0:08:00.200 --> 0:08:04.200 the United States since February. Alan says that in countries 0:08:04.240 --> 0:08:07.760 with robust mortality data, it appears that about twice the 0:08:07.800 --> 0:08:10.520 number of people may be dying because of the pandemic 0:08:10.880 --> 0:08:14.360 then what's officially reported as a COVID death. So I 0:08:14.400 --> 0:08:21.280 think unless we monitor this epidemic cleverly and comprehensively by 0:08:21.320 --> 0:08:24.480 looking at all of the deaths that COVID nineteen is causing, 0:08:24.520 --> 0:08:27.720 we are going to seriously underestimated and that will seriously 0:08:28.040 --> 0:08:32.480 misinform policy options and their timing. Alan says. The reasons 0:08:32.520 --> 0:08:36.040 why people die during the pandemic will also probably be 0:08:36.200 --> 0:08:39.880 quite different to what's usually observed. You've got an envelope 0:08:39.880 --> 0:08:42.920 of deaths, and you've got the COVID nineteen certified deaths, 0:08:42.920 --> 0:08:44.680 which you've got a lot of other deaths in there. 0:08:45.400 --> 0:08:50.160 So how have death rates from road traffic accidents from suicide? 0:08:50.160 --> 0:08:52.199 So road traffic athens may have gone the other direction 0:08:52.520 --> 0:08:55.520 and gone down because there's been fewer people circulating, but 0:08:55.600 --> 0:08:58.480 on the same with asma or acute respiratory diseases because 0:08:58.480 --> 0:09:01.000 pollution is gone down. On the other hand, you might 0:09:01.040 --> 0:09:04.800 have mental health conditions, particularly suicide, that would have incroducted 0:09:04.800 --> 0:09:08.800 well of increased We've talked also about skimmy cart disease, stroke, 0:09:08.920 --> 0:09:12.600 chronic lung disease, a number of conditions that COVID nineteen 0:09:12.679 --> 0:09:15.120 might have aggravated and we would have seen increases in 0:09:15.160 --> 0:09:17.800 these death rates. And these I'm not expecting these to 0:09:17.880 --> 0:09:20.439 be doubling of the death rates, but I do expect 0:09:20.440 --> 0:09:24.120 that we will see some significant increases in death rates 0:09:24.160 --> 0:09:27.000 that are directly attributable to the action of COVID nineteen. 0:09:31.760 --> 0:09:35.760 Across the world, tens of millions of deaths go unrecorded 0:09:35.760 --> 0:09:39.800 each year. This lack of information is a killer in 0:09:39.880 --> 0:09:43.040 its own right. Without an accurate measure of deaths and 0:09:43.080 --> 0:09:47.640 their causes, finding the pandemic and developing countries is much harder. 0:09:48.320 --> 0:09:51.520 Authorities simply like the basic information they need to make 0:09:51.520 --> 0:09:56.160 informed decisions. Full disclosure. Alan is the director of the 0:09:56.320 --> 0:09:59.960 Data for Health Initiative. It's funded by the Australian govern 0:10:00.040 --> 0:10:05.000 Meant and Bloomberg Philanthropies. Bloomberg Philanthropies was set up by 0:10:05.040 --> 0:10:08.600 former New York Mayor Michael Bloomberg, founder and majority owner 0:10:08.640 --> 0:10:12.880 of Bloomberg News parent Bloomberg LP. Data for Health partners 0:10:12.920 --> 0:10:16.240 with governments in low and middle income countries to strengthen 0:10:16.240 --> 0:10:18.960 their public health data and improve the way they use 0:10:19.080 --> 0:10:23.120 this information to make public health decisions and public health investments. 0:10:24.480 --> 0:10:27.640 We've also been very active in trying to help countries 0:10:28.120 --> 0:10:32.679 build up the notification systems so they know who's dying. 0:10:33.160 --> 0:10:35.800 This is critically important. You cannot diagnose the death and 0:10:35.880 --> 0:10:39.000 listen until you know that someone has died, and to 0:10:39.360 --> 0:10:42.440 know about that, you need notification systems in there. And remember, 0:10:42.520 --> 0:10:46.120 the vast majority of these deaths, unlike Australia, are occurring 0:10:46.160 --> 0:10:48.960 in communities, not in hospitals, and so how do you 0:10:49.000 --> 0:10:51.080 know that people are dying in villages and what they're 0:10:51.120 --> 0:10:53.559 dying from? And so a lot of the time that 0:10:53.600 --> 0:10:57.400 we've been working in countries, we've been focusing on cost effective, 0:10:58.040 --> 0:11:01.680 quick methods that will They're not perfect, but they will 0:11:02.760 --> 0:11:05.480 yield a kind of information that countries would need to 0:11:05.520 --> 0:11:10.600 monitor COVID nineteen with reasonable reliability and cheaply, and they work. 0:11:11.720 --> 0:11:15.040 The data for health program works in twenty countries across 0:11:15.080 --> 0:11:18.880 the world. Alan says that it's helped establish a baseline 0:11:18.920 --> 0:11:21.680 for the deaths that occur each year and that will 0:11:21.720 --> 0:11:24.800 make it easier to eventually figure out the global mortality 0:11:24.920 --> 0:11:28.040 from the pandemic. What we now need to do is 0:11:28.080 --> 0:11:34.120 to um collect the data on who died in the 0:11:34.200 --> 0:11:37.800 era of the COVID nineteen that will be undercounted for sure, 0:11:38.280 --> 0:11:40.960 and we will need to apply the statistical methods that 0:11:41.000 --> 0:11:43.520 we've developed over the years to those data to say 0:11:43.559 --> 0:11:45.760 we should adjust them in this and this way, and 0:11:45.800 --> 0:11:48.760 when we subtract those away from the baseline, this is 0:11:48.800 --> 0:11:52.800 the excess mortality that, in my viewing is probably the 0:11:52.840 --> 0:11:55.720 six to nine month exercise. I may be optimistic, but 0:11:55.800 --> 0:11:58.400 I think this time next year we would have a 0:11:58.440 --> 0:12:02.240 pretty good idea of the total global mortality and butten 0:12:02.280 --> 0:12:06.200 by country from COVID nineteen. Allen says the pandemic is 0:12:06.280 --> 0:12:10.160 underscoring the need to rapidly report debts to authorities in 0:12:10.200 --> 0:12:15.520 developing countries. Mobile phones have accelerated the notification process, especially 0:12:15.520 --> 0:12:18.640 when churches and other community based groups are able to 0:12:18.679 --> 0:12:23.720 contribute to surveillance activities. The hope is that by improving 0:12:23.720 --> 0:12:26.440 the collection of this kind of data, governments will be 0:12:26.480 --> 0:12:30.120 able to respond more effectively, not just to the pandemic, 0:12:30.600 --> 0:12:33.400 but all the other major causes of death and disease, 0:12:33.920 --> 0:12:38.000 and that will ultimately improve the health and well being 0:12:38.520 --> 0:12:47.320 of people everywhere. That was Jason Gale in Melbourne, and 0:12:47.360 --> 0:12:50.400 that's our show today for coverage of the outbreak from 0:12:50.400 --> 0:12:55.240 one bureaus around the world. Visit Bloomberg dot com slash 0:12:55.320 --> 0:12:59.480 Coronavirus and if you like the show, please leave us 0:12:59.480 --> 0:13:02.959 a review and a rating on Apple Podcasts or Spotify. 0:13:03.760 --> 0:13:06.360 It's the best way to help more listeners find our 0:13:06.400 --> 0:13:12.160 global reporting. The Prognosis Daily edition is produced by Topher FORHZ, 0:13:12.520 --> 0:13:18.520 Jordan Gaspure, Magnus Hendrickson, and me Laura Carlson. Today's main 0:13:18.600 --> 0:13:23.880 story was reported by Jason Gale. Original music by Leo Sidrin. 0:13:24.600 --> 0:13:29.440 Our editors are Francesca Levi and Rick Shine. Francesca Levie 0:13:29.480 --> 0:13:32.840 is Bloomberg's head of podcasts. Thanks for listening.