Why are some experts questioning the global death toll from COVID-19

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If there is one thing about the COVID-19 death toll that researchers seem to agree on, it is that the official number is probably too low.

But the extent of the shortage is a source of contention.

That may help explain why, when the influential Institute for Health Metrics and Evaluation in Seattle released a new model this month indicating that the true number of COVID-19 deaths around the world was more than double the number from World Health OrganizationResponse from other experts was mixed.

Some researchers interviewed for this story said that the model seemed robust, but also criticized by many, suggesting that the team ignores the uncertainties inherent in estimates like these and has not shared enough details about how the statistical sausage is made.

The IHME model indicates that the extent of underreporting varies from region to region around the world but amounts to nearly 7.3 million as of May 16, which is significantly higher than the official total of around 3.4 million.

The IHME team also made future predictions: by September 1, according to the model, 9.1 million people will have died.

In California, the death toll was estimated at 120,515 or so on May 16 – Almost double What the model called the declared number of the state is 62,596.

Dr.. Mark GalleyThe state’s health and human services minister expressed some doubts about doubling the numbers.

“We think that, of course, it will be an understated number because the data needs to be looked at more critically,” said Ghali. “But the idea that it’s 50% of reality – I think a lot of us don’t think that would be accurate. But [we] You need to spend more time looking at it closely. “

Dr.. Rochelle WallinskiThe director of the US Centers for Disease Control and Prevention said that the agency will examine the modified IHME form and decide whether to count any additional deaths of coronavirus.

“We will look into this matter carefully,” she said in a press release.

Many research groups have estimated the number of deaths that would have been expected in the absence of an epidemic and compared those estimates with the actual number of reported deaths to arrive at A statistic called “excess mortality”.

Not all excess deaths during the pandemic were caused by SARS-CoV-2 infection. But in some ways, the number is a more reliable marker of the true toll of the pandemic, according to World Health OrganizationPartly because many places lack the infrastructure and resources to accurately track COVID-19 deaths.

The researchers said there are good reasons why the official figures do not reflect reality. Among them: Cases may go undetected at times and in places with low coronavirus testing rates. Older deaths in the early days of the epidemic can be attributed to other causes. In some places, officials may not disclose accurate death figures for political reasons.

This is a problem, because an accurate death toll is essential to understanding the outbreak and predicting how it will spread. It allows policymakers to weigh the trade-offs more precisely between public health, the economy, and other priorities as they try to respond.

“It’s really important that we have a very clear vision of what the actual burden of this disease is,” he said James Scott, A statistician and data scientist at the University of Texas at Austin.

Registered nurses April McFarland, left, and Tiffany Robins sealing a body bag at Providence Holy Cross Medical Center in Mission Hills.

(Francine Orr / Los Angeles Times)

Dr. Timothy BrewerAn infectious disease expert and epidemiologist at the University of California, Los Angeles, noted that the IHME model used data from a few countries and an extrapolation to predict what happened in the rest of the world. He said, “This may or may not be a reasonable assumption.”

“I don’t think we can necessarily assume that what happens in the United States or California is the same as what will happen in Gabon or Ghana or anywhere else,” Brewer said. “I think that’s kind of my biggest challenge with this.”

Nicholas Jewell, A biostatisticsist and epidemiologist at the London School of Hygiene and Tropical Medicine, had similar concerns. He said taking information from places that have reliable death records and applying it to places where the records are less reliable is a tough business.

He said, “It is an analysis that deserves a full review, as statisticians can assess the methodology used in full detail and replicate the results if necessary.”

But overall, Brewer expressed confidence that the model is well thought out.

“I think their approach was complex. They did an excellent job gathering the available data.

Ruth!Population health scientist at the Fred Hutchinson Cancer Research Center in Seattle said that counting only direct COVID-19 deaths underestimates the true toll, given that the pandemic has delayed health care and caused other side effects for many. Regardless, she said the estimates provided by the IHME model seemed reasonable.

“I think this is plausible,” said Itzioni, because the total death toll is nearly twice the official number. “I think it is very difficult to put a specific number on it – but its being much higher than what has been reported is indisputable.”

I think it is very difficult to put a specific number on it – but being much higher than what has been reported is indisputable.

Ruth Itzioni is a population health scientist at the Fred Hutchinson Cancer Research Center

For their model, which was originally released on May 6, researchers at IHME estimated excess mortality for different places based on weekly or monthly data up to May 2 (although it has since been updated) and predicted it further, to September 1. They divided the data into six categories:

  • Deaths from direct SARS-CoV-2 infection.
  • Deaths due to delayed healthcare due to the epidemic.
  • Deaths from mental health disorders including depression, increased alcohol consumption and increased opioid use.
  • Avoid deaths because stay-at-home orders reduce injuries from traffic accidents and the like.
  • The deaths were avoided because the use of masks and social distancing reduced the transmission of other potentially deadly viruses, including influenza and measles.
  • Decreased deaths from chronic diseases such as cardiovascular disease because people who succumbed to these cases died from COVID-19 instead.

The researchers estimated excess deaths at each location that had weekly or monthly statistics for all causes. They have eliminated deaths from causes unrelated to COVID-19 and caused deaths that the pandemic has averted.

This information was used to build a model that they applied to all regions, including those whose mortality data was missing. Results varied.

According to estimates as of May 10, the United States has seen 913,081 deaths, according to the researchers’ estimate – nearly 60% more than the 578,985 deaths collected from official reports.

They said India had seen 737,608 deaths – nearly three times the reported death toll of 248,307. The estimated death toll in Mexico was 623,571 which is nearly three times the official number of 219,925.

While the death toll in the Russian Federation was slightly lower, the disparity was much higher: 607,589 COVID-19 deaths estimated by the IHME compared to the official number of 111,909.

The gaps between Egypt and Kazakhstan were among the worst. The IHME model estimated the death toll in Egypt at 175,488 (more than 12 times the official number of 13,962) and the death toll at 84,453 in Kazakhstan (more than 14 times the official number of 5,810).

Cemetery workers dig holes

Cemetery workers dig holes early to get a new crop from COVID-19 graves in Tijuana, Mexico.

(Marcus Yam / Los Angeles Times)

The results were met with great skepticism from a variety of researchers outside of IHME.

Scott, of the University of Texas, was one of a number of people who expressed deep concern about the fact that the estimated death numbers were very accurate without indicating any mathematical uncertainty about these numbers.

He said the model the IHME team used to estimate COVID-19 deaths was based on several assumptions – and each assumption injected a little uncertainty into the actions. It doesn’t take long for this uncertainty to build up.

This is why numbers like these usually come with error bars that show the level of uncertainty about the estimate. This was not the case for the IHME model: while projections of future deaths contain error bars, estimates of deaths that actually occurred are not.

Scott said, “You need the error bars.”

He added, “The error bars are what turn the account on the back of the envelope into something that one can judge and deal with as a scientific attempt.”

Eli KleinThe Johns Hopkins University epidemiologist expressed concern that the calculations appeared to be too conclusive.

“There has to be some uncertainty in their model that they have to report,” Klein said. For the United States, “Do they say that 900,000 deaths plus or minus two or three, or is it 900,000 plus or minus 500,000? I don’t know how much uncertainty there is in the model, which doesn’t allow me to judge the accuracy of their estimates.”

Ali MokdadThe IHME public health researcher and a senior faculty member leading the COVID-19 modeling effort, said calculations of past deaths do not need large error bars because estimates are in parentheses from real-world figures – the total number of deaths at a given location.

Amelia Abbeville, Media Relations Officer at IHME added that at present, the team is not reporting uncertainty about estimated deaths in the past “in order to simplify the modeling process,” although it is something they might explore in the coming weeks.

Many independent researchers believed the IHME numbers for the United States and elsewhere seemed to be on the playing field. However, some said the bigger problem is not whether the numbers are correct, but where they come from.

In some ways it might be related to the issue of trust in a particular group and their work, Brewer said.

“Overall, this is a very respectable group that has done a reasonable job before,” he said. Based on the description and detailed methods online, “It looks like they were working hard to get it right. That doesn’t mean they got it right, but it looks like they were trying to get it right. So I’m kind of giving them that confidence or leeway, so to speak.”

Al-Miqdad said criticism is part of the research process and he welcomed comments from others.

He said, “This is normal in science.” “We do something new and innovative and yes, we fix it as we go, if there are bugs. I’m not worried about that.”

Disclaimer: The opinions expressed within this article are the personal opinions of the author. The facts and opinions appearing in the article do not reflect the views of Algulf.net and Algulf.net does not assume any responsibility or liability for the same.

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