The Washington Post tracks every known US death, analyzes data from health authorities, and collects details from victims’ family and friends. In the first 1,000 deaths, some patterns have emerged in the epidemiology of the outbreak and its painful effects on humans. About 65 percent of the people whose age is known were older than 70 and almost 40 percent were over 80, which shows that the risk increases with age. About 5 percent of whose age is known were in their forties or younger, but many more in this age group were sick enough to be hospitalized. Of the victims whose gender is known, almost 60 percent were men.
What remains cloudy is exactly who dies during the pandemic in America, even though scientists and public health experts are looking for information that can help save lives.
Overwhelmed state and local authorities have published very different reports of the deceased, citing privacy laws to protect themselves against basic details about age, gender, and underlying conditions. The three categories of signals that epidemiologists consider to be key indicators of risk.
The disease control and prevention centers, which offer a respected and often cited public weekly tracker for the annual influenza season, do not offer comparable real-time monitoring for the novel coronavirus. And this analysis is based on spotty reports from states that have difficulty serving a flood of sick people.
There are some of the 1,000 deaths that have a public name, age, place of death and a life story: the playwright Terrence McNally, the rabbi Romi Cohn, the director Dezann Romain. They appear in local media reports: Sundee Rutter, mother of six, and breast cancer survivor in Washington State; Alvin Simmons, father of two, hospital worker in New York; and Elizabeth Eugenia Wells, a grandmother who sang in her church choir in Georgia.
But many only appear elliptically, in tweets and Facebook posts.
“Today one of my friends died, probably from complications related to coronavirus,” wrote a woman in Ohio on Monday in a tearful Facebook video message. “She was my age. She had a husband, a daughter who is like 3. She was immunodeficient. She had some longstanding health problems. She was not frail. She was young and happy and lively. And now she’s dead. “
And: “My uncle died of Covid-19 in California today. He was 78 years old and had Parkinson’s. I was on a cruise before all the warnings. Went home, got sick, went to the emergency room. Authorized. Lungs failed. Intensive care unit. Kidneys failed. I chose DNR pro MD. 100% mortality rate opinion when pressed. “
What becomes public is very different depending on the location. In King County, Washington, an early epicenter of the U.S. outbreak, the health agency publishes daily updates on its website that include a victim’s gender, age range, date of death, underlying health conditions, and the hospital where they were treated contain . This report may indicate that death is part of a cluster, for example at the Life Care Center in Kirkland.
“Of the 87 reported deaths, 37 were confirmed to be related to life care,” King County said on its website Monday.
Some states, such as Florida and Colorado, offer detailed nationwide data, while others, such as California, publish almost no demographic details and shift to counties.
The inconsistency in reporting is particularly strong in New York. State health officials were tacit with regard to the death statistics and usually left it up to Governor Andrew M. Cuomo (D) to announce the ongoing toll at his daily briefings. In New York City, the Department of Health has published daily reports summarizing deaths by age group, gender, neighborhood, and pre-existing medical problems.
There are numbers that set red flags: data that show that at least 96 percent of those who died on Wednesday had basic conditions and that 72 New Yorkers who died were under 64.
Even more deaths are not counted at all, such as those that have been misdiagnosed as having flu or any other disease and those that have died but never been tested, which highlights another important gap in the mortality information.
An epidemiologist who left New York State Health Department late last year said former colleagues had recently contacted him and were keen to develop tools that would make it easier to track the disease if it spreads and kills.
“Not only did they lack the ability to perform any type of modeling, forecasting, or time series, but they could not even provide or perform basic epidemiological analysis due to the lack of access to data,” the epidemiologist said on condition of anonymity to openly discuss operations in his area.
Usually, experts say, the public could be confident that the CDC would collect at least detailed, nationwide data on deaths and cases for internal analysis.
If an illness is classified as “immediately reportable, extremely urgent”, as is Covid-19, officers must call and notify the CDC within hours of a case being identified.
“That means likely, suspected, and then confirmed cases of Covid-19 – as well as deaths,” said Charles Branas, chair of epidemiology at Columbia University’s Mailman School of Public Health. Branas said that this call should be followed within one day by the submission of an electronic form.
However, state health agencies, including New Yorkers, are understaffed and overwhelmed by the pandemic so they haven’t filled out the forms with the basic information the CDC needs to do an analysis, CDC officials say.
The New York State Department of Health recently even requested volunteer help from local public health graduates, according to an email to The Post.
The first known deaths from the novel coronavirus were an 86-year-old woman and a 54-year-old man on February 26 in King County.
The toll had reached 50 two weeks later. Four days later it was 100. Then, 48 hours later, it had doubled.
Since March 21, the death toll has risen by 90 to 193 per day. On Wednesday, the authorities reported nearly 250 deaths, most in a single day in the United States.
“We are at the beginning of the wave in most places in the United States,” said Nahid Bhadelia, an infectious disease doctor and medical director of the specialty pathogen department at Boston University School of Medicine. “The worst is likely to come.”
The United States has the sixth highest death toll in the world after Italy, Spain, China, Iran and France. In Italy, where more than a third of virus-related deaths worldwide occurred, 21 days passed from the first to the 1,000th death recorded on March 13th. From there, the number of Italian victims increased faster. Last weekend, 793 deaths were recorded in a single day, the deadliest day of the outbreak.
Leaders and health experts in the United States have given Italy as an example of what could happen if the American health system is overwhelmed and underfunded.
Most of the victims had underlying diseases that hampered their immune system’s response to covid-19’s attack on their cells. In New York City, which reported 280 deaths on Wednesday night, 96 percent of people more than anywhere else in the country had an existing illness such as asthma, diabetes, lung disease or cancer.
The virus can also affect those who were otherwise healthy.
James Carriere, a well-known local lawyer and 10th generation Louisian, was one of these people. The 80-year-old was healthy, exercised regularly, and enjoyed family meals at classic hangouts in New Orleans when he fell ill.
He was hospitalized and died in quarantine about a week later.
His son Olivier Carriere said goodbye to him on FaceTime.
“He enjoyed life, he always did something. Then suddenly – ‘he said. “We are all in shock.”
Epidemiologists warn against being alarmed by the death of elderly people with no known underlying illness or by the story of a 35-year-old who appears to be in his prime and suffering from the disease.
“But the comparable data you should have is: what about all the 35 year olds who didn’t die?” Branas said. “Without that, these cases are just anecdotal.”
“Some people have so many pre-existing illnesses that they are at such a high risk that it is very difficult to prevent their death if they develop the disease,” added Branas. “That’s why you don’t want to rely solely on mortality data.”
In order to understand the likely course of a disease and who is most susceptible, scientists must be able to examine complete data on who survived and who died from the disease.
Swiss Post’s data on the first 1,000 deaths show trends that have already appeared in studies from other countries that have been fighting the outbreak for much longer. This has a silver lining, Bhadelia said: if the disease took a worse toll in the United States than in countries that have already been devastated – if it had also killed young people at a high rate – this would have been confirmed in these numbers. So far this has not been the case.
Dense urban centers, many in coastal states, were hit hardest in the first two months of the outbreak, but it is only a matter of time before the corona virus spreads to rural areas. In some places like Albany, Georgia, where at least 12 people had died by Thursday, this is already happening. When it arrives elsewhere, it can have a debilitating effect, especially in places where resources and healthcare workers are already scarce.
“It could take longer for covid-19 to make it to rural communities, and they may not get as many cases there,” said Bhadelia, “but the worrying thing is that it may not take as many cases to improve health overwhelm.” Care system in these areas. “
Or, as Cuomo put it earlier this week, to warn that his state is the canary in the coal mine: “We are your future.”
Lena H. Sun, Jennifer Jenkins and Julie Tate also contributed to this report.