OBSERVATIONS, OPINION
The Things We’ve Lost in the
Pandemic
Human lives, human touch and direct human interactions are gone—and so is the
sense that we can trust our leaders to act quickly and effectively in the face of a
catastrophe
By Ben Santer on May 19, 2020
I’ve been sheltering in place since mid-March. Days bleed into weeks, and weeks
into months. Each morning I write code. I immerse myself in the world of
computer programming. I compare temperature changes in satellite data and in
the latest climate model simulations. I develop scripts to display these
comparisons in maps, histograms and box-and-whiskers plots, in black and white
and in vivid colors. I try to understand the similarities and differences between
models and data. I try to understand whether newer versions of models
outperform older versions. There is always something to learn, even from the
simplest comparisons.
I find comfort in having a routine and a purpose in these uncertain, frightening
times. Science is my lifeline. It tethers me to the reality of the complex, life-
sustaining physical climate system. The science gives me great joy. Even though
I’ll be 65 next month—officially crossing the threshold into “old dude” territory—I
don’t feel old. Each day still brings the same childlike sense of wonder at the
possibility of unearthing a small scientific nugget that others have missed. You
never know what you’ll find.
Shelter-in-place afternoons are more prosaic. I write and respond to e-mails. I
read, edit and review papers. I participate in phone calls and Zoom meetings with
colleagues. If I’m ambitious I try to do a few bureaucratic chores. A supervisor
reminds me that I’m delinquent on my mandatory computer ergonomics training
and on my foreign travel training. The latter seems somewhat academic; any kind
of business travel, foreign or domestic, is looking highly unlikely for the
foreseeable future. I defer the foreign travel training with a mild sense of guilt.
In the early evening, I head out to Las Trampas Regional Wilderness. Getting out
of my little apartment, if only for a few hours each day, is essential for my physical
and mental health. I need to have my finger on the pulse of the seasonal cycle. I
need to see the awakening of wildflowers after the rains of last month, the
hillsides painted orange with iconic Californian poppies. I need to see sunlight
filtering through the leaves and branches of old oak trees, backlighting patches of
bright green grass, turning the simple into the sublime.
We all need things of beauty in our lives. Particularly now.
I take the Las Trampas ridge trail, eventually climbing to a point overlooking
Mount Diablo, Danville and San Ramon. It’s wild up here today. A strong wind
makes waves in the grass. There are half-closed poppies on either side of the trail,
a monochromatic honor guard, bobbing and swaying in the wind gusts. I think of
lines from an old poem by Wolfgang Borchert:
“Stell dich mitten in den Wind, glaub an ihn und sei ein Kind.
Lass den Sturm in dich hinein, und versuche gut zu sein.
Put yourself in the middle of the wind, believe in it and be a child.
Let the storm come inside you, and try to be good.”
Standing alone in the wind, in a restless sea of grass, I have the luxury of time.
There is time to watch the strange spectacle of an almost empty Interstate 680 on
a Saturday evening. Time to feel the sun and wind on my skin. Time to reflect on
some of the things lost in the last few months.
One thing lost is human touch. There is only the memory of touch—the memory
and residual warmth of fleeting, incandescent loves. The memory of my wife,
sheltering in place in a different state. I do not know when I’ll see her again. I’ve
lost her touch, the feel of her fingers gently clasping my hand as we walk around
Minnesotan lakes.
I’ve also lost face-to-face human interactions with my family, friends and
scientific colleagues. These interactions are all virtual now, and Zoom is the
tenuous glue holding us together. But Zoom is no substitute for sharing the same
room, the same space. Something vital is missing.
Nor are my masked, once-weekly visits to the grocery store an uplifting social
experience. Fear is palpable in the checkout line. We are all masked now. Layers
of gauze and cloth hide faces and muffle voices. Smiles and sadness are invisible.
Only the eyes yield a window to the interior.
Standing in the wind on the top of my lonely vantage point, I think about the loss
of lives in the pandemic. In our country, thousands died who did not have to die.
Their deaths could have been avoided with leadership grounded in science rather
than in magical thinking. In the United States, the spring of 2020 was not “our
finest hour.” We passed the baton of global leadership to other countries—to
countries like Germany, Denmark, South Korea and New Zealand, whose leaders
paid attention to science and acted decisively to protect their citizens.
This failure of U.S. leadership in responding to COVID-19 was not unexpected.
The current U.S. administration had already walked away from the Paris Climate
Agreement, ceding leadership on climate change to more enlightened countries.
The administration had already shown its disdain for science-based assessments
of climate and health risks. Its primary focus was not on protecting its citizens
from human-caused climate disruption, or on providing them with clean air and
water.
This loss of leadership should be deeply concerning to all of us. America is no
longer a textbook example of how a country should keep its citizens safe from
harm. We are no longer a shining beacon of rationality or democracy for the rest
of the world. In the middle of a global pandemic, we cut funding for the World
Health Organization. And in the middle of global climate disruption, we opted out
of the global community seeking to solve this problem.
Standing in the late-evening sun on the top of a nameless hill in northern
California, it feels as if America’s time in the sun is fading. I hope that does not
happen—but it will if we fail to elect better leaders in November 2020. Until then,
I’ll remember the words of Borchert’s poem, let the storm in, and try to be good.
Read more about the coronavirus outbreak from Scientific American here. And
read coverage from our international network of magazines here.
The views expressed are those of the author(s) and are not necessarily those of Scientific American.
ABOUT THE AUTHOR(S)
Ben Santer
Ben Santer is an atmospheric scientist and a member of the U.S. National Academy
of Sciences.
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PUBLIC HEALTH
How COVID-19 Deaths Are
Counted
Assigning a cause of death is never straightforward, but data on
excess deaths suggest coronavirus death tolls are likely an
underestimate
By Stephanie Pappas, LiveScience on May 19, 2020
https://www.scientificamerican.com/article/how-covid-19-deaths-are-
counted1/?utm_source=newsletter&utm_medium=email&utm_campaign=week-in-
science&utm_content=link&utm_term=2020-05-22_top-
stories&spMailingID=65315717&spUserID=NDU0NDQ2Nzg4OTk5S0&spJobID=1883140889&spRepor
tId=MTg4MzE0MDg4OQS2
As coronavirus has swept through the United States, finding the true
number of people who have been infected has been stymied due to lack of
testing. Now, official counts of coronavirus deaths are being challenged,
too.
In Colorado, for example, a Republican state legislator has accused the
state’s public health department of falsely inflating COVID-19 deaths; in
Florida, local media have objected to the State Department of Health’s
refusal to release medical examiner data to the public, alleging that the
state may be underreporting deaths.
The reality is that assigning a cause of death is not always
straightforward, even pre-pandemic, and a patchwork of local rules and
regulations makes getting valid national data challenging. However, data
on excess deaths in the United States over the past several months
suggest that COVID-19 deaths are probably being undercounted rather
than overcounted.
CAUSE OF DEATH
Death certificates can be signed by a physician who was responsible for a
patient who died in a hospital, which accounts for many COVID-19
deaths. They can also be signed by medical examiners or coroners, who
are independent officials who work for individual counties or cities.
Many COVID-19 death certificates are being handled by physicians
unless the death occurred outside of the hospital, in which case a medical
examiner or coroner would step in, said Dr. Sally Aiken, the president of
the National Association of Medical Examiners (NAME). In some
jurisdictions, including cities such as Chicago and Milwaukee, medical
examiners are involved in determining the cause of death for every
suspected COVID-19 case. In those jurisdictions, medical examiners
review medical records even of patients who die in hospitals to ensure
that the symptoms and any testing indicate that the patient did indeed
die of COVID-19.
Having medical examiners confirm COVID-19 deaths can create more
uniformity and clearer documentation, Aiken told Live Science. On a
death certificate, there are spaces to list an immediate cause of death, as
well as the chain of events that led to that final disease or incident. There
are also spaces for adding contributing factors.
For COVID-19, the immediate cause of death might be listed as
respiratory distress, with the second line reading “due to COVID-19.”
Contributing factors such as heart disease, diabetes or high blood
pressure would then be listed further down. This has led to some
confusion by people arguing that the “real” cause of death was heart
disease or diabetes, Aiken said, but that’s not the case.
“Without the COVID19 being the last straw or the thing that led to the
chain of events that led to death, they probably wouldn’t have died,” she
said.
DETECTING COVID-19
How hard it is to accurately determine whether COVID-19 was truly that
last straw depends on the situation. Most COVID-19 deaths seen at
Mount Sinai Health System in New York are in people who have
comorbid (or co-occurring) conditions such as coronary artery disease
or kidney disease, said Dr. Mary Fowkes, the chief of autopsy services at
Mount Sinai. But it’s not typically difficult to tell what killed them.
“Most of the cases are pretty straightforward,” Fowkes told Live Science.
“The lungs are usually so severely involved with pathology, so they are
two to three times or more the normal weight of a normal lung.”
(The excess weight is due to fluid and cell detritus from damaged lung
tissues.)
In some cases, particularly those where someone dies at home or quickly
perishes after entering an emergency room, the determination can be a
little more fuzzy, said Dr. Jeremy Faust, an emergency physician at
Brigham and Women’s Hospital in Massachusetts.
The challenge is knowing who died of COVID-19 versus who
died with the virus that causes COVID-19,” Faust told Live Science.
Autopsies can help answer that question, but autopsy rates were low even
pre-pandemic, Fowkes said. Even at Mount Sinai, a rare medical system
that offers every family a chance to have their loved one autopsied for
free, the rate of autopsy was only about 20% prior to the pandemic.
According to NAME, there is an ongoing shortage of forensic pathologists
working in the United States, with about 500 currently employed and a
need for 1,200. Autopsies for COVID-19 can also be dangerous due to the
infectious nature of the disease and ongoing shortages of personal
protective equipment for pathologists.
Another complication for assigning a cause of death for COVID-19 is that
some younger people have died of strokes and heart attacks and then
tested positive for COVID-19 without any history of respiratory
symptoms. The virus is now known to cause blood clots, suggesting that
COVID-19 was the killer in these cases, too. Fowkes and her colleagues
conducted a microscopic inspection of the brains of 20 COVID-19 victims
in her hospital system and found that six of them contained tiny blood
clots that had caused small strokes before death.
“We’re seeing it in younger patients than you would expect, and we’re
seeing it in a distribution that you wouldn’t expect, so we think it’s
related to the COVID,” Fowkes said.
The Centers for Disease Control and Prevention (CDC) has issued
guidelines for how to attribute a death to COVID-19. The guidelines urge
using information from COVID-19 testing, where possible, but also allow
for deaths to be listed as “presumed” or “probable” COVID-19 based on
symptoms and the best clinical judgment of the person filling out the
death certificate. A medical examiner trying to determine a cause of
death in the absence of testing would comb medical records and query
family and loved ones about the person’s symptoms before they died,
Aiken said. Postmortem COVID-19 tests may be possible, depending on
the jurisdiction.
UNDERREPORTING OR OVERREPORTING?
All of the inconsistencies of cause-of-death reporting precede the COVID-
19 pandemic, says Jay Wolfson, a professor of public health at the
University of South Florida (USF). But getting good data about deaths is
now extremely pressing, he told Live Science. Death certificates are often
used by epidemiologists and public health officials to detect strange
clusters of deaths or to link certain risk factors to certain causes of death.
But because different states and localities have different rules about
recording and reporting causes of death, the cumulative data is always
messy.
“I think some states are reluctant to open their databases up, knowing
they have validity problems or knowing the data might be misused,”
Wolfson said. But public health officials need access, he said, and they
need to figure out ways to dig into the data and standardize them.
Wolfson and other researchers at USF are already working with state
officials to see what kind of data the state can legally release, he said.
Meanwhile, as the political debate over the response to the virus heats
up, some have argued that death reports are being deliberately skewed.
Aiken rejected the notion of a vast conspiracy by medical examiners;
medical examiners are designed to be independent entities, she said, and
they run the political gamut from conservative to liberal.
“It always cracks me up,” she said. “Medical examiners and coroners
aren’t organized enough to have a conspiracy.”
In Colorado, the discrepancy over people dying with COVID-19
versus of COVID-19 is due to federal reporting guidelines requiring the
health department to report any COVID-positive death to the CDC, even
if COVID-19 wasn’t thought to cause the death, Gov. Jared Polis said in a
news conference Friday (May 15). The health department has been
instructed not to report those deaths as being caused by COVID-19 to the
public, Polis said.
In Florida, state law prevents the release of death certificate data,
Wolfson said, but it may be possible to get public release of death
certificates with identifying information removed, or of cumulative
datasets.
Both undercounts and overcounts of COVID-19 deaths are possible,
Wolfson said, but it’s not yet clear which is more likely, or whether they
might simply balance each other out. Fowkes said that based on her
experience, it’s more likely that COVID-19 deaths are being missed than
overcounted. That’s because New York is among several cities that show
spikes in deaths at home, and these anomalous spikes could be due to
untested, untreated COVID-19.
Perhaps, the best clue as to whether COVID-19 deaths have been
undercounted or overcounted is excess mortality data. Excess mortality is
deaths above and beyond what would normally be expected in a given
population in a given year. CDC data shows a spike of excess mortality in
early 2020, adding up to tens of thousands of deaths.
Some argue that many of these excess deaths are related to COVID-19
lockdowns, not COVID-19 themselves, Faust said, because people fear
catching the disease if they go to the hospital for other reasons. A study
in the Journal of the American College of Cardiology did find that nine
major hospitals saw a 38% drop in emergency visits for a particular kind
of heart attack in March. That suggests that people really are delaying or
avoiding medical care, which could mean that some of them die of
preventable causes.
But non-COVID conditions probably don’t explain most excess deaths,
Faust said. Only a portion of heart attack visits would have represented
lives saved, he said, because doctors must treat perhaps 10 patients to
save one life. And other causes of death—such as motor vehicle
accidents—are down.
This could change with time, Faust cautioned. For example, if cancer
patients forego their treatments for a year, rather than a few months, the
impact on their death rates is much more likely to be noticeable in the
population-wide data. But for now, he said, “it’s unlikely that the
coronavirus deaths are being overcounted by a magnitude that explains
our observation that something very unusual is going on.”
Copyright 2020 LiveScience.com, a Future company. All rights
reserved. This material may not be published, broadcast, rewritten or
redistributed.
Read more about the coronavirus outbreak from Scientific
American here. And read coverage from our international network of
magazines here.
ABOUT THE AUTHOR(S)
Stephanie Pappas
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