Vox clamantis in deserto
'In praise and dissent'
The Old South Meeting House steeple.
The church’s interior.
“We, the people—the tourists
and townies—one nation under
this vaulted roof, exalted voices
speaking poetry out loud,
in praise and dissent.
We draw breath from brick. Ignite the fire in us.’’
From “Old South Meeting House,’’ by January Gill O’Neil. The church was built in 1729 and then rebuilt after the Great Boston Fire of 1972. The church was the organizing point for the Boston Tea Party, in 1773.
If you’re not partly a coward you’re not brave
— Photo by Makemake
The Mark Twain House, now a museum, in Hartford, Conn., where he lived in 1874-1891. He then lived abroad and in New York City before spending his last years in Redding, Conn., in the grand house below, which burned down in 1923.
“Courage is resistance to fear, mastery of fear-not absence of fear. Except a creature be part coward it is not a compliment to say it is brave; it is merely a loose misapplication of the word. Consider the flea! - -Incomparably the bravest of all the creatures of God, if ignorance of fear were courage. Whether you are asleep or awake he will attack you, caring nothing for the fact that in bulk and strength you are to him as are the massed armies of the earth to a sucking child; he lives both day and night and all days and nights in the very lap of peril and the immediate presence of death, and yet is no more afraid than is the man who walks the streets of a city that was threatened by an earthquake ten centuries before. When we speak of Clive, Nelson, and Putnam as men who ‘didn't know what fear was,’ we ought always to add the flea-and put him at the head of the procession.”
— Mark Twain, in Pudd’nhead Wilson (1893)
Fine folding
Work by Peter Monaghan in his show “Peter Monaghan: Fold,’’ at Heather Gaudio Fine Art, New Canaan, Conn., Nov. 21-Jan. 9. He uses his folds as sculptures to evoke emotion and energy through color. Not surprisingly, he’s a former graphic designer.
The Moreno Clock, on Elm Street in New Canaan.
— Photo by Jasonacurry
1836 view by John Warner Barber
Get a grip
— Photo by W. Carter
Much have I spoken of the faded leaf;
Long have I listened to the wailing wind,
And watched it ploughing through the heavy clouds,
For autumn charms my melancholy mind.
When autumn comes, the poets sing a dirge:
The year must perish; all the flowers are dead;
The sheaves are gathered; and the mottled quail
Runs in the stubble, but the lark has fled!
Still, autumn ushers in the Christmas cheer,
The holly-berries and the ivy-tree:
They weave a chaplet for the Old Year’s bier,
These waiting mourners do not sing for me!
I find sweet peace in depths of autumn woods,
Where grow the ragged ferns and roughened moss;
The naked, silent trees have taught me this,—
The loss of beauty is not always loss!
— “November,’’ by Elizabeth Drew Stoddard (1823-1902), a native of Mattapoisett, Mass.
Chris Powell: Weakening police immunity needs review
Poster against "detested" Police at the town of Aberystwyth, Wales, in April 1850.
MANCHESTER, Conn
Sailing against a heavy political wind, Republican candidates for the Connecticut General Assembly were heartened by the vigorous endorsements they got from police unions for the Nov. 3 election. The police this year broke away from the government employee union apparatus in the Democratic Party.
The endorsements encouraged Republicans not because police officers are so numerous but because the public fears increasing disorder and crime amid the virus epidemic and political hatefulness and violence, and the police are the public's main defense.
Since some of the recent disorder and crime arises from protests against both the real and imagined use of excessive force by police against racial minorities, some people suspect that the Republican eagerness for police endorsements is anti-minority. After all, the unions are mad at Democratic legislators and Gov. Ned Lamont for enacting the recent police-reform legislation that was advocated by minority legislators. The new law purports to diminish the "qualified immunity" officers enjoy against personal lawsuits for their conduct on the job.
Police unions do have a lot to answer for. Like all government employee unions, they strive for more than due process of law for their members. They strive to defeat accountability altogether, as with the current state police union contract, which supersedes Connecticut's freedom-of-information law by forbidding disclosure of misconduct complaints that have been dismissed by police management. Of course without disclosure of all complaints, management itself cannot be evaluated and cover-ups can always prevail.
But critics of the police have a lot to answer for as well, like their silly calls to "defund" police precisely when disorder is worsening, as if any mistake or misconduct in police work eliminates the need for all police work.
Connecticut's new police law has several excellent provisions, like its requirement for regular recertification of state troopers and its nullification of the state police contract's secrecy clause. But the law's provision on immunity is questionable because its meaning and likely effect are not clear.
The Democratic legislators from minority groups who advocated the provision called it revolutionary. But white Democratic legislators supporting the provision insisted that it wouldn't change much at all.
It's no wonder police officers are resentful, and everyone should be concerned that once again the General Assembly didn't know what it was doing except rushing to oblige the special-interest politics of the moment -- just as the legislature did with the now-infamous law requiring Eversource Energy to buy the expensive electricity of the Millstone nuclear power station, causing a spike in electric rates.
There is misconduct in all occupations. It is most important to expose and stop it in police work. But police officers are far more sinned against than sinning. If it condemns all for the mistakes or misconduct of a few, society will only imperil itself.
While the "qualified immunity" provision is demoralizing officers, it won't take effect until July next year. It should be reconsidered authoritatively as soon as the legislature reconvenes.
xxx
COLLEGE SOLUTION: Students and teachers in the Connecticut State Universities and Colleges system are complaining about spending cuts to reduce the system's huge deficit. Some say there is too much administration, but eliminating all administration won't close the deficit, which has been caused largely by declining enrollment. With personal contact sharply curtailed during the virus epidemic, college on the internet is not much fun.
Fortunately there is a solution. Connecticut could handle higher education just as it handles lower education -- with social promotion. Everyone in high school can graduate just by showing up, without having to learn anything, and while most students never master high school work, everyone gets a diploma and is happy. So why not give bachelor's degrees to every high school graduate who wants one -- waiting, of course, for a few years to elapse so the degrees look more real?
Some specialized courses still could be offered for students who really want to learn something in college, but most students probably would settle for the degree alone. The savings would be enormous, and education's main objective would continue to be achieved: mere credentialism.
Chris Powell is a columnist for the Journal Inquirer, in Manchester, Conn.
Latest wrap-up of region's COVID-19 response
The front entrance of MGH, in Boston
Here is the most recent wrap-up the region’s COVID-19 developments from The New England Council (newenglandcouncil.com):
“Harvard Medical School Researchers Publish COVID-19 Rehabilitation Study – Researchers at Harvard Medical School have published a study detailing rehabilitation plans crafted for patients in Boston and New York-based hospitals. The team has treated over 100 patients and points to continued studies to address persistent COVID-19 symptoms. Read more here.
“Mass General Releases Guidance on Weaning Patients Off Ventilators – Clinicians at Massachusetts General Hospital have released an article with an accompanying video to demonstrate effective ways to wean patients with serious COVID-19 infections off of ventilators. The materials offer step-by-step instructions and were published in The New England Journal of Medicine. Read more here.
“Health Leads Releases Joint Statement on Ensuring Racial Equity in the Creation and Distribution of a COVID-19 Vaccine – Health Leads has released a statement, in conjunction with a number of other organizations and individuals, emphasizing the importance of supporting underserved communities in recovering from COVID-19. The statement includes strategies for ensuring equity in vaccine distribution. Read more here.’’
Mellow day on Cape Ann
“Head of Goose Cove, Annisquam” (oil on canvas, circa 1910), by George L. Noyes (1864-1954), at the Cape Ann Museum, Gloucester.
They’re happy they’re wild
Wild turkeys gather to discuss Indian Summer at Swan Point Cemetery, in Providence. No shooting allowed.
— NED photo
Hear some of the resilient folks in the oyster-aquaculture biz on the Maine Coast
Oysters growing in baskets.
— Photo by Saoysters
Listen to these podcasts with the plucky and ingenious oyster farmers on the Pine Tree State’s storied coast. Just hit this link.
Economy looking wetter in Rhode Island
The tiny, five-turbine wind farm off Block Island. It’s still the only offshore wind farm in the U.S. even as there are huge offshore wind farms in Europe.
From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com
It’s always good to see the Ocean State taking more advantage of, well, the ocean. There are two developments worthy of note. One is Gov. Gina Raimondo’s plan, working with National Grid, for Rhode Island to get 600 more megawatts of offshore wind power, as part of her hope to get all of Rhode Island’s electricity from renewable sources by 2030. That’s probably unrealistic but a worthy goal nonetheless. Certainly it would be a boon for the state’s economy to have that regionally generated power. Ultimately, with the development of new advanced batteries to store electricity, it would lower our power costs while making our electricity more reliable, helping to clean the air, slowing global warming and providing many well-paying jobs.
There is, however, the danger that if the Trump regime stays in power, it will slow or even sabotage offshore-wind development because it’s in bed with the fossil-fuel sector.
Then there’s the happy news that the Rhode Island Commerce Corporation plans to buy more land for the Port of Providence. This would come from a $70 million port-improvement bond issue that voters approved in 2016. $20 million of that is for expanding the Port of Providence. Considering its geography and location, Rhode Island for more than a century has used far too little of its potential to host major ports, with of course Providence and Quonset being the main sites.
Observers see considerable synergies between those ports and big offshore-wind operations off southeastern New England, much of which could be served from Rhode Island, as well as from New Bedford.
Please hit these links to learn more:
https://www.utilitydive.com/news/national-grid-to-develop-600-mw-offshore-wind-rfp-for-rhode-island/587866/
https://www.usnews.com/news/best-states/rhode-island/articles/2020-10-27/after-4-years-state-moves-to-buy-land-near-providence-port
Leadership as moral act
Gravestone for “Bart’’ Giamatti and his wife in New Haven
“Management is the capacity to handle multiple problems, neutralize various constituencies, motivate personnel….Leadership, on the other hand, is an essential moral act, not — as in most management — an essentially protective act. It is the assertion of a vision, not simply the exercise of a style.’’
— A. Bartlett Giamatti (1938-1989) in “An Address to School Administrators’’ . Born in Boston and a Renaissance literature scholar, he served as president of Yale University in 1978-86, as National {baseball} League president in 1986-89, and for only five months as baseball commissioner in 1989, before suffering a fatal heart attack at his summer home, in Edgartown, Mass., on Martha’s Vineyard. He was a lifelong Red Sox fan.
Olivia Ouellette: How safely can coyotes co-exist with humans?
A coyote pouncing on prey in the winter
-Photo by Yifei He
From ecoRI News (ecori.org)
University of Rhode Island graduate student Kimberly Rivera has been conducting a survey since the beginning of October on the coyote population in Rhode Island.
Rivera, who graduated in 2016 with a bachelor’s degree in environmental science from the University of Delaware, hopes to promote better co-existence between coyotes and Rhode Islanders.
Since the beginning of her work, Rivera has received about 425 completed responses. With a minimum goal of 500 completed surveys, Rivera plans to keep the survey open until at least December.
The survey takes about 5-10 minutes to complete and asks respondents about demographics — age, location, are you a full-time Rhode Island resident — and goes on to ask about any experiences with coyotes.
“Ultimately, what I really want to do is understand how people’s knowledge, belief and feelings tie back to these independent variables that were measured,” Rivera said.
Along with the survey, Rivera is also conducting more hands-on research using camera-trap technology. Initially intended for a bobcat study, these cameras are placed around Rhode Island, and when something walks by, it triggers the motion-sensor camera to take a series of photographs. These cameras then store the photographs, as well as save the date and time, letting Rivera look back and see when and where coyotes are most active.
Through her work, Rivera is trying to promote the acceptance and a better understanding of coyotes.
“I think co-existence is key moving into the future,” she said. “I want people to think about how they co-exist with coyotes and what that means to them.”
Rivera’s original plan was to travel to Madagascar to study seven native carnivore species there and see how the locals interact with those species. She was interested in seeing how people’s attitudes and knowledge about those species affected their interactions with them. The coronavirus pandemic required her to change her research plans.
Although her initial plans fell through, Rivera was still enthusiastic about reconstructing her project into a human-wildlife conflict study on coyotes, similar to what she would have researched in Madagascar.
“I’ve always had an interest in coyotes because on the East Coast they’re one of the only apex predators,” she said.
At the end of the survey there are a series of questions about how negatively people view coyotes in regards to certain issues, such as pets, livestock and property damage.
“I think it really depends on who you ask,” Rivera said. “I think there is potential for coyotes to be dangerous.”
One of the top concerns people have in Rhode Island in connection with coyotes is the safety of their pets.
“If you have small dogs that you are leaving out in the yard without fences or you have outdoor cats that are wandering around, there's always going to be a risk,” Rivera said. “And that could be coyotes or it could be a car hitting them, so it's just one of many risks.”
Olivia Ouellette is a University of Rhode Island journalism student.
Llewellyn King: Polls are setup shots and a plague for democracies
Nov. 3, 1948: President Harry S. Truman, shortly after being elected as president, smiles as he holds up a copy of the Chicago Daily Tribune issue prematurely announcing his electoral defeat. This image has become iconic about the consequences of bad polling data.
WEST WARWICK, R.I.
Damn, damn, damn the polls.
My irritation has nothing to do with how they botched this election, or how they botched the last two British elections or the Brexit vote.
It is not a matter, to my mind, of whether the polls get it wrong. It is a matter simply that they are taken at all. I have been railing against them for years.
I have found pollsters on the whole – I have interviewed quite a few -- to be decent, honest people who believe that they are taking the voters’ temperature scientifically; that their work is helpful, contributing to the national or regional understanding.
But polls are far from the benign things they purport to be. They are a setup shot that becomes the movie; a snapshot that changes the course of events, a contrived intrusion into the public discourse that then monopolizes it.
Polls sideline good people, bring into favor the known over the unknown, and promote a kind of national continuation. They begin to write the narrative, not to reveal it. They terrify timid leaders and office aspirants.
These same arguments can be made against a lot of market research. Ask people what they like, and they will tell you they like what they know.
Imagine if Harold Ross, the genius who was founding editor of The New Yorker magazine, had polled the public about the magazine he was about to start in 1925, and had asked, “Do you want a magazine in which the articles are long, the bylines are at the end of the articles, the headlines are in squiggly type, and there is no table of contents?” Do you think that there would be The New Yorker (it still has long articles, but the bylines are at the beginning, and it has a table of contents) today?
The most blame in the plague of polls that now distorts our elections belongs with the news media.
They commission polls relentlessly and then publicize the results, as though they have been allowed to see the face of God. This synthetic news.
Polls are not the revealed truth. They are an imperfect peek into the national thought portfolio. But once they become part of that portfolio, they corrupt the momentum of events.
Worse, polls sway the politicians. They turn the Pied Piper into one of the rats, getting in line with the rest.
In his Sept. 30, 1941 review of the war to the House of Commons, Prime Minister Winston Churchill chose to address the subject of opinion and leadership. He said, “Nothing is more dangerous in wartime than to live in the temperamental atmosphere of a Gallup Poll, always feeling one’s pulse and taking one’s temperature. I see that a speaker at the weekend said that this was a time when leaders should keep their ears to the ground. All I can say is that the British nation will find it very hard to look up to leaders who are detected in that somewhat ungainly posture.”
Quite right.
The damage is that polls have proliferated in recent years, and they perform various functions for various people. Universities and colleges have found, as in the case of the Quinnipiac University Poll, that polls are a branding asset. The Quinnipiac poll is run by a small college in the rolling hills of Hamden, Conn., with great professionalism and objectivity, which has given it considerable standing in the world of polling. It also has enhanced the standing of the college which runs it.
My quarrel with the polls will be partly assuaged if they continue to get it wrong. That way they will take their place in the background clutter, not the breathtaking political snapshots that undermine elections.
Llewellyn King is executive producer and host of White House Chronicle, on PBS. His email is llewellynking1@gmail.com and he’s based in Rhode Island and Washington, D.C
Web site: whchronicle.com
Uncertain how much but definitely rising
“Uncertain Waters,’’ by Robin Levandov, in her show “Unreal Estates,’’ Nov. 6-27 at Bromfield Gallery, Boston. The paintings are of imaginary landscapes.
Police are asked to do too much
— Photo by Scott Davidson
From Robert Whitcomb’s “Digital Diary,’’ in GoLocal24.com
There’s something to be said for those fliers cropping up in Providence that say “Don’t Call the Police. Scan for Alternatives’’ around a bar code. The Providence Journal’s Madeleine List wrote about this in the Oct. 27 paper.
If you scan the QR code with your smartphone you’ll be taken to a Web site that lists agencies that city residents can use to obtain assorted services, such as for housing, mental health and substance-abuse issues. These are things that the police don’t necessarily have to be brought into.
Unfortunately, Ms. List’s article says, the list also includes domestic violence. The police need to handle that.
The main point, to me, is that police are called upon all too often to act as social workers rather than as anti-crime and public-safety personnel. There’s no way that cops can be trained and otherwise resourced to adequately address all the problems that they’re unfairly called upon to face these days. School personnel are also increasingly asked to serve as social workers, especially in places with lots of dysfunctional and impoverished families, many with only one parent around – the mother. The more of these functions that can be spun off to specialized agencies the better.
Of course, some of these problems are intertwined. Much criminal behavior is caused by perpetrators’ mental illness. So you sometimes need to bring in the police and social services.
Find a surface and draw
NEW/NOW’’ (installation) by Shantell Martin, at the New Britain (Conn.) Museum of American Art. The museum says:
”One of the most versatile young artists working today, Shantell Martin is known for her exploration into the vast potential of the drawn line.’’
Downtown New Britain’s beautiful old commercial buildings. Up until the ‘70s, New Britain was a thriving factory town.
In 1907. Note the big elm trees, so common along the streets of New England towns and cities before the onslaught of Dutch Elm Disease
Where to live
“Let us live in the land of the whispering trees,
Alder and aspen and poplar and birch,
Singing our prayers in a pale, sea-green breeze,
With star-flower rosaries and moss banks for church.’’
-- From “For C.W.B., by Elizabeth Bishop (1911-1979). The celebrated poet was born in Worcester and often summered in North Haven, Maine, after she became famous.
Elizabeth Bishop’s summer house, on the island of North Haven, Maine. This Wikipedia entry is a pretty good description of North Haven:
”In the 1880s, the island was discovered by ‘rusticators,’ seasonal residents first from Boston, then followed a decade or two later by others from New York and Philadelphia. North Haven is best known today for its sizable summer colony of prominent Northeasterners, particularly Boston Brahmins, drawn to the island for over a century to savor its simple way of life. Among the more notable summer residents was the impressionist painter Frank Weston Benson, who rented the Wooster Farm as a summer home and painted several notable canvases set on the island.’’
"Summer" (1909), by Frank Weston Benson
The virtue to be free
“The time is not at hand when we shall see whether America has virtue enough to be free or not.’’
— Josiah Bartlett (1729-1795), fourth governor of New Hampshire as well as , among other things, a physician. He was delegate to the Continental Congress for New Hampshire.
xxx
A monarchy is a merchantman which sails well, but will sometimes strike on a rock, and go to the bottom; a republic is a raft which will never sink, but your feet are always in the water.’’
— Fisher Ames (1758-1808), Massachusetts congressman (1789-1797) and a Federalist leader
Julie Appleby/Victoria Knight: COVID death counts spawn conspiracy theories
In the waning days of the campaign, PresidentTrump complained repeatedly about how the United States tracks the number of people who have died from COVID-19, claiming, “This country and its reporting systems are just not doing it right.”
He went on to blame those reporting systems for inflating the number of deaths, pointing a finger at medical professionals, who he said benefit financially.
All that feeds into the swirling political doubts that surround the pandemic, and raises questions about how deaths are reported and tallied.
We asked experts to explain how it’s done and to discuss whether the current figure — an estimated 231,000 deaths since the pandemic began — is in the ballpark.
Dismissing Conspiracy Theories, Profit Motives
Trump’s recent assertions have fueled conspiracy theories on Facebook and elsewhere that doctors and hospitals are fudging numbers to get paid more. They’ve also triggered anger from the medical community.
“The suggestion that doctors — in the midst of a public health crisis — are overcounting COVID-19 patients or lying to line their pockets is a malicious, outrageous, and completely misguided charge,” Dr. Susan R. Bailey, American Medical Association president, said in a press release.
Hospitals are paid for COVID treatment the same as for any other care, though generally, the more serious the problem, the more hospitals are paid. So, treating a ventilator patient — with COVID-19 or any other illness — would mean higher payment to a hospital than treating one who didn’t require a ventilator, reflecting the extra cost.
There is one financial difference. Medicare, the government health program for the elderly and disabled, pays 20% on top of its ordinary reimbursement for COVID patients — a result of the CARES Act, the federal stimulus bill that passed in the spring.
That additional payment applies only to Medicare patients.
Experts say there is simply no evidence that physicians or hospitals are labeling patients as having COVID-19 simply to collect that additional payment. Rick Pollack, president and CEO of the American Hospital Association, wrote an opinion piece in September addressing what he called the “myths” surrounding the add-on payments. While many hospitals are struggling financially, he wrote, they are not inflating the number of cases — and there are serious disincentives to do so.
“The COVID-19 code for Medicare claims is reserved for confirmed cases,” he wrote, and using it inappropriately can result in criminal penalties or a hospital being kicked out of the Medicare program.
Public health officials and others also pushed back.
Said Jeff Engel, senior adviser for COVID-19 at the Council of State and Territorial Epidemiologists: “Public health is charged with the duty to collect accurate, timely and complete data. We’re not incentivized to overcount or undercount for any political or funding reason.”
And what about medical examiners? Are they part of a concerted effort to overcount deaths to reap financial rewards?
“Medical examiners and coroners in the U.S. are not organized enough to have a conspiracy. There are 2,300 jurisdictions,” said Dr. Sally Aiken, president of the National Association of Medical Examiners. “That’s not happening.”
Still, there’s an ongoing debate about which mortalities should be considered COVID deaths.
Behind the Numbers
The Centers for Disease Control and Prevention, as well as nongovernmental organizations like the COVID Tracking Project and Johns Hopkins University, compile daily data on COVID deaths. Their statistics rely on state-generated data, which begins at the local level.
States have leeway to decide how to gather and report data. Many rely on death certificates, which list the cause of death, along with contributing factors. They are considered very accurate but can take one to two weeks to be finalized because of the processes involved in filling them out, reviewing and filing them. These reports generally lag behind testing and hospitalization data.
The other way deaths get reported is through what’s known as the case classification method, which reports deaths of people with previously identified cases of COVID, whether listed as confirmed or probable. Confirmed COVID deaths are affirmed by a positive test result. Probable COVID deaths are classified by using medical record evidence, suspected exposure or serology tests for COVID antibodies. The case classification method is faster than using death certificates and makes the data available in a more real-time fashion. Epidemiologists say this information can be helpful in gaining an understanding in the midst of an outbreak of how many people are dying and where.
Some experts point out that, while both methods have their virtues, each shows a different mortality count at a different time, so the best practice is to gather both sets of information.
The federal government, though, has offered conflicting guidance. The National Center for Health Statistics, an arm of the CDC, recommends primarily using death certificate data to count COVID deaths. But in April, the CDC asked jurisdictions to start tracking mortality based on probable and confirmed case classifications. Most states now gather data only one of the two ways, though a couple use both.
This patchwork approach does lead to conflicting data on total deaths.
Why Is the Count So Hard?
For the most part, public health researchers and medical examiners agree that COVID deaths are likely being undercounted.
“It’s very hard in a situation moving as rapidly as this one, and at such a large scale, to be able to count accurately,” said Sabrina McCormick, an associate professor in environmental and occupational health at George Washington University.
For one thing, the processes for certifying deaths vary widely, as does who fills out the death certificates. While physicians certify most death certificates, coroners, medical examiners and other local law enforcement officials can also do so.
Aiken, the medical examiner of Spokane County, Washington, said any time someone in her area dies at home and may have had COVID symptoms, the deceased person will automatically be tested for the disease.
But that doesn’t happen everywhere, she added, which means some who die at home could be omitted from the count.
It’s also unknown how accurate post-mortem COVID testing is, because there haven’t yet been any research studies on the practice — which could lead to missed cases.
Another wrinkle: Doctors in hospitals might not always be trained in the best practices for filling out death certificates, Aiken said.
“These folks are dealing with ERs and ICUs that are crowded. Death certificates are not their priority,” she said.
Emergency room doctors acknowledged the challenges, noting they don’t always have the resources that coroners and medical examiners do to perform autopsies.
“Much of the time, we don’t have an answer as to the final reason that a person died, so we are often stuck with the old cardiopulmonary arrest, which coroners and certifiers hate,” said Dr. Ryan Stanton, a Lexington, Kentucky, ER doctor and board member of the American College of Emergency Physicians.
That gets to how complex it is to determine what, exactly, caused a death — and what some say is a confusion between who died “with” COVID-19 (but may have had other underlying conditions that caused their death) and who died directly “of” COVID-19.
John Fudenberg, the former coroner for Clark County, Nevada, which surrounds Las Vegas, said including some of those who died with COVID-19 could result in an overcount.
“As a general rule, if someone dies with COVID, it’s going to be on the death certificate, but it doesn’t mean they died from COVID,” said Fudenberg, now executive director of the International Association of Coroners and Medical Examiners. For example, “if somebody has end-stage pancreatic cancer and COVID, did they die with COVID or from COVID?”
That question has proven controversial, and Trump has claimed that counting those who died “with COVID” has led to an inflation of the numbers. But most public health experts agree that if COVID-19 caused someone to die earlier than they normally would have, then it certainly contributed to their death. Additionally, those who certify death certificates say they list only contributing factors that are certain.
“Doctors don’t put things on death certificates that have nothing to do with the death,” said Dr. Amesh Adalja, senior scholar at the Johns Hopkins Center for Health Security.
COVID-19 can directly lead to death in someone with cancer or heart problems, even if those conditions were also serious or even expected to be fatal, he said.
And the claim that some states are counting people who die in car accidents, but also test positive for COVID-19, as COVID deaths is just plain unfounded, experts said.
“I can’t imagine a scenario where a medical examiner would test someone for COVID who died in a motor vehicle accident or a homicide,” said Engel, at the epidemiologists council. “I think that’s been greatly exaggerated on the internet.”
Excess Deaths
An additional approach to determining the pandemic’s scope has emerged, and many experts increasingly point to this measure as a useful indicator.
It relies on a concept known as “excess deaths,” which involves comparing the total number of deaths from all causes in a given period with the same period in previous years.
A CDC study estimated that almost 300,000 more people died in the U.S. this year from late January through Oct. 3 than in previous years. Some of those excess deaths were no doubt COVID cases, while others may have been people who avoided medical care because of the pandemic and then died from another cause.
These excess deaths are “the best evidence” that undercounting is ongoing, said Dr. Jeremy Faust, an ER doctor at Brigham and Women’s Hospital in Boston. “The timing of the excess deaths exactly parallels the COVID deaths, so when COVID deaths spike, all causes of deaths spike. They are hugging each other like parallel train tracks on a graph.”
Faust believes the majority of the excess deaths should be attributed in some way to COVID-19.
Even so, it’s unclear if we’ll ever get an accurate count.
Aiken said it is possible but could take years. “I think eventually, when this is said and done, we’ll have a pretty good count,” she said.
McCormick, of George Washington University, isn’t as sure, mostly because the number has become a flashpoint.
“It will always be a controversy, especially because it’s going to be so politically charged,” she said. “I don’t think we’ll come to a final number.”
Victoria Knight and Julie Appleby are Kaiser Health News reporters.
Victoria Knight: vknight@kff.org, @victoriaregisk
Julie Appleby: jappleby@kff.org, @Julie_Appleby