A4 eZ sU THE WASHINGTON POST.FRIDAy, MARCH 27 , 2020
the coronavirus pandemic
any presence of underlying health
conditions and the h ospital where
they were treated. That report
may include a note that the death
is part of a cluster, such as at the
Life Care Center nursing home in
Kirkland.
“of the 87 deaths reported, 37
are confirmed to be associated
with Life Care,” King County re-
ported on its site o n monday.
Some states, such as florida
and Colorado, offer detailed state-
wide data, while others, such as
California, release almost no de-
mographic details and defer to
counties.
The inconsistency in reporting
is particularly stark in New York.
State health officials there have
been taciturn about death statis-
tics, usually leaving it to Gov. An-
drew m. Cuomo (D) to announce
the running toll at his daily brief-
ings. In New York City, the health
department has started releasingreports every day summarizing
deaths by age group, gender, bor-
ough and preexisting medical
problem.
Within them are numbers that
raise red flags: data that shows
that at least 96 percent of those
who died as of Thursday had un-
derlying conditions and that 77
New Yorkers who d ied were under
64.
Still more deaths are not being
counted at all, such as those who
were misdiagnosed with the f lu or
another illness and those who
died but were never tested, high-
lighting another key gap in mor-
tality information.
one epidemiologist who left
New York state’s health depart-
ment late last year said former
colleagues have reached out to
him recently, desperate to develop
tools that would make it easier to
track t he disease as it s preads.
“ They not only lacked the abili-ty to perform any type of model-
ing, forecasting or time series but
could not even provide or perform
basic epidemiologic analysis due
to lack o f access to data,” t he epide-
miologist said, speaking on the
condition o f anonymity to candid-
ly discuss operations within his
field.
ordinarily, experts say, t he pub-
lic could rest a ssured that t he CDC
is at least compiling detailed, na-
tionwide data on the deaths and
cases t o analyze internally.
When a disease is categorized
as “immediately notifiable, ex-
tremely urgent,” a s covid-19 is, offi-
cials are required to call and n otify
the CDC within hours of identify-
ing a case.
“ That m eans probable, suspect-
ed and then confirmed” cases of
covid-19 — as well as deaths, said
Charles Branas, the chair of the
epidemiology department at Co-
lumbia University’s mailmanCHrIs o'meArA/AssoCIATed PressABOVe: Medical workers are seen inside a tent before the start of coronavirus testing Wednesday in tampa. BeLOW: A motivational sign hangs tuesday in the window of a restaurant in detroit.
sArAH l. VoIsIN/THe WAsHINgToN PosT
Chef Floyd Cardoz, 59, left, and tony-winning playwright
terrence McNally, 81, above, are among the more than 1,
CHArles syKes/INVIsIoN/AssoCIATed Press people who have died of the novel coronavirus in the United states.their 40s or younger, but many
more in that age group have been
sick enough to be hospitalized. of
those victims whose gender is
known, nearly 60 percent were
men.
What remains murky is exactly
who is dying in America during
the pandemic, even as scientists
and public health experts race to
uncover information t hat can help
save l ives.
o verwhelmed state and local
authorities have been issuing
widely varying reports on those
who died, citing medical privacy
laws to shield even basic details
about age, gender and underlying
conditions, the three signal cate-
gories that e pidemiologists say are
key indicators of risk.
The Centers f or Disease Control
and Prevention, which offers a
well-regarded and o ft-cited p ublic
weekly tracker for the annual in-
fluenza season, offers no similar
real-time surveillance for the nov-
el coronavirus. The analysis the
agency does provide relies on spot-
ty reporting by the states strug-
gling to serve a surge of sick peo-
ple.
There are some among the
1,000 deaths who publicly have a
name, an age, a place of death and
a life story: the playwright Te r-
rence mcNally, the rabbi romi
Cohn, the principal Dezann ro-
main. They appear in local media
accounts: S undee rutter, a mother
of six and breast cancer survivor in
Washington state; Alvin Sim-
mons, a father of two and hospital
worker in New York; and Eliza-
beth Eugenia Wells, a grandmoth-
er who sang in her church choir in
Georgia.
But many others surface only
elliptically, in tweets and face-
book posts.
“ To day, one of my friends died,
presumably of complications re-
lated to coronavirus,” a woman in
ohio posted in a tearful facebook
video message monday. “She was
my age. She had a husband, a
daughter who is, like, 3. She was
immunocompromised. She had
some long-standing health prob-
lems. She wasn’t, like, infirm. She
was y oung and happy and v ibrant.
And now she’s d ead.”
And: “my uncle d ied of Covid-
today in California. He was 78
years old & had Parkinson’s Dis-
ease. Went on s ome c ruise prior to
all the warnings. Went home, got
ill, went to Er. Admitted. Lungs
failed. ICU. Kidneys failed. opted
to DNr per mD 100% mortality
rate opinion when pressed.”
What becomes public varies
widely by locality. In King County,
Wash., an early epicenter of the
U.S. outbreak, the health depart-
ment posts daily updates to its
website that include a victim’s
gender, age range, date of death,
deAtHs from A1 School of Public Health. That call
is then to be f ollowed, within a day,
with the submission of an elec-
tronic form, Branas said.
But s tate h ealth departments —
including, critically, New York’s —
are short-staffed and so deluged
by the pandemic that they have
not b een filling o ut t he f orms with
the basic information the CDC re-
quires to perform an analysis,
CDC officials say.
The New York State Depart-
ment of Health even recently s olic-
ited volunteer help from l ocal p ub-
lic-health graduate students, ac-
cording to an email shared with
The Post.
The first known deaths from
the novel coronavirus were an
8 6-year-old w oman and a 54-year-
old m an in King C ounty o n feb. 26.
T wo weeks later, the toll had
reached 50. four d ays after t hat, i t
topped 100. Then, 48 hours later, it
had d oubled.
Since march 21, t he toll has
increased by between 90 and 193
deaths per day, a nd on Wednesday,
agencies reported nearly 250 f atal-
ities, the most so far in the United
States i n a single d ay.
“We are at the beginning of the
wave in most places in the United
States,” said Nahid Bhadelia, an
infectious-diseases physician and
medical director of the special
pathogens unit at Boston Univer-
sity School of medicine. “The
worst i s probably y et t o come.”
The United States now has the
sixth-highest death toll in the
world, behind Italy, Spain, China,
Iran and france. In Italy, where
more than a third of the world’s
virus-related deaths have oc-
curred, 21 days passed from the
first death to the 1,000th, record-
ed on march 13. from there, I taly’s
toll has climbed faster. Last week-
end, it recorded 793 fatalities in a
single day, the deadliest day of the
outbreak anywhere.
Leaders and health experts in
the United States have pointed to
Italy as an example of what could
happen as the American health-
care system becomes over-
whelmed and under-resourced.
most victims had underlying
medical conditions, hindering
their immune systems’ responses
to covid-19’s assault on their cells.
In New York City, which had re-
ported 280 deaths as of Wednes-
day evening, more than anywhere
else in the country, 96 percent of
people had a preexisting illness,
such as asthma, diabetes, l ung d is-
ease or cancer.
Y et the virus can also strike
down those who were otherwise
healthy.
James C arriere, a prominent a t-
torney and 10th-generation Loui-
sianian, was one of those people.
The 80-year-old w as healthy, e xer-
cising regularly and enjoying fam-
ily dinners in classic New orleans
haunts when he fell ill.
He w as admitted to the h ospital
and died in quarantine about a
week later.
His son, olivier Carriere, said
goodbye t o him on faceTime.
“He enjoyed life; he was always
doing something. Then, all of a
sudden —” he said. “We’re all in
shock.”
Epidemiologists caution
against becoming alarmed by the
deaths of older people with no
known underlying conditions, or
by the s tory of a 3 5-year-old, s eem-
ingly in the prime of life, who
succumbs to the d isease.
“But the comparable data that
you s hould have i s: What about a ll
the 35-year-olds who didn’t die?”
Branas said. “Without that, these
cases are merely anecdotal.”
“Some people have so many
preexisting conditions that they
are so deeply at risk that when
they get the disease, it is very
difficult to prevent their death,”
Branas added. “That’s why you
don’t w ant to rely solely on mortal-
ity data.”
To understand the likely trajec-
tory of a disease, and who is most
vulnerable, scientists need to be
able to examine complete data on
who survived, in addition to who
died of t he disease.
The Post’s d ata on the first 1,
fatalities reveals trends that have
emerged in studies from other
countries that have been battling
the outbreak far longer. There’s a
silver lining to this, Bhadelia said:
If the disease were exacting a
worse toll in the United States
than in countries already ravaged
— i f it also killed y oung people at a
high rate — that would have been
borne out i n these numbers. So far,
that has not been t he c ase.
Dense urban centers, many of
them in coastal states, have been
hit h ardest i n the first two months
of the outbreak, but it’s only a
matter of time before the corona-
virus takes hold in rural areas, too.
In some places, such as Albany,
Ga., where a t least 1 6 had died as o f
Thursday, it’s already happening.
When it arrives elsewhere, i t could
have a crippling effect, especially
in places where resources and
health-care workers are a lready in
short supply.
“It might take longer for covid-
19 to make it into the rural com-
munities, and they might not get
as many cases there,” Bhadelia
said, “but the worrisome thing is,
it might not take as many cases to
overwhelm the health-care sys-
tem i n these areas.”
or, as Cuomo put it earlier this
week, warning that his state is the
canary in the coal mine: “We are
your future.”
[email protected]
[email protected]
[email protected]lena H. sun, Jennifer Jenkins and
Julie Tate contributed to this report.Epidemiologists lack critical data as states struggle to report details of deaths
seTH HerAld/AgeNCe FrANCe-Presse/geTTy ImAges