The Washington Post tracks every known American death, analyzes health data and collects information from victims’ families and friends. During the first 1,000 deaths, certain patterns have begun to emerge in the epidemiology of the outbreak and its painful human impact. About 65 percent of people whose ages are known were older than 70 and almost 40 percent were over 80, a risk that increases with age. About 5 per cent whose ages are known were aged 40 or younger, but many more in that age group have been ill enough to be admitted to hospitals. Almost 60 per cent of the victims whose gender is known were men.
What remains silly is exactly who dies in America during the pandemic, even when scientists and public health experts are competing to reveal information that can help save lives.
Overwhelmed state and local authorities have issued very different reports of those who died, citing medical integrity laws to protect even basic details of age, gender and underlying conditions, the three signal categories that epidemiologists say are important risk indicators.
The Centers for Disease Control and Prevention, which offers a reputable and often cited public weekly tracker for the annual flu season, offers no similar real-time monitoring for the new coronavirus. And that analysis is based on spotty reporting from states struggling to serve a wave of sick people.
There are some among the 1,000 deaths that have a public name, age, place of death and life history: playwright Terrence McNally, rabbi Romi Cohn, rector Dezann Romain. They appear in local media accounts: Sundee Rutter, a mother of six and breast cancer survivor in the state of Washington; Alvin Simmons, father of two and hospital workers in New York; and Elizabeth Eugenia Wells, a grandmother who sang in her church choir in Georgia.
But many surfaces are just elliptical, in tweets and Facebook posts.
“Today, one of my friends died, probably from complications related to coronavirus,” a Ohio woman wrote in a tearful Facebook video message on Monday. “She was my age. She had a husband, a daughter who is like 3. She was immunocompromised. She had some long-standing health problems. She wasn’t, like, sick. She was young and happy and lively. And now she’s dead. “
And: “My uncle died of Covid-19 today in California. He was 78 years old and had Parkinson’s disease. Went on a little cruise before all the warnings. Went home, got sick, went to ER. Adopted. The lungs failed. ICU. The kidneys failed. Selected DNR per MD 100% mortality evaluation when pressed. “
What becomes public varies greatly depending on the locality. In King County, Wash., An early epicenter of the U.S. outbreak, the Department of Health publishes daily updates on its Web site that include a victim of gender, age range, date of death, possible occurrence of underlying health conditions, and the hospital where they were treated. That report may include a note that the death is part of a cluster, for example, at the Life Care Center in Kirkland.
“Of the 87 reported deaths, 37 are confirmed to be associated with Life Care,” King County reported on its website on Monday.
Some states, such as Florida and Colorado, provide detailed information across the country, while others, like California, release almost no demographic details and push up to the counties.
Inconsistency with reporting is particularly great in New York. State health officials there have been silent about the death statistics, which usually leave it to statesman Andrew M. Cuomo (D) to announce the ongoing toll at his daily briefings. In New York, the health department has started releasing reports every day that summarize deaths by age group, gender, neighborhood, and previously existing medical problem.
Inside them are numbers that raise red flags: data showing at least 96 percent of those who died on Wednesday had underlying conditions, and that 72 New Yorkers who died were under 64.
No more deaths are counted at all, such as those misdiagnosed with influenza or another illness and those who died but never tested, which highlights another important gap in mortality information.
An epidemiologist who left New York’s health department late last year said former colleagues have reached him recently, desperate to develop tools that would make it easier to track the disease as it spreads and kills.
“They not only lacked the ability to perform any type of modeling, forecasting or time series, but could not even provide or perform basic epidemiological analysis due to lack of data access,” said the epidemiologist, speaking on anonymity to honestly discuss activities within his area.
Usually, experts say, the public can be confident that at least the CDC compiles detailed, nationwide death and case data to analyze internally.
When a disease is categorized as “immediately notified extremely urgent”, such as covid-19, officials must call and notify the CDC within hours of identifying a case.
“It means probable, suspect and then confirmed” cases of covid-19 – as well as deaths, said Charles Branas, chair of the epidemiological department at Columbia University’s Mailman School of Public Health. That call should then be followed within a day of submitting an electronic form, Branas said.
But state health departments – including, critically, New York – are short-staffed and so removed from the pandemic that they have not filled out the forms with the basic information that CDC requires to perform an analysis, CDC officials say.
The New York State Department of Health even recently requested volunteer help from local public health research students, according to an email with The Washington Post.
The first known deaths from the novel coronavirus were an 86-year-old woman and a 54-year-old man in King County on February 26.
Two weeks later, tolls had reached 50. Four days later, it peaked at 100. Then, 48 hours later, it had doubled.
Since March 21, tolls have increased by between 90 and 193 deaths per day, and on Wednesday the agencies reported nearly 250 fatalities, the most so far in the United States in a single day.
“We are at the beginning of the wave in most places in the United States,” said Nahid Bhadelia, an infectious disease physician and medical director for the special pathogen unit at Boston University School of Medicine. “The worst is probably not yet come.”
The United States now has the world’s sixth highest deaths, behind Italy, Spain, China, Iran and France. In Italy, where more than a third of the world’s virus-related deaths have occurred, 21 days went from the first death to the 1000th, registered on March 13. From there, Italy’s toll has risen faster. Last weekend, 793 deaths were recorded 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 can happen when US healthcare becomes overwhelmed and under resources.
Most of the victims had underlying medical conditions, which prevented their immune systems from responding to covid-19’s attack on their cells. In New York City, which has reported 280 deaths, more than anywhere else in the country, 96 percent of people had a pre-existing illness, such as asthma, diabetes, lung disease or cancer.
Nevertheless, the virus can also kill those who were otherwise healthy.
James Carriere, a prominent local lawyer and 10th-generation Louisian, was one of those people. The 80-year-old was healthy, exercising regularly and enjoying family dinners in classic New Orleans homes when he fell ill.
He was taken to hospital and quarantined about a week later.
His son, Olivier Carriere, said goodbye to him at FaceTime.
“He liked life, he always did something. Then suddenly – he said. “We’re all in shock.”
Epidemiologists warn of being worried about the death of elderly people without a known underlying condition, or by the story of a 35-year-old, apparently in the prime side of life, who is behind for the disease.
“But the comparable information you should have is: How about all 35-year-olds who didn’t die?” Sa Branas. “Without it, these cases are just anecdotal.”
“Some people have so many pre-existing 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 want to rely solely on mortality data.”
To understand the probable path of a disease and who is most vulnerable, researchers must be able to examine complete data on who survived, in addition to who died of the disease.
The Post’s data on the first 1,000 deaths show trends that have already emerged in studies from other countries that have been fighting the outbreak for much longer. There is a silver lining to this, Bhadelia said: If the disease required a worse toll in the United States than in countries that have already ravaged – if it also killed young people at a high rate – it would have been confirmed in those numbers. So far this has not been the case.
Dense urban centers, many of them in coastal states, have been hit hardest during the first two months of the outbreak, but it is only a matter of time before the corona virus also takes hold in the countryside. In some places, like Albany, Ga., Where at least 12 have died, things are already happening. When it arrives elsewhere, it can have a devastating effect, especially in places where resources and care workers are already deficient.
“It may take longer for Covid-19 to enter rural communities, and they may not get as many cases there,” Bhadelia said, “but the worrying thing is that it may not take so many cases to overwhelm health care systems in these areas. “
Or, as Cuomo put it earlier this week, warns 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.