18 April 2020

Lies, Damned Lies, And COVID-19 (CCPVirus) Deaths

"There are lies, damned lies and statistics."

Earlier, I noted that the real world data on the COVID-19 pandemic diverged from the "experts" projections in several key respects.  As I said at the time, "we're missing cases."

It turns out that not only are we missing cases, we are missing quite a few deaths as well.

The Media View Of The CCPVirus: Carnage

Nearly every part of the media, both legacy and alternative, portray the COVID-19 pandemic (aka, "CCPVirus"--which I maintain is the better label as it accurately reminds people of the authors of this contagion, the Chinese Communist Party).

Jack Posobiec of One America News tweeted out just recently that "37,000" were lost to CCPVirus:

ABC News, as of this writing, reports 37,625 deaths in the United States.

The media site BNO News, as of this writing, reports 37,432 deaths in the United States from CCPVirus.

To even the most jaded of observers, this look like a lot of death.

The CDC View Of The CCPVirus: Maybe Not So Bad

As of April 17, the CDC reported deaths from CCPVirus (COVID-19) as being 13,130 through the week ending April 11.

For comparison, the BNO News reported death toll on April 10 was 18,650.

Why is the BNO tally overstating CCPVirus deaths by some 42%? This is no mere rounding error, nor is it a discrepancy in timeliness of reporting. There is variance among the CCPVirus tracking sites--BNO News, Worldometer, and Johns Hopkins are the more commonly referenced "real time" tracking sites for CCPVirus--but they all are fairly close to one another. Their variations are largely a product of when each site gets updated.

The media sites are reporting at least 5,000 more deaths than the CDC. Either the media is grossly misstating the numbers, or the CDC is grossly misstating the numbers. It is not logically possible for both report sets to be accurate.

Unpacking The Data: It Only Gets Worse

The contradictions multiply the more we interrogate the CDC statistics.
  • On April 10, the CDC tally was 4,984 deaths. BNO News reported 18,650 deaths. Worldometer reported 18,725 deaths.
  • On April 3, the CDC reported 1,150 deaths, BNO reported 7,335 deaths, and Worldometer reported 6,780 deaths. 
When we dig into the CDC numbers to divine the cause of these discrepancies, comparisons of the archival numbers reveal substantial subsequent rewrites of the data set.
  • On April 5, the CDC report for the week of 3/14 was 41, for the week of 3/21 was 300, and for the week of 3/28 was 788.
  • On April 7, the CDC report for those weeks was revised to 42, 337,  and 1,072, respectively. The week of 4/4 was added at 415.
  • On April 8, the CDC report for these weeks was again revised to 43, 385, 1,406, and 1,450, respectively.
  • On April 10, the CDC report for these weeks was again revised to 45, 415, 1,764, and 1,818, respectively.
  • On April 11, the CDC report for these weeks was again revised to 45, 423, 1,891 and 2,602, respectively.
  • On April 13, the CDC report for these weeks was again revised to 44, 435, 2,034, and 3,240. The week of 4/11 was added at 1,153.
  • By April 14, the CDC report for these weeks had been revised to 44, 442, 2,117, 3,819, and 1,813, respectively.
  • By  April 18, the CDC report for these weeks had been revised to 44, 454, 2,339, 5,457, and 4,811, respectively.
To be sure, the CDC does include a caveat that this data is provisional, and that there is significant data lag:
The provisional counts for coronavirus disease (COVID-19) deaths are based on a current flow of mortality data in the National Vital Statistics System. National provisional counts include deaths occurring within the 50 states and the District of Columbia that have been received and coded as of the date specified. It is important to note that it can take several weeks for death records to be submitted to National Center for Health Statistics (NCHS), processed, coded, and tabulated. Therefore, the data shown on this page may be incomplete, and will likely not include all deaths that occurred during a given time period, especially for the more recent time periods. Death counts for earlier weeks are continually revised and may increase or decrease as new and updated death certificate data are received from the states by NCHS. COVID-19 death counts shown here may differ from other published sources, as data currently are lagged by an average of 1–2 weeks. 
However, as of this writing, the "lag" on some data is considerably longer than 1-2 weeks. The CDC is still "revising" data from nearly a month ago. Either someone in the CDC is quite literally constantly revisiting each and every case report received from the states, and recalibrating what is and is not a CCPVirus death, or people in the individual states are doing that.

This constant revision of data--particularly when one revision is downward--is not a "lag" of data, but an editing of data. Either the CDC or the agencies reporting this data to the CDC are manipulating the results.

Update: We must also note the CDC's April 2 claim to process 80% of mortality data "within minutes." As the above timeline of revisions demonstrates, either that is blatantly false or the state reporting systems are deeply and structurally flawed (or both--the two are not mutually exclusive).

Almost all states have electronic death registration systems that enable rapid transmission of death certificate data to NCHS, which processes up to 80% of the death data it receives within minutes. However, because it can take up to several weeks for death records to be submitted as well as processed, coded, and tabulated, data are lagged by an average of 1-2 weeks. 
Update: We must further note the reporting impact of multiple shifts in reporting criteria. The CDC's numerous revisions to reporting directives to the states led the site Worldometer to supply this news item as an explanatory text to their reported US death tolls (numbers which should be simple and straightforward, requiring no additional clarification).
Since every probable death necessarily implies a probable case, logic mandates that the adjustment be made to both deaths and cases, and not only to deaths. We have adjusted for New York State and the United States accordingly.
The CDC's reporting shifts are introducing reporting error even into the publicly available "news" sites and their data. 

The passage of a week has not improved the reporting discrepancies. The CDC official death toll through April 18 is 24,555.

BNO News' reported US death toll as of April 18: 37,432.

A discrepancy of 12,837 is just a wee bit more than rounding error or "lag".

We Have Seen This Before...In China

This constant revising of data is disturbingly similar to a pattern we have seen in China's CCPVirus statistics. We know that China, regardless of the reason, has constantly shifted the goalposts on its disease reporting, and even legacy media sites such as Time and CNN express skepticism about the reported numbers. As The Washington Post observed back in March:
China’s system of limited, quantified vision focused on these indicators out of a belief that close monitoring would generate effort and good results. Decades of rapid economic growth testify to the system’s success — but also gave officials incentives to misrepresent the truth and falsify statistics or look to achieve them through wasteful means.
In other words, when the focus on a particular metric borders on the obsessive, people involved in either the underlying data or its measurement frequently have significant reasons to slant and misrepresent the data, if not outright lie about it. Without speculating as to motives by anyone, we must acknowledge the current media obsession with the case counts and death toll for CCPVirus creates similar perverse incentives to misreport the data.

Moreover, as Helen Raleigh writing in The Federalist observed last month, massaged and "revised" numbers are a foundational component of any good disinformation campaign, and China has been mounting an aggressive disinformation campaign to conceal its culpability in the genesis of the CCPVirus and the global pandemic that has ensued.

Are we being disinformed by the CDC? Potentially, yes.

Misinformation Or Disinformation? Or Both?

While it is imperative to always follow the real-world data simply to keep one's understanding of a phenomenon grounded, we must always accept one basic aspect of data: it's wrong. Even if the measurements themselves are perfectly accurate (and no measurement is ever perfect), the data itself is always going to be either outdated, incomplete, or (more likely) both.

We run into this challenge most directly when attempting to grapple with that most abused of disease statistics, the mortality rate. As many commentators point out, with most infectious disease there is going to be a population of infections that go completely undetected. If one were to add the undetected cases of CCPVirus to the confirmed cases, the result is a denominator in the fatality rate calculation considerably larger than before, with a resulting fatality rate that is considerably less.

This is a known phenomenon. During the SARS outbreak in 2002-2003, many countries reported wildly differing fatality rates, that rose and fell as cases were reported. Hong Kong reported fatality rates as high as 71% at first, which later dropped to 17%. Canada's fatality rate for SARS rose to 38.5% before receding. Taiwan's rate spiked to 45% before retreating to around 15%.

This trend towards equilibrium is typical of all disease outbreaks: the greatest mortality fluctuations occur early on when the number of total cases is relatively small. As the case count rises, thus increasing the denominator in the mortality ratio, the rate itself declines. Consequently, we are always well advised to avoid reading too much into a mortality rate at any one point in time during an outbreak. The one certainty about the number is that it is going to shift.

However, what we see in the CDC data is something altogether different.  These are not new cases trickling in, nor is it credible to even speculate these are newly discovered deaths. For one thing, if the data can be reported to the media in near realtime fashion, why can it not be reported to and updated by the CDC in similar fashion? It beggars belief to suggest that weeks-long delays in data processing by the CDC is any sort of information-handling norm.

Moreover, we must also grapple with a seeming directive by the CDC to overstate CCPVirus deaths. On March 24, the CDC's National Vital Statistics System issued a new ICD code for reporting CCPVirus deaths. This directive took immediate effect and was expected to result in CCPVirus being reported more often than not as the underlying cause of death:
Will COVID-19 be the underlying cause?
The underlying cause depends upon what and where conditions are reported on the death certificate. However, the rules for coding and selection of the underlying cause of death are expected to result in COVID19 being the underlying cause more often than not. 
The directive further establishes a "default" cause of death of CCPVirus.
Should "COVID-19" be reported on the death certificate only with a confirmed test?
COVID-19 should be reported on the death certificate for all decedents where the disease caused or is assumed to have caused or contributed to death. Certifiers should include as much detail as possible based on their knowledge of the case, medical records, laboratory testing, etc. If the decedent had other chronic conditions such as COPD or asthma that may have also contributed, these conditions can be reported in Part II. (See attached Guidance for Certifying COVID-19 Deaths)
Note the use of the word "assumed".  Elsewhere in the directive it points out that the CDC expects data to be updated where CCPVirus testing is pending. This is a not implausible expectation that where post-mortem data is delayed, it gets incorporated when the data becomes available.

The issue is not that some data lags. The issue is that the reporting effect of that lag is not given proper treatment within the presentation itself. Merely stating in the April 2 addendum to the reporting directive that some data lags while claiming to process 80% of data "within minutes" gives no indication as to the magnitude of any lag nor any other means by which to gauge such reporting error.

Here we have a problem: The CDC table does not indicate what deaths are "pending" as to cause. It is one thing if data is simply slow to be obtained because of testing bottlenecks. While this is frustrating, it is hardly uncommon. However, those "pending" cases are to be reported to the CDC as "pending" according to the March 24 directive. Either those numbers are not being reported or those numbers are being inaccurately reported elsewhere. There is not a third option available. 

Why are those pending numbers not being clearly reflected in the publicly available statistics? Moving a case from a "pending" to a "confirmed" column in the statistical tables would be a reasonable ongoing modification of historical data and would allow for consistent treatment of the data over time.

We are not given a "pending" column. Rather, we are simply given the totals "as is". If we go by the April 17 tally, we must conclude the CDC is stating there are 13,130 deaths from the CCPVirus as of April 11, or a mere 60% of the media's total. On its face, the CDC data is not merely wrong, but is demonstrably false--or the media's data is. Further, we have direct evidence of deliberate distortion, since the directive calls for all deaths where CCPVirus is detected are to be recorded as CCPVirus deaths, and the implication is that any deaths no so recorded should be revised to conform.

Whether this amounts to disinformation requires a certainty as to motive, and the March 24 directive does not provide that certainty. However, if this is not disinformation, it is at the very least misinformation, as the data can be shown as materially at odds with established reality.

Reality Matters

This is no small concern. One reason we have the terms "underlying conditions" and "co-morbidities" is to grapple with the fact that while a particular illness or mishap might bring about a person's demise, very often that death is facilitated by the person's overall health, or lack thereof. This point was emphasized in a speech by Dr. Ann Bukacek recently that was picked up by a couple of alt-media outlets.
Among the points made by Dr. Bukacek, she said that even if you are tested positive for COVID-19, "that doesn’t mean you have the disease." She claims, "Someone who dies with the disease is not the same as someone who dies from the disease." If the network news dispensers have ever made that critically important point, I expect I’m not alone in having missed it.
The CDC is, in other words, blurring the distinction between testing positive for the virus and actually being sick, between dying while carrying the virus and actually dying from the disease. Given the CDC's lengthy history in reporting and developing data on infectious disease, it again beggars belief they are unable to address this highly essential context to the case data or unaware of its importance. 

Given the CDC's track record within this pandemic of inexcusable communications glitches and faux pas, this is yet another epic fail on their part.

Instead of addressing the missing context, the overall response has been to ignore it and, when challenged, to deny it. When questioned on this point by NBC in an April 9 interview, Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, simply said the mis-reporting/overreporting claim was not true, without offering any substantive defense of the CDC statistics.
"There is absolutely no evidence that that’s the case at all," Fauci told NBC on Thursday. "I think it falls under the category of something that’s very unfortunate – these conspiracy theories that we hear about. Any time we have a crisis of any sort there is always this popping up of conspiracy theories."
The reporting on this interview in the Guardian went on to observe, without any context or caveat, that the official CDC death toll that day stood at 12,574:
According to the official Centers for Disease Control (CDC) count, by the end of Wednesday there had been 12,754 deaths in the US due to the Covid-19 virus, from a total of 395,011 people who have been confirmed as infected.
Remember, the BNO News reported death toll on April 10 was 18,650. The BNO number for April 9 was 16,527.

16,527 deaths is hardly the same as 12,574 deaths. Either 16,527 deaths in the US were due to CCPVirus by April 9 or 12,574 deaths were due to CCPVirus. Both numbers cannot be true, and if we are forced to question the one we must necessarily question the other. We must challenge both numbers, for while it is impossible for both numbers to be true, it is exceedingly possible--and even probable--for both numbers to be false.

Challenging these discrepancies it not a "conspiracy theory". Rather it is the essential first step of any logically sound data analysis. If there is not a thorough understanding of the data collection methods and protocols, there can be no proper assessment of potential measurement error. We might know the data to be "wrong" as a matter of principle, but we cannot develop any insight into the magnitude or direction of the error.

In order to have a proper understanding of the severity of this disease, we need to know what the real-world deaths are from the virus. Reality matters in such understandings; projections, predictions, and models do not. Pursuing this understanding is never a "conspiracy theory," no matter who attempts such condescension.

Errors Abound

It would be a mistake to presume that the only sources of reporting error lie with the CDC. For all their byzantine bureaucy and data management mistakes, we must acknowledge that data comes to them already tainted by myriad arcane and frequently inept cause of death reporting systems within the states themselves. As many as one in three death certificates have an incorrect or incomplete cause of death listed.
Up to 1 in 3 death certificates nationwide were wrong before COVID-19, Bob Anderson, chief of the mortality statistics branch at the National Center for Health Statistics, said in an interview with the USA TODAY Network.
This immediately presents yet another contradiction. If deaths are reported electronically to the CDC, and they are able to process the reports "within minutes", how is it that death certificates themselves are demonstrably unreliable? Moreover, if one third of death certificates are wrong, what does that say about the data presented to the media?

The reasons for the errors range from uneven standards on who completes a death certificate and levels of medical expertise to simple disinterest on the part of attending physicians, many of whom view the death certificate as one more piece of paperwork drudgery.

Amazingly, the CDC has known about this problem for at least a decade.
A review of Missouri hospitals in 2017, for example, found nearly half of death certificates listed an incorrect cause of death. A Vermont study found 51% of death certificates had major errors. Nearly half of the physicians the Centers for Disease Control and Prevention surveyed in 2010 admitted that they knowingly reported an inaccurate cause of death.
If the CDC has made any effort to help states improve their reporting systems they have hidden it extremely well. Nationwide longstanding shortages of forensic pathologists have been well known throughout the government, with the Department of Justice estimating at least another 700 pathologists nationwide were needed before the pandemic. Pandemic caseloads are not helping reporting accuracy.

This makes federal directives to simply assume CCPVirus as the cause of death in many cases appear even more odd and questionable. Despite knowing full well the challenges in obtaining reliable death data from the states, the response of the CDC is simply to whitewash the problem, rewarding the lack of quality reporting with the easy out of simply recording any death where respiratory symptoms were present as a CCPVirus death, with or without actual laboratory testing and with no regard for the presence of any underlying conditions which might have been influential.

Instead of addressing the very real and probable errors in the death tallies being reported by the states, the CDC is merely pretending those errors do not exist.

Instead of highlighting the myriad of reporting defects across virtually every state, the legacy media merely accepts the data given uncritically.

This is poor data management and an abysmal lack of journalistic integrity. With no one addressing known reporting errors or confronting real sources of inaccuracy, we quite literally do not know how many people have actually died from the CCPVirus, or indeed from any other cause of death. The numbers could be significantly higher, but they could just as easily be very much lower. We have no way to tell, and no way to know.

Comorbidities Matter

Perhaps no revelation has had greater impact than the acknowledgement by the CDC that only 6% of recorded CCPVirus deaths had no comorbidity or complicating condition.
Table 3 shows the types of health conditions and contributing causes mentioned in conjunction with deaths involving coronavirus disease 2019 (COVID-19). For 6% of the deaths, COVID-19 was the only cause mentioned. For deaths with conditions or causes in addition to COVID-19, on average, there were 2.6 additional conditions or causes per death.
In 94% of all CCPVirus deaths, the patients suffered from, on average, 2.6 additional conditions.

As of August 26, 2020, some 153,504 deaths were attributed to CCPVirus. Applying these percentages works out to only approximately 9210 deaths being solely attributable to CCPVirus, with the remainder being the result of complications due to diabetes, heart disease, dementia, or other comorbidity.

Given the millions of people in the United States who have tested positive for the virus, for only 9,210 to have died from just the virus itself greatly alters the perception of the virus' lethality, and the risks for various patient demographics of perishing from the disease.

It is now intuitively obvious that the "experts" have not been giving us the complete picture on CCPVirus mentality.

Stupidity? Or Malice?

Whether we are focused on the "experts" at the CDC and NIH, potentially inept state and local coroners and medical examiners, or the legacy media presuming to report on them, we are confronted with the same problem: based on their track record to date, on what basis dare we trust any of them? Without trust, on what basis can we make use of what they tell us?

As I have pointed out previously, the trust we place in experts depends on three crucial attributes: expertise, integrity, and benevolence. An expert has to know their stuff, they have to be honest, and they have at least make us think they care about our best interests.

It is not possible, as a matter of simple logic, to conclude that a person "knows their stuff" when they are constantly adjusting and manipulating prior data. It is not possible, as a matter of simple logic, to conclude that a person reporting on a topic, has a grasp of the data when they blithely ignore or are unaware of such adjustments and manipulation.

It is not possible, as a matter of simple logic, to conclude that a person is intrinsically honest when they repeatedly fail to accurately and completely present the data. It is not possible, as a matter of simple logic, to conclude that people reporting on a topic are intrinsically honest when they repeatedly overlook such misrepresentations.

It is not possible, as a matter of simple logic, that a person who lacks sufficient self-reflection to address these defects of expertise and integrity has anyone's best interest at heart except their own. It is not possible, as a matter of simple logic, that people reporting on these matters who lack the self-reflection to call attention to these defects of expertise and integrity have anyone's best interest at heart except their own.

As a matter of simple logic, we do not need to conclude that either these "experts" or the media are in any way malevolent. The truism "never assume malice when stupidity will suffice" is sound logic. The failure of expertise alone is sufficient to deny both the "experts" and the media any trust or grant of credibility. 

Do not trust the experts--they are wrong. Do not trust the media--they are inept. Be careful about trusting the data--it is inaccurate or completely erroneous. Trust rather your own ability to research, ask questions, and form conclusions.

Do not trust. Verify instead.

20 April 2020: Updated to include the CDC's April 2nd addendum to the March 24 reporting guidlines.

21 April 2020: Updated to include Worldometer's statement on the impact of the CDC's changing reporting guidelines.
25 April 2020: Updated to include the CDC's official death toll as of April 18, along with the corresponding tally from BNO News.
26 April 2020: Updated to include reporting of preexisting issues with reporting causes of deaths among state and local coroners and medical examiners.
30 August 2020: Updated to reflect CDC data showing that only 6% of CCPVirus deaths had no comorbidity or complicating condition.

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