Why CDC isn't able to find an answer to 400-500 daily Covid deaths in US?

Who are the 400-500 people in the US who are still dying from this disease each day and what could be done to prevent these deaths?

Earlier this week, President Joe Biden seemed to commit one of his trademark gaffes by saying “The pandemic is over.” The backlash was swift. That’s understandable, given that hundreds of people are still dying from Covid every day. But President Biden may be doing what comes naturally to many of us — judging the situation by our own experiences.
 

To truly understand where we are in the Covid pandemic, we need to be able to answer an essential question: Who are the 400-500 people who are still dying from this disease each day and what could be done to prevent these deaths? It’s a surprisingly difficult question to answer.

Eric Topol, director of the Scripps Research Translational Institute in La Jolla, California, asked people not to be “numb” to these numbers on his popular Twitter feed, and people responded by asking the same questions I’ve been posing to experts for weeks. Who is dying in late 2022? Is it nursing home residents? Anti-vaxxers? Essential workers? How many of them have had the vaccine? Boosters? Did we fail them, or did they fail to take care of themselves?

When I asked the CDC for relevant statistics, they sent me a widely circulated graph which showed the rates of death were much lower for vaccinated people. But without raw numbers on these deaths, it’s still hard to know why the death toll has plateaued at such a high level.

In the same interview in which Biden remarked that the pandemic was over, the president also said that people seemed to be “in pretty good shape.” That’s a common perception, because most people who get Covid do recover and go on with life.

Michael Osterholm, who is director of the Center for Infectious Disease Research and Policy at the University of Minnesota, acknowledged as much on a recent episode of his podcast. Most people are not at high risk of death from Covid, he said, “and yet people are dying … What is it that makes people vulnerable to serious illness? Who is it that’s ending up in our ICUs? We don’t know. Our public health information systems are not providing us that kind of data.”

There is at least some data suggesting that more boosters among the elderly would help. There’s strong evidence that a first booster makes a big difference, and that the risk of death is much higher for those over 65. And yet, Osterholm said, only 70% of Americans over 65 have had their first booster. (Only 26% have had a second booster.) 

Topol has also shared concerns about our lack of information. Not only do we lack detailed information on how many (if any) vaccine shots they’ve had, we also lack data on what treatments they received. “Did they get Paxlovid? Did they get bebtelovimab?” he  asked in the Los Angeles Times. (Bebtelovimab is a monoclonal antibody treatment.)

Even if vaccines vastly reduce risk, it doesn’t follow that anti-vaxxers are the root of the problem. It’s easily possible for vaccines to be very protective but still see the majority of deaths among the fully vaccinated, simply because younger unvaccinated people face less risk than fully vaccinated seniors.

One reason clear data aren’t available is that the US doesn’t collect that information in a uniform way, said Stephen Kissler, an infectious disease researcher at the Harvard School of Public Health.  “A lot of public health happens at city level or lower so, because of that, it’s really hard to combine data across states to assess who is ending up in the hospital or dying of Covid-19,” he said. “The mix is hard to standardize.”

Another challenge has to do with the complex immunological landscape, he said. It’s not just a matter of how many boosters people have that determines their level of protection, but when they’ve gotten them. Add to that the fact that the most vulnerable people are more likely to get vaccinated.

There’s another deceptive factor that can make it look like everyone is in pretty good shape, said Andrew Noymer, a demographer and associate professor of public health at the University of California, Irvine. The infection fatality rate, a number many were obsessed with finding early in the pandemic, is probably now close to that of flu. But the disease is killing a lot more people than flu because so many people are getting Covid. It’s common for people to get Covid several times a year, whereas people tend to get flu — at most — several times a decade.

Even those public health experts who are furious with Biden for his remarks have had to concede they were wrong in claiming that we’d “crush” the pandemic if only enough people followed the rules, stayed locked down, or masked up for 100 days. “When this first arrived, we thought this would be a nightmare for six months and it would go away because we’d all have immunity,” said Noymer. “That hasn’t panned out.”

What Americans need is not to keep hearing the word “pandemic” but to get some clarity about what we should be doing. What do we owe our fellow citizens? What should we demand from our government? We don’t all share the same values, but we should at least have the chance to argue over the same data.