The number of confirmed and probable deaths from COVID-19 in New York City was 23,247 as of July 10, which is more than eight times the number who died in the 9/11 attack. Angela Weiss / AFP via Getty Images

How deadly is COVID-19? A biostatistician explores the question

Ron Fricker, Virginia Tech

The latest statistics, as of July 10, show COVID-19-related deaths in U.S. are just under 1,000 per day nationally, which is down from a peak average of about 2,000 deaths per day in April. However, cases are once again rising very substantially, which is worrisome as it may indicate that substantial increases in COVID-19 deaths could follow. How do these numbers compare to deaths of other causes? Ron Fricker, statistician and disease surveillance expert from Virginia Tech, explains how to understand the magnitude of deaths from COVID-19.

A visualization of the scale of deaths caused by COVID-19 in the USA.

As a disease surveillance expert, what are some of the tools you have to understand the deaths caused by a disease?

Disease surveillance is the process by which we try to understand the incidence and prevalence of diseases across the country, often with the particular goal of looking for increases in disease incidence. The challenge is separating signal from noise, by which I mean trying to discern an increase in disease incidence (the signal) from the day-to-day fluctuations in that disease (the noise). The hope is to identify any increase as quickly as possible so that medical and public health professionals can intervene and try to mitigate the disease’s effects on the population.

A critical tool in this effort is data. Often disease data is collected and aggregated by local and state public health departments and the Centers for Disease Control and Prevention from data that is reported by doctors and medical facilities. Surveillance systems then use this data and a variety of algorithms to attempt to find a signal amidst the noise.

Early on, many people pointed out that the flu has tens of thousands of deaths a year, and so COVID-19 didn’t seem so bad. What’s wrong with that comparison?

The CDC estimates the average number of flu-related deaths since 2010-11 is around 36,000 per year. This varies from a low of 12,000 deaths in 2011-12 to a high of 61,000 deaths in 2017-18. Thus, the number of COVID-19 deaths to date is three to four times greater than the annual average number of flu-related deaths over the past decade; it is 10 times larger when compared to the 2010-11 flu season but only about twice as large compared to 2017-18.

To make this a fair comparison, note that seasonal influenza mostly occurs over a few months, usually in late fall or early winter. So, the time periods are roughly comparable, with most of the COVID-19-related deaths occurring since late March. However, COVID-19 does not appear to be seasonal, and fatalities are a lagging measure because the time from infection to death is weeks if not months in duration, so the multiples in the previous paragraph will be greater by the end of the year.

Furthermore, while death rates have been coming down from a peak of more than 2,700 on April 21, 2020, the United States is now averaging just under 1,000 deaths per day as of July 10, and given the dramatic increase in cases of late, we should expect the fatality rate to further rise. For example, the University of Washington’s IHME model currently predicts slightly more than 208,000 COVID-19-related deaths by November 1.

So, by any comparison, the COVID-19 death rate is significantly higher than the seasonal influenza death rate.

What are some comparisons that could provide some context in understanding the scale of deaths caused by COVID-19?

As of this writing, more than 130,000 people have died of COVID-19, and that total could grow to 200,000 or more by fall. Those numbers are so big, they’re hard to grasp.

Michigan Stadium in Ann Arbor is the largest football stadium in the United States. It holds 107,420 people, so no football stadium in the country is large enough to hold everyone who has died from COVID-19 thus far. By the time bowl season comes along, assuming we have a football season this year, the number of COVID-19 fatalities will likely exceed the capacity of the Rose and Cotton bowl stadiums combined.

The state of Wyoming has a population of slightly less than 600,000 people, so it’s the equivalent of one out of every five people in that state dying in the last four months. By this fall, the COVID-19 death total will be the equivalent of fully one-third of the people in Wyoming dying.

The populations of Grand Rapids, Michigan; Huntsville, Alabama; and Salt Lake City, Utah are each just over 200,000 people. Imagine if everyone in one of those cities died over the course of six months. That’s what COVID-19 may look like by fall.

How do COVID-19 deaths compare to chronic diseases like cancer or heart disease?

Today, COVID-19 ranks as the sixth leading cause of death in the United States, following heart disease, cancer, accidents, lower chronic respiratory diseases and stroke. Heart disease is the leading cause, with just over 647,000 Americans dying from it each year. Alzheimer’s disease, formerly the sixth largest cause of death, kills just over 121,000 people per year. If the University of Washington IHME model’s current prediction of COVID-19-related deaths comes to pass, COVID-19 will be the third leading cause of death in the United States by the end of the year.

The American Cancer Society estimates that in 2020 there will be an estimated 1.8 million new cancer cases diagnosed and 606,520 cancer deaths in the United States. Lung cancer is estimated to kill about 135,000 people in the US in 2020, so the number of COVID-19 deaths is currently equivalent and will exceed it soon. Of course, it is important to note that the COVID-19 deaths have occurred in about the past four months while the number of lung cancer deaths is for a year. So, COVID-19 deaths are occurring at roughly three times the rate of lung cancer deaths.

What are some historical comparisons that you think are useful in understanding the scale of deaths from COVID-19?

The 1918 influenza pandemic was similar in some ways to the current pandemic and different in other ways. One key difference is the age distribution of deaths, where COVID-19 is concentrated among older adults while the the 1918 pandemic affected all ages. In my state of Virginia, only 8% of the people who died in the 1918 pandemic were more than 50 years old, compared to more than 97% for COVID-19.

The CDC estimates that the 1918 pandemic resulted in about 675,000 deaths in the United States, so slightly more than five times the current number of COVID-19 deaths. In October of 1918, the worst month for the influenza pandemic, about 195,000 people died – well more than all who have died so far from COVID-19.

As with any historical comparison, there are important qualifiers. In this case, the influenza pandemic started in early 1918 and continued well into 1919, whereas COVID-19 deaths are for about one-third of a year (March through June). However, today the United States’ population is about three times the size of the population in 1918. These two factors roughly “cancel out,” and so it is reasonable to think about the 1918 epidemic being about five times worse than COVID-19, at least thus far.

In comparison to past wars, the U.S. has now had more deaths from COVID-19 than all the combat-related deaths in all the wars since the Korean War, including the Vietnam War and Operations Desert Shield and Desert Storm. In World War II there were 291,557 combat casualties. So the number of people who have died from COVID-19 thus far is about 45% of the WWII combat casualties. By the fall, it could be more than 70%.

Finally, note that the number of confirmed and probable deaths from COVID-19 in New York City (23,247 on July 10, 2020) is more than eight times the number who died in the 9/11 attack (2,753).

Ron Fricker, Professor of Statistics and Associate Dean for Faculty Affairs and Administration, Virginia Tech

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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The diplomatic passports that weren’t,
scant documentation and other wonders

by Eric Jackson

Ricardo Martinelli Linares and Luis Enrique Martinelli Linares, sons of the former president of Panama, are in jail in Guatemala, facing possible extradition back to the United States from which the fled. The brothers were facing a pending immigration trial about overstayed visas in the USA. They had been negotiating bail in Panama, where they face multiple corruption charges, when they took off in a private jet for El Salvador, and from there made their way to Guatemala by land, where they were arrested on a US extradition request.

A Guatemalan judge gave the US government 40 to 60 days to substantiate its case. The two extraditions will be treated as separate cases. Proceedings have been delayed by a coronavirus epidemic closure of the Guatemalan court system.

The Americans have yet to lay all cards on the table and may never do so, but it’s about alleged laundering of millions of dollars in bribes from the Brazilian company Odebrecht to influence the contracting decisions of their father’s administration. It is said that this laundering took place through a string of Caribbean shell companies and bank accounts in Panama, Switzerland and the United States. It is said that there are at least 14 co-conspirators yet to be named by US federal prosecutors in Brooklyn, where the charges against the Martinelli’s were sealed.

These events have prompted an array of odd defenses. The ex-president’s chief of staff and de facto legal coordinator for the Martinellis’ many legal imbroglios, Luis Eduardo Camacho, protested diplomatic immunity: “Their bags were checked, they were recorded at all times, this was shown on videos that were made public. All of this is in breach of the treatment to be given to a diplomat.” It turns out, however, that although the brothers are non-attending alternate deputies in the Central American Parliament, they are not Panamanian diplomats and were traveling on ordinary passports renewed earlier this year at the Panamanian consulate in Miami. If the relationship with PARLACEN confers some immunity under Panamanian law, whether that counts for anything in Guatemala remains to be seen.

History may count more. Guatemala has never denied a US extradition request.

Step back and look at contexts. It may or may not help. For one thing, there are several different theories about it. For another, there appear to be wild cards and unhinged persons playing key roles. It does help to know how things have gone.

Aggression, non-aggression and blackmail

After the 1989 invasion, there was a wave of retribution against many of those connected with the dictatorship. But not all. US forces stole Panama’s government records and those have never been returned. It has meant that some of Noriega’s culpable collaborators were never exposed as such to the public light, but on the other hand knew that if they annoyed Uncle Sam they could be. These erstwhile collaborators ended up being sprinkled into all of the present political parties, or relatives of such blackmail-prone persons were, so successive Panamanian governments have not been eager to obtain, let alone publish, the dictatorship’s archives.

On the televised face of it, there was little love lost between Guillermo Endara, who with the invasion was belatedly installed in the office to which he had been elected, and his successor Ernesto “Toro” Pérez Balladares. Notwithstanding that, Toro stomped down hard on moves toward holding Endara and members of his family accountable for alleged infractions and didn’t particularly pursue people in his predecessor’s administration. It was the beginning of an unspoken non-aggression pact in post-invasion Panamanian politics. ‘We don’t investigate you while we are in office, and you don’t investigate us when you are in office’ was the post-invasion practice.

Then along came Ricardo Martinelli, beneficiary of an alliance with Juan Carlos Varela put together at the US ambassador’s residence with the aim of keeping the PRD and a one-time member of Noriega’s inner circle, Balbina Herrera, out of the presidency. Martinelli investigated his PRD predecessor, the PRD’s Martín Torrijos. His minions removed the attorney general appointed in Martín’s time, Ana Matilde Gómez, on flagrantly pro-corruption charges of authorizing the wiretap of a man who requested it because he said that a prosecutor working under Gómez was shaking him down (as the wiretaps verified). He went after political opponents, journalists and personal rivals real or imaginary in a variety of ways.

Will Ricky Martinelli bring this reporter up on charges for writing it? No matter what any court may have ruled, he obtained and used Israeli and Italian technology — the Pegasus system — not only to wiretap but to turn people’s cell phones and computers into room bugs. There were 150 people on a list of targets that national security operatives kept. This lineup was almost certainly partial, but in any case if you consider the people on the other end of the intercepted communications there were thousands of them, essentially in all political parties. The surveillance equipment was last reportedly seen in one of Martinelli’s private company offices. It was government property never turned over to his successor. There are hints that it may have been used and may still be in use, for example to intercept the so-called VarelaLeaks, WhatsApp messages that have embarrassed former president Juan Carlos Varela and a number of other persons, most notably former attorney general Kenia Porcell.

[Editor’s opinion, as one with a legal education and one of those who communicated with persons on the Martinelli administration surveillance list: In a country with an ordinary legal system, Martinelli, at his attorneys’ first proffer of the VarelaLeaks as a reason for anything, would be ordered under penalty of imprisonment for contempt for non-compliance, to produce the missing paraphernalia of Pegasus spying for court-appointed experts to examine.]

The Martinelli alliance with Varela lasted 26 months. An early casualty from the Varela team was the mayor of Panama City, the stupidly corrupt Bosco Vallarino. A bunch of Martinelistas went rashly out of their ways to insult Varela while he was vice president and in some cases to try to drive him out of that office.

When Varela assumed the presidency in 2014, the non-aggression practices that Martinelli first broke with respect to Torrijos were not reinstated. Martinelli and members of his family and administration were pursued. There was popular public demand for this. There still is.

Alliances: tacit, explicit and extorted

Miguel Antonio Bernal alleges that what’s going on right now is a tacit political alliance between President Cortizo and Ricardo Martinelli. At a glance it might, given some presumptions about traditional presidential meddling in the legal system, explain a few things. Like how the fugitive Martinelli brothers were granted bail in absentia. Like how the health minister approved their flight, planned for Panama but ending in El Salvador, as a humanitarian repatriation flight. Like the issuance of new passports at the consulate in Miami.

But Cortizo has always said that he doesn’t intend to interfere with the work of judges or prosecutors. They all say things like that.

Meanwhile, criminal proceedings against both Juan Carlos Varela and Ricardo Martinelli over the subject of Odebrecht bribes continue. Also, as to Martinelli, a money laundering case about New Business, a company said to have been a conduit for kickbacks from government contractors that were used to amass Martinelli’s media empire. The flagship of that communications companies is EPASA, which publishes El Panama America and La Critica. NexTV and other media properties are in Martinelli’s portfolio, which was put together during his presidency.

Stripping an ally of his main political assets? Strange sort of alliance, but then Panama had its origins in some strange betrayals, too. Panama is a lot less stable than the bankers and real estate vendors will say, so you always have to look at alliances in terms of situations. Consider the current legislature with which Nito Cortizo works.

Democratic Revolutionary Party (PRD) – 36 deputies. Democratic Change (CD or Cambio Democratico) – 18 deputies. Nationalist Republican Liberal Movement (MOLIRENA) – 5 deputies. Panameñista Party – 8 deputies. Independents – 5 deputies. The PRD is allied with MOLIRENA at the moment. Each party has internal divisions. Graphic by the Asamblea Nacional.

On its own, the PRD is a vote short of a majority in the 71-seat National Assembly. They get a legislative majority by way of an alliance with MOLIRENA. Among the populace, just over one-third of Panamanians voted PRD in the May 2019 elections.

The PRD has a xenophobic, homophobic neofascist element that might break away. Some PRD deputies ought to be in serious legal trouble and if they do get that sort of trouble may walk away because they were left unprotected. The religious far right has deputies in the MOLIRENA and CD caucuses. CD is riven between pro- and post-Martinelli factions. The Panameñistas, a traditional major party, are reduced in number and battered by scandals.

Then, the Independents — how independent are they, really, from the parties and from each other? To the extent that they are aligned with MOVIN, the Independent Movement, that’s most of all Stanley Motta but also a lot of the libertarian crows around Bobby Eisenmann. Because of the weird ways that votes for legislator are figured, the independents got more votes than the party candidates in their circuits and have far fewer members than their election votes would justify. Turn MOVIN into a political party and PRD bastions in San Miguelito and Panama City get devastated if the electoral cleavage is roughly as it was in 2019.

Does this explain the open venom spat at the independent deputies by their PRD colleagues in the National Assembly chamber, and all the PRD social media trolls and hashtags like #MOVINChantaje?

Where does Nito go if some members of his own party walk over to the opposition, or if the alliance with MOLIRENA collapses? He’d probably have to look to a faction of CD, or else try to cobble together the sort of dysfunctional “governability pact” that made life miserable and unproductive for Varela.

Like Martinelli did, Cortizo might cut off funds to legislators’ circuits to coerce them into switching sides. This, however, does not work well in the large multi-member circuits of the metro area and adjacent parts of Panama Oeste. He’s be hurting his own people too if he tried, for example, to cut off funds to San Miguelito to make one of its legislators vote with the PRD.

The carrot ordinarily works better than the stick, but Panama is deeply in debt. That there are people in his administration, in the PRD caucus of the legislature and in PRD-dominated local governments who act as if that were not the situation is likely to be the bane of Nito’s presidency.

With only 35 seats in the legislature, the PRD president can’t afford to burn too many bridges.

So these theories…

The Martinelli Linares brothers want to be sent to Panama and deal with the judicial system here. MUCH easier to buy a judge in Panama City than in Brooklyn, even if you might find jurists who go against the respective grains in both places.

One potential course of action they might take is to rush through a Panamanian extradition request to compete with the US petition. Note that Panama never petitioned the United States to extradite the brothers, although they could have done so. Plus, think about how that would look for Panamanian public consumption.

And what about US policy? Is there such a thing as a policy under Donald Trump?

It all makes fertile ground for weird conspiracy theories, and a desperate Martinelli camp is at the moment busily planting those seeds.

But maybe it’s The Illuminati after all.

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