Counting the flu

I found a useful discussion of the complexity of assigning cause of death to things like the flu or COVID-19 at an Allahpundit post at Hot Air.  Interestingly, he pointed to a post by an American doctor at Scientific American, who pointed out that the number of cases the CDC assigns to the fly is a very rubbery figure itself:

When reports about the novel coronavirus SARS-CoV-2 began circulating earlier this year and questions were being raised about how the illness it causes, COVID-19, compared to the flu, it occurred to me that, in four years of emergency medicine residency and over three and a half years as an attending physician, I had almost never seen anyone die of the flu. I could only remember one tragic pediatric case.

Based on the CDC numbers though, I should have seen many, many more. In 2018, over 46,000 Americans died from opioid overdoses. Over 36,500 died in traffic accidents. Nearly 40,000 died from gun violence. I see those deaths all the time. Was I alone in noticing this discrepancy?

I decided to call colleagues around the country who work in other emergency departments and in intensive care units to ask a simple question: how many patients could they remember dying from the flu? Most of the physicians I surveyed couldn’t remember a single one over their careers. Some said they recalled a few. All of them seemed to be having the same light bulb moment I had already experienced: For too long, we have blindly accepted a statistic that does not match our clinical experience.

The 25,000 to 69,000 numbers that Trump cited do not represent counted flu deaths per year; they are estimates that the CDC produces by multiplying the number of flu death counts reported by various coefficients produced through complicated algorithms. These coefficients are based on assumptions of how many cases, hospitalizations, and deaths they believe went unreported. In the last six flu seasons, the CDC’s reported number of actual confirmed flu deaths—that is, counting flu deaths the way we are currently counting deaths from the coronavirus—has ranged from 3,448 to 15,620, which far lower than the numbers commonly repeated by public officials and even public health experts. 

That really blows up the comparisons made by those on the Right who try to downplay the seriousness of COVID-19 by comparing it to (say) 60,000 a year allegedly dying of the flu ("and we don't close down the economy", yells Creighton.)

I think it should be clear that the true way of assessing the seriousness of a pandemic has to be looking at "excess deaths" compared to same period, and those figures are not looking good.  The Financial Times has been doing good work in that regard.