POLITICO NIGHTLY: Governors confront a bipartisan pandemic

 

BY RENUKA RAYASAM Nurses and volunteers from the Oakland County Health Department wait for patients to receive their coronavirus vaccine at the Southfield Pavilion in Southfield, Mich. | Emily Elconin/Getty Images KNOW WHEN TO HOLD ‘EM — There has remained, nearly two years in, a temptation on both the right and the left to declare political pandemic winners based on Covid case counts and deaths. It’s a debate that has been reignited as Michigan’s cases surged 67 percent in the last two weeks. Republicans blasted Democratic Gov. Gretchen Whitmer’s early pandemic restrictions, even as her actions won White House praise. Hospitals there are now again full, and deaths are expected to follow. Resist the temptation, said Ashish Jha, dean of Brown University’s School of Public Health. “I think that narratives that Democrats have gotten this all right or that Republicans have gotten this all wrong or vice versa is neither helpful nor true,” he said. “It’s been very frustrating to see how much Covid gets politicized.” Much like poker strategy as explained by Annie Duke, Covid outcomes are the result of both luck and decision making. Understanding how much random chance is involved is important. We still don’t know what sparks a particular Covid surge or what precipitates a case drop, said Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. For example, Whitmer is no more responsible for the virus slamming Michigan at this particular moment than Republican Gov. Ron DeSantis was for the Delta surge hitting Florida this summer. “We may ascribe success to a certain state, but it’s luck of the virus draw,” Osterholm said. That doesn’t mean policy is irrelevant. We may not totally understand virus patterns, but we know that Covid spreads more easily and quickly in indoor places, especially among unmasked and unvaccinated people. What’s crucial, said Jha, is to “hold politicians accountable for policies but not outcomes.” Over the long term, policies can change behavior and affect pandemic outcomes, but policies are also subject to short-term fluctuations and random chance, he said. On that score, policies that encourage masking, vaccinations and distancing are ones that governors should be pursuing, Jha said. About 95 percent of federal workers, for example, have been vaccinated after the Biden administration’s mandate. At the very least, states shouldn’t stop local governments and businesses from imposing measures to mitigate the virus spread. A governor might still get very unlucky with virus trends and they also can’t totally control their residents’ behavior, even if they played the right hand. Whitmer, for example, has been more encouraging of vaccines than DeSantis, but Florida still has a higher vaccination rate than Michigan. That still doesn’t mean that Democrats are always playing their cards well. Cheap or free, and ubiquitous, rapid testing, for example, could help curb transmission. But neither Democratic nor Republican states are considering the idea. Jha has been tracking both Vermont and South Dakota, which have similar demographics and seasonal patterns, over the course of the pandemic. Both states have Republican governors, but they have taken drastically different approaches to managing the pandemic. Vermont, which has closed businesses and pushed masks and vaccinations, has had 65 deaths per 100,000 people, while South Dakota, which imposed no Covid related measures, has four times as many deaths: 261 per 100,000 people. Right now, neither party is showing much political appetite to reimpose harsh restrictions that might make a dent in the virus trajectory, but come with other deeper societal costs. Austria has imposed a lockdown and vaccine mandate. That is not happening here, even as the U.S. continues to see a thousand Covid deaths a day. “We have another major wave to work through, but we’re doing very little to thwart it,” said Eric Topol, a professor of molecular medicine and director of the Scripps Research Translational Institute, a medical research institute. Whitmer recommended Michganders wear masks indoors, but she didn’t require them. One of the biggest recent federal policy blunders, Topol said, was the refusal to authorize vaccine boosters well before the holidays, and then not really urging those under 50 to get boosted. The best thing governors could do now is get more and more people vaccinated and boosted, Jha and Topol said. That may not help them prevent a future Covid case surge, but it would prevent their hospitals from filling and their residents from dying. Immunity for both vaccine- and infection-acquired immunity wanes at about the six-month mark, according to a CDC report . But immunity from a vaccine is more consistent — and unlike getting Covid, it comes with basically no risk of death or long-term symptoms. Even with waning immunity, vaccines do a better job of protecting people against serious illness and death. Topol said the Republican states banning vaccine mandates amounted to “idiocy.” “It will come back to haunt them,” he warned.“There are still a lot of people at risk all over the country.” Welcome to POLITICO Nightly. A programming note: We’ll be off for Thanksgiving this Thursday and Friday, but we’ll be back and better than ever on Monday, Nov. 29. Reach out with news, tips and Black Friday strategies at nightly@politico.com. Or contact tonight’s author at rrayasam@politico.com, or on Twitter at @RenuRayasam.   BECOME A GLOBAL INSIDER: The world is more connected than ever. It has never been more essential to identify, unpack and analyze important news, trends and decisions shaping our future — and we’ve got you covered! Every Monday, Wednesday and Friday, Global Insider author Ryan Heath navigates the global news maze and connects you to power players and events changing our world. Don’t miss out on this influential global community. Subscribe now.     ASK THE AUDIENCE Nightly asks you: Is there something you really want or need to buy, whether for the holiday season or just an everyday item, that you’ve noticed is far more expensive or seemingly impossible to get? Send us your responses using our form, and we’ll share some answers Wednesday. WHAT'D I MISS? — Biden administration asks court to lift stay of vaccine-or-test rule: The Biden administration is asking a federal court to lift an order halting its vaccine-or-test mandate for private employers , arguing that delaying the standard could have “significant” impacts outside the workplace. “Simply put, delaying the Standard would likely cost many lives per day, in addition to large numbers of hospitalizations, other serious health effects, and tremendous expenses. That is a confluence of harms of the highest order,” the government argued in a filing with the Cincinnati-based 6th Circuit Court of Appeals today. The U.S. Food and Drug Administration building behind FDA logos at a bus stop on the agency's campus in Silver Spring, Md. | AP Photo/Jacquelyn Martin — FDA nomination slips after Biden admin fails to send papers to Congress: A plan to speed Robert Califf’s nomination for FDA commissioner through the Senate next month is on hold after the Biden administration failed to submit the necessary paperwork to Congress in time , three people with knowledge of the matter told POLITICO. The delay means that Califf is now unlikely to get a confirmation hearing until mid-December at the earliest, effectively ruling out the possibility of a full Senate floor vote on his appointment before the end of the year. — Joint Committee on Taxation issues correction on Democratic social spending bill: The nonpartisan Joint Committee on Taxation issued a major revision to its estimates of the Democrats’ multi-trillion climate and families plan, finding that actually millionaires will pay more in taxes. Under the legislation, those making more than $1 million would pay 3.2 percentage points in 2022 more in taxes — and even more in subsequent years. — Jan. 6 investigators subpoena Proud Boys, Oath Keepers as probe turns to domestic extremism: The Jan. 6 select committee today subpoenaed the leaders of the Proud Boys and Oath Keepers , extremist groups that responded to Donald Trump’s call to descend on Washington and played central roles in the attack on the Capitol. The House committee issued subpoenas today to Proud Boys Chair Enrique Tarrio and Oath Keepers founder Stewart Rhodes, as well as both of the organizations they lead. It also subpoenaed a lower-profile far-right group, 1st Amendment Praetorian, along with its leader, Robert Patrick Lewis. — Christian groups furious at Blinken for removing Nigeria from religious violence list: Christian groups, a U.S. government panel and former senior U.S. diplomats are furious over Secretary of State Antony Blinken’s decision to take Nigeria off a list of countries accused of engaging in or tolerating religious persecution . Blinken’s decision was revealed last week just before he visited Nigeria, Africa’s most populous country and one where Muslim-Christian tensions have long flared.   STEP INSIDE THE WEST WING: What's really happening in West Wing offices? Find out who's up, who's down, and who really has the president’s ear in our West Wing Playbook newsletter, the insider's guide to the Biden White House and Cabinet. For buzzy nuggets and details that you won't find anywhere else, subscribe today.     AROUND THE WORLD SURGE CONCERN STAYS GLOBAL — As the world heads into the third year of the Covid-19 pandemic, U.S. and international health representatives are increasingly worried that the virus will outpace the global effort to vaccinate large portions of the world in the first part of 2022, Erin Banco, Adam Cancryn and Carmen Paun write. Although COVAX, the global vaccine equity effort, has secured hundreds of millions of doses for the beginning of next year, officials fear the virus will spread uncontrollably, infecting vulnerable populations, before more countries can receive and administer first doses. To date, only 43 percent of the world is fully vaccinated, with many countries in Africa still waiting for first doses. Despite initial commitments from COVAX to ship 2 billion doses by the end of 2021, the vaccination effort has fallen short, with only about 1.45 billion doses expected by January. The delays are attributable to multiple factors, from failure to obtain regulatory authorizations for companies such as Novavax, to India’s vaccines export ban, and protracted negotiations with firms such as Moderna and Pfizer, whose substantial pledges came too late to reach low- and moderate-income countries. Now, as case numbers and hospitalizations have begun to surge again in Europe, top Biden administration officials and international health groups are scrambling to find ways to deliver and help facilitate vaccinations in low- and middle-income countries in the next several months. NIGHTLY NUMBER More than $25 million: The amount in damages a jury awarded in a mixed verdict today against white nationalist leaders for violence that erupted during the 2017 Unite the Right rally . After a nearly monthlong civil trial, a jury in U.S. District Court in Charlottesville deadlocked on two key claims but found the white nationalists liable on four other counts in the lawsuit filed by nine people who suffered physical or emotional injuries during two days of demonstrations. PARTING WORDS Biden speaks on the economy during an event at the South Court Auditorium at Eisenhower Executive Office Building. | Alex Wong/Getty Images STRATEGERY AT THE PUMP — Republicans were quick to slam Biden’s decision today to open the taps on the nation’s oil reserves, accusing him of misusing a national security stockpile for the politically expedient goal of lowering gasoline prices just before Thanksgiving. But Biden has the GOP to thank for helping him to do it, Ben Lefebvre writes. Legislation enacted under the Republican-controlled House during the Trump administration ordered the government to sell more than 100 million barrels from the Strategic Petroleum Reserves by 2027 to raise money for the Treasury. Biden’s Energy Department specifically cited one of those mandates when it announced today that it was selling 50 million barrels, the biggest ever release. Releasing crude oil from the reserves is the one easy tool at Biden’s disposal to try to tamp down rising fuel prices, which have fed inflation and helped chip away at the president’s approval ratings. Weeks of anticipation about today’s move have already started to have a calming effect at the pump, said the administration, which had also coordinated with countries like China, Japan, India and South Korea to make their reserved crude available.   Follow us on Twitter Chris Suellentrop @suellentrop Tyler Weyant @tweyant Renuka Rayasam @renurayasam Myah Ward @myahward   FOLLOW US

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Could the global Covid death toll be millions higher than thought?

 

At the Guardian, Laura Spinney reports on the latest estimates of how many people really died of Covid-19 and, believe me, it's not pretty! Tom

"For the past 18 months, hunkered down in his Tel Aviv apartment, Ariel Karlinsky has scoured the web for data that could help him calculate the true death toll of Covid-19.

The 31-year-old economics student at the Hebrew University of Jerusalem had never worked on health matters before, but he was troubled by rumours early in the pandemic that Israel was not experiencing a rise above expected death rates, and therefore Covid was not serious.

“This was, of course, not true,” he said. “Excess mortality was definitely there and it was definitely very visible.” He pulled up the numbers to prove it, which was easy enough to do in Israel with its sophisticated vital registration system.

But other rumours followed. One was that countries that had put in place no or minimal containment measures, such as Russia, were not experiencing significant excess mortality either. Again it was not true – but getting hold of the data to prove that was trickier.

Karlinsky realised this was the case for most countries. Even those that routinely gathered excess-mortality data often did not publish it until at least a year later, meaning they were unaware of a sensitive indicator of the pandemic’s scale and progress – one that could inform their response.

It became a challenge to gather that data for as many countries and in as close to real time as possible.

Through Twitter he encountered another researcher, the data scientist Dmitry Kobak of the University of Tübingen in Germany, who was attempting the same thing, and they agreed to collaborate. While Karlinsky searched for the numbers, Kobak took on the analysis.

The result is the World Mortality Dataset, which forms the basis of estimates of Covid mortality as published by the Economist, the Financial Times and others, and which gives the lie to the official global death toll of 4.8 million. The Economist, for example, puts the real number closer to 16 million.

Those who measure the impact of public health disasters have applauded Karlinsky and Kobak’s effort. “This is a data revolution that parallels that seen in vaccine development and pathogen sequencing,” the epidemiologists Lone Simonsen, of Roskilde University in Denmark, and Cécile Viboud, of the US National Institutes of Health, wrote.

A pandemic’s death toll can be measured in various ways, all of which have advantages and disadvantages. The official number is derived from national reports of Covid deaths but these depend on testing rates and are almost always underestimates.

“The official Covid death tolls are just not credible at all for a large group of countries,” said the data journalist Sondre Ulvund Solstad, who leads the Economist’s pandemic tracking effort.

Excess mortality, defined as the increase in deaths from all causes over the level expected based on historical trends, does not depend on testing rates. It is an old tool, having been used to estimate the death tolls of historical pandemics – especially where there was no diagnostic test for the disease in question – but until now it has always been calculated retrospectively.

Karlinsky and Kobak’s innovation is to collect and publish the data during a pandemic, for a swathe of the world, using established statistical techniques to fill in the gaps.

One disadvantage of excess mortality is that it is a composite. It captures not only Covid deaths but also deaths indirectly linked to the pandemic, such as those of cancer patients who could not get timely treatment or the victims of domestic abuse during lockdowns, without telling you much about the relative contributions of each.

By comparing the timing of excess-mortality peaks and lockdowns, however, Karlinsky and Kobak have shown that, in the case of Covid, excess mortality mainly reflects deaths from the disease.

Calculating excess mortality can also generate some strange results. In June, for example, they reported in the journal eLife that excess mortality had been negative in countries including Finland, South Korea and Australia – meaning fewer people had died there than in previous years – because those countries’ pandemic control had been excellent and they had also all but eliminated flu in 2020. In such cases, according to Simonsen and Viboud, official Covid deaths are a more accurate indicator of the pandemic’s toll.

The World Mortality Dataset contains information on more than 100 countries. Among those missing are most African and many Asian countries, including some of the world’s most populous and – judging by news reports and other sources – worst-affected. India, for example, does not routinely release national vital data, yet some researchers estimate its Covid death toll could be as high as 4 million.

Karlinsky and Kobak have scraped subnational data sources from these data-poor countries – or been supplied them by journalists, academics and dissidents living there – and applied various techniques of extrapolation to produce national estimates.

Or they have projected from neighbouring countries where data is available, adjusting for such factors as population density, Covid testing strategy and press freedom.

Uncertainty in the data is why Karlinsky and Kobak have avoided estimating the global death toll, but they say that nationally, excess deaths are 1.4 times higher than reported Covid deaths, on average, which would give a rough global tally of 6.7 million.

Solstad’s modelling put the number between 9.9 million and 18.5 million, a range that Simonsen found reasonable.

To put these numbers in a historical perspective, she and Viboud took excess-mortality estimates for previous pandemics and adjusted them for the world’s population in 2020.

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This gave death tolls for the previous four flu pandemics, if they had happened now, of 75 million (1918), 3.1 million (1957), 2.2 million (1968) and 0.4 million (2009).

Covid is the deadliest pandemic in a century, they conclude, “but has nowhere near the death toll of the pandemic of 1918”.

The new dataset shows countries that attracted international headlines for having severe outbreaks, such as Italy, Spain and the UK, have not actually been the worst affected.

The worst include Mexico and Bolivia – but also some countries in eastern Europe, which have experienced more than a 50% increase in mortality. The worst affected, Peru, has recorded a 150% increase.

The dataset becomes more precise over time because some data trickles in with a time lag. Some countries asked their national statistics offices to accelerate the collection and publication of vital data early in 2020, but others either could not or would not release it. Turkey was expected to release monthly vital data for 2020 early this summer. It has not.

“Turkey is a prime example of a place where they have the numbers but they are not releasing them because they do not want to explain the discrepancies,” Karlinsky said.

In fact, he said, excess mortality could open a revealing sidelight on government transparency. If official Covid deaths were lower than excess deaths but followed roughly the same trajectory, it was likely the country simply lacked testing or vital registration capacity.

But if there is no relation between the two, that points to official obfuscation. Russia is a case in point.

Last February, in Significance, a magazine published by the UK’s Royal Statistical Society, Kobak explained that Russia’s excess mortality was 6.5 times higher than its reported Covid deaths, making its official death toll one of the least reliable in the world. The under-reporting varied regionally and was most dramatic in Chechnya, Tatarstan and Bashkortostan. “It may not be a coincidence that [these] are among the regions for which there is also statistical evidence of data manipulation in election results,” he wrote.

Solstad thinks excess mortality should be tracked continuously in future, because it would provide better insights into all kinds of crises, including wars and famines. “It’s a pretty objective measure of things going wrong,” he said. Karlinsky agrees. When a heatwave struck Egypt in 2015, for example, state media reported 61 deaths; his estimate was closer to 20,000.

Some countries may not wish to do so. In February, the World Health Organization took the first step towards harnessing excess mortality as a surveillance tool, when it set up an expert committee to assess Covid mortality.

Governments could act more quickly and proportionately if they know a crisis is imminent. They would also be better equipped to convince the public of the need to do so. “Some people truly believe that if we hadn’t done anything to stop this virus not much would have happened,” Simonsen said. What the World Mortality Dataset showed, she added, was that in many countries “a lot happened”."

https://www.theguardian.com/.../global-covid-death-toll...

THEGUARDIAN.COM

Could the global Covid death toll be millions higher than thought?