POLITICO NIGHTLY: What counts as a Covid death

 

BY RENUKA RAYASAM Presented by American Institutes for Research WHO LIVES, WHO DIES, WHO TELLS YOUR STORY — More than a year and a half after the U.S. recorded its first Covid death in February 2020, there is still no consensus about the exact number of people who have been killed by the disease. The official tally is more than 725,000, according to the CDC, a number the U.S. hit Monday, the same day that Colin Powell died from Covid complications. But did Powell’s passing count as a death from Covid? Surprisingly, there is no consensus on that question. “There is no standardized national case definition that I am aware of yet,” Michael Phillips, chief hospital epidemiologist at NYU Langone Health, told Nightly today. “There are a lot of opportunities for difference.” The phrase “died of Covid complications” means a variety of different things with no definition. States — or even individual hospitals — have their own criteria for how to count deaths from Covid. Death investigations in the U.S. are generally “non-uniform,” James Gill, the current president of the National Association of Medical Examiners, said. There are more than 2,000 jurisdictions that report deaths in the U.S.: Coroners, physicians, sheriffs, justices of the peace and others can all fill out death certificates. Those death certificates are what the CDC examines for its official tally. Flags fly at the "In America: Remember" public art installation near the Washington Monument in September in Washington. States’ official tallies are climbing as jurisdictions revise their death tolls based on a closer look at death certificates. Oklahoma added more than 1,000 deaths to its count this week after the state health department investigated Covid deaths. New York added nearly 12,000 Covid deaths to its official tally in August after accounting for all death certificate data and not just those from hospitals, adult care facilities and nursing homes. Both states’ data now more closely match the CDC numbers. At NYU, every patient who comes into the hospital — regardless of why they are there — gets tested for Covid to trigger infection protocols if necessary, Phillips said. If the patient is still in the infectious period when they die, NYU counts that as a Covid death. For the most part, NYU’s Covid death count accurately captures the number of people who died because they contracted Covid, Phillips said. But there are rare cases in which a gunshot victim who tests positive gets thrown into the official count. It’s far likelier that there is an undercount of Covid deaths, rather than an overcount. People who don’t die in hospitals, say in nursing homes or prisons or in their homes, may never have been tested before dying. The CDC counts only deaths where Covid is listed on a death certificate as a cause or contribution to the patient’s passing. It acknowledges that about 20 to 30 percent of death certificates have issues with “completeness,” saying “cause-of-death information is not perfect, but it is very useful.” These subtleties will be important to historians who study the pandemic and its toll. But they don’t matter for most Covid patients. It’s clear what they died of, Lisa Maragakis, an infection prevention specialist and epidemiologist at Johns Hopkins Health System, told Nightly. The distinction between dying of Covid and dying from complication of Covid isn’t part of the official language. Often a person comes into the hospital because of Covid, but that can lead to a series of other related problems, such as sepsis or organ failure. A family might withdraw care after a patient has been unresponsive on a ventilator for a long time. Or a patient could die from severe lung damage. A death certificate might list the official cause of death as pneumonia, heart attack or stroke, but if Covid is what brought that ailment on, it’s listed as a contributing factor. Overwhelmingly, she said, respiratory failure is what is killing the Covid patients she sees. People with compromised immune systems or an underlying health conditions are prone to dying if they get Covid, but Covid is still the reason that patients like Powell died, said Maragakis. Their weakened immune systems couldn’t fight off the infection, but had they never gotten Covid, they would still be alive. “People live with cancer for a long time,” she said. “It is pretty clinically clear that Covid was the thing that tipped them over.” Welcome to POLITICO Nightly. Reach out with news, tips and ideas for us at nightly@politico.com. Or contact tonight’s author at rrayasam@politico.com or on Twitter at @RenuRayasam.   A message from American Institutes for Research: For 75 years, AIR has used evidence to improve lives. Today, we’re applying our know-how to address our biggest problem right now—inequity. The AIR Equity Initiative is a $100 million, five-year investment in social science research so institutions can combat injustice and build bridges of opportunity for people and society. Learn More.   WHAT'D I MISS? — DeSantis calls for special legislative session to fight Biden's vaccine mandate: Florida Gov. Ron DeSantis today called for a special legislative session to block the Biden administration’s vaccine mandates , taking the most aggressive action yet in his fight with the White House over Covid restrictions. — CDC advisers endorse Moderna, J&J boosters plus mix-and-match strategy: A panel of independent vaccine advisers to the CDC unanimously recommended Moderna and Johnson & Johnson Covid-19 boosters for some adults today , the penultimate step to allowing millions of Americans to receive additional doses. The advisory committee endorsed the FDA's decision to authorize a Moderna booster for people 65 and older and for all adults who either have underlying conditions or work in settings where they're more likely to be exposed to the virus. Those people may obtain the booster, which is half the size of each dose used for initial vaccination, six months after completing the primary vaccine series. — Facebook lobbying surges to $5M during whistleblower uproar: Facebook outspent nearly the entire D.C. influence industry on lobbying during the quarter ending Sept. 30 , putting in its second-most lavish three months ever, according to new filings from the social network, which is embroiled in damaging revelations from whistleblower Frances Haugen. The $5.1 million spree outpaces the company's big tech peers Google, Amazon and Microsoft. The only entities that outspent Facebook on lobbying for the quarter were the U.S. Chamber of Commerce, the National Association of Realtors, Business Roundtable and the drug lobby PhRMA, according to disclosures filed late Wednesday.   INTRODUCING CONGRESS MINUTES: Need to follow the action on Capitol Hill blow-by-blow? Check out Minutes, POLITICO’s new platform that delivers the latest exclusives, twists and much more in real time. Get it on your desktop or download the POLITICO mobile app for iOS or Android. GET A FIRST LOOK AT CONGRESS MINUTES HERE.     — Battle over creating Space National Guard: The Space Force is here to stay. But a debate over whether the military's newest branch should have its own weekend warriors has turned into the latest space-based political brawl. Lawmakers from Colorado, Florida, Hawaii and other states that are home to space operations are pushing for a dedicated Space National Guard that can provide a talent pool for the technical space branch — while also benefiting from some of the additional spending that would go with it. The House recently passed bipartisan defense policy legislation mandating that a Space Guard be established within 18 months. — Texas asks Supreme Court to let its abortion ban stand: Texas urged the Supreme Court today to turn away a Biden administration effort to halt enforcement of the state’s six-week abortion ban but broached the possibility that justices could also opt to use the matter to more broadly consider decades-old precedents affirming abortion rights. The Justice Department this week asked the Supreme Court to take emergency action that would block Texas’ novel abortion ban from being enforced while litigation over its constitutionality goes forward. — Fed cracks down on trading by top officials: The Federal Reserve announced today it will ban top officials from trading in individual stocks and bonds as part of a major overhaul of conflict-of-interest rules at the central bank in the wake of recent trading scandals. Under the new rules, Fed policymakers and senior staff will be prohibited from active trading and will be able to purchase only diversified investment vehicles like mutual funds, according to a news release from the central bank.       ASK THE AUDIENCE It’s October. So Nightly asks you: What’s your biggest pandemic fear right now? Share your responses using our form, and we’ll include select answers in Friday’s newsletter. AROUND THE WORLD German Federal Minister of Defence Annegret Kramp Karrenbauer and Federal Minister for Foreign Affairs Heiko Maas speak during a weekly government cabinet meeting at the Chancellery in Berlin. | Henning Schacht - Pool/Getty Images BERLIN TO EUROPE: GET REAL — German Defense Minister Annegret Kramp-Karrenbauer has a blunt message for her European counterparts: Forget your lofty ideas about the Continent defending itself and get real. Kramp-Karrenbauer is doubling down on her dismissal of the idea of European strategic autonomy, which sparked a diplomatic blow-up with French President Emmanuel Macron, and which she sees as further off than ever. While some European leaders have declared the chaotic U.S.-led withdrawal from Afghanistan shows Europe must be able to operate more on its own militarily, Kramp-Karrenbauer has drawn the opposite conclusion: She argues the debacle demonstrates that Europe and the U.S. need to cooperate more closely to be more effective militarily. “There is a lot of talk about European autonomy, or sovereignty, or — as I prefer to call it — more ability to act from the European Union in security and defense. People are asking why we were not in a position to hold the Kabul airport ourselves,” Kramp-Karrenbauer told POLITICO in an interview in her Berlin office this week, ahead of a meeting of NATO defense ministers in Brussels today and Friday. “We have to say quite openly: Without the capabilities of the Americans, we, as Europeans, would not have been able to do that,” she said.   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.     NIGHTLY NUMBER 9 The number of Republicans who voted today in favor of holding Steve Bannon in contempt of Congress for defying a subpoena on the Jan. 6 attack. The vote in the House passed 229-202. Bannon’s fate is now in the hands of the U.S. attorney’s office in Washington, D.C., which will decide whether to prosecute. PARTING WORDS STOP BY ROSSLYN IF YOU HAVE THE TIME — Biden is returning to the trail to campaign for former Virginia Gov. Terry McAuliffe in the closing days of the state’s hotly contested governor’s race, Zach Montellaro writes. Biden and McAuliffe will rally in Arlington on Tuesday, a week before the election in the commonwealth. It is the second time the president will stump for McAuliffe in the D.C. suburbs, following an event in the area in late July. McAuliffe and his Republican opponent, Glenn Youngkin, a first-time candidate and former private equity executive, are deadlocked in a tight election. A poll from Monmouth University released on Wednesday had the two men tied at 46 percent each among registered voters. Why Northern Virginia: The suburbs of the nation’s capital in the state are a voter-rich area where McAuliffe is expected to dominate in the election. In the recent Monmouth poll, McAuliffe led in Northern Virginia, 58 percent to 34 percent, which represented a slight gain for Youngkin from a September poll from the university.   A message from American Institutes for Research: AIR is applying its know-how to address the biggest problem we face right now—systemic inequity. By investing over $100 million in social science research over the next five years, AIR’s Equity Initiative will build and use evidence that can guide policy and improve the lives of people and communities. But we won’t do it alone. The AIR Equity Initiative will work side-by-side with partners and stakeholders, bringing together expertise and diverse viewpoints so we can create sustainable change. Systemic inequity is a formidable challenge, but we believe in the power of evidence to bridge the gaps that are holding us back. With research and collaboration, we can improve lives across our country—now and into the future. Learn More.     Follow us on Twitter Chris Suellentrop @suellentrop Tyler Weyant @tweyant Renuka Rayasam @renurayasam Myah Ward @myahward   FOLLOW US

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POLITICO NIGHTLY: What’s full in Florida — besides hospitals

BY MARC CAPUTO Presented by THE COAST ISN’T CLEAR — Welcome to Florida, a state so open for business these days that our hotels are almost as full as our hospitals. The juxtaposition of our tourism and Covid numbers — both as high as ever — illuminate the strange moment the Sunshine State finds itself in right now: a vacation hotspot as well as a coronavirus hot zone. Despite all the understandably gloomy and alarming headlines and cable-news punditry on Republican Gov. Ron DeSantis’s laissez faire approach to coronavirus, there’s been a surprising lack of discussion about a basic tenet of epidemiology: More people often means more infections. If you live in Florida or vacation here, it’s hard to ignore just how packed the state has been this summer, one of about five interlocking factors that have established Florida as the nation’s most notorious Covid hotspot. As vaccinations climbed and coronavirus cases fell earlier this year, Florida’s tourism industry was primed for a comeback — and therefore an influx of people. The state was understandably seen as lax on Covid precautions, so the vaccinated and unvaccinated alike were ready to hit the 663 miles of beach in the state. Airlines responded to the demand by adding more leisure flights to Florida, with one executive telling Bloomberg in February that “everything we do stems from demand.” Fireworks are seen during Rolling Loud at Hard Rock Stadium on July 23 in Miami Gardens, Fla. | Rich Fury/Getty Images Florida also spent an additional $25 million from the federal government to lure people to the state. According to Jason Salemi, a University of South Florida epidemiologist who runs the premier website for Covid data in Florida: “A lot of people had pandemic fatigue. They wanted to go somewhere for the summer before school starts. And a lot of people decided to come to Florida.” Florida International University epidemiologist Aileen Marty worries about who’s coming: “It’s important to remember that if you give a message to people that we don’t care about the virus here, you’ll attract more people who have that mindset.” By Memorial Day, the cumulative number of hotel rooms sold in Florida began exceeding the total number at the same time in 2019 — before the pandemic — according to an analysis from Visit Florida, the state tourism agency. By the week of July 25, the most recent for which data are available, the state notched the “10th consecutive week that rooms sold topped the number sold during the comparable week in 2019.” Along with the surge in visitors came an alarming increase in coronavirus cases, which began exponentially skyrocketing around Independence Day. The state has started to shatter hospitalization records as well. As of July 25, according to Salemi’s data, almost 7,400 Florida hospital patients were being treated for Covid. Today, it’s almost 25,000, about 25 percent of all hospitalizations in the state. About 83 percent of hospital beds statewide are occupied, and some systems are starting to cancel elective surgeries. Florida hotels, meanwhile, have been 75 percent full or more. To be clear, it’s foolhardy and false to peg Florida’s explosion in Covid cases solely on tourists. While all the visitors coming to the state certainly played a role, epidemiologists and experts say there are at least four other interlocking factors that contributed to Florida’s current predicament: 1) the highly transmittable Delta variant; 2) DeSantis’s management of the pandemic; 3) the sheer number of the unvaccinated (about 8 million vaccine-eligible people plus 2.8 million more children who aren’t eligible); 4) the hot weather that’s leading more people indoors in poorly ventilated rooms where the virus spreads. Unless DeSantis has a marked change in philosophy, don’t expect state policy to change. DeSantis has reiterated his opposition to mask mandates, even for schools, though the Delta variant is leading to more cases among kids and school is about to start as cases are higher than ever. He’s still an opponent of vaccine passports. He has shown no willingness to try to incentivize more vaccinations, which he began paying less interest to after having a more hands-on approach with seniors earlier in the year. He has long been a proponent of herd immunity, which the state is de facto experimenting with, and has solicited the input of vaccine skeptics and mask opponents. DeSantis said Friday that “these waves ebb and flow” but “it’s not something that government can control.” Today, his office threatened to withhold the salaries of superintendents and school board members who impose mask mandates. DeSantis is also disinclined to listen to critics, many of whom predicted disproportionately terrible outcomes for Florida after two other waves rolled through the state, which then emerged in the middle of the pack for Covid death rate and unemployment. In the short term, all of the infections, hospitalizations, deaths and wall-to-wall media coverage of Covid will have an effect on the tourism industry at least. In an email accompanying its otherwise rosy analysis, Visit Florida noted that “there are some significant headwinds that could start to have an impact over the next few weeks and into the fall months. A Destination Analysts survey from the week of July 26 suggests that a quarter of Americans have postponed a trip due specifically to the Delta variant, and nearly a fifth have cancelled a trip.” Welcome to POLITICO Nightly. It’s not just Florida: Texas Gov. Greg Abbott has asked the state’s hospitals to postpone elective medical procedures and announced that the state is looking for out-of-state medical workers to help with the influx of Covid patients. Reach out with news, tips and ideas for us at nightly@politico.com. Or contact tonight’s author at mcaputo@politico.com and on Twitter at @MarcACaputo.   A message from AT&T: Accessible, affordable broadband helps communities reach their American Dream. That’s why AT&T is making a $2 billion, 3-year commitment toward helping close the digital divide, so more low-income families have the ability to succeed. Find out how.   WHAT'D I MISS? — Pentagon will seek to mandate Covid vaccine for 1.4 million troops: Defense Secretary Lloyd Austin will seek to make the Covid-19 vaccine mandatory for all of its 1.4 million service members by mid-September , a date that could be accelerated if needed, according to a new memo from the Pentagon chief released today. — Khanna won’t challenge Padilla for Senate, ends intraparty threat from left: Rep. Ro Khanna announced his endorsement of Sen. Alex Padilla today , ending speculation that the progressive Silicon Valley Democrat would mount an intraparty challenge to Padilla next year. Padilla (D-Calif.) this year became the first Latino to serve as a senator from California when he was appointed by Gov. Gavin Newsom to fill the seat vacated by Kamala Harris when she became vice president. Padilla is a heavy favorite to win in 2022, but Khanna had yet to endorse him until today. He was the last of California’s 42 House Democrats to do so. — Judge mulls blocking Biden’s new eviction ban: A federal judge suggested today that the Biden administration was engaging in legal “gamesmanship” in order to resurrect a pandemic-related eviction ban despite an indication from the Supreme Court that the measure was unlawful. U.S. District Court Judge Dabney Friedrich made the pointed remark at a hearing on a request by real estate brokers and landlords to block the new policy the CDC rolled out last week. Biden let a previous eviction moratorium expire at the end of July but revived the restrictions Tuesday after he came under intense pressure from liberal lawmakers and activists. — Assembly to proceed with Cuomo impeachment ‘with all due haste’: New York lawmakers will take the next few weeks to review the evidence and hear from experts as the state Assembly prepares to impeach Gov. Andrew Cuomo , leaders announced this afternoon. “Our goal is now to bring this matter to a conclusion with all due haste,” Speaker Carl Heastie said. — Space Force wary of taking over UFO mission: The Pentagon is considering giving the Space Force a greater role in a stepped-up effort to track and investigate reports of UFOs. But the newest military branch isn’t over the moon about the idea . Space Force leaders are still struggling to rebrand an organization that has been lampooned since before its birth. Now, they are conflicted about becoming the military’s go-to on what the Pentagon now calls “unmanned aerial phenomena,” according to five current and former officials taking part in the discussions.   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 NATION THE TEX DEM DILEMMA — Democratic state representatives in Texas united to grind the state legislature to a halt last month. But they’re having trouble rallying around what to do next, Marissa Martinez writes. The Democrats fled the state in mid-July to deny Republicans a quorum in the state House through the end of a special legislative session, waiting out legislation that would add new restrictions on voting after the 2020 election. As promised, Republican Gov. Greg Abbott called a new legislative session as soon as the previous one expired. Though the group is still united around opposing the GOP’s elections bills, the Democrats appear uncertain who exactly is going to remain off the House floor and who has signed onto a speculative lawsuit trying to preserve the quorum break. Of the more than 50 Democratic lawmakers who originally fled, at least 26 have said they plan to remain in the nation’s capital to continue advocating for voting rights with congressional leaders — though Congress’ summer recess is about to begin.   A message from AT&T:     AROUND THE WORLD TEHRAN’S AWKWARD STOCKHOLM JOURNEY — Iraj Mesdaghi, a former political prisoner in one of Iran’s most notorious jails, thinks he has found one of his captors. On Tuesday, that alleged jailer will appear in a Stockholm courtroom. Hamid Noury is accused of playing a key role in the execution of scores of dissidents — as well as the torture of Mesdaghi and many others — at the Gohardasht prison, outside Iran’s capital Tehran, in a 1988 purge. “Noury had an active role in that massacre,” Mesdaghi said. “I saw him, I know him well.” Noury denies the charges. The trial has been headline news in Sweden because of the seriousness of the charges that Noury faces — “gross crimes against international law and murder” — and its scale: The police case documents name 38 plaintiffs and the main hearing is expected to continue until April 2022 with three sessions a week. The case also promises to offer a rare insight into atrocities allegedly committed by the Iranian state during one the darkest periods in its modern history — summer 1988 — when reports by human rights organizations say thousands of members of political opposition groups were executed on the orders of supreme leader Ruhollah Khomeini. The case is particularly sensitive for Iran now because its new president, Ebrahim Raisi, has long stood accused of being a central figure in the massacre, as a member of a committee that ruled who should be killed and who should be spared during the purge. A line of vehicles wait to enter Canada at the Peace Arch border crossing on Aug. 9 in Blaine, Wash. | Elaine Thompson/AP Photo WOE CANADA — Canada opened to fully vaccinated Americans today, increasing pressure on the Biden administration to respond in kind to its northern neighbor, Sue Allan writes. “The Biden administration should reciprocate this policy decision — given the high rate of vaccination across Canada — without further delay,” U.S. Travel Association President and CEO Roger Dow said in a statement from Washington. “Every month that travel remains stagnant, the U.S. loses $1.5 billion in potential travel exports and leaves countless American businesses vulnerable.” Even as Prime Minister Justin Trudeau shared plans to welcome fully vaxxed Americans, the Biden administration rolled over U.S. restrictions on nonessential travel until at least Aug. 21. Rep. Brian Higgins (D-N.Y.), co-chair of the Northern Border Caucus, used an essay in Barron’s to advocate for clarity and an update to U.S. travel policies. “This is not a partisan issue or one exclusive to states positioned along the border,” he wrote.   SUBSCRIBE TO "THE RECAST" TODAY: Power is shifting in Washington and in communities across the country. More people are demanding a seat at the table, insisting that politics is personal and not all policy is equitable. The Recast is a twice-weekly newsletter that explores the changing power dynamics in Washington and breaks down how race and identity are recasting politics and policy in America. Get fresh insights, scoops and dispatches on this crucial intersection from across the country and hear critical new voices that challenge business as usual. Don't miss out, SUBSCRIBE . Thank you to our sponsor, Intel.     NIGHTLY NUMBER 1.1 degrees Celsius The current amount of global warming from the pre-industrial era. The planet’s top scientists said in a monumental report released today they have definitively linked greenhouse gas emissions, for the first time, to the type of disasters driven by a warmer climate that have touched every corner of the globe this year. PARTING WORDS NEWSOM TO DEMS: VOTE NOTHING ON QUESTION 2 — Newsom said today that Democrats should not vote for any of the 46 candidates vying to replace him in the upcoming recall election. Recall ballots contain two parts: an up-or-down vote on whether to retain Newsom and an open-ended question of who should replace him. Newsom said he was focused on prevailing on the first part and discouraged his base from taking sides on the second. “We’re just focusing on ‘no’ on the recall, leaving the rest blank,” Newsom said. Newsom’s admonition highlights the strategic gamble his campaign took in dissuading other prominent Democrats from running. Some Democratic officials and campaign operatives believed it was in Newsom’s interest to have a fallback Democrat on the ballot in case Newsom is ousted. But Newsom’s team emphasized party unity and warned that another Democratic candidate could help the recall succeed by fracturing the liberal electorate. As a result, recall ballots will list several prominent Republican candidates but no Democrats with political experience. If Democratic voters leave that second question blank, they could be ceding the question of Newsom’s successor to Republican voters and other recall supporters.   A message from AT&T: Susana Chávez became valedictorian of International High School at Langley Park while juggling numerous jobs throughout school. But what kept her powering through it all was her American Dream. With the help of accessible and affordable broadband, she was able to focus on her studies, get assistance from teachers and stay in touch with her mother back home. And thanks to Access from AT&T, we can connect low-income households like Susana’s, and more communities in areas we serve with their American Dream. Find out how.   Did someone forward this email to you? Sign up here.   Follow us on Twitter Renuka Rayasam @renurayasam Chris Suellentrop @suellentrop Tyler Weyant @tweyant Myah Ward @myahward   FOLLOW US

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