Max Nowalk

January 18, 2021

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Contrary to many pundit analyses of the 2020 Presidential and Vice-Presidential debates, there was plenty of substance exchanged between both parties. I don’t mean to suggest there was civility — because there wasn’t much of that for any of the debates, including against the consensus surrounding the Vice Presidential and second Presidential debate, though that is a different topic. There’s also no doubt the Trump administration’s representatives walked onto the stage out of bad faith. Most observers could tell you the two dug their heels into spreading any number of lies and misinformation when there hasn’t been a more important time in modern American history when we needed to hear the truth.

And yet, regardless of your political persuasion, there was genuine substance on display. For instance: the strategy of a democratically elected administration during a global pandemic that has claimed 2 million lives worldwide at the time of writing (only three months after the debates, when we still thought 200,000 COVID deaths in the US was a scary number).^[1]

By “substance,” I mean everything worth noting concerning the administration’s response to a disease that isn’t waiting for people to social distance or mask appropriately. President Trump most notably claimed that although, at the time, there were close to 200,000 deaths attributable to the coronavirus, Joe Biden’s hypothetical administration would have lost upwards of millions of lives.^[2] Of course Trump did not explicitly concede 200,000 people had died on his watch and he did not cite any specific models or numbers that would have supported such an outrageously speculative (and I’d say improbable) claim.

It is worth noting that a quick fact check confirms there were models back at the beginning of the pandemic in March 2020 that forecast around 2.2 million Americans could die from COVID. Important to note with this claim is that the model in question from Imperial College London is based on no response whatsoever from the US presidential administration. That is, 2.2 million people could have died in America alone if the administration had made no efforts to stop the spread of the disease (along with a presumed absent response from state and local levels of government).^[3] So just to clarify Trump’s inflamed rhetoric here, he baselessly claimed that Joe Biden’s administration would have done as badly as 2.2 million deaths, and the only foreseeable reason that this could’ve happened according to the study’s assumptions is that the administration would’ve done absolutely nothing to combat the spread of the disease.

Politics.

But there is something you might not have noticed that I think we should be very scared of in Trump’s reasoning here. Sure, he’s an idiot who doesn’t know what he’s talking about (what else is new?), but he’s playing what looks like a classic politician’s card. He’s shrugging off the fact that, at the time, 200,000 Americans had died from COVID-19 in order to argue that in other scenarios, the deaths could’ve been a lot higher.

There might be something to that. You could say for any situation with a gross outcome that the end result you had to sacrifice for was better than the alternative situation in which you hadn’t made the sacrifice. It’s basic loss-gains reasoning: nobody wants to argue 200,000 dead Americans is worse than 2,200,000 dead Americans.

But here’s the thing: 200,000 dead Americans is still 200,000 dead Americans. And at the time of this article’s writing, the US has suffered over 397,000 deaths.^[4] We shouldn’t have to say that 397,000 dead Americans is a policy failure on any scale – but we do. I’d like to point out a few more things about why this kind of sentiment’s underlying cynicism is so corrosive to policy initiatives of any kind.

What is the real cost of COVID-19?  No one really knows. Not even for the past couple months, and certainly not for the foreseeable future. But we have access to data that should frighten us beyond the mere 397,000 dead Americans we’re already grieving. I’m not talking about the immeasurable psychological, and likely generational, trauma that the survivors will harbor for the rest of our lives (I’d bet most analogously similar to survivors of the Great Depression). I’m not even talking of the sometimes harmless, sometimes debilitating, and often unknown long-term effects of the disease itself. I’m talking, for example, about the uncounted COVID deaths that did not for whatever reason find their way into the daily tally we dread hearing about. The “real” cause of death for COVID patients can be hard to pin down, often ultimately due to pneumonia or forms of respiratory distress. Yet the real “cause” of a death that results from another effect originating after COVID would intuitively seem most attributable to COVID.^[5] This problem quickly demonstrates the unreliability of some death tallies and errs on attributing higher deaths to the disease itself.

Another problem we have to consider when appreciating frightening statistical models for future case and death numbers is the simple fact that they are analytical tools, not fortune tellers to deliver us the full reality of what’s to come. Trying to predict the pandemic’s full toll is always fraught with errors of unpredictability as well as variables that should’ve been included in the model for the most detailed outcome. For example, what about above average normal deaths? The number of deaths in elderly nursing care facilities from neglect – most often attributable to the lack of attention from overburdened health care workers – has claimed tens of thousands of lives.^[6] This raises the further question of how we are supposed to comprehend the deaths that have happened in the wake of COVID, those that weren’t directly caused by people contracting the disease but dying because of the circumstances around the pandemic. To take nursing homes as another example: many patients die from sheer loneliness following the loss of social interaction.^[7]

Back in October, before the new devastating wave of cases and deaths that started raging after Halloween weekend, one metanalysis predicted the US COVID deaths may be underestimated by 36%, especially in minority and low-income communities.^[8] That’s a lot when you’re juggling numbers of human lives in the hundreds of thousands, and again the study was published in October. The New York Times published pieces back in August that the “true” death toll had exceeded 200,000 long before the official tally met that number. In mid-December, it claimed the true death toll was around 377,000.^[9]

If we stop to contemplate the outcomes that defy quantitative measures, what can we say about the devastating effects on mental health?  A “second wave” of mental health and substance abuse crisis was imminent during the presidential debates.^[10] That was before the winter season had really set in, and before further lockdown measures in major cities had forced people to seriously curtail many of their social activities again. Unsurprisingly, the effects of these domestic problems were severest once again in minority communities which continue to suffer disproportionate impact on almost every scale as they have since the start of the pandemic.^[11]

I won’t even attempt to guess the economic and financial devastation we are collectively embarking on (with the recent news headlined by the US federal government having delayed its second round of stimulus aid for months, and the richest billionaires continue a profit field day).^[12] Of note on the topic is that the Federal Reserve projects keeping interest rates to control for inflation close to 0% through 2023;^[13] the last time they held interest rates that low was in response to the 2007/08 Financial Crisis and corresponding Great Recession. We can probably agree things don’t look too good.

The point I am trying to make isn’t that the world is really bad at the moment. What’s most shocking is how numb we are to it. We’re so numb that we don’t blink an eye when the top politician in American government tells us with a straight face that things aren’t so bad because, well, his opponent would’ve made them much worse.

Let’s assume for an absurd moment that Trump was right. Maybe Biden would’ve chosen to encourage herd immunity tactics and sacrifice grandma for the sake of a healthy stock market. Maybe, let’s assume, Trump’s “plan” saved as many lives as possible. I think it should be obvious with all the data we currently have at our disposal, not to mention the data we’ll have in the future to remember the abject failure of American public health and governance, that 200,000 dead Americans is an untold failure on our part regardless of any potentially worse scenario. So is the 397,000 dead Americans we are mourning now. And so will the over 550,000 dead Americans projected for April of 2021.^[14]

Every number we recite to ourselves represents an asterisk for other numbers. All of those other numbers have culminated in a single statistic that is isolated from other statistics resulting from an experience of suffering and probably despair. The real question we need to ask ourselves is: What are public health policies about and how should we measure their success? Hell, what is government supposed to do in times of crisis, and what constitutes success? I have a feeling 397,000 dead Americans isn’t the “win” we should be hoping for. Sure, some of that number is inevitable at a certain point, whatever that means. But the kind of resignation we need to conceptualize hundreds of thousands of preventable deaths as “inevitable” suggests a defeated mentality, if not a flawed worldview. Take this quote famously attributed to Joseph Stalin, of all people: “One death is a tragedy; a million deaths a statistic.” Stalin of course grew up in a tumultuous historical period: World War, Revolution, global pandemic… You have to wonder how the worldview of a generation numbed by 9/11, the Great Recession, and a new global pandemic will end up.

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^[1] “Home,” Johns Hopkins Coronavirus Resource Center, accessed January 2, 2021, https://coronavirus.jhu.edu/. 

^[2] “Highlights from the Final Trump-Biden Presidential Debate,” NBCNews.com (NBCUniversal News Group, October 27, 2020), https://www.nbcnews.com/politics/2020-election/live-blog/2020-10-22-trump-biden-election-n1244210/ncrd1244395.  

^[3] NBC Debate Highlights.

^[4] Johns Hopkins.

^[5] S. Andrew Schroeder, “How Many Have Died?,” Issues in Science and Technology, November 24, 2020, https://issues.org/covid-19-pandemic-deaths-excess-mortality/.  

^[6] Matt Sedensky, “Not Just COVID: Nursing Home Neglect Deaths Surge in Shadows,” AP NEWS (Associated Press, November 19, 2020), https://apnews.com/article/nursing-homes-neglect-death-surge-3b74a2202140c5a6b5cf05cdf0ea4f32. 

^[7] The Editorial Board, “Nursing Home Patients Are Dying of Loneliness,” New York Times (New York Times, December 29, 2020), https://www.nytimes.com/2020/12/29/opinion/coronavirus-nursing-homes.html?searchResultPosition=1.  

^[8] Michele W. Berger, “U.S. COVID Deaths May Be Underestimated by 36%,” Penn Today, October 2, 2020, https://penntoday.upenn.edu/news/US-covid-deaths-may-be-underestimated-36-percent/. 

^[9] Josh Katz, Denise Lu, and Margot Sanger-katz, “True Pandemic Toll in the U.S. Reaches 377,000,” The New York Times (The New York Times, December 16, 2020), https://www.nytimes.com/interactive/2020/us/covid-death-toll-us.html. 

^[10] Naomi Thomas and Sam Romano, “A ‘Second Wave’ of Mental Health Devastation Due to Covid-19 Is Imminent, Experts Say,” CNN (Cable News Network, October 12, 2020), https://www.cnn.com/2020/10/12/health/mental-health-second-wave-coronavirus-wellness/index.html. 

^[11] CNN Mental Health.

^[12] Samuel Stebbins and Grant Suneson, “Jeff Bezos, Elon Musk among US Billionaires Getting Richer during Coronavirus Pandemic,” USA Today (Gannett Satellite Information Network, December 1, 2020), https://www.usatoday.com/story/money/2020/12/01/american-billionaires-that-got-richer-during-covid/43205617/. 

^[13] Ann Saphir, “Fed Will Be Tested in 2021 as Vaccines Boost U.S. Economic Outlook,” December 15, 2020, https://www.reuters.com/article/us-usa-fed-idUSKBN28P0HW. 

^[14] “IHME: COVID-19 Projections,” Institute for Health Metrics and Evaluation, December 23, 2020, https://covid19.healthdata.org/united-states-of-america?view=total-deaths. See also: “COVID-19 Forecasts: Deaths,” Centers for Disease Control and Prevention (Centers for Disease Control and Prevention, December 30, 2020), https://www.cdc.gov/coronavirus/2019-ncov/covid-data/forecasting-us.html/.