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There are pros and cons to the federal government’s decision to largely leave the coronavirus response up to each state.
The good part of that strategy is that it allows local leaders to make decisions based on the realities in their communities. While we’re all facing the same disease, the impact of COVID-19 has been very different in, say, New York than it was in Utah. A one-size-fits-all approach doesn’t make a lot of sense, which is why Utah says it is easing even more restrictions this weekend.
The downside, though, is that we’ve lost a lot of the benefit of the size and power of the United States. Governors are left to bid against one another for crucial supplies — for example, Utah was left to pay $15 per testing swab for a box of 100,000 in one contract, rather than the typical $1.25 per swab after being outbid internationally. Those higher prices hurt everyone in our country.
But frankly, this dispersion of responsibility has also hurt our ability to learn more about the virus. Each state has made its own decision on how to report the data, which means apples-to-apples comparisons sometimes aren’t available.
For example, the COVID Tracking Project gives each state a “Data Quality Grade,” which has been all over the map. Utah’s is currently a B. For a while there, a few states had F grades. Some states took forever to report negative tests; North Dakota didn’t start until May 2. There’s still no national definition of the term “recovered” — Utah just decided, after not hearing from the feds, that anyone who wasn’t dead after 21 days had recovered.
This doesn’t need to be a problem! Ideally, you’d have a national reporting standard that everyone would stick to, one that would give us a much better idea of the current state of the disease in our nation. Unfortunately, that hasn’t happened.
That lack of cohesion also means that we haven’t been able to take on other large-scale studies, as other countries have.
Take Spain. That government just completed a randomized serology study that included 100,000 people and more than 60,000 of them were given a blood test. What did the Spanish researchers learn? A ton!
They learned that roughly 5% of their population had already had the coronavirus, when their positive test count was 0.5%. They were missing about nine out of every 10 cases. Given their confirmed death count, that means the infection fatality rate in Spain is about 1.2%.
Thanks to consistent sampling from every population and every region of their nation, these researchers learned where the hotspots are. They learned that they’re still very far away from herd immunity, even in Madrid, where 11% of residents have already had the disease. They learned 26% of infections were asymptomatic. They learned that 3.6% of students had COVID-19, 5.8% of active workers, and 6.1% of retired people. They learned who had underlying health conditions and who didn’t, and which symptoms people were most likely to get given all of the above.
They learned, in short, incredibly valuable information about the disease. Each region in Spain can use this data in their community, but it has also been compiled according to national standards. We just don’t know that kind of information right now in our country — the states are having to do their own research in hodgepodge fashion.
Indiana, for example, tested 4,600 people for COVID-19 antibodies. It found that 2.8% of the state’s population had the disease so far, or that it was missing about 10 out of 11 cases. That gave Indiana an estimated infection fatality rate of 0.58%. (The flu fatality rate is about 0.1%.) The study found that 45% of the state’s cases were asymptomatic.
Utah is conducting its own study of 10,000 people for antibodies, but says it’ll have to spend the “next several months” conducting the research. The CDC is going to start a national serology study “in the summer.” We’re still significant time away from understanding what’s going on.
I suppose that the good news is that we can take some lessons from these studies elsewhere. For example, if we wanted to estimate Utah’s infection fatality rate, we might look at the results from places that have done these serology studies and then adjust them for our younger population. From previous research, we know that the majority of deaths are from the elderly, from 70%-90%.
Well, let’s do a brief comparison, then.
Given that Utah is younger than many other places, on this basis alone, you might estimate that Utah’s infection fatality rate is likely to be 0.3% to 0.6%, somewhere in there. Given that 75 people have died so far, that might lead you to estimate that 15,000 to 30,000 people had been infected in Utah. And that number would mean that fewer than 1% of Utahns have had the disease so far.
See how much guesswork that is, though? We can do our best, but every extrapolation means more and more chance for error. Errors make for bad decisions.
And that doesn’t even begin to get at the number of positive interventions we’re missing out on. Take this U.K. study. It looked at every single coronavirus death, 2,494 deaths for those between the ages of 20 and 64 in that country, to determine which jobs had the highest death rates due to the disease. Then, it split deaths of men and women, in order to compare apples to apples.
Researchers found that, of males, low-skilled workers were the most likely to die from the virus. Among these, the professions most likely to die were security workers, process plant workers, and construction workers.
For women, the category that included caring, leisure and other service occupations were responsible for the most deaths.
Another dangerous job was transport drivers. Truck and van drivers were mostly OK, but bus drivers died at higher rates, and taxi drivers at the highest rates.
Researchers were also curious about how health care workers were doing. They died at only average rates. But social care workers — a group that included social workers, workers in nursing homes and mobile care units — died at huge rates.
Isn’t that valuable information to know? If you were running the U.K. government, you’d acquire and distribute protective gear for social workers, bus drivers, and taxi drivers. You’d investigate low-skilled occupations, and figure out what security companies, manufacturing plants, nursing homes and construction sites could do better. That would give you the information you need to save lives.
Leaders in the United States can read that study and think “hey, maybe we should check in on our taxi drivers, see how they’re doing.” But when we wait for other countries to do research for us, we lose time, as well as the opportunity to study and solve whatever problems are happening uniquely domestically.
To be sure, Utah is trying to solve these problems by doing its own research, but we’re never going to have the scale of deaths to figure out something like the U.K.’s job-by-job figures. That’s where sheer federal size and resources can make a huge difference — and federal information gathering has come up short so far.
When it comes to learning about the coronavirus, we’ll do our best to make lemonade. But I sure wish we were being handed more lemons.