Putting coronavirus into context for Hawaii
Even with the uptick in cases and deaths in August the coronavirus is still a very low risk compared to many other causes of death and illness
As of August 31, 20, Hawaii’s Covid-19-related death count stands at 64. Infection numbers are up significantly in August and the state has entered a second round of lockdowns for the island of Oahu and there is now serious discussion about the neighbor islands also shutting down a second time.
It’s important in knowing how to respond personally, as well as making public policy, to put the risk from coronavirus into proper context. Our policymakers here in Hawaii and around the nation have often seemed to consider only the immediate perceived threat of the virus and ignored foreseeable consequences of their policy choices on other aspects of public health and human wellbeing.
It’s also important to craft policy responses specific to each jurisdiction — a scalpel approach rather than a one-size-fits-all approach. Each jurisdiction is different. Big Island is not Oahu is not Maui is not Kauai.
Figure 1 shows that the new virus is still an extremely small cause of death here in Hawaii for all islands. The only communicable disease in the top ten is flu/pneumonia, which is why we often hear Covid-19 compared to flu/pneumonia. Even though deaths attributed to Covid-19 in the U.S. as a whole are significantly higher than a normal or even a severe flu season, Covid-19 deaths in Hawaii remain at 1/10th of a normal flu season.
(Figure 1 uses 2017 data, the latest available from CDC for Hawaii, but I discuss below the 2020 flu/pneumonia data).
It hardly needs stating that Hawaii has never considered lockdowns for a normal or even a bad flu season — even though a normal flu season brings 10 times the mortality we’ve seen so far from Covid-19.
Flu/pneumonia deaths for 2020’s flu season total 623 as of early August. The state Department of Health issues a weekly report on flu/pneumonia. The August 14, 2020 report states:
For week 31 [July 26 to Aug. 1] of the current influenza season:
2.0% of all deaths that occurred in Hawaii during week 31 were related to pneumonia or influenza. For the current season (season to date: 6.6%), there have been 9,481 deaths from any cause, 623 of which were due to P&I.
So of the more than 9,481 deaths from any cause in Hawaii in 2020 so far, 64 have been attributed to covid-19.
But this is not the end of the analysis. These deaths are attributed to Covid-19 but, based on news accounts of each death (which is the only data we have at this point on this issue), most and perhaps the large majority of these deaths have occurred in elderly patients with one or more serious underlying conditions — raising serious questions about whether these people died “from” Covid-19 or “with” Covid-19.
Many jurisdictions have simply defined a “Covid-19 death” as any person who died after testing positive for the virus, which follows the CDC (NVSS) guidelines for reporting Covid-19 death as an underlying cause of death even if it is suspected in the causal chain. This is one of the most inclusive definitions of a Covid-19-related death in the world. And the definitions used by each country, in terms of how inclusive or not the definition is, correlates well with the mortality rate across countries. The top ten mortality rate nations, which does not include the U.S., often have the most inclusive definitions of Covid-19 deaths.
Accordingly, even the nation’s lowest death rate we have experienced from Covid-19 here in Hawaii is probably significantly lower than has been reported to date. We won’t know for sure until at some point in the future when death certificates and hospital reports are reexamined. Such a reexamination recently took place in England and resulted in a reduction of more than 5,000 deaths attributed to the virus, simply because of a change in definition of what counts as a Covid-19 death.
Hawaii’s death toll will surely climb as the current infections cause the most damage to the most vulnerable, but most reported deaths will probably still be “with” Covid-19 rather than “from” Covid-19 in terms of the causal chain leading to death.
Figure 2 shows where Hawaii stands in relation to other U.S. states in terms of mortality. Given the extreme concern among our leaders and our news media one would think we are now topping the list of Covid-19 fatalities. The opposite is the case: we are literally doing the best of all 50 states in seeing a very low mortality rate.
Hawaii has also had the benefit of a “negative excess deaths” rate for 2020, which means that overall we’ve seen fewer deaths than normal. Only Hawaii and Alaska have enjoyed zero or negative excess deaths for 2020.
Looking at infection rates (Figure 4 below), even with the big uptick in Hawaii in August we are still in the bottom five of all 50 states for infection rates.
In sum, current data about deaths from Covid-19 and other major causes of death do not support the panic taking place among the public and our leaders and policymakers.
The uptick in test positivity rate (Fig. 5 below) is cause for some concern — but it should be taken in context with the statistics just shown about our extremely low mortality and infection rates. Figure 5 shows the testing data, including positivity rate, for Hawaii since May. Testing rates jumped 4-fold since June (shown by the bars in the chart and the scale on the left side), which itself accounts for a significant part of the increase in reported infections (in the same manner that a decline in testing would, all else equal, result in fewer reported infections).
But the positivity rate (shown by the scale on the right side of the chart, black line) also climbed significantly in the same time period, from about 1% to about 5% — which is cause for concern. In the last week of August it started to diminish again.
A later essay will look at hospitalization rates and concerns in Hawaii about our health care system being over-run by the pandemic.