How many deaths from COVID-19 are acceptable?

With a downturn in COVID-19 cases and deaths in the United States, officials and others are considering how many COVID deaths are acceptable moving forward:

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Implicit in a decision to drop the last remaining safety rules is a willingness to abide the current mortality rate. Over the last week, COVID-19 has claimed an average of 626 lives in the U.S. each day. That’s fewer than the roughly 1,900 who die of heart disease and the 1,650 who die of cancer each day, on average, but well above the 147 are lost to influenza and pneumonia combined.

For public health experts, the calculus is more explicit. Mortality and morbidity — the words their profession uses for death and illness — are on one side of the equation, and tools like seat belts, blood pressure medication, smoking-cessation programs and vaccines are on the other.

Those tools vary in cost, intrusiveness and political acceptability. Despite public health campaigns and legal mandates, Americans continue to drive drunk and leave seatbelts unfastened. Tobacco kills more than 480,000 people a year in the United States, yet 34.2 million adults continue to smoke. Diabetes claims more than 100,000 lives a year, but efforts to discourage the sale and consumption of sugary drinks — a significant contributor — have met fierce resistance.

At some point, all efforts to limit preventable deaths will hit the hard wall of funding constraints, medication availability, and people’s willingness to take steps to protect themselves and others. That’s where the number of deaths that is “acceptable” comes into focus…

The CDC and other federal agencies are still deciding on the criteria they’ll use to determine when the pandemic has ended. There’s still time — Dr. Rochelle Walensky, the agency’s director, said as recently as last week that we’re not there yet.

What I would highlight here as a sociologist:

  1. The relative risk of different illnesses or behaviors are not just determined by numbers. The first paragraph cited above highlights the number of people who die each day in the US due to different conditions. But, this does not mean each of these illnesses is experienced the same nor is thought of as the same kind of threat. See earlier posts on the acceptable deaths due to driving (and pedestrians).
  2. Decisions like these are made by a constellation of actors with a variety of interests. The public is involved in how leaders think the public will perceive changes, pressure the public can place on officials to make particular decisions, and in how the public responds. This is a process with numerous organizations and institutions involved.

Declaring an end to the COVID-19 pandemic is not easy nor is addressing the illness beyond the official end of a pandemic. Like much involving health, policies and behavior depends on social conditions and influences.

Large disparities in risk of death across American transportation modes

Here is the risk of dying in a vehicle compared to other modes of transportation:

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Northwestern University economics professor Ian Savage examined American crash data over a decade, concluding that 7.3 people died in a car or truck for every billion passenger miles, 30 times the risk on urban rail and 66 times the risk aboard a bus. (If you’re wondering, motorcycles are by far the riskiest vehicles of all, while airplane travel is the safest.)

Even with these numbers, there are multiple reasons why many continue to prefer to drive:

Studies show that people typically feel safer in vehicles they control compared to those they cannot (i.e., a car compared to a bus or train). Worse, the rare transit crash is often a top media story, while daily car collisions barely register. “It’s baked into how we talk about crashes,” says Millar, of Washington State. “We had an Amtrak train crash here, three people died, and it was international news. That same week 10 people died on highways in this state—and it was the same the week before that, and the week before that.”

According to psychology’s “availability heuristic,” the intense attention paid to exceedingly rare plane or train crashes can lead us to unconsciously exaggerate their frequency, while the media’s shrug at car crashes causes us to discount the dangers of driving. One extreme example: A study found that the shift away from flying toward driving in the aftermath of 9/11 led to over 2,000 additional traffic deaths in the United States.

Lots of interesting factors to consider here. Do the perceived advantages of driving block out any consideration of the risk? Even if people had these numbers at their fingertips, would they consider risks or numbers?

I have argued before that the preference for driving is strong. If people in the United States have the resources and opportunity, they will pick driving over mass transit. Of course, the system is set up to make this choice for driving easier with an emphasis on roads and linking important cultural values and driving (such as individualism, taking road trips, suburban life, etc.).

This may be a prime case where making an argument from the numbers simply will not get far given the cultural narratives and social systems already in place. Perhaps the numbers could be paired with a compelling story or narrative? Even then, it could take a long time to convince Americans that because driving is more dangerous than other options they need to switch to other modes of transportation.

Deaths and COVID-19 by groups, communities in Cook County

COVID-19 is big in its effects but I am surprised we have not seen more coverage all over the place about who specifically is affected more within regions and big cities. WBEZ looks at recent data in Cook County, Illinois:

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In the earliest weeks of the pandemic, Chicago’s Black residents were dying of COVID-19 at alarming rates. More recently, in the few weeks since the arrival of the omicron variant, Black Chicagoans are again dying at much higher rates than their Asian, Latino and white counterparts, shows a WBEZ analysis of data on COVID-19 related deaths from the Cook County Medical Examiner’s Office.

Since Dec. 7, 2021, the date when the state’s first omicron case was found in Chicago, the city’s Black residents are dying at rates four times higher than Asians, three times higher than Latinos and nearly two times higher than white residents, according to WBEZ’s analysis. A total of 97 Black Chicagoans died of COVID-19 during the seven-day period ending Jan. 9, 2022 — more than at any point since May 11, 2020.

Black Chicagoans aren’t the only demographic that has been particularly vulnerable since the arrival of omicron. Older suburban Cook County residents have also seen their seven-day COVID-19 death totals reach levels not witnessed in more than a year. According to WBEZ’s analysis, a total of 181 suburban Cook County residents 60 years and older died from COVID-19 during the week ending Jan. 9, 2022. That’s the highest seven-day total for that group since Dec. 24, 2020…

While several communities on Chicago’s South and West sides have been hit hard by COVID-19, the pandemic’s death toll has also weighed heavily in various parts of suburban Cook County. WBEZ’s analysis finds some of the county’s highest COVID-19 death rates in parts of northwest suburban Niles, Norridge and Lincolnwood, southwest suburban Palos Heights, Chicago Ridge, Oak Lawn and Bridgeview; and south suburban Hazel Crest, Markham, Harvey, Robbins and Country Club Hills.

I am sure there are already and will continue to be many academic studies that examine these differences. Even as COVID-19 has impacted many, the impacts of COVID-19 are not distributed evenly. It arrived at a time of inequality, including in health outcomes and experiences, and it exacerbated issues.

At least in the Chicago area, data on this topic is available online. For example, I have tried to keep track of the disparate effects of COVID-19 in DuPage County where there are significant differences across racial and ethnic groups, age groups, and communities (earlier post here).

Blame drivers for 94% of crashes or find fault in the larger system

Are drivers responsible for 94% of accidents? That is just one way to look at the issue:

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In 2015, the National Highway Traffic Safety Administration, a branch of the U.S. Department of Transportation, published a two-page memo declaring that “the critical reason, which is the last event in the crash causal chain, was assigned to the driver in 94% of the crashes.” The memo, which was based on the NHTSA’s own analysis of crashes, then offered a key caveat: “Although the critical reason is an important part of the description of events leading up to the crash, it is not intended to be interpreted as the cause of the crash.”…

Seeking to find a single cause for a crash is a fundamentally flawed approach to road safety, but it underpins much of American traffic enforcement and crash prevention. After a collision, police file a report, noting who violated traffic laws and generally ignoring factors like road and vehicle design. Insurance companies, too, are structured to hold someone accountable. Drivers aren’t the only ones who face such judgments. Following a crash, a pedestrian might be blamed for crossing a street where there is no crosswalk (even if the nearest one is a quarter mile away), and a cyclist might be cited for not wearing a helmet (although a protected bike lane would have prevented the crash entirely). News stories reinforce these narratives, with stories limited to the driver who was speeding or the pedestrian who crossed against the light…

With responsibility falling on those directly involved in a crash, it’s unsurprising that so many highway-safety efforts revolve around education campaigns, assuming that if people were just more careful, we’d all be okay. Officials at the NHTSA and state DOTs pour millions of dollars into these programs, but their benefits seem modest at best. Officials “see their role as trying to cajole people on the roads to make smarter decisions,” Seth LaJeunesse, a senior research associate at the University of North Carolina’s Highway Safety Research Center, told me. “Wear a seat belt, don’t be drunk when driving, and signal appropriately. I think it’s misguided. After all, who’s going to address structural problems, if it’s just people being stupid out there on the road?”…

With the infrastructure bill now signed into law, the federal government has a chance to rethink its approach and messaging. Dumping the dangerous 94 percent myth would be a good start; deemphasizing pointless traffic-safety PR campaigns would help too. Encouraging state and local transportation agencies—not just law enforcement—to investigate crashes, which New York City is now doing, would be even better. What we need most is a reexamination of how carmakers, traffic engineers, and community members—as well as the traveling public—together bear responsibility for saving some of the thousands of lives lost annually on American roadways. Blaming human error alone is convenient, but it places all Americans in greater danger.

Put together a society based around driving and a cultural emphasis on individualism and you have this situation. Is the individual operator responsible or a system that puts people in large vehicles traveling at fast speeds?

It is less clear from this piece how to view the system as a whole in order to improve the safety of roads. There are a lot of pieces that different actors have highlighted over the years. Fewer vehicles on the road? More room for pedestrians and bicyclists? More safety features in vehicles? Lower speeds? All of these could help but they would each threaten the current system which attempts to move as many vehicles as quickly as possible.

The approach many government and business actors seem to take at the moment toward this are attempts at incremental progress. Who would put all of these pieces together in a short amount of time, especially if individual drivers are willing to take responsibility? Americans seem fairly content with traffic fatalities and pedestrian deaths.

Wrestling with the ongoing – and increasing – numbers of pedestrian deaths in the United States

After a pedestrian death in her neighborhood, one writer considers the issue in the United States:

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My neighborhood isn’t unique. So far this year, 15 pedestrians have been killed by drivers in the nation’s capital, and total traffic fatalities are up to 37-the highest number since 2008. This is all despite Mayor Muriel Bowser’s goal to end traffic deaths by 2024 as part of the Vision Zero program signed on to by leaders of D.C. and other major U.S. cities. The District Department of Transportation has made some changes to protect walkers and cyclists, such as reducing speed limits and installing more bike lanes. Ironically, total traffic fatalities have increased steadily since the program began.

The same trend is reflected in cities across America. Part of the increase in pedestrian deaths is probably because our vehicles are bigger than ever. “Our pickup trucks and SUVs are gigantic compared to the sizes they used to be,” giving drivers less visibility and a greater sense of security, which makes them more aggressive on the road, says Rohit Aggarwala, a fellow at the urban Tech Hub at Cornell Tech and the former director of long-term planning and sustainability for New York City. During the pandemic’s early days, as fewer Americans drove to work or school, it seemed safe to assume that fewer pedestrians would die Instead, fatalities have jumped. Conclusive research isn’t out yet, but the increase is likely at least in part due to a drop in traffic congestion and an ensuing increase in speed: “People were still walking around their neighborhoods during lockdown, and you had a [small] number of people on the streets driving very, very fast,” Aggarwala told me. Older adults, people walking in low-income areas, and Black and Native Americans are all overrepresented in pedestrian-death statistics.

Most pedestrian deaths are preventable, and experts believe that the solutions are straightforward. Aggarwala and his team at Cornell Tech are pushing for three major changes to America’s driving infrastructure: more robust traffic-camera enforcement, to capture not just speeding but all kinds of moving violations; road redesign that would decrease lane size and add speed bumps to nudge drivers to slow down; and finally, upping the standards for vehicle safety. Car manufacturers in Europe are required to test cars for pedestrian impact; they design hoods to slope downward so that drivers can see anyone who might wander into the road. American automakers could do the same, or add pedestrian-detection systems or speed limiters to cars. Many of these changes would not only make roads safer for pedestrians but also could reduce police violence at the same time. “The U.S. hasn’t considered any of this,” Aggarwala said. “We have a tradition of focusing on vehicle safety as only being about the occupant.”

This is an ongoing issue as long as roads are primarily for cars and vehicles. The priority for decades in the United States has been to make roads optimal for vehicles. Pedestrians and other street level activity is, on the whole, not as important.

When I read this, I thought about the efforts to include equipment in all new cars that would test to see if the drivers was driving impaired. How did this come about? Drunk driving has been a recognized issue for years with organized groups making sure it was on the public’s radar screen. Is a social movement against pedestrian deaths and promoting pedestrian safety necessary to make significant changes? The solutions might be straightforward but the political and societal will is lacking.

Driving down, traffic deaths up in Illinois and across the US

Usually traffic deaths decrease when people drive less. This has not been the case in Illinois or the United States as a whole in the last year:

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About 1,166 people died in motor vehicle crashes in Illinois in 2020, a nearly 16% increase over 2019, according to the Illinois Department of Transportation. That’s a provisional number, said IDOT spokesperson Guy Tridgell, since it takes the state agency 12-18 months to finalize annual data…

Speeding and traffic fatalities typically go down during recessions, according to an October study published by the National Highway Traffic Safety Administration. In Illinois, for example, deaths dipped sharply in 2008 and 2009 according to state data, though they’ve been up slightly since…

About 28,190 people died in crashes from January to September 2020, more than a thousand more fatalities than in the same period in 2019, the federal agency estimated. A full annual report is expected to be released in the late fall…

What’s more, traffic deaths nationally were down from March to May, but jumped back up after states began reopening in June, according to the agency’s estimates.

This suggests safety is not solely a function of the number of miles driven or trips taken. How people drive and the conditions matter quite a bit. In this case, the article hints at multiple possible reasons for this jump. This includes speeding, more impaired drivers, and less seat belt use among those hurt.

I wonder if there are several other factors at play. With many public and private locations shut down, did driving become an even more important escape for some Americans? With limited places to go, driving and doing so dangerously could be a kind of release not available elsewhere.

Second, is there a safety feature to a certain level of traffic? With fewer people out, does this encourage riskier driving compared to having to navigate more vehicles on the road? Too many cars likely leads to more accidents but what about too few compared to typical conditions?

Still looking for helpful numerical comparisons to make sense of COVID-19 deaths

A list of the most deaths on a single day has been making the social media rounds. Titled “The Deadliest Days in American History,” spots #4-7 are recent days with COVID-19 deaths following the Galveston Hurricane, the battle of Antietam, and September 11, 2001. But, the numbers on the list are not what they seem:

An infographic listing the "Deadliest Days in American History."
I first saw the image on Facebook.

For one thing, a list of the “deadliest days” in American history would include days with the most deaths, not the most deaths from one discrete event. On all of the days included, more people in the United States died than the numbers listed. According to Reuters, 2,861 COVID-19 deaths were indeed reported last Thursday. But that doesn’t account for the number of people who died from heart disease (last week’s daily average was 1,532 deaths), lung and tracheal cancer (last week’s daily average was about 560 deaths), or chronic kidney disease (last week’s daily average was about 290 deaths). Deaths from drug overdoses have also been reaching record highs this year, a trend that may have been worsened by the pandemic. (Obviously, more people died on the days of the Galveston hurricane, the Battle of Antietam, 9/11, and Pearl Harbor, too.)

By its own rules, the list is also incomplete. More than 3,000 people died in the 1906 San Francisco earthquake, which isn’t mentioned, nor is the 1899 San Ciriaco hurricane, which killed more than 3,300 people in Puerto Rico over the course of six to nine hours. While we’re at it, the population of the United States is much larger now. The U.S. was home to about one-tenth of the current population during the Battle of Antietam. Losing 3,600 people back then would be like losing 36,000 people now.

But yes, the general idea behind this list—and other attempts to communicate the horrors of the pandemic as a set of digestible facts—is worthwhile. It can be helpful to compare the number of deaths specifically from the coronavirus to other historical events in which there were huge losses of American life. More than 286,000 people in the U.S. have died from COVID-19 thus far. Compare that to the 116,000 Americans who died in World War I; 405,000 Americans who died in World War II; 37,000 Americans who died in the Korean War; and 58,000 Americans who died in the Vietnam War. The 1918 flu pandemic killed 675,000 Americans, the 1968 influenza A pandemic killed 100,000 Americans, and the 2009 H1N1 pandemic killed 12,469 Americans.

The general idea may be a good one: similar numbers reported day after day lose their power. It can be hard for the general public to interpret large numbers in the abstract, as this earlier post about comparing an earlier death figure from COVID-19 to my community’s population. The list tries to place the daily death totals in historical context by noting that these are not just normal numbers; they are high numbers for any day in American history.

Yet, as noted above, the numbers do not quite work out. Perhaps the list should have a new title like “Days with the most deaths directly attributable to unusual causes” since it ignores all causes of death on particular days. And even then, other natural disasters are ignored and putting the numbers in a different context – as a percent of the population as a whole – also changes the list.

The list might still spur people to action, even if the list has flaws. And this was probably the goal of the list in the first place: it is not meant to be an academic study on the topic but a call to action. Like many statistics, these numbers are used in a way intended to nudge people toward different behavior.

Interpreting data: the COVID-19 deaths in the United States roughly match the population of my mid-sized suburb

Understanding big numbers can be difficult. This is particularly true in a large country like the United States – over 330,000,000 residents – with a variety of contexts. Debates over COVID-19 numbers have been sharp as different approaches appeal to different numbers. To some degree, many potential social problems or public issues face this issue: how to use numbers (and other evidence) to convince people that action needs to be taken.

This week, the number of deaths in the United States due to COVID-19 approached the population of my suburban community of just over 53,000 residents. We are a mid-sized suburb; this is the second largest community in our county, the most populous suburban county in the Chicago region outside of Cook County. The community covers just over 11 square miles. Imagining an entire mid-sized suburb of COVID-19 deaths gives one pause. I had heard the comparison a week or two ago to the deaths matching the size of a good-sized indoor arena; thinking of an entire sizable community helps make sense of the number of deaths across the country.

Of course, there are other numbers to cite. Our community has relatively few cases – less than hundred as of a few days ago. Considering the Chicago suburbs: “If the Chicago suburbs were a state, it would have the 11th-highest COVID-19 death toll in the nation.” The COVID-19 cases and deaths are scattered throughout the United States, with clear hotspots in some places like New York City and fewer cases in other places. And so on.

Perhaps all of this means that we need medical experts alongside data experts in times like these. We need people well-versed in statistics and their implications to help inform the public and policymakers. Numbers are interpreted and used as part of arguments. Having a handle on the broad range of data, the different ways it can be interpreted (including what comparisons are useful to make), connecting the numbers to particular actions and policies, and communicating all of this clearly is a valuable skill set that can serve communities well.

 

 

A nation beholden to cars: a record number of pedestrians die in US in 2019

A new report highlights the dangers to pedestrians in the United States:

Based on data from the first six months of 2019, the Governors Highway Safety Association predicts there were 6,590 pedestrian deaths that year, which would be a 5 percent increase over the 6,227 pedestrian deaths in 2018.

The 2019 figure is the highest number of such deaths in more than 30 years, according to the association…

While there’s been a significant increase in pedestrian deaths over the past decade, the number of all other traffic deaths increased by only 2 percent…

“Following 30 years of declining pedestrian fatalities, there has been a complete reversal of progress,” Retting said in the release. “Pedestrians are at an inherent disadvantage in collisions, and we must continue to take a broad approach to pedestrian safety.”

While there are particular aspects of driving and pedestrian behavior that could be debated and addressed, there is a larger point that can be made with such data: the priority on American roadways goes to vehicles. This has been the case for decades and will continue to be the case for years to come. While efforts to make streets more amenable to walkers and bikers, these efforts are often limited to only a few areas. The goal of roadways in many places, included dense, populated areas, is to move as many vehicles as quickly as possible to where drivers want to go.  Tackling specific issues may help reduce the number of deaths but still leave the larger problem: Americans like cars and driving and our lives are often organized around driving.

The case for a social problem: over 49,000 pedestrian deaths in the US 2008-2017

A new report addresses pedestrian deaths in the United States:

Harrowing data showed that between 2008 and 2017 the number of annual pedestrian deaths in the U.S. increased by 35.7 percent. A total of 49,340 died in that 10-year period. That’s more than 13 people killed per day or one person every hour and 46 minutes…

“Why is this happening?” authors of the report asked. “We’re not walking more and we’re only driving slightly more than we were back in 2008. What is happening is that our streets, which we designed for the movement of vehicles, haven’t changed. In fact, we are continuing to design streets that are dangerous for all people.”

Federal and state transportation policies, blueprints and funding are stuck in the age of the automobile, when sprawling growth patterns — especially in the Sun Belt — led to wider roads, longer blocks and street engineering that prioritized high speeds for cars over safety for people on foot, on bikes or using mass transit, the report says.

Among the victims, death rates are disproportionately high for the elderly, minorities and people walking in poor communities, data showed. Older adults are more often struck at an intersection or in a crosswalk than younger victims. In San Francisco, Pittsburgh and Milwaukee, residents organized marches, flash mobs and 20-second performances in crosswalks to campaign for longer signal times for elderly and disabled people.

The numbers are likely shocking for many readers: that many people died over a 10 year stretch from walking? The cause for many a social problem is advanced by such figures which reveal to the average person the scope of an issue they rarely consider.

But, put those figures next to those that died in car accidents and they pale in comparison. Are the two numbers combined – both primarily the result of an automobile dependent culture – more valuable? Or, are they simply what Americans are willing to do for the sake of driving?

To me, the next step is to ask what it would take to reach a critical mass of Americans to push against a car dominated society and press for better options for pedestrians and other non-vehicles on streets and roads. This is not an easy task; diverting resources and attention away from roads and highways is difficult.