SJ: I’m going to challenge the mortality statistics of the seasonal flu you have quoted, which are widely quoted, and was quoted by Donald Trump, too – though its source isn’t fake news but the CDC. Aren’t these figures an estimation or projection? And isn’t it true that the deaths attributable to COVID-19 is derived more from direct counting than from an estimation and, therefore, likely to be more accurate?

JPA: It’s true that mortality of seasonal flu is an estimation. But this estimation isn’t science fiction. It’s derived from sound scientific principles. The data on seasonal flu (flu-like illnesses) is robust. We know much more about the seasonal flu than COVID-19.

Now, your point that we’re literally counting, as opposed to estimating, deaths from coronavirus is correct. But I’ll push back that this may not yield mortality figures as accurately as people think. Because of the attention on coronavirus, we’re better at knowing that a deceased person had coronavirus than had the flu. This means we’re good at knowing when someone died with coronavirus – but not necessarily that they died from the infection. We assume that dying with coronavirus is dying from coronavirus.

SJ: But many have died in their homes with no documentation of being infected. We have assumed that dying without documented coronavirus is not dying from coronavirus. Surely, misattribution of deaths to coronavirus works in both directions.

JPA: I agree. Which is why we need better data to understand this virus better. One point I want to emphasize – the misattribution is paradoxically greatest in the group most vulnerable to coronavirus, i.e. those with limited life expectancy. This group is most likely to die from COVID-19. Because of their limited life expectancy, this group is also likely to die from their non-COVID morbidities.

One way to better measure the impact of COVID-19 is measuring excess deaths, which is the death rate beyond what one usually encounters annually. Excess deaths comprise several groups – e.g. people killed by COVID-19 infection and people who have died because they didn’t receive timely care because they were afraid to go to the hospital, or because healthcare resources were focused on COVID-19 patients. The magnitude of the latter group will be more evident in years to come. Another group are deaths caused by the social and economic consequences of the lockdown, such as from suicides and alcohol and drug abuse. This number, which’ll also be evident in years to come, shouldn’t be underestimated. At a global level, consequences of lockdown-induced starvation, derailment of immunizations for lethal childhood diseases, and lack of proper management of tuberculosis are tremendous threats.