SECTIONS SEARCH SKIP TO CONTENTSKIP TO SITE INDEXPOLITICS Account POLITICS | Trump Suggests Virus Death Count Is Inflated. Most Experts Doubt It The Coronavirus Outbreak Latest Updates Maps and Cases Live Better at Home States Reopening Newsletter Trump Suggests Virus Death Count Is Inflated. Most Experts Doubt It Senior White House and health officials have sought new ways to find the extent of infections and deaths, questioning whether official counts are inflating the toll of the virus. Cemetery workers in New Orleans at the end of April. How deaths are tallied often varies from one state or county to the next. Noah WeilandMaggie HabermanAbby Goodnough By Noah Weiland, Maggie Haberman and Abby Goodnough WASHINGTON — President Trump, eager to reopen the economy, has begun questioning the official coronavirus death toll, suggesting the numbers, which have hobbled his approval ratings and harmed his re-election prospects, are inflated. In coronavirus task force and other White House meetings, conversations with health officials have returned to similar suspicions: that the data compiled by state health departments and the Centers for Disease Control and Prevention include people who have died with the coronavirus but of other conditions. The numbers, some say, include too many “presumed” cases of Covid-19 and too many Americans who were never tested for the disease. Last Friday, Mr. Trump told reporters that he accepted the current death toll, but that the figures could be “lower than” the official count, which now totals nearly 95,000. Most statisticians and public health experts say he is wrong; the death toll is probably far higher than what is publicly known. People are dying at their houses and nursing homes without ever being tested, and deaths early this year were likely misidentified as influenza or described only as pneumonia. Dr. Anthony S. Fauci, the nation’s top infectious disease expert, told lawmakers this month that the overall toll was likely an undercount. “I don’t know exactly what percent higher but almost certainly it is higher,” he said at a Senate health committee hearing. Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, which is closely tracking the coronavirus pandemic, said that “the officially reported numbers don’t reflect the true level of illness and death that have occurred.” “We very much feel the reported numbers reflect an undercount,” she said. Inside the White House, doubts about the official numbers are pervasive, though they come in different forms. Mr. Trump is in search of good news to promote his administration’s response to the pandemic and to press states to reopen. Dr. Deborah L. Birx, the White House’s coronavirus response coordinator, is a numbers obsessive and wants her own data to supplement information coming in from the states and the C.D.C. One official has even accused hospitals of potentially exaggerating their coronavirus patient counts to milk money from Medicare. Top White House officials have even discussed appointing a “forensic” team to audit how some hospital systems and state health departments have been tallying infections and deaths, according to one senior administration official. Multiple senior White House officials said they were unaware of such conversations. In a brief interview Thursday, Dr. Birx stressed that there had been no pressure to alter data. “I’ve never been in a meeting where anyone has discussed changing the death numbers,” she said. And she disputed that the White House was debating the C.D.C.’s counting of probable infections. “There is no tension about their presumed cases,” she said. ImageA team led by Dr. Deborah L. Birx has spent weeks compiling its own information from state and local health departments in hard-hit parts of the country. A team led by Dr. Deborah L. Birx has spent weeks compiling its own information from state and local health departments in hard-hit parts of the country.Credit...Doug Mills/The New York Times But she herself has said publicly that the American health care system incorporates a generous definition of a death caused by Covid-19, the disease caused by the coronavirus. “In this country we’ve taken a very liberal approach to mortality,” Dr. Birx said at a White House news conference last month. “There are other countries that if you had a pre-existing condition, and let’s say the virus caused you to go to the I.C.U., and then have a heart or kidney problem — some countries are recording that as a heart issue or a kidney issue and not a Covid-19 death.” Robert Anderson, who runs the mortality statistics branch of the C.D.C.’s National Center for Health Statistics, said the federal government deployed two parallel, related systems to tally deaths, one based on case reports and one on death certificates. He said it was unlikely that there was any kind of overcount. “The case reporting system asks: Did the patient die from this illness?” he said. “It’s not asking if the patient with Covid-19 died. It’s asking if they died from Covid-19.” A death certificate, Mr. Anderson said, clearly establishes a cause of death or a contributing factor. That has not deterred some at the White House to search for new data. Dr. Birx often begins her days before 5 a.m. examining fresh numbers from a small group of Trump administration officials who work late nights in the White House complex. Detailed to Dr. Birx from the C.D.C., the State Department, the White House budget office and a technology agency called the U.S. Digital Service, the employees compile their own information about the pandemic from state and local health departments in hard-hit parts of the country. That data is then shared with the White House’s coronavirus task force. White House officials say skepticism in the Trump administration over C.D.C. data, including for opioid use, long predates the coronavirus outbreak. But new reasons have cropped up. At least one senior White House official has mentioned that hospitals could be inflating their coronavirus patient counts, responding to financial incentives — Medicare offers higher payments to providers for treating coronavirus patients. Several senior officials said they were unaware of such talk. An official with the American Hospital Association disputed that idea. “There’s guidance around what you have to do, and the clinician has to say, ‘This is the diagnosis,’” said Nancy Foster, the association’s vice president for quality and patient safety policy. “They’re putting their professional reputation on the line to say that.” Without doubt, the C.D.C., which collects data from states, has been hampered during the pandemic by inconsistent protocols and limited resources at a local level. How deaths are tallied often varies from one state or county to the next and involves a chaotic mix of health care providers, medical examiners, coroners, funeral homes and local health departments that fill out death certificates, often without official test results. White House officials have also wanted the C.D.C. to standardize how states report cases to the federal government, a role that now belongs in part to a professional organization, the Council of State and Territorial Epidemiologists. “There is no organization on earth better at standardizing surveillance than the C.D.C.,” said Dr. Thomas R. Frieden, the agency’s former director. “Could it be better? Absolutely. It could be more timely. It could be more complete.” Image President Trump has expressed skepticism about the number of Covid-19 deaths in the country. President Trump has expressed skepticism about the number of Covid-19 deaths in the country.Credit...Doug Mills/The New York Times Dr. Birx was caught off guard in April when states began incorporating both confirmed and “probable” cases and deaths, senior administration officials said, a change that encouraged a deeper suspicion among those who have doubted the overall mortality figures. The Coronavirus Outbreak Frequently Asked Questions and Advice Updated May 20, 2020 What are the symptoms of coronavirus? Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. How many people have lost their jobs due to coronavirus in the U.S.? Over 38 million people have filed for unemployment since March. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said. How can I protect myself while flying? If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) Is ‘Covid toe’ a symptom of the disease? There is an uptick in people reporting symptoms of chilblains, which are painful red or purple lesions that typically appear in the winter on fingers or toes. The lesions are emerging as yet another symptom of infection with the new coronavirus. Chilblains are caused by inflammation in small blood vessels in reaction to cold or damp conditions, but they are usually common in the coldest winter months. Federal health officials do not include toe lesions in the list of coronavirus symptoms, but some dermatologists are pushing for a change, saying so-called Covid toe should be sufficient grounds for testing. Can I go to the park? Yes, but make sure you keep six feet of distance between you and people who don’t live in your home. Even if you just hang out in a park, rather than go for a jog or a walk, getting some fresh air, and hopefully sunshine, is a good idea. How do I take my temperature? Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications. Should I wear a mask? The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing. What should I do if I feel sick? If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. How do I get tested? If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested. How can I help? Charity Navigator, which evaluates charities using a numbers-based system, has a running list of nonprofits working in communities affected by the outbreak. You can give blood through the American Red Cross, and World Central Kitchen has stepped in to distribute meals in major cities. Dr. Birx was again angered by news reports divulging drastic projections she had never seen, the officials said, including those laid out in an internal document obtained by The New York Times that forecast about 200,000 new cases each day by the end of May. The data, which had not been vetted by the White House, came from the Johns Hopkins Bloomberg School of Public Health, which said it was preliminary and should not have been released. It has also proved false. The Trump administration has looked to the outside to get its numbers. The Department of Health and Human Services has used a technology program devised by Palantir to track numbers gathered by federal agencies, states, private health providers and universities. The administration also signed a $10 million deal with a tracking contractor — first reported by The Washington Post — that monitors hospital capacity and Covid-19 deaths, essentially repeating and privatizing the work of the C.D.C.’s National Healthcare Safety Network. “If you set up parallel tracks, you will get inconsistent information,” Dr. Frieden said. “You can ask different questions at different times and get different answers.” Mr. Anderson of the C.D.C. said in an interview that the agency was looking at new systems, including artificial intelligence, to get a better grip on coronavirus trends. “We are in the process of exploring some machine learning and A.I. techniques to try to make the coding more efficient and make the system more nimble,” he said. Epidemiologists are also rethinking their tabulations, but not in ways the White House would like. They have increasingly compared recent totals of deaths from all causes, which provide a more complete picture of the pandemic’s impact than tracking only deaths of people with confirmed diagnoses. Fatalities in the gap between the observed and normal numbers of deaths are called “excess deaths.” A study of mortality statistics in New York City showed more than 24,000 excess deaths from March 11 to May 2. Mr. Trump is hardly the only politician uncomfortable with the official coronavirus counts. Jared Polis, Colorado’s liberal Democratic governor, said on “Fox News Sunday” that “the C.D.C. criteria include anybody who has died with Covid-19, but what the people of Colorado and the people of the country want to know is how many people died of Covid-19.” Last Friday, Colorado’s health department revised its death toll downward, forming two categories to account for what it said were patients who had Covid-19 but died from other causes. Trying to separate the cause of death in coronavirus-infected patients is “ludicrous,” said Dr. Alicia Skarimbas, a physician in Bergen County, N.J., who has treated around 75 Covid-19 patients. “I have yet to have anyone infected with Covid die from anything else,” she said. Noah Weiland and Abby Goodnough reported from Washington, and Maggie Haberman from New York. Site Index Site Information Navigation Skip to main content The Guardian - Back to home News Opinion Sport Culture Lifestyle Show More Coronavirus will reshape our cities – we just don't know how yet A road closed to traffic in London UK Photograph Antonio Olmos The Observer The development of cities has been by affected by disease for centuries so what legacy will Covid-19 leave on urban life? by Michael Safi Few residents of the world’s great metropolises would have thought much about plagues before this year Outside China and east Asia – made vigilant by swine flu and Sars – the trauma of pandemics such as Spanish flu or typhoid has largely faded from popular memory But our cities remember An outbreak of yellow fever in Philadelphia in 1793 prompted administrators to take over the task of cleaning streets clearing gutters and collecting rubbish It worked and governments across the US adopted the responsibility over the next decades A misconception that the odour emanating from wastewater was responsible for diseases such as cholera prompted one of the world’s first modern underground sewer systems in London and the development of wider straighter and paved roads - which helped prevent water from stagnating Coronavirus the week explained - sign up for our email newsletter Read more Cities have evolved over the centuries according to theories of how to fight disease turning features such as public parks and sewers into a mundane part of city thinking says Michele Acuto a professor of global urban politics at the University of Melbourne The legacy Covid-19 might leave on the world’s great cities is being hotly debated although most specialists admit it is too early to know for sure It will depend in the end on how we analyse this virus how is it spreading? How is it making people sick? says Roger Keil a professor of environmental studies at Toronto’s York University We don’t know the full answers but once they become clearer urban planners and other professionals will start to think as their predecessors did 100 years ago as they laid sewer pipes and cleaned out parts of the city that were considered insalubrious The sanitary infrastructure that trails in the wake of Covid-19 may be digital Acuto says in the form of the surveillance technology used by cities such as Singapore and Seoul to retrace the steps of infected people and warn others who have crossed their path Life in the megacities of the future will be less private than ever Some of the changes already taking shape may make cities more pleasurable mayors from Bogotá to Budapest are taking the opportunity to lay down vast networks of bike lanes Athens is widening its pavements enlarging public squares and banning traffic from areas beneath the Acropolis The pandemic has strengthened the case for making neighbourhoods self-sufficient in the vein of Melbourne’s plan to put shopping leisure and work within 20 minutes of its residents’ homes or the promise by the mayor of Paris Anne Hidalgo to transform it into a 15-minute city People walk on a closed street as part of New York City’s Open Streets People walk on a closed street as part of New York City’s Open Streets Photograph Alexi Rosenfeld That’s the good news The bad is that the pandemic is a catastrophe for many of the things that make cities worth living in Busy streets squares and nightclubs will be zones for transmission for as long as the virus lasts And once it does abate many of the comedy clubs bars galleries and theatres that have shuttered their doors may never reopen It’s crippling to the life and energy of New York says Roddy Bottum a member of the band Faith No More and a fixture of the city’s music scene There are so many venues in the city that are small and have to keep up their month-to-month payments How are those places going to survive? How will opera take place or Broadway shows? Social distancing in the audience and masks on stage? It’s horrifying to think about It’s going to be terrible for a while says Sanjoy Chakravorty a professor of geography and urban studies at Temple University People have to get used to the idea of sitting closely again Then they have to have enough job security and money to blow 100 quid on an evening of interpretative dance But he is among those who are bullish on the prospects of a resurgence of city life The modern city is indestructible he says Fires earthquakes bombings the blitz of London or the siege of Stalingrad these cities lost population but then they came back People return for fundamental reasons he says They need work and cities create lots of it Cities are engines of economic growth he says If you want work you eventually have to come to the cities because the density makes work more efficient They are the most innovative and creative places in the world; where the creative types the artists the scientists compete and collaborate If there is going to be a rebound it’s not going to be in the rural areas It’s going to be in the cities But the rebound might not be strongest in the cities that currently have superstar status People were already leaving the cores of metropolises such as New York and Paris before Covid struck says Joel Kotkin a fellow in urban studies at Chapman University in California London’s population was being sustained only by international arrivals The outmigration was being accelerated by several factors Kotkin says Millennials are getting into their 30s and are thinking of buying a house getting married having kids and of course the pandemic is going to make space more attractive And the kind of urban development we’ve had has produced enormous inequality much worse in the big cities and that was chasing people out The enforced experiment in working by Zoom over recent months might convince some they can survive outside big cities Downtown offices were falling out of favour for years even before Covid sent tens of millions of employees home – companies such as Twitter and Salesforce have already said they will allow workers to stay there The need to physically distance their employees may require companies to rent even more expensive office space adding to the allure of alternative arrangements It is true that cities have historically bounced back from pandemics Kotkin adds but some went through hundreds of years of decline They pay a price They won’t disappear but we’ll have a much more dispersed world If the fate of the metropolis is to be decided anywhere it will be Asia where the largest migratory waves in history have been into cities such as the Indian capital Delhi for the past three decades Millions of those migrants left for their home villages in the days after India announced it was going into lockdown Many of those who didn’t now find themselves trapped in cities such as Mumbai or Bangalore and running out of cash It has made apparent that India’s urbanisation process has been a rush job says Gautam Bhan from the Indian Institute for Human Settlements a Delhi-based research centre Our model has created cities without the capacity to support the people who live in them he says It’s a deeply scarring psychologically wounding experience to have worked in a city for 10 years and to realise no one here is looking out for you People queue to get on buses to leave the city of Ahmedabad in India as the lockdown is extended People queue to get on buses to leave the city of Ahmedabad in India as the lockdown is extended Photograph Amit Dave Reuters Unless urban safety nets can be weaved Bhan says workers might eschew better paying work in big cities for safer options closer to home They might not return to Delhi or Mumbai They will go to small towns and smaller urban centres where they make a bit less but think ‘I’m safer nearer to home and won’t be cut off like this again’ Cities after coronavirus how Covid-19 could radically alter urban life Read more Inequality will not just shape the recovery of the cities of the global south Among the few winners from the pandemic are likely to be the tech conglomerates whose products have allowed parts of our lives and industries to continue functioning from home Their dominance in cities such as Seattle and San Francisco is likely to be extended says Mark Muro a senior fellow with the Metropolitan Policy Program at the Brookings Institution Big tech will get bigger It is brimming with revenues from before the crisis and fat balance sheets that will allow it to buy other companies he says The leaders of some cities might choose to lean in to these changes pursuing a Singapore-style model of luring the wealthy and ambitious along with the ground army of food-delivery workers cleaners drivers and cooks to keep their lifestyles humming There is historical precedent to the wealthy consolidating their hold on cities after disasters says Keil If you look at residential real estate the people who ruled Florence before the plague were all those who owned the land and ruled Florence after the plague Keil says There is a certain consistency If you look at how these major events have hit cities the ones who come out on top were the ones who were on top before But what happens next is not predestined A virus is a biological phenomenon but it is being governed by social and political processes Keil says The solidarity being forged by communities banding together to feed vulnerable people in neighbourhoods or to organise rent strikes could prove just as crucial in shaping the future of the world’s great cities as the forces of government policy or capital There is no one path for all great cities to follow Keil says This is a negotiated process It’s one we have some agency in News is under threat just when we need it the most Millions of readers around the world are flocking to the Guardian in search of honest authoritative fact-based reporting that can help them understand the biggest challenge we have faced in our 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