Welcome to Prognosis. I'm Laura Carlson. It's day one, twelve since coronavirus was declared a global pandemic. Our main story. Even as the infection rates surges around the United States, some have pointed to lower death rates as proof that this stage of the outbreak isn't as bad as it seems. But a close look at the numbers shows it may be too early to declare that fatalities are really declining. But first, here's what happened in virus news today. As the alarming coronavirus surge continues in dozens of U S states, New York City postponed a planned return to indoor dining next week. Mayor Build a Blasio side rising cases in Florida, California, and Texas after some of those states reopened restaurants. The city had planned to allow restaurants to have a limited number of available tables indoors starting this Sunday. Instead, it will now help restaurants expand operations outdoors on sidewalks and in curbside parking spaces. He said. Some large US companies are also reevaluating their plans to ramp up normal operations. Google is pushing back a plan to reopen its u S offices. In a memo to employees, the company said all US offices will remain closed until September seven, at the earliest. An experimental coronavirus vaccine is showing promise. In an early trial, fiser and bio n text treatment has been shown to be safe. It also successfully prompted patients to produce and bodies against the virus that has kept it at the front of the pack in the race to develop a vaccine. Finally, Europe may be starting to see a tenuous economic recovery following months of coronavirus shutdowns, but the road ahead will be long. European Central Bank President Christine Lagarde renewed her warning at a United Nations event that the hardest times are yet to come. She said the recovery would be uncertain and uneven, and would lead to arise in inequality and unemployment that will leave the most vulnerable in difficult conditions. And now for our main story, the coronavirus continues it's terrifying rampage of large swaths of the country, but the Trump administration has made a point of mentioning that even while cases are rising deaths are declining. That disconnect is Trump says, proof that the COVID nineteen pandemic is under control. But the mismatch could be an anomaly caused by quirks in how death data is collected and reported. It could also be that a greater number of younger people are catching the virus not necessarily assigned. The coronavirus is becoming less lethal or easier to treat. Robert Langre and Emma Court report that medical experts say it's too soon to know for sure that deaths are still declining in recent days. In recent weeks here in the US, we have been seeing case counts rise pretty much across the board, particularly in the sun belt in the South and the West. And yet one interesting thing about these developments we've been seeing is that even as the case counts rise, the corresponding mortality rate, the death rate does not seem to be climbing with the same rates. And I was wondering if you could unpack that for us, what are we seeing here? One thing to be really aware of it is sort of that that death rates in this for COVID are kind of the ultimate lacking indicator. We don't really know yet what the death rate is going to be for this current rise in case counts. And that's because some of the cases in the States are reported rather quickly. But you know, deaths really do take a while to come roll in. Once you diagnose with COVID, even a bad case, it may take the people that do die, it may take, you know, two or three weeks for them to die, if you're going to die. And then these these death numbers that come in, they aren't the deaths that occurred yesterday. These are deaths that may have been occurred a week or two weeks or even three weeks ago. That that is, after once someone dies, it can take a while days, even weeks or dr filling the death certificate, turn it in for the state authorities to kind of adjudicate and verify it, and then reported out to two people so to the rest of the world. To some of these these death numbers coming are quite you know, quite delayed, and it just takes several weeks corresponding to the cases we're still seeing now. Is the first thing to be very aware of. We don't really know yet, you know, what the death rate is going to be for this current wave of cases. But there are several reasons also to believe to suspect that the death rate, you know, when we have the numbers will actually be lower. We're now six months into this into this pandemic. I mean, is it a question with regards to the death rates that were simply treating COVID nineteen more successfully. For months, medical providers have been you know, learning about how to treat this virus, sharing best practices. And I think the answer is yes. You know, we still don't have all the information we'd like to have. Doctors still don't have like a you know, a perfect treatment for this condition. We definitely don't have any vaccines right now, except experimental ones that are still being tested. You know, It's true that we've learned a lot and doctors have better practices now and um, and you know, I think we are seeing that payoff. But it's not totally clear how all of these factors break down in terms of what we're seeing right We think, you know, the death rate lagging maybe one factor. Another factor is this friend towards younger patients, you know, better treatments. Another potential factor is maybe the virus is just not transmitting as well in the summer. You know, it was sort of hypothesized that the summer might make for less virus transmission because that hot air, you know, pushing the virus kind of down out out of kind of the path of transmission. But you know, it's not clear that that's happening. But it's possible that perhaps a weaker form of the virus is being transmitted people aren't getting as sick. There's also been a pretty high profile theory that the virus is getting sort of weaker in and of itself as it applicates around the world, and that's been pretty roundly criticized. It's not totally clear that's what's happening, but there's a variety of explanations here. We just we just don't really know. Unfortunately, it does seem to be a lot more complicated or perhaps even a lengthy process in recording the death count. And I was wondering if maybe you could go into some of the different kinds of factors that go into potentially delaying the recording of a death due to COVID nineteen. If you look a few days ago, there's a huge spike of death just like three or four days ago, and almost all of that was new to New Jersey suddenly adding probable COVID nineteen deaths and we're in its account before. And those weren't deaths that occurred in the last few days. There was their deaths that went way back this you know, county of deak Is a is. It just takes a while for the death to roll in. Often, for example, in Arizona, one of the researchers of follows Is showed me when some of the deaths occurred. And so for the deaths reported in the weekending June fourteenth in Arizona due to COVID, So it turns out only half of those deaths reported that week we're from that week, and fully fifty were from two or three or even more weeks before. That's when they actually happens. That that's an example just how the lag can be. And that's from when the death actually happens to whether it's reported as a death due to COVID. That doesn't even count the fact that you know, you get sick, you got a case so to take, you know, and it takes two to three weeks for that to play out, and you either to get better or not. Deaths lag not just because It takes time when someone gets COVID to die, um, you know, from the disease, to succumb to the disease. But but then afterwards there's these official processes that takes some time. Right. It takes time for you know, the health officials to adjudicate the death. It takes time, you know, doctors have to decide did this person die of COVID nineteen. You know, if they you know, had COVID nineteen and then seemed to recover a little bit and then ended up dying, you know, was that a death from COVID nineteen or not? There there are some questions about you know, the squish nous of of these subjects, right, And during this time, everyone wants to rely on the data, right. They put all this trust in the numbers that are coming out of the states and the numbers that we see about testing on the federal level too. But you know, importantly this data is not infallible, right, I mean, especially when you think about the fact that you know, in terms of diagnoses, the only cases that we know we only know about cases that actually get diagnosed. We only know about people who test positive because they got a test. There are likely many more people who are not getting tested for these symptoms, for instance. So you know, these are official counts, but that's important to remember. These are the official numbers, right and there are probably a lot of numbers that aren't getting captured in these data even now. So I think that's also important when you think about deaths. You know, there has been some back and forth even earlier in the pandemic about whether all of the death from COVID nineteen were actually being counted, you know, as health to partments got overwhelmed and things like that. So these are the official numbers, but do they tell the complete and full and completely thorough story, Like we probably won't know that for some time, you know, if at all. What should we be looking at or taking away from the numbers as they stand right now, and what should we be preparing for. You know, we don't know exactly what's going to happen in two or three weeks from now, and that would be very very interesting to watch because we do have in some of these southern states increased hospitalizations, increased numbers of people in I c u s. You know, what does that translate into. So some of the research we talked to in Arizona said that what they would expect might be, you know, leveling off of this decline in depths and you know, somewhat at an increase again, you know, and maybe not a huge spike like we had before in April when the in New York, when this disease is totally new, when we were kind of unprepared. Hospitals are better prepared and there are some treatments and they have some better strategies. So be very very interesting, you know, to watch. And then I have four or five or six weeks from now, the deaths, you know, haven't gone up at all, and despite lots of people in the hospital of I see you, that will be an indication you know, we've gotten there's something's changed a little about the the the virus, or you've gotten better treating it, or somehow you know, we've kept it out of the older, most vulnerable people. One of those you know three things. I think also an important part of this is to understand the different kinds of data and how they trickle in, right, I mean, public health officials can't wait for deaths to spike to take action to control an outbreak, right, they have to start relying on earlier forms of data like case counts and especially hospitalizations. The problem is the earliest data that we have coming in our case counts, and that doesn't present the fullest possible picture of an outbreak, but it is the earliest indicator we have. And an expert I spoke with at Johns Hopkins put this really well. He said, Basically, you know, a couple of weeks ago when the case cases were spiking in some of these states like Arizona and Texas and Florida, which we now know, you know, are having problems in terms of the outbreak in their communities. He's you know, this is early data in terms of the case counts rising, but it's important to act on early data because by the time you get more thorough data, more final data, you get hospitalization spiking, you get death god forbid spiking. You know, that may be too late, and I think that sensitivity towards the mechanism of these numbers is important for public health officials to be eyeing. You know, waiting for the deaths to rise is not the most productive tack here. Right by the time deaths rise, you maybe four or five weeks behind something that's happening in a state or a local area. That was Robert Lang and Emma Cord. And that's it for our show today. For coverage of the outbreak from one bureaus around the world, visit Bloomberg dot com slash Coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by Top for foreheads Jordan gas Pure, Magnus Hendrickson and me Laura Carlson. Today's main story was reported by Robert Langrath and Emma Court. Original music by Leo Sidran. Our editors are Rick Shine and Francesco Levi. Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.

Welcome to Prognosis. I'm Laura Carlson. It's day one, twelve since coronavirus was declared a global pandemic. Our main story. Even as the infection rates surges around the United States, some have pointed to lower death rates as proof that this stage of the outbreak isn't as bad as it seems. But a close look at the numbers shows it may be too early to declare that fatalities are really declining. But first, here's what happened in virus news today. As the alarming coronavirus surge continues in dozens of U S states, New York City postponed a planned return to indoor dining next week. Mayor Build a Blasio side rising cases in Florida, California, and Texas after some of those states reopened restaurants. The city had planned to allow restaurants to have a limited number of available tables indoors starting this Sunday. Instead, it will now help restaurants expand operations outdoors on sidewalks and in curbside parking spaces. He said. Some large US companies are also reevaluating their plans to ramp up normal operations. Google is pushing back a plan to reopen its u S offices. In a memo to employees, the company said all US offices will remain closed until September seven, at the earliest. An experimental coronavirus vaccine is showing promise. In an early trial, fiser and bio n text treatment has been shown to be safe. It also successfully prompted patients to produce and bodies against the virus that has kept it at the front of the pack in the race to develop a vaccine. Finally, Europe may be starting to see a tenuous economic recovery following months of coronavirus shutdowns, but the road ahead will be long. European Central Bank President Christine Lagarde renewed her warning at a United Nations event that the hardest times are yet to come. She said the recovery would be uncertain and uneven, and would lead to arise in inequality and unemployment that will leave the most vulnerable in difficult conditions. And now for our main story, the coronavirus continues it's terrifying rampage of large swaths of the country, but the Trump administration has made a point of mentioning that even while cases are rising deaths are declining. That disconnect is Trump says, proof that the COVID nineteen pandemic is under control. But the mismatch could be an anomaly caused by quirks in how death data is collected and reported. It could also be that a greater number of younger people are catching the virus not necessarily assigned. The coronavirus is becoming less lethal or easier to treat. Robert Langre and Emma Court report that medical experts say it's too soon to know for sure that deaths are still declining in recent days. In recent weeks here in the US, we have been seeing case counts rise pretty much across the board, particularly in the sun belt in the South and the West. And yet one interesting thing about these developments we've been seeing is that even as the case counts rise, the corresponding mortality rate, the death rate does not seem to be climbing with the same rates. And I was wondering if you could unpack that for us, what are we seeing here? One thing to be really aware of it is sort of that that death rates in this for COVID are kind of the ultimate lacking indicator. We don't really know yet what the death rate is going to be for this current rise in case counts. And that's because some of the cases in the States are reported rather quickly. But you know, deaths really do take a while to come roll in. Once you diagnose with COVID, even a bad case, it may take the people that do die, it may take, you know, two or three weeks for them to die, if you're going to die. And then these these death numbers that come in, they aren't the deaths that occurred yesterday. These are deaths that may have been occurred a week or two weeks or even three weeks ago. That that is, after once someone dies, it can take a while days, even weeks or dr filling the death certificate, turn it in for the state authorities to kind of adjudicate and verify it, and then reported out to two people so to the rest of the world. To some of these these death numbers coming are quite you know, quite delayed, and it just takes several weeks corresponding to the cases we're still seeing now. Is the first thing to be very aware of. We don't really know yet, you know, what the death rate is going to be for this current wave of cases. But there are several reasons also to believe to suspect that the death rate, you know, when we have the numbers will actually be lower. We're now six months into this into this pandemic. I mean, is it a question with regards to the death rates that were simply treating COVID nineteen more successfully. For months, medical providers have been you know, learning about how to treat this virus, sharing best practices. And I think the answer is yes. You know, we still don't have all the information we'd like to have. Doctors still don't have like a you know, a perfect treatment for this condition. We definitely don't have any vaccines right now, except experimental ones that are still being tested. You know, It's true that we've learned a lot and doctors have better practices now and um, and you know, I think we are seeing that payoff. But it's not totally clear how all of these factors break down in terms of what we're seeing right We think, you know, the death rate lagging maybe one factor. Another factor is this friend towards younger patients, you know, better treatments. Another potential factor is maybe the virus is just not transmitting as well in the summer. You know, it was sort of hypothesized that the summer might make for less virus transmission because that hot air, you know, pushing the virus kind of down out out of kind of the path of transmission. But you know, it's not clear that that's happening. But it's possible that perhaps a weaker form of the virus is being transmitted people aren't getting as sick. There's also been a pretty high profile theory that the virus is getting sort of weaker in and of itself as it applicates around the world, and that's been pretty roundly criticized. It's not totally clear that's what's happening, but there's a variety of explanations here. We just we just don't really know. Unfortunately, it does seem to be a lot more complicated or perhaps even a lengthy process in recording the death count. And I was wondering if maybe you could go into some of the different kinds of factors that go into potentially delaying the recording of a death due to COVID nineteen. If you look a few days ago, there's a huge spike of death just like three or four days ago, and almost all of that was new to New Jersey suddenly adding probable COVID nineteen deaths and we're in its account before. And those weren't deaths that occurred in the last few days. There was their deaths that went way back this you know, county of deak Is a is. It just takes a while for the death to roll in. Often, for example, in Arizona, one of the researchers of follows Is showed me when some of the deaths occurred. And so for the deaths reported in the weekending June fourteenth in Arizona due to COVID, So it turns out only half of those deaths reported that week we're from that week, and fully fifty were from two or three or even more weeks before. That's when they actually happens. That that's an example just how the lag can be. And that's from when the death actually happens to whether it's reported as a death due to COVID. That doesn't even count the fact that you know, you get sick, you got a case so to take, you know, and it takes two to three weeks for that to play out, and you either to get better or not. Deaths lag not just because It takes time when someone gets COVID to die, um, you know, from the disease, to succumb to the disease. But but then afterwards there's these official processes that takes some time. Right. It takes time for you know, the health officials to adjudicate the death. It takes time, you know, doctors have to decide did this person die of COVID nineteen. You know, if they you know, had COVID nineteen and then seemed to recover a little bit and then ended up dying, you know, was that a death from COVID nineteen or not? There there are some questions about you know, the squish nous of of these subjects, right, And during this time, everyone wants to rely on the data, right. They put all this trust in the numbers that are coming out of the states and the numbers that we see about testing on the federal level too. But you know, importantly this data is not infallible, right, I mean, especially when you think about the fact that you know, in terms of diagnoses, the only cases that we know we only know about cases that actually get diagnosed. We only know about people who test positive because they got a test. There are likely many more people who are not getting tested for these symptoms, for instance. So you know, these are official counts, but that's important to remember. These are the official numbers, right and there are probably a lot of numbers that aren't getting captured in these data even now. So I think that's also important when you think about deaths. You know, there has been some back and forth even earlier in the pandemic about whether all of the death from COVID nineteen were actually being counted, you know, as health to partments got overwhelmed and things like that. So these are the official numbers, but do they tell the complete and full and completely thorough story, Like we probably won't know that for some time, you know, if at all. What should we be looking at or taking away from the numbers as they stand right now, and what should we be preparing for. You know, we don't know exactly what's going to happen in two or three weeks from now, and that would be very very interesting to watch because we do have in some of these southern states increased hospitalizations, increased numbers of people in I c u s. You know, what does that translate into. So some of the research we talked to in Arizona said that what they would expect might be, you know, leveling off of this decline in depths and you know, somewhat at an increase again, you know, and maybe not a huge spike like we had before in April when the in New York, when this disease is totally new, when we were kind of unprepared. Hospitals are better prepared and there are some treatments and they have some better strategies. So be very very interesting, you know, to watch. And then I have four or five or six weeks from now, the deaths, you know, haven't gone up at all, and despite lots of people in the hospital of I see you, that will be an indication you know, we've gotten there's something's changed a little about the the the virus, or you've gotten better treating it, or somehow you know, we've kept it out of the older, most vulnerable people. One of those you know three things. I think also an important part of this is to understand the different kinds of data and how they trickle in, right, I mean, public health officials can't wait for deaths to spike to take action to control an outbreak, right, they have to start relying on earlier forms of data like case counts and especially hospitalizations. The problem is the earliest data that we have coming in our case counts, and that doesn't present the fullest possible picture of an outbreak, but it is the earliest indicator we have. And an expert I spoke with at Johns Hopkins put this really well. He said, Basically, you know, a couple of weeks ago when the case cases were spiking in some of these states like Arizona and Texas and Florida, which we now know, you know, are having problems in terms of the outbreak in their communities. He's you know, this is early data in terms of the case counts rising, but it's important to act on early data because by the time you get more thorough data, more final data, you get hospitalization spiking, you get death god forbid spiking. You know, that may be too late, and I think that sensitivity towards the mechanism of these numbers is important for public health officials to be eyeing. You know, waiting for the deaths to rise is not the most productive tack here. Right by the time deaths rise, you maybe four or five weeks behind something that's happening in a state or a local area. That was Robert Lang and Emma Cord. And that's it for our show today. For coverage of the outbreak from one bureaus around the world, visit Bloomberg dot com slash Coronavirus and if you like the show, please leave us a review and a rating on Apple Podcasts or Spotify. It's the best way to help more listeners find our global reporting. The Prognosis Daily edition is produced by Top for foreheads Jordan gas Pure, Magnus Hendrickson and me Laura Carlson. Today's main story was reported by Robert Langrath and Emma Court. Original music by Leo Sidran. Our editors are Rick Shine and Francesco Levi. Francesco Levi is Bloomberg's head of podcasts. Thanks for listening.