The Numbers Must Have Context

The United States, in a matter of days, surpassed both China and Italy in COVID-19 cases and deaths. There was no real way to know New York City would count over 3700 deaths over one day. This shroud of numbers of the nameless dead stands useless, as counts themselves on their own have no meaning without context. Viruses do not know logic other than replication. But they are deeply attracted to distinct patterns of human behavior.

A new normal of physical distancing likely accounts for some of the differentials in death tolls between New York and the rest of the country. But the truth is we cannot be certain, and it is likely not just these efforts that explain this phenomenon alone. Rather, it is the sociocultural, demographic, and geographic reasons to which I pointed in my article in last month’s Rail. New York City exploded for many reasons that could not be foretold. Its mass transit system, with its painful closeness and wide spread, is one. Its status as a primary travel hub to and from Europe is another. Its sheer living, breathing monstrosity of density, yet another. All of these factors, happenstance, and the particular health issues of Americans led to mass death. 86 percent of the mortalities in New York have at least one comorbidity; this is another uniquely American factor that now makes us number one for COVID-19infections in the world (USA, USA!), as the virus kills those with underlying conditions like diabetes, asthma, cardiovascular disease, and cancer, ailments all too common among our citizens. Painfully ironically, these diseases that combine with SARS CoV-2 to produce the deadliest outcomes are also the chronic ailments that kill us the most. The virus temporarily surpassed cardiovascular disease as the number one daily killer of Americans, but this statistic will normalize in due time.

It was impossible to foresee the particular constellation of death in New York City happening in the way it has based only on the numbers from China and then the numbers from Europe. Each of these areas has very different cultures, and this very clearly has great consequences for the shape of this pandemic, and any other that will materialize. Disasters always work this way, though. You can never really predict how they will play out, even if you see what is happening ahead of time. In Italy the focus was on the aged, not the aged and the infirm. Here those factors have mattered intensely. But what is of import in New York might not be of consequence in the next afflicted city within the United States. That we do not have another urban area with the convergence of factors like the density, the mass transit, and the pre-distancing closeness of New York City—the perfect deadly conditions for SARS CoV-2’s—might be the beginning of the end of the pandemic. But there may be other conditions still unnoticed. One thing this horror should burn into our heads is that in every disaster there is always something missed at first, a lesson to be learned only later for the next time. The numbers must have context.