Before noon on January 20th, President Trump will leave his office.  At that time the reported death toll from COVID-19 in the USA will be over 400,000 – the exact number depending on who does the tallying.  Worldmeter will show 412k – real-time, Johns Hopkins will show 402k – lagging by a day, and CDC will show lower – lagging by a couple of days.  All these estimates understate the real toll history will attribute to Trump – over 500k Americans died on his watch.    

COVID-19 death reporting has time lags and other issues.

1.     Accurately assigning the correct cause of death is sometimes more art than science.  There are the underlying cause and the proximate cause issue.  Sometimes COVID-19 starts a chain of events that lead to death many months later from lung, heart, kidney, liver, or diabetes problems that are not uniquely attributable to COVID-19.  The US CDC separately defines confirmed and probable counts and reports both now.  A confirmed case or death is defined by matching confirmatory laboratory evidence for COVID-19.  A probably case is more loosely defined but is now included by most states reporting to the CDC.  There is no time limitation.  (Other countries use different definitions that sometimes make comparisons across jurisdictions difficult.)

2.     Excess deaths, or deaths above normal average year expectations, often exceed the reported COVID-19 deaths implying that undercounting of COVID-19 deaths may be occurring using the direct method.  As of Oct. 15th when reported deaths were 216k, CDC estimated excess death near 299k – 42% more.  

3.     Reported deaths sometimes occur more than a month after the actual date of death  Currently, 60% of all US deaths are reported within 10 days of death but some state (like Florida) and many countries can take more than 2 months to be just 75% complete.   

Our models for the COVID-19 virus infection and death are based on curves that rise quickly after exposure, peak, and then fall off with a long exponential tail.  The virus incubates in the victim’s body and proliferates until 10 days after exposure when the viral load begins to decline in response to the body’s defenses.  Those with a low overall viral load may never see a high enough load to experience any symptoms or request testing.  About 10% of those exposed and get tested, typically around day 5, test positive (the current US weekly positivity rate).  About half of these never develop any symptoms but carry a high enough viral load to infect others for about 10 days after test or 15 days after exposure.  Half of those who test positive will usually experience some symptoms.  Most will stay home and treat themselves with medical guidance.  Some 6% of all positives will get sick enough to go to the hospital – although this has dropped recently to near 3%.  The steady drop since August is due to more kids and young adults being positive not requiring hospitalization, but it could also be due to overcrowding of hospital systems in certain regions like Los Angeles and Arizona.  About 1.5% of all those that tested positive will ultimately die in an average of 14 days from testing and 19 days from exposure.  As noted above, these deaths could take up to 8 weeks to get reported and counted.    

Thus when President Biden is sworn in on Jan 20th there will be:

1.     Deaths that have already occurred before Jan 20th that will get reported over the following 8 weeks (35k). 

2.     There will be a percentage of the 3.4M cases confirmed in the period before Jan 20th that will progress to hospitalizations, ICUs, and deaths that no one will be able to save.  The full accounting will take another eight weeks (69k).

3.     Alternatively, by the end of March the excess death report from the CDC will provide a measure of all deaths to Jan 20th and a portion of deaths to Feb 3rd that should be attributed to Trump’s policies and actions that President Biden could not reverse (140k). 

Whether using the case classification method or the excess death certificate method – the conclusion will be that more than half a million Americans died of COVID-19 under Trump’s watch that no one else could have saved.  Some might argue that every country suffered from the same devastating COVID-19 pandemic – it’s not Trump’s fault.  However, if Trump performed as well as the average government around the world and experienced the same average fatality per capita, only 71k Americans would have died by Jan 20th.  Trump’s gross mismanagement of the pandemic will be a large part of his legacy.