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It seems like in wealthy Western countries with bad outbreaks of COVID-19, total excess mortality is about 1.5x higher than confirmed COVID-19 deaths. Quick thread on how I think about this.

nytimes.com/interactive/20…
Does that mean you can just multiply confirmed COVID-19 deaths by 1.5 to get the "real" death count? Well, in some cases, it might not be a terrible approach. But you'd have to be careful.
For instance, NYC *is* trying to count *probable* COVID-19 deaths, and their total (confirmed + probable) death count is about 1.5x as high as their confirmed count. www1.nyc.gov/site/doh/covid…
Still, inferring from excess mortality data can be tricky. Being in lockdown with heavy strain on hospitals can have various effects that push other types of deaths up (e.g. you have a heart attack, the ambulance takes longer to come & you die) and down (fewer traffic accidents).
Plus, jurisdictions can vary in how thorough they are. France has done an admirable job of trying to count nursing home deaths, for instance. And if a place *is* trying to count probable deaths, as in NYC, there's going to be considerably less undercounting.
Also, all of those qualifiers I put at the top are important: "wealthy Western countries with bad outbreaks of COVID-19". That's where these numbers, at least the ones that are getting highlighted in the media, mostly come from.
I'd be especially careful about making inferences outside of that narrow band of countries/places. There is possibly less undercounting in wealthy Western places with *mild* outbreaks (e.g. Canada, Utah) because their medical and record-keeping systems are less overwhelmed.
There could be much more underreporting in poorer places with less access to medical care and worse record-keeping systems, by contrast, or places that are in some form of denial about the extent of their outbreak.
Overall though, this data puts some boundaries on what the real death counts are in the US and Western Europe. Unless places are explicitly trying to count probable deaths (e.g. NYC), there is clearly likely to be an undercount. But it is not likely, say, a 3x or 5x undercount.
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Nate Silver
@NateSilver538
This is interesting data from New York City, which has been i) tracking probable in addition to confirmed deaths and ii) tracking deaths on the date they think the death actually occurred, not when it shows up in their records. github.com/nychealth/coro…
The further back you go, the more likely a death is to be confirmed instead of probable. Around 80% of (confirmed + probable) deaths that occurred in March were confirmed, for instance. But only ~50% of deaths to occur in the past 5 days are confirmed.
At appears that on average, it takes about 6 days for a death to occur before it shows up in the "confirmed" column. That's an average, though; there's a long tail of deaths they're counting that actually occurred weeks ago. Probable deaths can often catch these sooner.
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Nate Silver
@NateSilver538
A big challenge in determining the effectiveness of policy interventions (i.e. social distancing) is that there are really several buckets that determine how bad the outbreak is in any given area and it's not clear policy interventions are the most important one in the short run.
The buckets are something like:

1) Policy interventions
2) Immutable location-based characteristics, e.g. geography, density, age structure of the population, "culture", weather
3) Luck. How much undetected community spread was there before March? Perhaps strains matter also.
My guess is 3 > 2 and 2 > 1, especially given the narrow range of interventions available in the short run. (If every country could "do South Korea", it might be different, but they can't on short notice.)

That could lead to some wrong conclusions about what works, what doesn't.
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Nate Silver
@NateSilver538
A severe thunderstorm disrupts most of these categories (+ others such as energy). The question is whether to expect a new equilibrium when the storm recedes.
Of course, there are a lot of unplanned experiments being performed. But in at least some cases, it seems like people are unhappy with the digital replacements for the physical experience. Education is one example. Live performance (concerts, etc.) maybe another.
It's not clear whether you're referring to the medium run (what happens while COVID-19 is still a threat) or the long run. In the medium run, sure, we'll have to make all sorts of accommodations. In the long run, it's not obvious how many we'll like/keep.
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