Through July 11, the State of Texas has reported 3,112 COVID-related fatalities according to the COVID Tracking Project (“CTP”). For the week ending July 11, it reported 504 fatalities. In recent weeks, Texas’ fatalities had been running less than half that number.
To put this in historical context, Texas averaged about 3,800 fatalities per week during this same period in 2019, according to the CDC. Prior to last week, Texas’ reported COVID-related fatalities were running a little less than 5% of historical fatalities. This week was a little over 13%.
At just over 10 fatalities per 100,000 residents, Texas’s per capita fatality rate has been remarkably low compared to other states. Currently it ranks 40th among all states and is well below the 10 most populous states.
Texas’ daily per capita fatality rate last week was 0.24 per 100,000 residents but drifted higher in the last half of the week to about 0.33. In those last few days of the week, Texas has been running about a third higher than the national average, but below other hot spots like California and Florida.
Recently, there have been comparisons of the current fatalities in Texas to “what happened in New York.” Such comparisons are ludicrous. At the height of New York’s epidemic, it was recording over 4 fatalities per 100,000 residents per day, twelve times what Texas experienced in the last half of last week.
It is true that New York at its high point was reporting about the same number of new cases as Texas is now, but at that time New York was doing less than half the testing Texas is today on a per capita basis and it was regularly reporting positivity rates in the 40-75% range. Texas’ highest one-day positivity rate is 26% and the average for last week was 16%.
But Texas is almost certainly in for a higher level of fatalities until the cases begin to decline. I interviewed Dr. James McDeavitt and Dr. James McCarthy on Common Sense this week. They are respectively in charge of the COVID responses for Baylor and Memorial Hermann. They both estimate the current fatality rate at about 1%. If their estimate is right, at 10,000 new cases per day, we can expect the daily fatality toll to be around 100. The current CDC ensemble model projects Texas will have about 4,000 fatalities by August 1.
There is a growing narrative in the media that Texas may be under-reporting the number of COVID fatalities because it only reports laboratory confirmed fatalities. Some reporters have seized on the uptick in “dead on arrival” emergency ambulance incidents, few of which are tested for COVID, as evidence that the COVID fatalities have been under-counted. However, some doctors have suggested that it is also evidence that people are unnecessarily dying because they delay seeking medical care because they are afraid to go to the hospital, and the uptick has nothing to do with COVID.
According to the CTP, twenty states now report “probable” fatalities in addition to laboratory confirmed fatalities. However, those states have only reported 3,600 such cases, half of which come from New Jersey.1 So the fact that Texas is only reporting confirmed cases is not unusual and is highly unlikely to significantly affect the count.
There are also those who argue that COVID fatalities are overstated because of the high level of comorbidities, questioning where some of the fatalities attributed to COVID would have occurred without the infection.
To attempt to analyze the actual effect of COVID on the fatality rate, the CDC conducts an “excess death” estimate that compares current fatalities from all causes to previous years. It currently shows Texas at 100% of expected fatalities through July 4. But because of the significant lag time in reporting fatalities, this is misleadingly low.
A fairer comparison would be the fatalities through an earlier date for which we have more complete data. The latest number we can probably use for that purpose is the end of May.2 At that time, Texas’ total fatalities for 2020 were 91,795 compared to 87,338 for 2019, an increase of 4,457 (5%). Fatalities have been growing by an average of just under 2% annually in line with the state’s population growth. So, population growth probably accounts for about a third of the increase.
Through May, Texas had reported 1,648 COVID deaths, also accounting for about a third of the increase. That leaves about 1,500 fatalities unaccounted for. Even if all of those fatalities were attributed to COVID, Texas would still have the second lowest per capita fatality rate among the 10 most populous states and its rate would be about a third of the national average.
The attempts to quantify the COVID-related fatalities in Texas have been callously politicized by partisans to promote their agendas and irresponsibly sensationalized by many in the media to garner readers and viewers. The COVID fatality level in Texas is neither a hoax nor the apocalypse. It is a serious problem that needs to be managed with the best tools we have available. Neither exaggerating nor minimizing the count is helpful in doing so.
1 New York has also included about 5,000 probable fatalities in its report of the CTP, but it has not reported their fatalities separately yet. The CDC also reports probable fatalities in its numbers. As of July 11, the CDC was reporting about 7,000 more fatalities than CTP. I have not been able to track down the source of that difference, but I believe it is the number of “probable” fatalities” CDC has added to their total. The high number of probable cases in New York and New Jersey is most likely due to the limited testing at the outset of the epidemic there.
2 There will be a few more fatalities, COVID and non-COVID, reported from before the end of May, but the number will be so small that they will unlikely have any significant impact on the percentages.