Melissa Ward-Peterson, PhD, MPH/Guest Columnist
Numbers have a strange ability to numb.
Early this month, Florida passed a grim new milestone in its battle against COVID-19: more than half a million confirmed cases. At the end of last month, Florida experienced four consecutive days of record reported COVID-19 deaths from July 28 to July 21. And on August 11, Florida set yet another record: 276 COVID-19 deaths added to the state’s database.
The death toll in the state now stands at 10,733 Florida residents as of August 26. When we hear large numbers published by researchers and news outlets, it is easy to forget each digit represents an individual legacy that is now being grieved by loved ones.
Similarly, small numbers drive a false sense of security. When we hear that the infection fatality ratio of SARS-CoV-2 (the virus that causes COVID-19) is estimated to be between 0.5-1%, it is easy to think, “That doesn’t sound so bad! I’ll take my chances.”
A common error that has been made is comparing infection fatality ratios (IFRs) to case fatality ratios (CFRs). An IFR is estimated from the number of deaths occurring among all who have been infected, including both identified and unidentified cases (such as asymptomatic infected individuals who have not been tested). A CFR is estimated from the number of deaths occurring among identified, confirmed cases.
Because IFRs have a larger denominator than CFRs, estimates of IFRs tend to be lower than estimates of CFRs. Some news outlets and viral internet sources have compared estimates of SARS-CoV-2’s IFR to estimates of seasonal influenza’s CFR, which is like comparing apples to oranges and must be avoided.
What can we do to combat the dulling effect of numbers? One strategy is to equate them to units that may be more concrete and personal to us.
The numbing effect of numbers is compounded by the uncertainty surrounding COVID-19. The human brain naturally craves immediate and straightforward answers. Unfortunately, this level of certainty is not currently possible: SARS-CoV-2 has only been around in humans for approximately 8-9 months. Scientists are actively studying its behavior and health impacts. Although it may seem like IFR would be an easy number to calculate, it’s not.
Because estimating IFR requires trying to figure out the number of asymptomatic individuals who may not know they have been infected, it is a complex measure and accurately estimating it requires sophisticated study designs. Numbers that seem even more obvious, such as the total number of COVID-19 related deaths, require careful reviews of death records and will likely be re-estimated and revised long after the virus is impacting our daily lives.
So what can we do to combat the dulling effect of numbers? We must remember that, when applied to entire populations, seemingly small IFRs translate to large absolute numbers. When it comes to large numbers, one strategy is to equate them to units that may be more concrete and personal to us.
For example, I live in Broward County. The total number of Floridians who have died at the time of this writing (8,553 as of 8/11/20) is more than the entire population of Southwest Ranches, which is only a few miles away from my home. I work in Miami-Dade County. The total number of Floridians who have now tested positive (536,981 as of 8/11/20) is more than the entire population of the City of Miami.
And what can we do about the uncertainty? For me, one strategy that has helped has been to remember the things that are at least more certain, and those are the steps I can take to reduce the transmission of SARS-CoV-2: wearing my mask, staying physically distant from others, avoiding crowded indoor spaces, washing my hands consistently with soap and water for at least 20 seconds and sanitizing frequently-used surfaces in my home.
These things are within my control, and practicing them helps me regain a sense of agency. When I begin to feel overwhelmed with sadness because I’ve successfully personalized the numbers, I remember that these are the proactive steps I can take to save lives in my community.
Despite how overwhelming and paralyzing numbers and uncertainty can feel at times, we can all take active, empowering steps to fight this virus.
Melissa Ward-Peterson is a postdoctoral associate at FIU’s Community-Based Research Institute.
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