{"id":47557,"date":"2020-05-20T08:59:28","date_gmt":"2020-05-20T07:59:28","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47557"},"modified":"2020-05-22T19:50:58","modified_gmt":"2020-05-22T18:50:58","slug":"deaths-from-covid-19-could-be-the-tip-of-the-iceberg","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/","title":{"rendered":"Deaths from covid-19 could be the tip of the iceberg"},"content":{"rendered":"

The public health impact of choices made now will have implications long after the immediate crisis is over<\/span><\/p>\n

<\/p>\n

Public health has been defined an <\/span>\u201cintegrative approach to protecting and promoting the health status of both individuals and society<\/span><\/a>.\u201d\u00a0 Made up of different disciplines including epidemiology, environmental and population health, biostatistics and socio-medical sciences and using a range of research and analytical tools, the public health approach has evolved beyond addressing a single health outcome or disease. In this way it takes into account information about specific populations, the health systems with which they interact, and the social and environmental factors that promote health and prevent disease.\u00a0<\/span><\/p>\n

Across the world, the driver of the approach taken in the response to covid-19 has been to <\/span>\u201cflatten the curve\u201d\u2014<\/span><\/a>the strategy is to slow down the spread of the virus to enable health systems to cope better with the high-end intensive care capacity required by severe cases. Countries have therefore implemented a <\/span>range of lockdown measures<\/span><\/a> aimed at spatial and physical distancing.\u00a0<\/span><\/p>\n

While this strategy is proving effective in reducing the spread of covid-19<\/span>, these measures have also resulted in compromises to a range of other health services, including care for those who may require it for <\/span>other conditions<\/span><\/a>. <\/span>Visits for routine preventive care have <\/span>decreased drastically<\/span><\/a>. Further, there is increasing evidence of <\/span>excess deaths<\/span><\/a>, meaning people dying of heart attack or stroke because they didn\u2019t access care early enough or at all. There are also reports of increasing <\/span>family violence<\/span><\/a>, <\/span>stress<\/span><\/a> and <\/span>mental health problems<\/span><\/a>,<\/span> including for children and youth, now coined \u201cgeneration C\u201d for the lifelong impact this pandemic will confer upon them.\u00a0<\/span><\/p>\n

In addition to the direct effects, lockdown measures have also compromised a range of social determinants of health, including\u00a0<\/span>educational attainment<\/span><\/a>, <\/span>food security<\/span><\/a>, <\/span>employment and income<\/span><\/a> which <\/span>disproportionately<\/span><\/a> affect those families and populations who are already vulnerable, and further exacerbating health inequities and <\/span>discrimination <\/span><\/a>within and across countries.\u00a0<\/span>Given that many people have underlying conditions associated with both poverty and <\/span>covid-19<\/span><\/a>, including <\/span>obesity<\/span><\/a>, heart disease, <\/span>diabetes,<\/span><\/a> and hypertension, the lockdown may have resulted in putting asymptomatic or mildly symptomatic people shedding the virus in close <\/span>household contact<\/span><\/a> with people at risk.\u00a0\u00a0<\/span><\/p>\n

The public health impact of choices made now will have implications long after the immediate crisis is over. After decades of work to reduce maternal and child deaths, including through <\/span>vaccination programme<\/span><\/a>s, the negative impact of placing these services on hold, particularly in countries with high fertility, a large under-5 population and high rates of infectious diseases, is already having <\/span>serious consequence<\/span><\/a>.<\/span><\/p>\n

Recognizing that many of the current mitigation strategies are based on <\/span>limited evidence<\/span><\/a>, we must put in place a global learning agenda so that mistakes are not repeated and secondary population health effects are not overlooked.\u00a0<\/span><\/p>\n

It is not too late to re-introduce many of <\/span>essential services of public health<\/span><\/a> and the principals of population health into the covid-19 response. To do this, hospitals and public health authorities must collect, collate, and share disaggregated clinical, demographic, and socioeconomic data so that public health professionals can better decode both the clinical risks and understand the risks for various population groups. This will also allow for a response which takes into account social determinants, including population density, mobility, poverty and inequalities when assessing health outcomes.\u00a0<\/span>Summary tables<\/span><\/a> are not enough to drive evidence-based decision making or <\/span>precision public health<\/span><\/a> which is required to target efforts to those most at risk.<\/span><\/p>\n

Context matters<\/span><\/a> and different contexts require different interventions. Lessons from other public health emergencies of international concern, including from <\/span>Ebola<\/span><\/a> and <\/span>HIV,<\/span><\/a> provide us with a blueprint on <\/span>types of strategies<\/span> and approaches for <\/span>community engagement<\/span><\/a> that can address the immediate health issue while also reducing stigma, discrimination and fear. Unfortunately, these lessons on community partnerships have largely <\/span>been absent in the covid-19 response<\/span><\/a>. They could have and still can help improve the design of prevention measures such that communities themselves have agency and voice in deciding how best to protect themselves.\u00a0\u00a0<\/span><\/p>\n

When we are past the immediate crisis, the community and countries themselves must convene independent expert panels, that include a range of voices and actors, to review decisions taken. In the meantime, we must urgently shift our approach and begin learning, evaluating and adapting our strategies in real-time.\u00a0 If not, deaths from covid-19 will be the \u201ctip of the iceberg\u201d of the public health problems created by a single disease-focused response. The hard-won public health gains, as well as the potential to achieve Sustainable Development Goals in health and other areas, will be lost for our generation and generations to come.\u00a0\u00a0<\/span><\/p>\n

Nina Schwalbe<\/strong> is a Principal Visiting Fellow at the United Nations University International Institute of Global Health and on the Faculty at Heilbrunn Department Columbia of Population and Family Health at Columbia University\u2019s Mailman School of Public Health.\u00a0<\/span><\/em><\/p>\n

Siobhan Crowley<\/strong> is the Chief Strategy Officer at the Penta Foundation.\u00a0\u00a0<\/span><\/em><\/p>\n

Susanna Lehtimaki<\/strong> is a Senior Advisor at Spark Street Advisors.\u00a0<\/span><\/em><\/p>\n

Pascale Allotey<\/strong> is the Director of the United Nations University International Institute for Global Health<\/span><\/em><\/p>\n

Competing interests<\/strong>: None declared<\/em><\/p>\n

The authors would like to thank Anna-Carin Matterson, Nathanial Hupert, and Katherine Holland for the contribution to this piece.<\/span><\/i>\u00a0<\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

The public health impact of choices made now will have implications long after the immediate crisis is over […]<\/p>\n

More…<\/a><\/p>\n","protected":false},"author":1,"featured_media":47444,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[263],"tags":[],"class_list":["post-47557","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-global-health"],"yoast_head":"\nDeaths from covid-19 could be the tip of the iceberg - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Deaths from covid-19 could be the tip of the iceberg - The BMJ\" \/>\n<meta property=\"og:description\" content=\"The public health impact of choices made now will have implications long after the immediate crisis is over [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2020-05-20T07:59:28+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2020-05-22T18:50:58+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_person_wheelchair.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Deaths from covid-19 could be the tip of the iceberg\",\"datePublished\":\"2020-05-20T07:59:28+00:00\",\"dateModified\":\"2020-05-22T18:50:58+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/\"},\"wordCount\":877,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_person_wheelchair.jpg\",\"articleSection\":[\"Global health\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/\",\"name\":\"Deaths from covid-19 could be the tip of the iceberg - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_person_wheelchair.jpg\",\"datePublished\":\"2020-05-20T07:59:28+00:00\",\"dateModified\":\"2020-05-22T18:50:58+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_person_wheelchair.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2020\\\/05\\\/coronavirus_person_wheelchair.jpg\",\"width\":540,\"height\":350,\"caption\":\"A couple walks as a woman is pushed on a wheelchair during the hours in which the elderly are allowed to walk outdoors, for the first time since the lockdown was announced, amid the coronavirus disease (COVID-19) outbreak, in Barcelona, Spain, May 2, 2020. REUTERS\\\/Nacho Doce\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2020\\\/05\\\/20\\\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Deaths from covid-19 could be the tip of the iceberg\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Deaths from covid-19 could be the tip of the iceberg - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/","og_locale":"en_US","og_type":"article","og_title":"Deaths from covid-19 could be the tip of the iceberg - The BMJ","og_description":"The public health impact of choices made now will have implications long after the immediate crisis is over [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2020-05-20T07:59:28+00:00","article_modified_time":"2020-05-22T18:50:58+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_person_wheelchair.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"4 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Deaths from covid-19 could be the tip of the iceberg","datePublished":"2020-05-20T07:59:28+00:00","dateModified":"2020-05-22T18:50:58+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/"},"wordCount":877,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_person_wheelchair.jpg","articleSection":["Global health"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/","url":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/","name":"Deaths from covid-19 could be the tip of the iceberg - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_person_wheelchair.jpg","datePublished":"2020-05-20T07:59:28+00:00","dateModified":"2020-05-22T18:50:58+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_person_wheelchair.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/05\/coronavirus_person_wheelchair.jpg","width":540,"height":350,"caption":"A couple walks as a woman is pushed on a wheelchair during the hours in which the elderly are allowed to walk outdoors, for the first time since the lockdown was announced, amid the coronavirus disease (COVID-19) outbreak, in Barcelona, Spain, May 2, 2020. REUTERS\/Nacho Doce"},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2020\/05\/20\/deaths-from-covid-19-could-be-the-tip-of-the-iceberg\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Deaths from covid-19 could be the tip of the iceberg"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/47557","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=47557"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/47557\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/47444"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=47557"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=47557"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=47557"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}