Darcel Richardson knows she’s fortunate in one sense: She still has her job as a vocational counselor in Baltimore. But despite that, she won’t be able to make her rent payment this month because she’s not getting her full salary for a while. More than $400 per biweekly paycheck — about a quarter of her after-tax income — has been siphoned off by Johns Hopkins University for unpaid medical bills at one of its hospitals.

Richardson, 60, got word of the garnishment from her employer just as the coronavirus pandemic was arriving in full force last month. “My job was going to take the money out. They don’t want to get in trouble,” she said. “I spoke with our payroll accountant, and the bottom line was, even though the crisis had begun, they still had to pay my money to them.”

In a moment when hospitals nationwide are being heralded for their role at the front lines of fighting the pandemic, some Americans continue to experience a less favorable side of hospital operations: aggressive collection for unpaid medical bills, even at a time when many of the debtors are seeing their income plunge. Debt collection is occurring on other fronts as well, over unpaid college and bank loans among others, prompting debates over protecting people’s economic stimulus checks from collection agencies or suspending garnishments outright. But collection by the very hospitals that are treating coronavirus patients brings the health and economic exigencies of the moment into especially stark relief.

In a few cases, hospitals have brought new cases against former patients in recent weeks, such as in Wisconsin, where Froedtert Hospital in Milwaukee filed 46 small-claims lawsuits even after the governor declared a state of emergency on March 12, and other hospital systems in the state filed dozens more, according to a report by Wisconsin Public Radio and Wisconsin Watch. Steve Schoof, Froedtert’s director of external communications, told ProPublica in a statement that the hospital stopped filing small claims suits on March 18. “Moving forward,” the statement continued, “Froedtert Health will no longer be filing small claims suits for medical debt collection. Unfortunately, there was a miscommunication that resulted in small claims filings after March 18. We immediately rectified this miscommunication and dismissed these small claims cases that were filed after March 18.”

More often, though, the collection stems from cases filed months before the pandemic arrived, as the legal process grinds its way forward. “Where debt collection is underway for pre-COVID medical debt, they will continue to do that,” said Jenifer Bosco, a staff attorney for the National Consumer Law Center.

In Richardson’s case, the debt stemmed from a two-day 2018 visit to Johns Hopkins Bayview Medical Center in southeast Baltimore, one of a string of medical visits she has had to make over the years to deal with a knee injury from a fall, a hip injury from a car accident, hernia repairs and back trouble. She had insurance coverage through her job, which at the time was with the state Division of Correction, but it left a balance of almost $1,000 for her to pay. Richardson, who lives by herself in a modest apartment complex just east of the city, started hearing from a collections lawyer for Hopkins last fall and tried to work out a payment schedule with him, but she couldn’t make it work.

“I just didn’t have the money,” she said. “I said to the lawyer, I might be able to pay an amount monthly, but when it came time, I just didn’t have it. What can you do when you’re caught between a rock and a hard place? I prioritize. I’m going to try to pay my rent first, pay for gas and electric, cellphone costs. And I’ve got to eat.”

The court judgment was finally entered against Richardson in Baltimore City District Court in January: $923.21, plus $34 in court costs and $138.49 in attorney’s fees. The notice of wage garnishment went out on March 6 — the day after Maryland Gov. Larry Hogan announced the state’s first three coronavirus cases. The garnishment was confirmed by Richardson’s new employer, the nonprofit drug treatment organization Gaudenzia, on March 16, the day that Hogan decreed the closure of all bars, restaurants, gyms and movie theaters, and three days after Richardson and her colleagues were barred by safety precautions from providing counseling inside prisons. She now works at a small treatment center that houses seven women, where social distancing is easier.

Johns Hopkins, by far the largest private-sector employer in the state and the largest beneficiary of billionaire Michael Bloomberg’s charitable giving, has long faced scrutiny for its aggressive collection of medical debt, including from the many low-income Baltimore residents it serves, who in theory should be able to qualify for the hospital’s charity care programs. In 2008, The Baltimore Sun reported that Hopkins and other Maryland nonprofit hospitals had filed more than 32,000 debt-collection suits over the past five years, winning at least $100 million in judgments. Last May, a coalition that includes the AFL-CIO and National Nurses United, which has been trying to organize Hopkins nurses, released a report finding that Hopkins had launched 2,400 lawsuits in Maryland courts since 2009 against patients with unpaid bills, increasing from 20 in 2009 to a peak of 535 in 2016.

In response to the 2019 report, Hopkins officials said they offered considerable free and discounted services, and that “for patients who choose not to pursue those options or who have a demonstrated ability to pay, we will make every effort to reach out to them and to accommodate their schedule and needs. In those rare occasions when a patient who has the ability to pay chooses not to, we follow our state required policies to pursue reimbursement from these patients.”

The cases have slowed in pace but not stopped altogether since the report. Bayview, one of several hospitals under the Hopkins umbrella, has filed about 60 cases over the past year, according to Maryland court records. Dozens of them, including Richardson’s, remain open.

Kim Hoppe, vice president for communications for Johns Hopkins Medicine, said in a statement that after looking into the matter, the medical system has become aware of nine garnishments that went into effect in February and March, and that it has now placed a “hold” on them. “Johns Hopkins remains committed to providing affordable access to all patients in need of our care, regardless of ability to pay,” Hoppe said. “We also make numerous efforts to communicate with patients who have overdue bills. Typically, patients receive more than a dozen contacts via mail or phone call along with multiple opportunities to file for medical or financial hardship. At all points in that process, patients are encouraged to speak with financial counselors; their bills will be forgiven if they can show financial hardship or inability to pay.”

For Cheri Long, aggressive medical debt collection came with less warning than it did for Richardson. Long, a nurse at an assisted living center in northern West Virginia, had stopped by a Dollar General on March 23 to pick up some groceries for her kids and some requests for residents at the center: prunes, caramel candies and adult diapers. When she went to pay with her debit card, the machine told her she had insufficient funds. She checked the account after leaving the store and found there had been a debit for about $900. She assumed her account had been hacked and the funds would be restored. In fact, the bank told her, her account had a hold on it from the magistrate court.

She told the bank she had not received any notification. But that night, a card was waiting in her mailbox alerting her that there was a certified letter waiting for her at the post office. She picked the letter up the next day and rushed to the magistrate court, and she learned that the account had been garnished by West Virginia University Hospitals, the official name for J.W. Ruby Memorial Hospital, the large nonprofit academic medical center in Morgantown that is the flagship of the WVU Medicine system.

The bills were for care received by her husband, Seth — after a motorcycle accident seven years ago and after a visit for alcohol rehab after he had started drinking heavily upon losing his coal mining job three years ago. He had insurance coverage at the time of both hospital stays, even supplemental motorcycle insurance, but the coverage had left a balance of about $3,500. Seth had gotten work at another mine but lost it again two years ago, leaving the family relying on Cheri’s income, about $3,000 per month in take-home pay. “Times are hard,” she said in an interview. “That [medical bill] was my last priority. I didn’t think they would do anything over $3,500.”

The bank garnishment sent her into a panic. She was in tears at the courthouse, pleading for someone to help her. She eventually filed for an “affidavit for exemption” through the sheriff, seemingly got the garnishment lifted temporarily and changed her direct deposit to another account to be on the safe side. But when she went for groceries again on April 3, her card was declined. Her account had been zeroed out again despite the exemption, apparently due to a bureaucratic oversight.

She borrowed money for groceries and gas from her co-workers, nursing aides who make minimum wage. Her father-in-law offered to cover the house payment. And, on Easter Sunday, she started writing emails — to the governor, to the attorney general. “It was a very depressing time,” she said later. “I’m out working, busting my butt, and they’re going to take my money.”

At last, she got help. The National Consumer Law Center put her in touch with a local legal aid lawyer, Jennifer Wagner with Mountain State Justice. Wagner filed a lawsuit on behalf of Long, arguing that it was unconstitutional to seize her property when the closure of the court system undermined her ability to seek due process.

On April 15, Preston County Judge Steven L. Shaffer issued an emergency order halting seizure of both Long’s bank account and her imminent stimulus funds, thereby restoring the money already taken. “Seizure of personal property during the court closure and stay at home order and related state of emergency … violates due process of law,” he wrote in the order, first reported by the Times West Virginian newspaper.

In a statement, WVU Medicine spokeswoman Angela Knopf said that the system gave guidance to its third-party collection vendors in March to be mindful of the economic impact of the pandemic crisis in seeking repayment, but it did not order them to hold back entirely. “At WVU Medicine, we need to balance our need to liquidate patient balances with the needs of our community, especially during times of disruption,” read the guidance. “Collection calls and letters can continue. However, please take a soft approach to calls and express the compassion that WVU Medicine has for our community during this difficult time. We do not want to beat our patients up as they are sequestered in their homes, compounding the stress of the current situation. We want to be a partner in helping them through this.” The guidance instructed vendors not to file any new lawsuits for “at least the next 60 days,” but it does not explicitly address the garnishing of accounts from cases launched before the crisis.

Wagner, the legal aid lawyer, said she is getting calls from more than a dozen other people in the area facing collection from the hospital and is considering filing a class-action lawsuit over the garnishments. “We’re contemplating seeking broader relief because of our concerns that they haven’t stopped, notwithstanding the order,” she said. “It’s actually going to dissuade people from seeking medical care during a time when it’s really important to seek medical care, and that is really alarming.”

Governors have issued orders temporarily banning wage and bank garnishments in several states, including in Illinois, Massachusetts and Washington. The Texas Supreme Court has decreed that any new garnishment orders not be served until after May 7. Governors or state attorneys general have taken the more limited step of barring the seizure of stimulus checks during bank account garnishments in some other states, among them California, New York and Ohio. But this leaves several dozen states where medical debt collection can still carry forward, with or without the ability to seize stimulus checks in the process.

In recent years, revelations of aggressive medical debt collection have been especially prevalent in states that chose not to expand Medicaid under the Affordable Care Act, which has left hospitals with more unreimbursed care than in states that did expand Medicaid. Kaiser Health News reported on 36,000 lawsuits filed in recent years by the University of Virginia medical system, most predating the state’s expansion of Medicaid in 2018, and ProPublica last year reported on 8,300 lawsuits over five years by Methodist Le Bonheur Healthcare in Memphis, where Tennessee lawmakers have refused to expand Medicaid. That reporting resulted in a pullback by Methodist, which announced that, while not altogether abandoning collection lawsuits, it would expand its financial assistance policy and stop suing its own employees over medical debts.

Meanwhile, though, another Memphis hospital, Baptist Memorial, has kept up aggressive collection during the economic crisis. The Shelby County court system lists about 20 garnishments for Baptist Memorial debts initiated last month alone, some of them for debts going back more than a decade.

One of the Baptist Memorial targets found out that she was about to have her paycheck garnished for a 13-year-old debt when she received a letter in the mail from a lawyer seeking to represent her in the matter. “It’s just been very hard,” said the woman, who asked that her name not be used. “I had offered a settlement, but they wouldn’t work with me. They’re playing hardball.”

A Baptist Memorial spokeswoman said in a written response, “These are not new cases; these judgments were made months ago. You’re looking at renewals that were filed in January — well before the first known COVID case was diagnosed in the U.S. If any of these people lost their jobs, we would stop trying to collect. If they have other financial issues, they can contact us and we’ll work with them. We have modified payment plans for hundreds of patients since the COVID pandemic began.”

Critics of the hospital debt collection say they are aware that hospitals may be more sympathetic creditors at the current moment, when they are strapped by the demands of treating victims of the pandemic, while losing much of their usual business. Johns Hopkins, for one, announced this week that it was running a $100 million deficit, due largely to a dropoff in the elective medical procedures that provide much of its revenue base.

But the National Consumer Law Center notes that hospitals nationwide are receiving $100 billion in the federal relief packages to help recover some of the costs of the crisis. And Cecilia Behgam, an AFL-CIO researcher who helped produce the 2019 report on Hopkins, notes that collection on unpaid bills makes up just a tiny sliver of hospital revenue — for a giant institution like Hopkins, typically less than one-tenth of a percent. “This is not making a significant difference in the budget of these hospitals,” she said.

Behgam also noted that in cities such as Baltimore and Memphis, the lawsuits and garnishments are being brought mostly against exactly the demographic that has been shown to be most vulnerable in the pandemic: lower-income African Americans with underlying health conditions. “These are people who are already disproportionately feeling the impact of the epidemic,” she said.

In Baltimore, Darcel Richardson says she has so far managed to talk the managers of her apartment complex into letting her pay the outstanding balance of her rent once the garnishments stop. They might even be willing to cancel the usual fees for late payment, she said. “I am a firm believer in trusting God,” she said. “He’ll meet my needs. So far, he’s still kept the roof over my head.”

Wendi C. Thomas contributed reporting.

In the past two weeks, researchers across America have begun announcing results from studies showing that there have been many more coronavirus infections in their communities than were previously recorded.

Findings have come in from Santa Clara County, California, as well as Los Angeles, New York, Chelsea, Massachusetts, and Miami-Dade County, Florida. The debates began immediately. What did the study results actually mean? If more people were infected than previously known, did that mean the death rate is actually lower than previously thought? Is the coronavirus actually more like the flu, after all? And are we close to “herd immunity,” meaning enough people are infected that the virus won’t spread easily anymore?

These studies all were based on antibody tests, which are diagnostics that can look in a person’s blood and see if there is evidence of prior infection. In the past month, as these tests have reached the market, researchers have launched large-scale studies, known as sero-surveys (sero is short for serology, the study of blood serum). By running these surveys, scientists are finally able to start estimating how many people have been infected, which can give us information about how deadly the disease is and where the disease was most concentrated geographically.

It’s a pity that some of the first of these studies conducted in the U.S. have been dogged by controversy. Within hours of results being announced, researchers started to pick apart the studies’ methodologies, arguing over whether the surveys were well designed, which added to confusion over whether the results could be trusted. While the scrutiny is well warranted, my fear is that the public might lose trust in future survey results, when in fact, antibody studies are going to be critically important in helping us better understand the coronavirus and how to fight this pandemic.

But I’m hopeful, because there are many such surveys in the works that can learn from the shortcomings of the initial attempts. We’re all going to be hearing far more about antibody tests and surveys — and maybe even participating in them — in the coming months. So here’s a primer on what they do, how they should be properly wielded and how you, a critical reader (or journalist), can interpret a study that’s hot off the presses.

Antibody studies can be used to answer more questions than you might think.

When the coronavirus emerged, the first type of diagnostic that scientists raced to produce was a test that could detect an active infection. Those tests will continue to be necessary, but they can only catch the virus red-handed. Once a patient has recovered, that kind of test won’t come back positive anymore.

In the U.S., especially at the start of the outbreak, there was a paucity of such tests — and even now, there aren’t enough to test every person who has only mild symptoms, let alone identify people who are asymptomatic carriers.

So that means the case counts that we see reported every day are certainly an undercount. The question is: how much of an undercount? The only way to know is to test a random sample of a given population and see who has antibodies — proteins in the blood that indicate past infections.

Once you know the percentage of people who have been infected (the fancy word for that is “sero-prevalence”), then you can calculate what’s known as the “infection fatality rate.”

Bear with me here as we wade through some jargon, because I think it’s worth your time. So far, the death rates you’ve seen in headlines have largely been case fatality rates, which are the number of deaths reported divided by the number of cases confirmed with a diagnostic test. That’s all we’ve been able to report so far. You should expect the case fatality rate to be higher than the infection fatality rate, because there are way more people infected than people who have been able to be tested. We’ll get back to what we’re learning about the infection fatality rate in available studies later on, but for now, just know that this is one reason why sero-surveys are so useful to us.

But there’s more you can learn from a sero-survey. Dan Larremore, an assistant professor at the University of Colorado Boulder, whose recent work has focused on designing antibody surveys, said you can use sero-surveys to find out if there are certain neighborhoods that have been harder hit than others. Or, by surveying specific populations, you can study questions like: “How much transmission is there within a household?” or “What’s the role of kids in all of this?”

Setting up a sero-survey correctly means you need to test a random population — easier said than done.

For now, most of the studies being set up around the country, as well as nationwide ones being conducted by the National Institutes of Health and the Centers for Disease Control and Prevention, are focused on asking the most basic question, which is, what percentage of a given population has been infected?

To do that properly, researchers need to test a random sample of the population. One of the main criticisms of some recent studies is that their results could have been biased because of how participants were recruited. Take, for example, the study conducted in Santa Clara, California. Researchers at Stanford put out ads on Facebook, asking people to volunteer to participate.

“The problem is there are people who will think, ‘Oh, yeah, I had this nasty flu, or cough, or whatever, and I think I had it.’ And if you said to them, ‘Would you like to get tested?’ They would say, ‘Abso-frickin-lutely!’” said Marm Kilpatrick, a professor at the University of California at Santa Cruz who studies infectious diseases. Conversely, people who felt totally healthy could be less inclined to participate. “So there’s a differential excitement to go get tested, and if that leads to the first group being at a higher chance of being participants in the study, then you’ve just totally blown your estimates.”

Contrary to Kilpatrick’s concern, Dr. Jay Bhattacharya, senior author of the Santa Clara study, said in an email that while “volunteer bias is certainly a potential problem in any survey that recruits participants the way we did … in our study, the evidence points in the direction of healthy volunteer bias” because people in “wealthier and healthier” ZIP codes signed up faster. Bhattacharya said his team made adjustments in its calculations to represent the county properly by ZIP code, race and sex, and thinks it is “still likely underestimating prevalence because of healthy volunteer bias.”

In New York City, researchers tested shoppers at grocery stores and big box stores. That method is still not perfectly random: You’re only testing the subset of people who are out shopping in person. “You’re not sampling people who are too old, or high risk, who don’t want to shop for themselves,” Larremore said. “You’re also sampling predominantly from people who are old enough to go shopping, or who feel that they may have been infected and think they’re safe enough.”

The ideal way to conduct a sero-survey, according to Natalie Dean, assistant professor of biostatistics at the University of Florida, would be to randomly select addresses from a database of the population you want to survey and then send a team of researchers door to door to collect samples. The World Health Organization’s guidance for such studies recommends inviting all people who live in the household to participate in the study, including children.

But sending teams door to door is labor intensive and potentially also a contagion risk, not to mention that people staying home may not want to let someone in at this time. So around the country, different cities and states are trying different methods. Miami-Dade researchers partnered with Florida Power & Light to randomly generate phone numbers and invite people to come to 10 drive-thru testing locations. Preliminary results released on April 24, based on two weeks of testing and about 1,400 participants, estimated that about 6% of the Miami-Dade population had antibodies.

The county plans to keep running the survey on an ongoing basis. “Repeated cross-sectional studies — where they’re repeating it every week — are valuable, even if there’s some sort of bias, because you can look at trends,” Dean said.

Larremore is looking into a finger-prick test that captures a drop of blood on a special type of paper, which could potentially be mailed to participants in a sero-survey being planned in Colorado. The dried blood could then later be analyzed for antibodies back in the lab. If this works, Larremore said, that could further help to reduce bias, because people could participate from the safety of their homes.

Test accuracy can skew results in some pretty surprising ways.

Another key question for any sero-survey is how accurate the test was. Tons of antibody tests have hit the market over the past few weeks, and their accuracy is still being scrutinized. Not all tests have the same degree of accuracy.

Even a test that is very good can give out more false positives than true positives when the prevalence of a disease is very low in a population.

Let’s say you’re running a sero-survey among 1,000 people and only 4% of the population is actually infected. Presume the test correctly identifies positives 100% of the time, meaning it is 100% “sensitive” in scientific parlance.

There are 1,000 people in your sero-survey.

With a 4% infection rate, the test would accurately identify those 40 people who are positive.

But say the test is 95% “specific,” meaning that it returns false positives 5% of the time. Then among the 960 people who are truly negative, 48 people would get a false positive.

In this scenario, more people would get a false positive result than a true positive.

So when you are running a sero-survey in a community where a small percentage of the population has been infected, you have to worry about many of your positive results being false positives, explained Andrew Gelman, a professor of statistics at Columbia University.

You can have more confidence in the signal you’re getting when there’s a higher percentage of the population that’s been infected, as in a situation like New York City, because the number of true positives would drown out a smaller number of false positives, Gelman said.

Unfortunately, New York didn’t actually share much information on how accurate its tests were when Gov. Andrew Cuomo first announced the findings of its study on April 23, so the experts I called said they didn’t have much to scrutinize. “My confidence is in the Wadsworth lab test,” health commissioner Dr. Howard Zucker said at the press briefing the following day, referring to New York state’s public health lab, “which has unbelievable sensitivity and specificity.”

Forget the headlines, your city is nowhere near herd immunity.

As more of these studies read out in the future, there are probably going to be a lot of headlines that say: “study finds [X] times more people in [CITY/STATE] infected than confirmed case counts,” or more vaguely, “Coronavirus infections more common than previously thought.”

These headlines may be accurate, but that does not mean that your city or state is close to “herd immunity,” which is when the vast majority of a given population have been infected. In such situations, the virus has a hard time infecting the remaining people, because there aren’t enough carriers to reach them.

In order to achieve herd immunity, scientists say that a community would need to have at least 60% of its population infected. That’s the lowest estimate I’ve been told. Other scientists have told me 80% to 90%. The reason this percentage isn’t precisely known is because it depends on things like exactly how contagious the virus is and also whether people who have been infected are immune forever, or if they lose immunity after a while, which researchers also are furiously working to figure out.

None of the studies I’ve seen so far have reported a number anywhere near that high. The highest rate I’ve seen is in Chelsea, Massachusetts, the epicenter of the coronavirus outbreak in that state. Researchers at Massachusetts General Hospital tested 200 pedestrians and found about a third had antibodies.

The other way to achieve herd immunity is via a vaccine, which is far safer and doesn’t involve millions of people getting sick. But developing vaccines is a slow process, so achieving herd immunity that way won’t happen any time soon.

There are two types of death rates. Most people are mixing them up.

Another thing I’ve seen some people say, when some of the study results came out, is that the coronavirus is far less deadly than we thought it was.

A columnist wrote that antibody testing “proves we’ve been had!” adding: “We’ve been told that the true death rate is 7.4% in New York. … We were told that this was worse than the flu. … But none of these ‘truths’ turns out to be so. The death rate in New York State isn’t 7.4%, it is actually 0.75%.”

This columnist is mixing up the case fatality rate and the infection fatality rate. There has never been an abundance of diagnostic tests in New York, which means mostly very sick patients are the ones who’ve been tested. As of April 24, according to the State Department of Health, 282,143 people had tested positive, and 16,599 of those people had died. That translates to a case fatality rate of 5.9%.

(As a side note, there are many reasons why the case fatality rate is a very squishy estimate. The denominator depends both on how many tests are available and how many people are seeking testing. The numerator is also shaky — for one, many people are dying at home without getting tested, and the extent to which deaths are undercounted is still unknown. Moreover, we don’t yet know the outcome, whether recovery or death, for many patients that are identified as positive.)

On April 23, Cuomo announced preliminary data from the state’s sero-survey, saying that 13.9% of state residents had tested positive for antibodies. In New York City, it was about 21%. The state is continuing to test residents in order to generate an ongoing series of “snapshots” of the levels of infection. Cuomo had updated numbers by April 27 showing huge regional variation.

Kilpatrick, from UC Santa Cruz, said that if the estimates from New York stand up to scrutiny, the infection fatality rate in New York City would be approximately 0.8%.

He told me that is not very surprising, because scientists have been able to get some estimates of infection fatality rates using data from enclosed populations where nearly everyone got tested — on cruise ships. Epidemiologists at the London School of Hygiene and Tropical Medicine, for example, analyzed data from the Diamond Princess, the ill-fated ship on which more than 700 passengers got infected. Researchers adjusted for the fact that cruise passengers are older than average and estimated the coronavirus’ infection fatality ratio as 0.6%.

Remember, the IFR is not inherent to the virus — how old and healthy your population is and how many ICU beds were available for patients also will affect this number for your region.

Stop comparing this to the flu. Without a coronavirus vaccine, we are far more vulnerable.

Now let’s talk about the flu. Comparisons to the flu keep coming back like a many-headed hydra, and they roared back last week with a vengeance.

The estimates I’ve seen for influenza IFR range from about 0.14% on the upper end to 0.04% on the lower end. So if the IFR for this coronavirus ends up being around 0.5%, that’s still many times worse than the flu.

But that’s not the main problem. At the end of the day, wherever the coronavirus fatality rate ends up, it doesn’t change the fact that we don’t have any immunity to the virus, which is a critical factor in why we’ve had to behave differently in our response to it.

Marc Lipsitch, head of the Harvard T.H. Chan School of Public Health’s Center for Communicable Disease Dynamics, has estimated that ultimately 20% to 60% of the population could be infected with COVID-19. By comparison, because of immunity provided by flu shots, only about 10% to 20% of the population gets sick with influenza every year, according to Kilpatrick.

Kilpatrick sketched out what this meant: “If it’s five times deadlier than the seasonal flu, and three times as many people are going to get it, that means we’re going to get 15 times as many deaths. And 15 times 30,000, which is the middle-of-the-road kind of a seasonal flu year, that’s 450,000 deaths — about half a million deaths — that’s a pretty big, scary number, I think.”

There are additional reasons why comparing the flu to the coronavirus isn’t apples to apples. We’re two to three months into the coronavirus pandemic in the U.S. By comparison, the typical flu season lasts many months. So comparing current deaths from the coronavirus to a complete flu season doesn’t make sense.

Dean, from the University of Florida, also notes that the discussion about exactly how deadly COVID-19 is doesn’t change the reality of how many people have died. While it’s important that New York City’s sero-survey has helped to quantify the number of people who have had mild infections, that doesn’t change the fact that, as of April 27, about one out of every 500 residents of New York City has died from this virus. (This includes deaths that New York City deems likely to be due to COVID-19, despite not having a lab-confirmed test.)

“We know that this disease can completely decimate health care systems, and that’s important to keep in mind in terms of how we respond,” Dean said.

Antibody tests aren’t ready to be used to issue “immunity passports.”

As antibody tests become more widely available, there’ll naturally be a temptation to start using the tests for ourselves on an individual basis, to determine if we’re immune and can go about our lives, free of the paranoia and fear that have been plaguing us for the past two months.

But it’s too early for that. Besides the issue of potential false positives, scientists haven’t yet figured out exactly what level of protection an individual has after being infected and whether the protection lasts forever (like with chickenpox) or wanes after a while. The World Health Organization issued a scientific brief last week warning that detection of antibodies alone shouldn’t serve as a basis for an “immunity passport” allowing an individual to assume they are totally protected from reinfection.

So for now, the antibody tests are best used in these population-wide surveys, to better understand the spread of the disease, how it’s being transmitted and regional infection fatality rates.

There are far more surveys to come. You could be part of one.

Sero-surveys have only just begun. Many of those that are soon launching appear to be robust and thoughtfully designed, such as in Indiana, where the State Department of Health has said it will test at least 20,000 Hoosiers in four phases over the next year. Participants would be randomly selected, by invitation only, “to ensure that the sampling is representative of the population,” the department said.

While everyone is eager to know the results of these studies, many researchers I spoke to also said they hoped that there could be a better balance reached between sharing results quickly and publishing full information. So far, while key findings from the studies done in Los Angeles and New York State have been announced, their authors haven’t yet published many details about their methods.

“I think there should be more pushback when people are not providing their methodology,” said Dean, from the University of Florida. “They shouldn’t be running to the press. You should explain what you did. How do we know what you did, if it’s credible or not?”

For all the criticism that the Santa Clara study has received, Larremore says he’s “thankful that the researchers put the preprint out there, so the community could help them correct it.” (A preprint is a draft research paper, shared publicly before it has been peer-reviewed and published in a scientific journal.)

Bhattacharya, the author, said his team “received hundreds of constructive comments on our preprint from scholars around the world” and is now updating its paper. The new version will be “substantially better as a result of this worldwide peer-review.”

Overall, he said, “the open science model has really worked well.”

It’s always easier to criticize studies than to run them. Just a few weeks ago, in the U.S., we had no antibody survey results to look at, and now we have some data. I’m hopeful that as more and more studies are done, researchers will be able to discard bad data, confirm good information, start to track trends and gather intel on this virus, so we are better equipped to make wise, evidence-based decisions on how to fight the disease at local and state levels, as a country and as a global community.