The virus is unfortunately now big enough to make a dent in all-cause mortality.

Death is now the most reliable test, and the comparison to the daily or weekly death rate in a given region from a year ago tells us the true toll of the virus.

Example from @DellAnnaLuca: https://twitter.com/matthewstoller/status/1245780711459733506

In general I treat confirmed cases and deaths as loose *lower* bounds, with a bit higher confidence if there is a lot of testing going on.

Absence of testing is, at this point, evidence of likely presence. Because it shows a health system that can’t get its act together.