COVID-19 fatality rate may be much lower than previous estimates

[RAE]

Interesting short article in the Wall Street Journal yesterday that basically confirms what I have thought since the start of this. New data from northern California shows that a MUCH higher percentage of the population may have already been infected with the virus than anyone knew (like up to 85 times more people infected than reported, based on the little testing that was done). If confirmed, that means that the fatality rate is actually something like 0.1 - 0.2 percent, not the 1.0 - 3.0 percent that some epidemiologists estimated. A fatality rate of 0.1 - 0.2 percent would be similar to regular influenza.

This really should not be all that surprising, when you consider the extremely small percentage of the US (and world) population that has been tested for COVID-19 so far. In most areas, the test was not available (and is still not readily available) unless you were both very ill, and met a bunch of other criteria that most people did not meet. So, if you are only testing a subset of very sick people, you are probably vastly underestimating the true rate of infection, and thus your fatality rate estimate could be off by orders of magnitude.

Of course, COVID-19 is much more contagious than the flu, which has allowed it to spread rapidly around the globe. And when that happens, you can strain hospital capacity in many places, since so many people are sick at one time, some very sick.

At any rate, I thought this was interesting. And if it's true, it's actually good news, because it would mean that something like 99.8% of people that become infected with COVID-19 do not experience life-threatening complications.

https://www.wsj.com/articles/new-da...5b77f94fcd14afe1a&reflink=article_email_share

 

[PatrickA5]

Couldn't the fatality rate of the flu also be overestimated? I know a lot of people that think they had the flu, but didn't get tested. The last time I had the flu the doctor didn't even do a test - just said you probably have the flu.

I tend to agree with the thought that the fatality rate of Covid19 is much less than what they think it is now, but as you said it appears to be a LOT more contagious.

 

[Midpack]

I can’t read the article behind a paywall, but lots of stats are being mixed up. Most of the 0.1-0.2% fatality rates use total population as the denominator whereas the 1-3% fatality rates use total (confirmed infected) cases as the denominator. Both can be true. Add stats of cases versus deaths and it gets even harder to follow.

It does appear the US may have less than the 100,000 to 240,000 deaths the White House reported. But then I think bracing us for worst case and scaring us into staying home was part of their calculus, one of the leading experts has since projected 60,000 deaths.

 

[audreyh1]

Well sure, if we are only testing the sickest, the disease is far more widespread in the US than we can measure at the moment. But still based on what has been sampled so far in some areas a very small % of the population has been exposed, and I’m not sure it reduces the near term projections of deaths which are based on current conditions.

I really do think we need to test widely for various reasons, including having a decent measure of population wide exposure.

 

[Rianne]

It's important to consider the long term effects of CV19 and the way it attacks the body. From Medscape article. IMHO, the fatality rate is secondary to long term serious effects of this virus. I think I'd rather pass than live with what is discussed here.



"In particular, Yale New Haven (Conn.) Hospital is dealing with unexpected complications up close. Almost half of the beds there are occupied by COVID-19 patients. Over 100 people are in the ICU, and almost 70 intubated. Of the more than 750 COVID admissions so far, only about 350 have been discharged. "Even in a bad flu season, you never see something like this; it's just unheard of," said Harlan Krumholz, MD, a Yale cardiologist and professor of medicine helping lead the efforts there."


"When they get to the ICU, we are seeing lots of people with acute kidney injuries; lots of people developing endocrine problems; people having blood sugar control issues, coagulation issues, blood clots. We are just waking up to the wide range of ways this virus can affect people. Our ignorance is profound," Dr. Krumholz said, but physicians "recognize that this thing has the capability of attacking almost every single organ system, and it may or may not present with respiratory symptoms."

 

[RAE]

Here's a link to the abstract of the actual N. California study, for those who could not read the WSJ article. I think you can access the entire study in .pdf format also, for those that want all the specifics:


https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1?mod=article_inline

 

[Aerides]

I'll quote Nate Silver here:

"...it's usually going to be better to do a meta-analysis of all studies, including thinking about biases that could systematically affect all of them, than to spend a huge amount of energy picking apart any one study.

There are at least ~a dozen studies already that attempt to measure seroprevalence (how many people were infected) for COVID-19 in various parts of the world. Will likely be dozens more in a few weeks. I'm seeing analysis of e.g. the Santa Clara Co study that take it in a vacuum.

Taken as a whole, those studies seem to suggest it's possible—but hardly certain—that the ratio of total infections to detected cases is higher than the ~10x ratio commonly cited. But the thing is there's not just going to be one universal ratio; it will vary from place to place."

 

[Sunset]

....
It does appear the US may have less than the 100,000 to 240,000 deaths the White House reported. But then I think bracing us for worst case and scaring us into staying home was part of their calculus, one of the leading experts has since projected 60,000 deaths.

Since we are already over 37,000 deaths, and this thing will continue for many more months, I think the low death count number is wishful thinking at best.

At the end of March we had less than 4,000 dead, and in just over 2 weeks we added over 33,000 deaths. That is with severe social distancing by the majority of people.

 

[mountainsoft]

I'm sure there are plenty of people who are infected with COVID and never realize it. Unless you experience significant symptoms you might just think you have allergies or something. That's one of the reasons it spreads so easily, you can be contagious without any symptoms.

On the flip side, I'm sure a lot of people are dying from COVID but aren't counted as a fatality since they were never tested for the virus.

 

[DenverGuy42]

It does appear the US may have less than the 100,000 to 240,000 deaths the White House reported. But then I think bracing us for worst case and scaring us into staying home was part of their calculus, one of the leading experts has since projected 60,000 deaths.

I don't think we'll ever know honestly. I think the reported numbers are low.

https://www.cnn.com/2020/04/06/health/coronavirus-coroners-uncounted-deaths-invs/index.html

people that do not make it to the hospital (the poor, the elderly, people that die outside of a hospital) are in general not getting tested to see if they had the virus due to the inability to test on a massive scale.

So, there are people out there that have passed in the last few weeks that died of coronavirus, but we'll never know how many because coroners are not among the group of health care workers with access to the tests.

 

[Midpack]

Since we are already over 37,000 deaths, and this thing will continue for many more months, I think the low death count number is wishful thinking at best.

At the end of March we had less than 4,000 dead, and in just over 2 weeks we added over 33,000 deaths. That is with severe social distancing by the majority of people.

You may be right, though it's not clear what you're estimating. We're being told we're peaking/peaked so I wouldn't expect May will look anything like Apr as compared to Mar. I am sure the curve won't be symmetrical, but if we've peaked and the other side was similar that would put us around 74,000 deaths ROM (37,000 x 2). That assumes there's no appreciable second wave, though I wouldn't bet on that yet by any means.

And Fauci has said we could be closer to 60,000 total IF we continue mitigation until told otherwise. I hope he's right, and it's not worse.

 

[fh2000]

Using the same multiples (85X) on Spain (47M with 190,000 cases), that means 1/3 of her population is infected right now. Using Italy's data (60M, 175,000 cases), 1/4 of her population is infected.

That sounds too high.

 

[Winemaker]

Join the tin foil hat club with me.

 

[aiken]

Check out the wisdom of Dr. Bhattacharya...

 

[molly312]

Well sure, if we are only testing the sickest, the disease is far more widespread in the US than we can measure at the moment. But still based on what has been sampled so far in some areas a very small % of the population has been exposed, and I’m not sure it reduces the near term projections of deaths which are based on current conditions.

I really do think we need to test widely for various reasons, including having a decent measure of population wide exposure.

-TOTALLY AGREE 1000%
-We will never know the extent of the virus or how to smother it without good data and testing.

 

[unclemick]

Numbers is numbers. I am also prone to take percents with a grain of salt.

Even though a retired engineer I have a Katrina prejudice.

heh heh heh - the post Katrina environment disrupted all kinds of - routines, mental and physical. I won't begin to list the people I knew personally who passed away (50's and 60's) for 'other' causes 1 to 3 years after the big event.
Hindsight showing average death rates per year by country ten years from now might prove interesting. For those viewing the data.

 

[Zathras]

We also have reports of numerous people who pass away at home, or in nursing homes without ever being tested.
The numbers could go either way, higher or lower.

As others have said, we need much more testing for many reasons, this being one.

 

[ivinsfan]

I'm sure there are plenty of people who are infected with COVID and never realize it. Unless you experience significant symptoms you might just think you have allergies or something. That's one of the reasons it spreads so easily, you can be contagious without any symptoms.

On the flip side, I'm sure a lot of people are dying from COVID but aren't counted as a fatality since they were never tested for the virus.

I don't know, death is pretty noticeable, a spike up in unexplained or unexpected deaths is going to be noticed in the present situation.

 

[ivinsfan]

We also have reports of numerous people who pass away at home, or in nursing homes without ever being tested.
The numbers could go either way, higher or lower.

As others have said, we need much more testing for many reasons, this being one.

I think this happened in NY and they have revised their number upwards to adjust for some of this. The English have acknowledged that deaths in nursing homes and homes were not included in their deaths numbers..

 

[DenverGuy42]

I don't know, death is pretty noticeable, a spike up in unexplained or unexpected deaths is going to be noticed in the present situation.

not necessarily, coroners do not have access to testing for covid-19 will not be able to put a cause of death that includes that right now:

https://www.cnn.com/2020/04/06/health/coronavirus-coroners-uncounted-deaths-invs/index.html

due to testing being limited to people in the hospital and front line workers - people that don't make it in will not be counted in current tallies, the tallies we are supposedly making decisions from.

Maybe in a few months or longer, a statistician can come along after all of the numbers have been reported and say "there is this probability that this percentage of deaths unattributed to covid-19 should have been". But you need more than a few weeks of numbers to do that sort of analysis.

 

[ivinsfan]

not necessarily, coroners do not have access to testing for covid-19 will not be able to put a cause of death that includes that right now:

https://www.cnn.com/2020/04/06/health/coronavirus-coroners-uncounted-deaths-invs/index.html

due to testing being limited to people in the hospital and front line workers - people that don't make it in will not be counted in current tallies, the tallies we are supposedly making decisions from.

Maybe in a few months or longer, a statistician can come along after all of the numbers have been reported and say "there is this probability that this percentage of deaths unattributed to covid-19 should have been". But you need more than a few weeks of numbers to do that sort of analysis.

I noticed that NY has started adjusting some of their past numbers so that's a start in the right direction.

 

[Sunset]

You may be right, though it's not clear what you're estimating. We're being told we're peaking/peaked so I wouldn't expect May will look anything like Apr as compared to Mar. I am sure the curve won't be symmetrical, but if we've peaked and the other side was similar that would put us around 74,000 deaths ROM (37,000 x 2). That assumes there's no appreciable second wave, though I wouldn't bet on that yet by any means.

And Fauci has said we could be closer to 60,000 total IF we continue mitigation until told otherwise. I hope he's right, and it's not worse.

I don't feel the curve is symmetrical, as the early part is with isolation, and even if the post peak part is with isolation, there is no end to the tail, and the tail will be high due to a lessening of the isolation.

Strangely a lot of projections I see all have the tail go to zero by Summer, which seems unlikely to my limited understanding, maybe they were hopefully the warm weather would kill it off.

I don't feel this will be like 1918 which had a second and third wave from mutations, and in many ways I hope it doesn't. Instead I think it will just carry on every month sickening X people and killing Y amount of them until we get a vaccine or herd immunity.

 

[ivinsfan]

I don't feel the curve is symmetrical, as the early part is with isolation, and even if the post peak part is with isolation, there is no end to the tail, and the tail will be high due to a lessening of the isolation.

Strangely a lot of projections I see all have the tail go to zero by Summer, which seems unlikely to my limited understanding, maybe they were hopefully the warm weather would kill it off.

I don't feel this will be like 1918 which had a second and third wave from mutations, and in many ways I hope it doesn't. Instead I think it will just carry on every month sickening X people and killing Y amount of them until we get a vaccine or herd immunity.

Perhaps here in the US we'll learn more about a possible second wave as Europe starts to open up in the future. Let's hope we are quick learners this time around, I see a lot of our borders and international air travel being locked down for quite some time.

 

[ejman]

Numbers is numbers. I am also prone to take percents with a grain of salt.

Even though a retired engineer I have a Katrina prejudice.

heh heh heh - the post Katrina environment disrupted all kinds of - routines, mental and physical. I won't begin to list the people I knew personally who passed away (50's and 60's) for 'other' causes 1 to 3 years after the big event.
Hindsight showing average death rates per year by country ten years from now might prove interesting. For those viewing the data.

Agree. We have multiple experiments in many countries - all different- on how to deal with this thing. It will certainly be interesting to see how it all shakes out. With my severe immune disease sure hope I get to see the how it all turns out. And BTW psssst Wellesley!

 

[RAE]

I don't know, death is pretty noticeable, a spike up in unexplained or unexpected deaths is going to be noticed in the present situation.

Yes, the spike may be noticed, but unless the people that died were tested for COVID-19, the cause of death would have been listed as something else, like pneumonia. This is apparently exactly what happened in Florida in mid-March - there was a big spike of deaths attributed to pneumonia (or maybe pneumonia due to influenza) at that time. None of these patients were tested for COVID-19. So, no one will ever know how many of those deaths were actually caused by COVID-19. It could have been a majority of them, for all we know.