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Thread: Is the Coronavirus as Deadly as They Say? Wall Street Journal

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    Is the Coronavirus as Deadly as They Say? Wall Street Journal

    Is the Coronavirus as Deadly as They Say?
    Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.

    By Eran Bendavid and Jay Bhattacharya
    March 24, 2020 6:21 pm ET

    If it's true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there's little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.

    Fear of Covid-19 is based on its high estimated case fatality rate—2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.

    The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That's not only plausible but likely based on what we know so far.

    Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.

    Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That's more than 130-fold the number of actual reported cases. Since Italy's case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.

    In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland's first case was reported on Feb. 28, weeks behind the U.S. It's plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.

    The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450 rostered players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn't a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.

    How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn't catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven't adequately adapted their estimates to account for these factors.

    The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that's a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.

    This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don't know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.

    If we're right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.

    A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lockdowns.

    Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford. Neeraj Sood contributed to this article.

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    Senior Member Colonel's Avatar
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    Influenza hit a high a few years ago here in Norway with 1700 fatalities in one year. That's roughly 300 per million inhabitants. Or corresponding to 100,000 fatalities in the US, in one year. Which is roughly 300 per day. On average. It might peak out at 1,000 per day. So anything over 1,000 deaths in the US per day from the new virus would amount to an unusual viral epidemic. The problem may still be the need for respirators. In Italy, which is already way over that number for its population size, they have stopped giving respirators to anyone over 60 which means that they are likely to die in agony. The numbers for Italy seem to have flattened out but Spain is getting even worse.

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    Senior Member Colonel's Avatar
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    The death rate for an area with a life expectancy of 78 years is 35 per million inhabitants per day.

    The current death rate from Corona alone for some areas :

    Spain : 18
    Italy : 15
    State of New York : 14
    USA : 1.6
    Norway : 0.8
    Canada, Australia ~ 0.1

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    Senior Member Colonel's Avatar
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    The death rate for an area with a life expectancy of 78 years is 35 per million inhabitants per day.

    Yesterday's death rate from Corona alone for some areas :

    Spain : 17.5
    Italy : 12.5
    State of New York : 9
    USA : 1.1
    Norway : 0.6
    Canada, Australia ~ 0.1

    Things are, at the moment, improving. Holland is getting close to 10.
    Last edited by Colonel; 03-30-2020 at 12:35 PM. Reason: incomplete numbers

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    So if the Son sets you free, you will be free indeed. John's Avatar
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    > Is the Coronavirus as Deadly as They Say?

    Yes and no.

    There are actually two types of the current Chinese created virus. You have type "L" and type "S". The L type is the one that is dangerous. The S type is milder and more "recoverable". If you get the S type you will also develop an immunity to the L type, that's good news. The L type is just nasty, that is the one causing deaths.

    A peculiar transmission pattern was also observed in the study. Among the 27 viral strains isolated from Wuhan before January 7, 2020, a whopping 26 were found to be L type, and only 1 was S type. On the other hand, out of 74 strains isolated after January 7, only 45 were L type, and 28 were S type. In the latter case, only one was from Wuhan, 33 accounted from other places in China, and 40 were taken from patients outside the country.

    The data highlights that the L type strain was found to be more prevalent in Wuhan, as compared to other places. Also, the results indicate that the prevalence of L-type was more in the early stages of the outbreak in Wuhan. But the frequency of cases due to L-type virus decreased after the first week of January 2020. One hypothesis is that the selective pressure due to human intervention may have played a role in this changing dynamics.
    COVID-19: Study Identifies Two Coronavirus Types, Highlights Peculiar Transmission Pattern | The Weather Channel

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    A choir decided to go ahead with rehearsal. Now dozens of members have COVID-19 and two are dead

    Choir practice turns fatal. Coronavirus is to blame - Los Angeles Times

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    Is the Coronavirus as Deadly as They Say?
    ask people in New York what they think

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    Frozen Chosen A.J.'s Avatar
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    Quote Originally Posted by tschau View Post
    ask people in New York what they think
    From what I understand, New York refused to acknowledge the danger and went ahead with Chinese New Year celebrations and all that entails, mainly as a rebellion against president Trump's advisory to stop all incoming flights from China.... They're paying the price for ignoring Trump just because they don't like him.

    And this is just speculation on my part, but didn't New York cheer when the abortion up till birth legislation was passed? God will not be mocked.

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  11. #9
    lets get some facts
    • The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 (WHO)
    Chinese New Year was just over, so till that time there is nobody you blame. Mr Trump has not advised to stop flights from China before Chinese New Year because of Covid-19

    At the end of January only South Korea and Singapore were worried and taking action.

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    Frozen Chosen A.J.'s Avatar
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    Quote Originally Posted by tschau View Post
    lets get some facts
    • The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 (WHO)
    Chinese New Year was just over, so till that time there is nobody you blame. Mr Trump has not advised to stop flights from China before Chinese New Year because of Covid-19

    At the end of January only South Korea and Singapore were worried and taking action.
    Ok, I stand corrected. I read so much stuff, it would take me forever to find where I read that particular issue.


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