Questions rising about underlying predictions of millions dead

Questions rising about underlying predictions of millions dead

  • 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.

  • Discussion
  • I think for the under 50 crowd in China there is a good chance they were exterminated by the chicoms rather than being consumed by covid19....

    This post was edited by blugldmn 10 months ago

  • user generated

  • blugldmn said... (original post)I think for the under 50 crowd in China there is a good chance they were exterminated by the chicoms rather than being consumed by covid19....

    There's no way those cynical bastards didn't take advantage of it to accomplish some stuff that they didn't want to advertise to the general public

  • Lot of people disappeared it seems..

    What’s happening in Hong Kong?

  • blugldmn said... (original post)Lot of people disappeared it seems..What’s happening in Hong Kong?

    HKers know how to meld with the shadows....and they pretty much all wear masks anytime they're outside b/c of the cameras anyway. Believe they all scattered and haven't had bad infection rates

  • blugldmn said... (original post)I think for the under 50 crowd in China there is a good chance they were exterminated by the chicoms rather than being consumed by covid19....

    I saw a headline today about 20+ million Chinese (racist me) cellphone users vanishing.

    Didn’t read the story or even see who it was so it might have been some wacko site or something.

  • I could be wrong, but I chalk that up to diplomacy -- and he's probably only being diplomatic b/c the Chinese ambassador to the US came out and publicly rebuked the foreign minister spreading the conspiracy theory that the virus was from here, spread by the US Army. After all, there members of Congress (as well as members of other country's political bodies) now calling for investigation into China's handling of the outbreak...so now he doesn't have to ring that bell. Instead, he can pivot to a more dovish stance in preparation for future trade negotiations.

  • HypnoToad13 said... (original post)I could be wrong, but I chalk that up to diplomacy -- and he's probably only being diplomatic b/c the Chinese ambassador to the US came out ...

    China’s handling of the outbreak was abhorrent. Keeping it secret and refusing to allow the press report on it was typical of a totalitarian regime.

  • Robbie0210 said... (original post)China’s handling of the outbreak was abhorrent. Keeping it secret and refusing to allow the press report on it was typical of a totalitarian regi...

    I agree

  • Small minds can’t see big pictures

  • blugldmn said... (original post)Lot of people disappeared it seems..What’s happening in Hong Kong?

    Lots of Chinese keep 2 phones and one of the phones is required by government. Cell phone is how you access your bank and all govt services. 2nd phone is personal phone and accounts that weren't paid were landlines or mobile lines that were like luxury spending and were dead because owners stuck in quarantine/ That's what I read at least.

  • To summarize so far lower death rate than originally projected. Deaths were originally extrapolated from known cases. Blood tests of Chinese and Italians in quarantined areas show CV19 has already infected huge swath of population and % of all infected who ultimately die is minuscule. Known cases based on random blood tests are up to 30 times larger than estimated. In USA deaths per infected population .01 % may be the real number. Regular flu is .9. Italy's fatality rate projected at .06 from much larger pool of infected than previously thought. Trump was right this is the biological equivalent of y2k.

  • Pieersquared said... (original post)To summarize so far lower death rate than originally projected. Deaths were originally extrapolated from known cases. Blood tests of Chinese an...

    I hope all of your friends and relatives stay safe.

  • Robbie0210 said... (original post)I hope all of your friends and relatives stay safe.

    and yours too. Thank you

  • Pieersquared said... (original post)To summarize so far lower death rate than originally projected. Deaths were originally extrapolated from known cases. Blood tests of Chinese an...


    Average mortality rate for influenza is 0.1% not 0.9%

  • blugldmn said... (original post)Lot of people disappeared it seems..What’s happening in Hong Kong?

    The rapture?

  • Pieersquared said... (original post)Lots of Chinese keep 2 phones and one of the phones is required by government. Cell phone is how you access your bank and all govt services. 2n...

    Sounds plausible