Data from Dr. Bendavid and Dr. Bhattacharya,professors of medicine at Stanford, was used in this article.
Are projections of the death toll from Covid-19 orders 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. However, the true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.
The numbers are 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.
mortality rate = # of deaths ÷ # of cases. And we have no idea how many cases there are because red tape held up testing for so long. In New York alone, 150,000 people have been tested. Across the US, the number of tests is 100k per day. It is logical we have the most cases in the world, but a much lower death rate. We are catching cases early before they lead to complications and death.
On an. 31, countries sent planes to evacuate citizens from Wuhan, China. The passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. With a population of about 20 million, Wuhan would have around 178,000 infections, which is much more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.
The Italian town of Vò, 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.
About the Author
This whole shebang is a CUOMO COVID CLUSTER-**** CIRCUS in this country right now that just like everything else, is being driven by partisan politics between the Democrats and Trump, especially with the November presidential election coming up, and everything about COVID not coming from the CDC or some reputable medical group has to be considered untrustworthy and highly suspect.
With respect to Cuomo, who is nothing more than an up-jumped hack lawyer who knows nothing about public health or rule of law for that matter, consider the simpering puff-piece about Cuomo in the Albany, New York Times Union entitled “Churchill: This is Andrew Cuomo’s finest moment – New York’s governor has been the nation’s most authoritative voice during the pandemic” by Chris Churchill @chris_churchill on Sunday, March 22, 2020, to wit
ALBANY — Those of us who live in and around Albany are more aware of Andrew Cuomo’s faults and foibles than most New Yorkers.
But in recent days, as the COVID-19 pandemic has grown to impact most every aspect of our lives, we’ve been watching a different Cuomo than the governor we’ve known.
Who is this guy?
It’s like he was born for this.
Cuomo’s is a voice America is listening to during this crisis, with his daily briefings from the Capitol airing nationally, even on Fox News.
Suddenly, Cuomo might be the nation’s most popular Democrat, with his leadership getting rave reviews even from former critics.
In part, Cuomo’s in the spotlight because New York is the epicenter of the epidemic, with more confirmed COVID-19 cases than any other state.
Manhattan also happens to be the nation’s media capital.
But it’s not just that.
Cuomo is being listened to because he deserves to be heard.
While the information flowing out of the White House has been muddled and unserious, if not ridiculous and irresponsible, Cuomo is bluntly delivering truths we need to hear.
end quotes
In my opinion, if anyone in the Commonwealth of Virginia is listening to this out-of-control hysterical A-HOLE Cuomo, they have to be brain-dead, which takes us back to a Politico article entitled “Cuomo sails to primary victory, with eyes to the White House” by Laura Nahmias on 09/13/2018, where we have some essential background as to the GAME Cuomo is playing at here, to wit:
NEW YORK — This time, conventional wisdom proved right.
The Associated Pressed called the Democratic Party vote for New York Gov. Andrew Cuomo on Thursday within a half hour of polls closing, beating back Cynthia Nixon’s anti-establishment attack from the left with a message of experienced leadership.
Although Cuomo tried to position the race as a contest between himself and President Donald Trump, who is deeply unpopular in many areas of his home state, the primary election became a referendum on Cuomo’s eight years in office, his centrist style of governing and the state’s Democratic establishment.
Now as Cuomo positions himself for a possible 2020 presidential run, he’ll do so as the head of New York’s sizable Democratic majority in a state that fashions itself as a leader in challenging Trump’s actions to push the country to the right.
“It’s a great night for the governor, and we’re all proud of that because we believe he’s got a great record as governor,” said Bill Mulrow, a former top Cuomo aide.
“He’s obviously willing to fight back against what’s going on in Washington.”
Officially, Cuomo says he’s not running, but with 88 percent of districts reporting Cuomo posted big numbers, beating Nixon roughly 65 to 35 percent, he has some momentum.
George McDonald, a Cuomo ally and founder of the Doe Fund, said he was holding out hope.
“He’s by far the best candidate the Dems” could run and “I’m going to try to convince him of that, even though he said he’s going to serve four more years,” he said.
end quotes
So for Andy Cuomo, this is all political and the more people he can scare with inflated numbers, the more he is going to inflate those numbers to scare people with, so he can be THE HERO WHO SHOULD BE PRESIDENT, by telling people what he is telling us today – “What I am doing is for your own good, and look a lot less died than could have because of my measures.”
And that takes us to a CBS article “Trump challenges Cuomo: ‘I don’t believe you need 40,000 or 30,000 ventilators'” by Audrey McNamara on March 27, 2020, where we had more of the political CUOMO COVID CLUSTER-**** CIRCUS, as follows:
President Trump said on “Hannity” Thursday night that he doesn’t think states need as many ventilators as they have requested from the federal government to deal with the coronavirus crisis.
The president appeared to reference the dire request from New York Governor Andrew Cuomo for 30,000 ventilators.
end quotes
Now, consider the medical reality with respect to the onset of COVID-19:
Patients typically report fever and cough.
Dry cough appears more common than cough with expectoration.
Other symptoms include fatigue, myalgia, diarrhea and headache.
About five days after symptom onset, some patients develop shortness of breath and dyspnea (trouble breathing) prompting medical attention.
Rapid deterioration to acute respiratory distress syndrome (ARDS) requiring mechanical ventilation occurs in about 10 percent of patients who develop shortness of breath.
end quotes
Now given that some interpolation has to be done here given the present uncertainties, we can assume that those who will experience shortness of breath will be about 20%, so 20 people out of a hundred, or 200 out of a thousand, and ten percent of that 20 percent, or 20 people out of a thousand will need a ventilator.
Out of a million, 200,000 will develop shortness of breath, and 10 percent, or 20,000 will need ventilators.
But a million people out of the total population of 19.54 million in New York is 5 percent infected, while in Italy, the total infected out of a population of 60,480,000 was .1 percent.
So what is Cuomo talking about then with his numbers, saying he needs 30,000 ventilators?
Let’s go back to CBS and see what more we can see:
On Friday, Cuomo appeared to respond to the president’s challenge, saying he hopes the state doesn’t need 30,000 ventilators, but that he’s basing the request on data being provided to him by experts.
end quotes
But that is pure CUOMO BULL****, because the experts are at the CDC, and I am staying abreast of their continuing flow of information, and I have not come across that number, but if one drops back in time a bit, one across CDC Volume 23, Number 6—June 2017, “Stockpiling Ventilators for Influenza Pandemics,” where we have as follows:
The American Association for Respiratory Care suggested the SNS inventory should increase to at least 11,000–16,000 ventilators in preparation for a severe influenza pandemic (10).
end quotes
That is for the whole nation.
So why does Cuomo need 30,000 ventilators for New York?
Let’s go back to CBS again, as follows:
“Somebody said on one of the cable news shows said: ‘The ventilators that New York needed aren’t even being deployed, they’re in a stockpile,'” Cuomo said.
“Yes, they’re in a stockpile, because that’s where they’re supposed to be, because we don’t need them yet, we need them for the apex, the apex isn’t here so we’re gathering them in the stockpile so when we need them they will be there.”
end quotes
Yeah, right, Andy – you’re so full 0f horse****, it is disgusting!
So, is Andy Cuomo of New York “cooking the books” here for partisan political gain over Trump in November?
Would Andy Cuomo of New York do that?
Of course, he would, which takes us to this article on actual COVID deaths entitled “Clinical Progression and Recovery of Patients with COVID-19” byVito Iacoviello, MD & Heather D. Marshall, PhD on March 19, 2020, to wit:
The true mortality rate of COVID-19 is unknown.
In China, the first 40,000 hospitalized cases had a mortality rate of about two percent.
Based on case counts reported by the World Health Organization on March 18 among countries with more than 1,000 cases, mortality ranged from nearly eight percent in Italy to 0.2 percent in Germany.
During a pandemic, calculating mortality rate is only an estimation because case counts are informed by local and regional testing capacity and reporting policies.
It will only be after the pandemic is over, when serological assays can be used to screen for exposure, that we will be able to calculate a definitive case fatality rate.
end quotes
Everybody get hysterical if you want, but that is about the best way there is to make yourself really sick.
And once again, thanks to Wayne Creed and the Cape Charles Mirror for being the only news publication in the whole of the United States of America with the hormones to challenge this political horse**** about COVID that is sweeping the nation thanks to Andy Cuomo and the irresponsible, ignorant MAIN STREAM MEDIA that does not know a thing about independently researching what is being said by this Cuomo, who they love as their SAVIOR, as we see from the Chris Churchill simpering Cuomo puff-piece in the Albany Times Union, to wit:
But in recent days, the governor’s impact hasn’t been solely about his command and mastery over facts and data.
It’s also been about his emotional authenticity.
He’s been … comforting.
Cuomo has used his briefings to talk about his mother, Matilda, and how hard social distancing is on the elderly and the people who love them.
He has talked about worrying for his daughters and his powerlessness to protect them.
He has been poignant, moving, gentle.
Gov. Andrew Cuomo.
As we confront this terrible crisis, we’re fortunate to have him.