Coronavirus: South Korea’s aggressive testing gives clues to true fatality rate
scmp.com
scmp.com
Whatever the global mortality rate shakes out to be in the long-run, it’s impossible to ignore the fact that this virus killed nearly a dozen nursing home residents in the span of 2 weeks. There’s a lot we don’t understand about COVID-19, certainly more than a single metric can tell us.
Based on what we’re seeing in the state of Washington and around the world, it’s safe to say that older patients are at higher risk for developing respiratory failure. Beyond that, it’s simply way too early to draw conclusions.
This is completely misleading, unless the other 6244 people have already recovered.
The low death rate so far is because the detected illnesses have not yet run their course.
Edit: The source above says that the number of people in South Korea who have recovered from the illness is... 135.
Two strains source: https://www.newscientist.com/article/2236544-coronavirus-are...
There are more than 100 strains, which you can see here: https://nextstrain.org/ncov
http://virological.org/t/response-to-on-the-origin-and-conti...
This is somewhat the problem with these epidemics the mortality rate is highly dependent on the available level of care.
If the healthcare services get overwhelmed the mortality rate can easily spike.
E.g. for each case,
date of detection, age of patient, ongoing|recovery date|date of death- https://data.humdata.org/dataset/novel-coronavirus-2019-ncov...
The GitHub repo with datasets:
- https://github.com/CSSEGISandData/COVID-19
Start there, and reach out to the staff if you’re looking for something more specific. They may be able to point you in the right direction.
You need to be able to figure out infected_at_t_and_dead/(infected_at_t_and_recovered+infected_at_t_and_dead) for some time t sufficiently in the past so that basically everyone falls into these two categories.
And if you want to draw transferable conclusions you also need an interval where treatment conditions were relatively uniform (e.g. already completely overwhelmed health system, or health system that could cope, throughout). As well as an age breakdown of recovered and dead.
The data from Italy does not look promising, they have an old population but seem to have reacted well and still have capacity to treat people. And yet CFR seems 3.8%, without excluding people who are ongoing and will die in the next days and weeks.
It would be very interesting to have a more detailed comparison with the South Korean outbreak, where again reaction has been very good as well and we could look at a subset of people for whom we have no undetected cases, so very good estimates ought to be possible.
http://www.pref.hokkaido.lg.jp/hf/kth/kak/hasseijoukyou.htm
Table shows quite a bit of data about each case including age, gender, location, any link discovered to other patients and status. The pdf shows additional data on when they had fever and other symptoms, when they went to different medical facilities and when they were confirmed as infected.
This implies very serious efforts, though, which I'm not sure we're seeing in the West.
The answer is that with early detection, and keeping the virus numbers low, the health care network can be kept free for caring for the cases that do come through.
And ICU level care cannot cure the virus but can reduce fatalities.
- If someone is witness to the start of the fire, they’re going to call the fire department who will mobilize all resources available to a small area -> fire is contained quickly and with minimal loss of life or property
- If the fire starts in a remote area with nobody around for miles, it will get bigger and avoid detection until it becomes an imminent risk to people. At that point, the same resources will be spread across a larger area. As the wildfire grows, the wind caries embers and sparks other fires miles away, making the situation worse.
Obviously if you suffer from preexisting health issues, especially cardiopulmonary issues, you're far more likely to develop pneumonia, primary or secondary, or otherwise succumb.
[1] This page equivocates Severe Acute Respiratory Syndrome with pneumonia: https://medlineplus.gov/ency/article/007192.htm
[2] https://www.sciencedirect.com/science/article/pii/S120197121...
The lack of decisiveness in the west worries me. It's like they wait for the hospitals to be full before they decide quarantine might be in order.
People here aren't as docile as Chinese people and don't fear their government. If a city was quarantined like Wuhan with the situation turning to shit, many people would take to the street to protest instead of staying nicely confined at home.
And if the government's repression got too harsh there, you'd get protests all around the country in support.
That's why I haven't heard anything from my government about potential large-scale quarantine. They know that here it probably would make the situation worse.
2) i wouldn't be so sure that quarantine measures would be such universally disliked. it'll take a couple deaths and a few tv interviews with medical personnel with an overwhelmed hospital in the background to sway the public emotion in the containment direction. it better be executed well, though, or riots become a serious proposition.
Where do you escalate from that? Machine-gunning people in the streets?
But now, we know this virus isn't ebola's death rate combined with measle's R0. Large scale quarantine like in China is probably overkill and quite risky if your population isn't as docile as populations in authoritarians regimes.
Closing schools, cancelling mass events and asking people to work from home if they can is a more measured approach. Even without that, the apocalypse isn't coming anytime soon.
Don't underestimate the sense of doing what's good for the community and the patriotism of the Chinese people (and I'm sure many others).
I think they understood what was at stake and what had to be done, and did it but not because they are "docile" or because they "fear their government".
From a cynical point of view, the governments in the west might see this disease as a god-send. It mostly kills the old and sick. So if you let it run its course through the whole population, the strain on pension and public health systems will (eventually) be reduced -- "sozialverträgliches Frühableben" as one German top medic once called it. A disease that mostly leaves the young and productive part of the population intact might thus be welcomed as a solution to the demographic problems in the west.
Note, I don't agree with this point of view, but it might help explain the timid response in the west.
Everyone in my office could work from home, but we're not allowed because "it's not that bad" yet. One of my colleague is coughing for a week and still coming in and everyone is making joke about "aha he could be patient 0 here".
So I'd say b) is most likely. People are criticizing China's release of information but compared to NK, they're pretty transparent.
Even if the situation on the ground was disastrous, I'd bet that the government would do everything to hide it.
1) The Diamond Princess is our best source of data. Every person who got infected on it was identified (~700), and those who were infected got the best medical care possible. This led to a ~1% mortality rate (6/700) and a ~5% ventilator support rate (35/700). 6/700 is subject to significant error in both directions, but let's go with it.
2) Their average age was in the upper 40s, so assuming younger people don't suffer the most serious ill effects from it, a guess for the general population might be a 0.5% base mortality rate and 2.5% ventilator support. This is a rough order of magnitude estimate: obviously expected mortality should be adjusted for actual age distributions.
3) South Korea's mortality rate is 0.6%. Cases outside of Wuhan but within China have a reported mortality rate of 0.4%. Singapore (at ~100 cases) is 0%. These are all consistent with the estimated mortality rate I extrapolated from the DP.
4) All of the areas mentioned in 3) have very aggressive testing protocols. No evidence has come up suggesting widespread infection among the broader community. This includes China randomly sampling some areas and not finding meaningful unknown pockets of infection.
5) But what about Wuhan? It has a much higher mortality rate (>3%). The reports on the ground suggested that it was the medical system being overwhelmed that drove the mortality through the roof. If we assume everyone who needs a ventilator but doesn't get one dies, that explains in one fell swoop Wuhan's elevated mortality rate.
6) What about Italy? Its mortality rate is ~3.5%. But, compare the number of hospital beds in Italy and SK. It's ~3/1k vs ~10/1k. SK is already running into issues with hospital bed availability, so it stands to reason that the situation is much worse in Italy. Italy also has a significantly older population than SK. So it's starting to run into the same nightmare scenario as Wuhan. Of note, the US has a younger population than Italy, but fewer hospital beds.
7) What about Iran? It has ridiculous mortality rates. My best explanation is that testing constraints probably lead to more undercounting of infections in the hardest hit areas, so Hubei, Italy, and Iran probably all have artifically elevated mortalities, while the reality for all of them is much closer to 2.5%.
8) There's no need for weird hypotheses about Asians having different proteins in their lungs, there being multiple strains that act radically differently from each other, China running secret death camps for the infected, etc.
9) Policy-wise, we need to keep the rate of infection low enough such that the medical system is not overloaded. This is possible, as it's been done in multiple countries, and that's the difference between a severe-but-normal flu season and over a million dead in the USA. We also have to start taking decisive action yesterday, with today being a second best option.
https://res.mdpi.com/d_attachment/jcm/jcm-09-00538/article_d...
Early case fatality rate estimates tend to be somewhat overestimates. Anecdotally, for 2009 H1N1 vs later estimates differed by a factor of 100.
https://www.reddit.com/r/COVID19/comments/f9jo57/historical_...
The next two questions are whether or not it can be contained without the economy-shutting down response we saw in China, and whether the upcoming warmer summer weather will sufficiently lessen community spread (at least in the Northern hemisphere) to allow for some meaningful containment.
...and then, of course, we're hoping for an effective vaccine by summer 2021.