Adjusted Age-Specific Case Fatality Ratio During for COVID-19 in Hubei [pdf]
medrxiv.org
medrxiv.org
This parameter can be found experimentally by testing for antibodies against the virus in a random sample of the population. This has not been done so far. As long as that's true, CFR estimates will be quite uncertain.
Also really interesting in this context is how Germany is looking more and more like a huge outlier in terms of fatality. Almost 1000 cases and 0 deaths so far. Sure, that may still change, but the outbreak has been going on for a while there already.
The first case in Germany was 3 days after the first in France. They reached 4 cases the same day. When France hit 11 cases, Germany already had 13 and for 15 days they both only got 1 to 3 more cases in total. They both began increasing a lot on the 26th of February.
While they reached 4 cases the same day, that doesn’t mean that they had the same number of unknown infections. Let’s say France had 10x as many unknown infections than Germany. How would that impact the disparity in death count? And is this even a large enough sample size for that disparity to not just be explained to a high degree by mere chance?
Source? I’ve heard exactly the opposite - Germany is testing the whole cluster as soon as infection is found. That explains the low mortality.
Belgium only does tests on people who have recently been in regions at risk (China, Italy) or who have symptoms of pneumonia.
200 infected to date, zero deaths (so far).
If I had to guess why CFR is so much lower in S Korea, it's because they tend to test more widely, ie. don't only test when patients show up at the hospital with severe symptoms. Or in other words they are closer to the real CFR.
As of 2020-03-08 0:00 AM UTC+9 [1]:
Patients Deaths
Age (% of total) (% in group)
80+ 212 (3.0%) 14 (6.6%)
70--79 409 (5.7%) 18 (4.4%)
60--69 878 (12.3%) 11 (1.3%)
50--59 1349 (18.9%) 5 (0.4%)
40--49 975 (13.7%) 1 (0.1%)
30--39 760 (10.7%) 1 (0.1%)
20--29 2133 (29.9%) 0 (0.0%)
10--19 360 (5.0%) 0 (0.0%)
0--9 58 (0.8%) 0 (0.0%)
Total 7134 50 (0.7%)
The estimated average time to die for those who die from COVID-19 is 28 days. 28 days ago, Korea had fewer than 50 cases total.
If everyone were tested, the denominator goes up by some constant factor. In Korea, people are already being tested at the first sign of cold symptoms.
Also the demographics of those tested are skewed to the 20–40s age range as the member of a reclusive church was sick and didn’t say anything. They the proactively tested everyone they were in contact with at the church and the demographics of that church skew younger.
Afaik antibody tests do not yet exist but are in development
For example, the number of people infected in France and Germany is rising in near perfect synchrony, but France has 11 deaths now. Similarly, growth in the early phase of the South Korea outbreak looks nearly identical to Germany and France (with a ca. 2 week delay), and they had 10 deaths when they had 1000 infected.
Germany is looking increasingly anomalous every day.
There has to be a difference with respect to detection, unless it's something more out there like viral strain differences.
Related to this, what I haven't seen mentioned or discussed extensively is not only would the fatality rate increase for Covid-19 cases if hospitals are overloaded, but I would assume the fatality rate for _all other needs_ of a hospital would also increase. Does anyone know this has been assessed? (e.g., did Hubei see a notable increase in non-Covid-19 related deaths during this period?)
[0] https://www.aljazeera.com/news/2020/03/coronavirus-wreaks-ha...
I really disliked Fauci's comments that "the risk is low" to the American population, pointing to the rate of infection. He hedges this with some hand waving that it could change at any moment. I thought it was irresponsible to say the risk is low when they hadn't done any real testing and we've actually got outbreaks like in Kirkland. Regarding his comment that the WHO fatality rate is too high because of asymptomatic population and the denominator in reality is much higher. Fine. But he doesn't acknowledge that the numerator might be much higher as well. How many 80+ year olds, especially those with preexisting conditions, die and are assumed to have just passed from old age and the preexisting conditions. It is a characteristic of this virus that the people getting killed are the most likely ones not to raise huge red flags early. So in general, I would've preferred him to not say anything about risk until we actually get more numbers and real testing within our population. The average fatality rate hides the fact that this virus is very dangerous to the elderly.
In this study, about 9% of non-elective geriatric patients admitted to a hospital die. https://academic.oup.com/ageing/article/34/5/467/40349
In this study, it was closer to 15%. http://www.scielo.br/scielo.php?pid=S1807-59322009000700002&...
Now, if they only covid19 test people sick enough to be hospitalized, and if most of the deaths are over 70, shouldn't there be a comparison in the death rates to those patients testing negative?
Probably not most of them?
To put it another way, if we didn’t have extremely well established flu surveillance networks or even knew what the flu was, and people just started coming to the hospital with ILI and then dying, you would see 200,000 cases with a CFR of 10%.
But because we do have widespread, fast, and cheap testing we know that each year 30 million people get the flu and only about 1% go to the hospital, and 10% of those die, so the IFR is about 0.1%.
https://www.cdc.gov/flu/about/burden/preliminary-in-season-e...
https://www.cdc.gov/flu/about/burden/2018-2019.html
> CDC estimates that the burden of illness during the 2018–2019 season included an estimated 35.5 million people getting sick with influenza, 16.5 million people going to a health care provider for their illness, 490,600 hospitalizations, and 34,200 deaths from influenza (Table 1).
> We chose to fix to 100% the reporting rate of infected individuals that have symptoms and are aged 80 and more, and estimate the reporting rates in other age groups relatively to that of older individuals. If further data, coming from a study in the general population, shows that this assumption is violated, this would lead to an overestimation of the CFR in our study.
I find it hard to believe that 100% of cases in individuals over 80 will be reported. It seems like any estimation of fatality rate at this time is going to be guesswork without more systematic sampling of the population.
I’m not trying to minimize the danger of Covid-19. It seems like caution to prevent further spread is absolutely necessary.
I'm not sure which it is more common to report, but the 2% estimate that was used earlier in the epidemic was for the disease rather than the virus, apparently.
Further to that, some individuals are asymptomatic which means that not only are they not reported, but they never are. They don't get the disease. It has nothing to do with how far the disease progressed in them, because they never have it.
I have a question about the Spanish Flu.
Most reliable literature CDC, WHO lost the CFR for the Spanish Flu at 2.5. This makes no sense to me.
The Spanish flu killed between 50-100 Million people, 3-6% of the world’s population, it infected about 500 Million people, so why isn’t the CFR between 10-20%?
https://www.nih.gov/news-events/news-releases/bacterial-pneu...
As someone in their forties, I can't think of any other potential risk that I am aware of where I might have a 1 in 50 chance of dying if I catch this (assuming an elevated risk) given that I am relatively health otherwise.
TL;DR dont infect ur parents as 60-69 has 1 in 21 chance of death.
Plenty here are going to have parents in 70-79 (like I do) or 80+. And I really don’t like those odds.
Also what this number kind of glosses over is how are the survivors doing. Half of those that get ARDS have life-long consequences. There are still 20.000 active cases in China, 1 month after the epidemic peaked there.
EDIT: I took BASE jumping risk from here http://www.wingsuitfly.com/risk/4572000812 not from the wiki reference
Gotta admit, it’s scary. One death took place in the hospital where I had a checkup, on the day of the checkup.
For younger people, it's like having a fair part of a year's worth of life risk, for older people several years.
Do you want that risk for no benefit? There's also whatever problems you get that don't kill you. I suspect you waste a good few weeks of your life regardless of whether you survive.
https://www.ons.gov.uk/peoplepopulationandcommunity/birthsde...
A 1 order of magnitude lower risk (0.1%) is basically negligible, like a regular flu. On the other hand, a 1 order of magnitude increase, i.e., around 10% risk of dying would already rate among the deadliest epidemics in history, and far above things like the Spanish flu, so comparing orders of magnitude is just not the right way to think about this number.
For sure old people are at at least a year's risk.
Having said that, it's still a bad situation, since getting infected increases the likelihood of others getting infected and dying, including people in higher CFR brackets. This is not like "getting cancer" or "getting hit by lightning", because there one person getting it doesn't affect the probability of another getting it.
It’s fine to have an intellectual discussion about the merits of the study, but let’s make sure that we keep our eye on the prize. Each of us has a responsibility to do our part in protecting our parents, friends, and coworkers.
TL;DR - This study suggests that many of us on HN will be fine no matter what. But it also demonstrates that, if left unchecked, it’s possible (if not probable) that many of us will be grieving the loss of someone we love. There’s no need to panic, and there’s no room for those who seek to be dismissive, flippant, or ignorant. Everyone will be fine if each of us focuses on doing the right thing.
Chicken pox is a thing parents commonly seek out for their kids around here. But in the long term the vaccine is still better at reducing long term consequences.
(Got it intentionally as a child then again [unintentionally] as a teen. Had some nerve damage since. Not looking forward to shingles.)