Study of 72,000 COVID-19 patients finds 2.3% death rate

Researchers from China's Center for Disease Control and Prevention today describe the clinical findings on more than 72,000 COVID-19 cases reported in mainland China, which reveal a case-fatality rate (CFR) of 2.3% and suggest most cases are mild, but the disease hits the elderly the hardest.

The study, published in JAMA, is the largest patient-based study on the novel coronavirus, which was first connected to seafood market in Wuhan, China, in December, and has since traversed the globe.

A total of 72,314 COVID-19 cases, diagnosed through Feb 11 were used for the study. Of the 72,314 cases, 44,672 were classified as confirmed cases of COVID-19 (62%; diagnosis based on positive throat swab samples), 16,186 as suspected cases (diagnosis based on symptoms and exposures only), 10,567 as clinically diagnosed cases (from Hubei province only, diagnoses based on symptoms, including lung x-ray), and 889 as asymptomatic cases (diagnosis by positive test result but lacking typical symptoms).

"Most cases were diagnosed in Hubei Province (75%) and most reported Wuhan-related exposures (86%; ie, Wuhan resident or visitor or close contact with Wuhan resident or visitor," the authors said.

Eighty-seven percent of patients were aged 30 to 79 years (38,680 cases). This age-group was the most affected by a wide margin, followed by ages 20 to 29 (3,619 cases, or 8%), those 80 and older (1,408 cases, or 3%), and 1% each in ages less than 10 and 10 to 19 years.

Of the confirmed cases, 1,023 patients—all in critical condition—died from the virus, which results in a CFR of 2.3%. The CFR jumped considerably among older patients, to 14.8% in patients 80 and older, and 8.0% in patients ages 70 to 79. Among the critically ill, the CFR was 49.0%.

A smaller study today based on 52 critically ill patients at a Wuhan hospital confirms this finding. Thirty-two of the 52 critically ill patients (61.5%) died, and older age and acute respiratory distress syndrome were correlated with mortality.

The authors of the smaller study also found that 30 (81%) of 37 patients requiring mechanical ventilation had died by 28 days.

A total of 81% of cases in the JAMA study were classified as mild, meaning they did not result in pneumonia or resulted in only mild pneumonia. Fourteen percent of cases were severe (marked by difficulty breathing), and 5% were critical (respiratory failure, septic shock, and/or multiple organ dysfunction or failure).

In comparison to SARS (severe acute respiratory syndrome) and MERS (Middle East respiratory syndrome) coronaviruses, which were both identified in the past 20 years, COVID-19 is likely more highly transmissible but not as deadly, the researchers noted. (SARS had a CFR of 9.6%; MERS has a CFR of 34.4%.) And unlike SARS and MERS, hospital-based outbreaks do not seem to be hallmark of COVID-19 at this time.

"Most secondary transmission of SARS and MERS occurred in the hospital setting," the authors wrote. "Transmission of COVID-19 is occurring in this context as well—3019 cases have been observed among health workers as of February 11, 2020 (of whom there have been 1716 confirmed cases and 5 deaths). However, this is not a major means of COVID-19 spread. Rather, it appears that considerable transmission is occurring among close contacts."

In other research news, a study in the International Journal of Infectious Diseases uses data from the Diamond Princess cruise ship to calculate COVID-19's reproductive number (R0, or R-naught), or the number of people a single infected person is likely to infect.

Among the 355 passengers who contracted the virus, the researchers calculated an R0 of 2.28, similar to other R0 modeling published in the past several weeks.

Also today, two groups announced major developments in COVID-19 vaccine developments. China's Clover Biopharmaceuticals will partner with GlaxoSmithKline (GSK) on Clover's protein-based coronavirus vaccine candidate, COVID-19 S-Trimer, according to a GSK news release. And the University of Queensland in Australia announced a vaccine candidate is ready for a proof-of-concept study after just 3 weeks in development.

This even, whether it turns out to be as dire as predicted or not, is a significant event along the lines of 9/11.

Trump had already warned of concentration risk of doing business with China and the tariffs were scaring people into diversifying supply chain.

This virus has sped this up a decade. China will never recover from this and Trump’s anti globalist message is vindicated.

I think that’s why he wanted USMCA so badly. Next term he goes after the cartels with our military. Which is a far better cause than some shitholes in the ME. This stabilizes Mexico.

Mexico becomes a destination for assembling products. We have free trade with Mexico. Mexico becomes prosperous, illegals self deport. Drugs stop coming over the border.

In the words of the Great Ronald Reagan on the Soviets: We win. They lose.

That’s China’s future.

This even, whether it turns out to be as dire as predicted or not, is a significant event along the lines of 9/11.

Trump had already warned of concentration risk of doing business with China and the tariffs were scaring people into diversifying supply chain.

This virus has sped this up a decade. China will never recover from this and Trump’s anti globalist message is vindicated.

I think that’s why he wanted USMCA so badly. Next term he goes after the cartels with our military. Which is a far better cause than some shitholes in the ME. This stabilizes Mexico.

Mexico becomes a destination for assembling products. We have free trade with Mexico. Mexico becomes prosperous, illegals self deport. Drugs stop coming over the border.

In the words of the Great Ronald Reagan on the Soviets: We win. They lose.

That’s China’s future.

How about the hypothesis that a majority of the infected persons think they have a cold or the flu and don’t even know that they have the corona virus and recover just fine?

...

That can happen.

If an outbreak isn’t too large I think most infected people can be found by contact tracing. Singapore just found two recovered people who were key transmitters in their outbreak. They used a new antibody test that can be used on people who have already recovered from the virus.

Thanks for the tip. My wife has tons of supplements for everything. I’m sure there is D3 in there.

I remember being in college years ago. Said to my roommate that I didn’t feel well, so I was going to the health center. Wore a denim jacket. It was about 30 degrees and pouring raining.

Walked into the health center soaking wet and said “I think I have a fever”. Nurse took my temperature and next thing I knew I was in some crazy room and they were icing me down.

Apparently I had a 104.5 fever and they took blood and my white blood cell count was off the charts. Felt like a 100 bucks the next day. They couldn’t understand what I had and why I reacted so harshly.

They said I shouldn’t have been coherent, able to walk the quarter mile from my fraternity house. Instead I was lucid and embarrassed that I was bothering them. Haha!

“China will never recover from this and Trump’s anti globalist message is vindicated.”

Hence Democrats’ flinging of histrionics at Trump re corona.
Expect Progressives to get REALLY hysterical (as though their current baseline is “normal”) as nationalism kicks into the next gear.

people (not you) toss the term flu around loosely.

People get a cold with a little aches, pains and a fever and immediately self diagnose it as the flu. Makes you feel tougher and gets more sympathy.

Actual is .01? Where do you get that from?

The real fatality rate is currently around 9%, assuming China’s numbers are close to accurate, which I highly doubt they are. Probably closer to 20-25%.

Re: You can’t look at “total cases” because most of those are still sick, and some will die.

You need to explain that to the CDC - not to me.

The CDC is counting “total case” death rates because that is the only hard data point they have to work with at the moment.

In China, the “Case Fatality Rate” (CFR) has been quite steady at 2% to 3.5%.

98% of total deaths have been inside China.

In the USA and Canada - six weeks after corona went international - our CFR is still zero.

Obviously, the “Recovered” rate is very important.

But, with a novel virus, standards for “Recovered” can be highly subjective, and there is no way to know if “Recovered” cases are being reported in a timely fashion.

Re: "The real fatality rate is currently around 9%"

Corona virus went international more than six weeks ago.

There are 210 confirmed cases in the USA, Canada, northern Europe, Australia, and New Zealand.

So far, just two fatalities - both of them in France.

Only people with obvious symptoms are being tested in those countries.

It is very hard to believe that 9% of those 210 confirmed cases are going to die in the next few weeks.

I keep seeing people grossly overstating flu mortality (has there been any flu that significantly exceeded 0.1% in the past 50 years?), and grossly understating COVID-19 mortality, which appears to be near 2% at best, and possibly over 5% depending if you include the many unresolved cases as survivors or ignore them until they “resolve”.

Obviously, better care, new treatments, etc could change everything. Singapore seems to be the gold standard right now, but not enough cases to be statistically significant.

Re: “Has there been any flu that significantly exceeded 0.1% in the past 50 years?”

In the USA, the mortality rate for an “average” flu season is 0.2%.

The CDC uses statistical models to estimate the final mortality, so the margin of error is probably significant.

In the 1918-20 Spanish Flu epidemic - in the USA - the mortality rate was 2.5%.

The great killer was the “infection rate” - which was 30%.

I see a couple that reach 0.17%, but not 0.2%, and most are lower, as is the average obviously. Still, that is above 0.1. Most other models I have seen, put the US Flu/Pneumonia mortality at 0.1% and below.

The CDC also estimates over 15% are hospitalized. That number also seems high to me. But they obviously know more than I do...

The CDC’s total flu death calculation is also frequently on the high side - 70,000 in some years (from memory).

When you have thousands of USA doctors making judgment calls about the cause of death for elderly patients with multiple health issues, it is probably impossible to reach a consensus around a “final flu number.”

New topic...

I just saw something on the Johns Hopkins corona website that rattled me a little.

South Korea has about one half of the international corona cases - 2,022. Their CFR (Case Fatality Rate) is 0.65% (13 dead).

Italy has 655 cases and 17 dead, for a CFR of 2.6%.

Italy's CFR is FOUR times higher than South Korea.

I wonder if South Korea is fudging its numbers?

And why does Italy have such huge numbers?

Muslim immigrants? Mediterranean cruise ships?

It’s hard to make sense of some of the numbers. Italy’s number grew quickly, along with deaths, making me think many of the cases were infected for quite some time before they knew there was a problem. Iran is even worse. SK’s cases also spiked about the same time, but they are aggressively following up on known contacts within very specific groups. There just isn’t consistency between countries testing/screening where numbers are easily comparable.

It is very hard to believe that 9% of those 210 confirmed cases are going to die in the next few weeks.

Given that the non-Chinese fatality rate was, as of a couple days ago, 15%, I would expect just over 30 of those people to die. But there's a ton of factors that can affect it either way, with the biggest ones being that we have much much better medical facilities (so should have a much lower rate), and the complete uncertainty that such low sample sizes bring (CFR can go big or small in either direction). Obviously as more people die/recover, the calculated rate will get closer to the real accurate number, but 200 people out of millions (billions worldwide) is statistically basically zero. So to get an actual dependable fatality rate is going to need a LOT more cases.

The extensive ‘drive thru’ testing in SK is picking up all cases, not just those sick enough to go to a hospital/doctor and their immediate contacts.

SK is the one to watch. Their system will pick up the mild case rate more effectively than any other nation at this point.

The extensive ‘drive thru’ testing in SK is picking up all cases, not just those sick enough to go to a hospital/doctor and their immediate contacts.

SK is the one to watch. Their system will pick up the mild case rate more effectively than any other nation at this point.

Thanks for the helpful update.

Every country seems to have its own distinctive story to tell.

I have tried to focus on the numbers, but its not possible to verify them, or even to know if different countries are using different tests and different medical standards.

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