The mystery of the true coronavirus death rate

Financial Times ^ | March 30th, 2020 | Camilla Hodgson

[Kalija]

But there are other sources of doubt too, including how many coronavirus victims would have died of other causes if no pandemic had occurred. In a typical year, around 56m people die around the world — an average of about 153,000 per day.

[Kalija]

An open minded column.

[wastoute]

It’s the thing about epidemics. You can’t wait until it’s horrifying to act. If you do, it’s still gonna get worse every day for perhaps weeks after you have decided, “Enough!”

[FatherofFive]

Why link to a source that needs a subscription to read?

[SmokingJoe]

But there are other sources of doubt too, including how many coronavirus victims would have died of other causes if no pandemic had occurred.

Like in Italy, where 99% of coronavirus dead had other serious diseases and had an average age of over 79.

In a typical year, around 56m people die around the world —

I feel fairly sure that after all is said and done, the number of total deaths at the end of 2020 wouldn't be much different from the normal 56 million.

[MeneMeneTekelUpharsin]

We are going to find out we’ve been over-hyped for political and/or financial gain. Businesses will be lost, 401k savings will be lost and jobs will be lost. What does it take to make people mad enough to do something about it? What?

[Kalija]

I don’t have a subscription and the link provided the full article.
The figure at the root of so much global angst about coronavirus is currently 4.7 per cent. That is the proportion of people, as of Sunday afternoon, who have died after being diagnosed with the virus — 32,137 out of the 685,623 who have tested positive for Covid-19 around the world.

It compares with a death rate of around 0.1 per cent for seasonal flu and 0.2 per cent for pneumonia in high-income countries. However, 4.7 per cent is not only changeable but frustratingly unreliable, both for governments seeking to calibrate their policy response and for citizens trying to gauge how much they should worry.

The proportion of people who have died from the disease varies strikingly from country to country. Researchers warn that there are so many uncertainties — not least over the true number of infections — that it remains almost impossible to draw firm conclusions about the death rate.

Mike Ryan, executive director of the World Health Organisation’s health emergencies programme, has outlined four factors that might contribute to the differing mortality rates: who becomes infected, what stage the epidemic has reached in a country, how much testing a country is doing, and how well different healthcare systems are coping.

But there are other sources of doubt too, including how many coronavirus victims would have died of other causes if no pandemic had occurred. In a typical year, around 56m people die around the world — an average of about 153,000 per day.

Insufficient testing

Arguably the biggest unknown about Covid-19 is the true number of people worldwide who have contracted the virus. Without that information no accurate death rate can be calculated.

Many infected people will display either mild or no symptoms, and will remain absent from the data unless they are tested. Since resources are limited and different countries are testing to different extents, the size of the information gap varies from place to place.

John Ioannidis, a professor of epidemiology at Stanford University, has branded the data we have about the epidemic “utterly unreliable”.

“We don’t know if we are failing to capture infections by a factor of three or 300,” he wrote last week. If thousands more people are surviving than we know about, then current mortality rate estimates are too high — perhaps by a large margin.

Bar chart of Tests per million as at Mar 25 2020 showing Coronavirus testing rates vary considerably
Researchers at the University of Hong Kong have estimated that, in Wuhan, where the pandemic began, the likely death rate was 1.4 per cent — much lower than the previous estimate of 4.5 per cent, which was calculated using official statistics on the region’s cases and deaths.

In the UK, where the government has been criticised for a slow initial response, only the most serious cases are being tested. In total 1,231 people have died out of 19,758 confirmed cases, giving a death rate of 6.2 per cent.

Rosalind Smyth, professor of child health at UCL, said official UK coronavirus data was “so misleading that it should not be used”. Using conservative estimates, the true number of people infected “is likely to be 5-10 times higher”, she said.

The age of people infected

Much depends on who gets infected, how old they are and whether they have underlying health conditions. It is well known that those who are older are more likely to become seriously ill and die. But Robin May, professor of infectious diseases at Birmingham University, notes: “There are 70-year-olds who are wheelchair bound and others who run miles every week.”

The WHO has also warned that younger people are “not invincible” and must take the virus seriously.

Italy has to date been the worst affected country in Europe, with 10,023 deaths and 92,472 infections, giving a crude mortality rate of 10.8 per cent. But the average age of Italians who have tested positive is 62, and the vast majority of those who have died have been 60 or over.

“Italy has been a poster child for healthy people living into old age,” said Dr Ryan. “Unfortunately, in this case, having that older population may mean that the fatality rate appears higher because of the actual age distribution of the population.”

But different countries are also reporting cases and deaths in different ways: in Italy, Covid-19 is listed as the cause of death even if a patient was already ill and died from a combination of illnesses.

“Only 12 per cent of death certificates have shown a direct causality from coronavirus,” said the scientific adviser to Italy’s minister of health last week.

Spain’s national government simply lists how many people with confirmed cases of coronavirus have died and provides no extra information on any other medical conditions.

© Chung Sung-Jun/Getty
In South Korea, which has a younger population than Italy, around a third of confirmed cases were in people aged 30 or under: 152 people have died so far out of 9,583 infections, giving a mortality rate of 1.6 per cent. In Germany, which has recorded 455 deaths, the majority of infections have occurred in people aged 15 to 59. Based on the available data, the country’s death rate is around 0.8 per cent, but this may also reflect its aggressive approach to testing people with milder symptoms.

Risk of death from other causes

In the UK, around 150,000 people die every year between January and March. To date, the vast majority of those who have died from Covid-19 in Britain have been aged 70 or older or had serious pre-existing health conditions.

What is not clear is how many of those deaths would have occurred anyway if the patients had not contracted Covid-19.

Speaking at a parliamentary hearing last week, Professor Neil Ferguson, director of the MRC Centre for Global Infectious Disease Analysis at Imperial College London, said it was not yet clear how many “excess deaths” caused by coronavirus there would be in the UK. However, he said the proportion of Covid-19 victims who would have died anyway could be “as many as half or two-thirds”.

What stage of the outbreak preparations begin

At what stage in the epidemic cycle a country begins to prepare its healthcare system is crucial.

If a healthcare system becomes overwhelmed, as happened in Italy and parts of China, the standard of care that patients receive is likely to fall. This is likely to increase the mortality rate.

In one hospital in Lombardy, northern Italy, a chronic shortage of equipment means staff are now using snorkelling masks bought from Decathlon, a leisure goods chain, to hook up patients to oxygen supplies.

Given the number of patients in intensive care in the region, the WHO’s Dr Ryan said last week, the fact that doctors are saving “so many is a miracle in itself”.

Dr Clarke said it was “not a given that [the UK and Germany] will end up in exactly the same place that Italy is in,” because “you can’t draw any cast-iron conclusions from a trajectory on a graph”.

Being behind the curve gives countries longer to prepare for an outbreak and learn from others’ mistakes

[Kalija]

My sense is it will be less.

The crude death rate is defined as “the mortality rate from all causes of death for a population,” calculated as the “[t]otal number of deaths during a given time interval” divided by the “[m]id-interval population”, per 1,000 or 100,000; for instance, the population of the U.S. was ca. 290,810,000 in 2003, and in that year, approximately 2,419,900 deaths occurred in total, giving a crude death (mortality) rate of 832 deaths per 100,000.[5]:3-20f As of 2020, the CIA estimates the U.S. crude death will be 8.3 per 1,000, while it estimates that the global rate will be 7.7 per 1,000.[4][contradictory]

https://en.m.wikipedia.org/wiki/Mortality_rate

[urtax$@work]

Would be interesting to see average March/April death rates in states and/or cities from historical records.

[HarleyD]

I feel fairly sure that after all is said and done, the number of total deaths at the end of 2020 wouldn't be much different from the normal 56 million.

The problem is we will never know what the true statistics are. China, Russia, Germany and a good number of other countries aren't reporting. Because everyone is quanatine, it has slowed the infection down. Plus quick experimental treatment has started. So even if it is the same as the normal flu, chances are it is much higher because numbers weren't counted and steps were taken. Trouble is, we just won't know how high the total count would have been.

[trebb]

Yep - too bad so many have already bought their coffins and urns so they need not listen to reason...

[Clutch Martin]

IMHO:

If a metric is elusive that means ONLY ONE PIECE OF THE PROBLEM is an effective weapon required to disarm this creature one case at a time.

The rest of the problem, is what should be currently transpiring.

Control of the Border and ports of entry, travel restrictions etc... lock down.

Social Distancing (which from what I understand now is strongly being suggested at 10 to 30 meters) set at an effective distance due to spray patterns from coughing.

The sanitatation situation is going to be dire if stocks aren’t resupplied in a timely manner.

The disinfectant situation is going to be dire if stocks aren’t resupplied in a timely manner.

PPE is a situation that is going to be dire if stocks aren’t resupplied in a timely manner.

All on a scale of 300+ million people.

At the point our leadership in congress decides to become an adult in the room is up in the air.

https://youtu.be/Gd5PGlfBoJU

Throwing temper tantrums in Congress that are incoherent, is not leadership screaming, not yielding the floor etc... is not leadership that is childish behavior. Congresswoman Haley Stevens from Michigan doesn’t understand leadership concepts.

Inciting malfeasance through communication systems in this country is shameful, short of treason.

The administration is setting goals and milestones to achieve those goals based upon the best information due diligence can pull together. But the situation on the ground will continue to dominate until sanitation and resupply goals are achieved.

And this is but one facet of a multi-faceted situation. There is the financial piece, the compensation piece, the compassionate aid, etc...

[SoCal Pubbie]

You’re so right. If the world hadn’t hunkered down and stopped 90% of total economic activity, we would have lost 70,000 souls in this country back in ‘57. What a horrible Asian Flu that year! And I can clearly remember skipping sixth grade back in ‘68. Might been a 100,000 lost that time if we hadn’t acted.

Oh wait....

[bramps]

I feel fairly sure that after all is said and done, the number of total deaths at the end of 2020 wouldn’t be much different from the normal 56 million.
::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::

I would guess you will be correct and the biggest reason will be the steps taken to mitigate.

[brookwood]

“Only 12 per cent of death certificates have shown a direct causality from coronavirus,” said the scientific adviser to Italy’s minister of health last week
I noticed that on 9/11/2001, NYC said that 3,000 people died because the World Trade Center was hit by 2 airplanes. But many of those people also had hypertension or diabetes, many were over 60. So the real number of deaths was much lower right?

[DannyTN]

Country	Total cases	Total Deaths	Case Mortality Rate
World	735,833	34,847	4.7%
USA	142,793	2,490	1.7%
Italy	97,689	10,779	11.0%
Spain	85,195	7,340	8.6%
China	81,470	3,304	4.1%
Germany	62,435	541	0.9%
Iran	41,495	2,757	6.6%
France	40,174	2,606	6.5%
UK	19,522	1,228	6.3%
State
New York	59,648	965	1.6%
New Jersey	13,386	161	1.2%
California	6,358	132	2.1%
Michigan	5,486	132	2.4%
Massachusetts	4,955	48	1.0%
Florida	4,950	60	1.2%
Washington	4,896	200	4.1%
Illinois	4,596	65	1.4%
Louisiana	3,540	151	4.3% Source worldometers approx 7:10am CST.

[bramps]

You’re arguing with the wrong person. Your argument supports what I said. 3000 people, even if they had medical conditions, would have gone home on 9/11 and continued life as normal if terrorists did not fly into the towers.

The same with people with pre-existing conditions who contract the virus. They would still be here if they did not contract the virus. My logic tells me that the virus killed them.

[Sicon]

The same with people with pre-existing conditions who contract the virus. They would still be here if they did not contract the virus. My logic tells me that the virus killed them.

I’m afraid your logic is flawed.

[Fireone]

You’re still more likely to be attacked by two men wearing MAGA hats in downtown Chicago, at 0200, than you are of dying of the cornvirus.

[CodeToad]

Probably because the States are reporting all deaths as COVID. Everyone by now has been exposed to the virus so anyone who dies will show up as infected, regardless if the virus had anything to do with the person’s death.

[exDemMom]

Can’t read the column due to pay wall.

However, I find very distressing the attempt to downplay the seriousness of the Covid-19 by claiming that everyone who has a comorbidity and died from Covid-19 actually died of the comorbidity. This is disturbing for the fact that it brushes off the hastening of people’s deaths, when the real message is that we need to be extra careful to avoid exposing people with certain conditions to the virus.

I also find the attempt to say it’s not so bad by referring to innumerable undiagnosed asymptomatic cases for which there is no scientific evidence to say they exist. Looking at the actual R naught value (the average number of people each sick person infects), the number of cases is about where we would expect. In other words, the math and biology just do not support millions of undetected cases.

I have to wonder what is the motivation behind trying to downplay the seriousness of a virus that is essentially a killer cold, comparable to common cold in transmissibility, and has a 4.7% death rate. Could the extinct humanity movement be behind it? Is it hard for people to comprehend what a real pandemic looks like, who think that stuff like that only happened in the distant past and does not affect us in the modern world? Or is it an attempt to push away fear by downplaying the risks? Probably all three.