The CDC's New 'Best Estimate' Implies a COVID-19 Infection Fatality Rate Below 0.3%

That rate is much lower than the numbers used in the horrifying projections that shaped the government response to the epidemic.

According to the Centers for Disease Control and Prevention (CDC), the current "best estimate" for the fatality rate among Americans with COVID-19 symptoms is 0.4 percent. The CDC also estimates that 35 percent of people infected by the COVID-19 virus never develop symptoms. Those numbers imply that the virus kills less than 0.3 percent of people infected by it—far lower than the infection fatality rates (IFRs) assumed by the alarming projections that drove the initial government response to the epidemic, including broad business closure and stay-at-home orders.

The CDC offers the new estimates in its "COVID-19 Pandemic Planning Scenarios," which are meant to guide hospital administrators in "assessing resource needs" and help policy makers "evaluate the potential effects of different community mitigation strategies." It says "the planning scenarios are being used by mathematical modelers throughout the Federal government."

The CDC's five scenarios include one based on "a current best estimate about viral transmission and disease severity in the United States." That scenario assumes a "basic reproduction number" of 2.5, meaning the average carrier can be expected to infect that number of people in a population with no immunity. It assumes an overall symptomatic case fatality rate (CFR) of 0.4 percent, roughly four times the estimated CFR for the seasonal flu. The CDC estimates that the CFR for COVID-19 falls to 0.05 percent among people younger than 50 and rises to 1.3 percent among people 65 and older. For people in the middle (ages 50–64), the estimated CFR is 0.2 percent.

That "best estimate" scenario also assumes that 35 percent of infections are asymptomatic, meaning the total number of infections is more than 50 percent larger than the number of symptomatic cases. It therefore implies that the IFR is between 0.2 percent and 0.3 percent. By contrast, the projections that the CDC made in March, which predicted that as many as 1.7 million Americans could die from COVID-19 without intervention, assumed an IFR of 0.8 percent. Around the same time, researchers at Imperial College produced a worst-case scenario in which 2.2 million Americans died, based on an IFR of 0.9 percent.

Such projections had a profound impact on policy makers in the United States and around the world. At the end of March, President Donald Trump, who has alternated between minimizing and exaggerating the threat posed by COVID-19, warned that the United States could see "up to 2.2 million deaths and maybe even beyond that" without aggressive control measures, including lockdowns.

One glaring problem with those worst-case scenarios was the counterfactual assumption that people would carry on as usual in the face of the pandemic—that they would not take voluntary precautions such as avoiding crowds, minimizing social contact, working from home, wearing masks, and paying extra attention to hygiene. The Imperial College projection was based on "the (unlikely) absence of any control measures or spontaneous changes in individual behaviour." Similarly, the projection of as many as 2.2 million deaths in the United States cited by the White House was based on "no intervention"—not just no lockdowns, but no response of any kind.

Another problem with those projections, assuming that the CDC's current "best estimate" is in the right ballpark, was that the IFRs they assumed were far too high. The difference between an IFR of 0.8 to 0.9 percent and an IFR of 0.2 to 0.3 percent, even in the completely unrealistic worst-case scenarios, is the difference between millions and hundreds of thousands of deaths—still a grim outcome, but not nearly as bad as the horrifying projections cited by politicians to justify the sweeping restrictions they imposed.

"The parameter values in each scenario will be updated and augmented over time, as we learn more about the epidemiology of COVID-19," the CDC cautions. "New data on COVID-19 is available daily; information about its biological and epidemiological characteristics remain[s] limited, and uncertainty remains around nearly all parameter values." But the CDC's current best estimates are surely better grounded than the numbers it was using two months ago.

A recent review of 13 studies that calculated IFRs in various countries found a wide range of estimates, from 0.05 percent in Iceland to 1.3 percent in Northern Italy and among the passengers and crew of the Diamond Princess cruise ship. This month Stanford epidemiologist John Ioannidis, who has long been skeptical of high IFR estimates for COVID-19, looked specifically at published studies that sought to estimate the prevalence of infection by testing people for antibodies to the virus that causes the disease. He found that the IFRs implied by 12 studies ranged from 0.02 percent to 0.4 percent. My colleague Ron Bailey last week noted several recent antibody studies that implied considerably higher IFRs, ranging from 0.6 percent in Norway to more than 1 percent in Spain.

Methodological issues, including sample bias and the accuracy of the antibody tests, probably explain some of this variation. But it is also likely that actual IFRs vary from one place to another, both internationally and within countries. "It should be appreciated that IFR is not a fixed physical constant," Ioannidis writes, "and it can vary substantially across locations, depending on the population structure, the case-mix of infected and deceased individuals and other, local factors."

One important factor is the percentage of infections among people with serious preexisting medical conditions, who are especially likely to die from COVID-19. "The majority of deaths in most of the hard hit European countries have happened in nursing homes, and a large proportion of deaths in the US also seem to follow this pattern," Ioannidis notes. "Locations with high burdens of nursing home deaths may have high IFR estimates, but the IFR would still be very low among non-elderly, non-debilitated people."

That factor is one plausible explanation for the big difference between New York and Florida in both crude case fatality rates (reported deaths as a share of confirmed cases) and estimated IFRs. The current crude CFR for New York is nearly 8 percent, compared to 4.4 percent in Florida. Antibody tests suggest the IFR in New York is something like 0.6 percent, compared to 0.2 percent in the Miami area.

Given Florida's high percentage of retirees, it was reasonable to expect that the state would see relatively high COVID-19 fatality rates. But Florida's policy of separating elderly people with COVID-19 from other vulnerable people they might otherwise have infected seems to have saved many lives. New York, by contrast, had a policy of returning COVID-19 patients to nursing homes.

"Massive deaths of elderly individuals in nursing homes, nosocomial infections [contracted in hospitals], and overwhelmed hospitals may…explain the very high fatality seen in specific locations in Northern Italy and in New York and New Jersey," Ioannidis says. "A very unfortunate decision of the governors in New York and New Jersey was to have COVID-19 patients sent to nursing homes. Moreover, some hospitals in New York City hotspots reached maximum capacity and perhaps could not offer optimal care. With large proportions of medical and paramedical personnel infected, it is possible that nosocomial infections increased the death toll."

Ioannidis also notes that "New York City has an extremely busy, congested public transport system that may have exposed large segments of the population to high infectious load in close contact transmission and, thus, perhaps more severe disease." More speculatively, he notes the possibility that New York happened to be hit by a "more aggressive" variety of the virus, a hypothesis that "needs further verification."

If you focus on hard-hit areas such as New York and New Jersey, an IFR between 0.2 and 0.3 percent, as suggested by the CDC's current best estimate, seems improbably low. "While most of these numbers are reasonable, the mortality rates shade far too low," University of Washington biologist Carl Bergstrom told CNN. "Estimates of the numbers infected in places like NYC are way out of line with these estimates."

But the CDC's estimate looks more reasonable when compared to the results of antibody studies in Miami-Dade County, Santa Clara County, Los Angeles County, and Boise, Idaho—places that so far have had markedly different experiences with COVID-19. We need to consider the likelihood that these divergent results reflect not just methodological issues but actual differences in the epidemic's impact—differences that can help inform the policies for dealing with it.

Pardon the length:

Does COVID-19 truly warrant a nationwide shutdown?

Daniel Hamilton

10h ago

Changed by Christ yet in need of more changing by HIM

No, and that has been made increasingly clear. The predicted dire need for hospital beds did not overall materialize, while most of those who were infected and died have been among those who are quarantined, especially elder care facilities which account for over 40% of US deaths.[1]

Up to about 80 percent of those infected with COVID-19 are estimated to be silent carriers, [2] meaning they show no symptoms (the New York City labor and delivery unit found 88 percent of infected patients had no symptoms, [3] while over 600 sailors on the coronavirus-stricken aircraft carrier Theodore Roosevelt tested positive, yet 60% of them had no symptoms such as fever, fatigue, or cough,[4]and in four U.S. state prisons nearly 3,300 inmates test positive for coronavirus yet 96% were without symptoms[5] and or recover without medical care[6]) Which means that the infected fatality rate is much lower than the misleading case fatality rate that is usually quoted.

Meanwhile the vast majority of those who die because it are 65 years-old or more[7] and with almost 25% of all documented Covid-assigned (which does not mean the subject was tested for Covid) fatalities in the US (91,976 as of May 18 at 8:49PM EDT) are from New York (28,480)[8] and according to one report 54% of all U.S. deaths were in the 100 counties in or within 100 miles of NYC.

And the Centers for Disease Control and Prevention (CDC) reported that almost 90 percent of U.S. coronavirus patients who have been hospitalized had underlying health problems, or comorbidities.[9]

And which relates to the issue of inaccurate fatality numbers, partly due to the problem of determining the actual cause of death and the CDC guidelines which allow for reporting COVID-19 as the “probable” or “presumed” cause on the death certificate if the certifier even suspects COVID-19 was likely (e.g., the circumstances were compelling within a reasonable degree of certainty), the cause.[10] Which resulted in NYC suddenly adding 3,700 additional people to its death count[11](also, Federal legislation pays hospitals higher Medicare rates for COVID-19 patients and treatment[12]), leading to charges of over-counting[13][14] while Pennsylvania removed some after coroner reports.[15] Later, Colorado’s Health Department revised their official coronavirus death count from 1,150 as of May 15 downward to 878 (a reduction of 23.7 percent) and created two separate distinguishing categories, one of people who died directly because of the virus and another of people who had COVID-19 at their time of death but died of other causes that may not be attributable to the virus.[16][17] However, some others believe the problem is more that of under-counting. [18]

Also, another study finds that the risk of coronavirus spreading in schools is 'extremely low'.[19]

And while states continue to parrot the “stay sheltered” mantra, research shows that sunlight destroys virus quickly[20], and even a Department of Homeland Security official affirmed that increasing temperatures, humidity and sunlight are detrimental to coronavirus saliva droplets on surfaces and in the air.[21] Also, over 600 doctors signed onto a letter sent to President Trump favoring an end the "national shutdown," referring to it as being a "mass casualty incident" with "exponentially growing health consequences."[22]

Yet miles upon miles of parks and public waterfronts are shutdown, and for too long NY put infected persons in nursing homes[23] (and as of April 26, about 40 percent of COVID-19 deaths were in the state of New York alone. New Jersey was in second place, with nearly 5,900[24]yet the death rate is uncritically employed to justify nationwide lockdowns) while in states such as Illinois law-breaking prisoners were released from their “quarantine” - including some “high risk” sexual offenders[25] and some convicted of murder - [26] and almost a third of county jail inmates have been released from facilities during the coronavirus pandemic.[27] Meanwhile over 2,000[28] of the most vulnerable souls a day in “quarantine” - their mother’s womb - are murdered, many by the same persons claim to be for protecting the vulnerable.

Moreover, the extremely restrictive all-ages long-term response to COVID-19 simply has no precedent in American history except (to a degree) that of the 1918 flu (in which baseball was still played) which up t 675,000 deaths are attributed.[29]

The Asian flu pandemic of 1957-1958 resulted in a estimated 116,000 deaths in America[30] (followed by the Hong Kong flu with about est. 100,000 American deaths in 1968–69), when at about 173,000,000, the population size in 57-58 was close to half of what it is now (330,541,000, rounded figures).

Meaning that not only was the infection death rate much higher than for COVID-19, but there would have to be about 200,000 COVID-19 est. deaths to be comparable to the Asian flu as regards percentaged of population. Yet that would simply make it basically equal as concerns the numbers of deaths in proportion to population size, but to justify the "CovidCaptivity," one would have to argue that the Asian flu should have necessitated a response like that to COVID-19. The Soviets would have favored that for sure.

The question then is, where was the COVID-19 comparative response in 57-58 in proportion to its threat? Yes, the 116,000 deaths in America to the Asian flu was for the whole year, yet even if we reach about 200,000 deaths (we pray not) for COVID-19 then that type of equality would still mean that the extremely restrictive all-ages long-term response to COVID-19 simply has no precedent in American history, except to a degree with the far more deadly (550,000 to 675,000 Americans, or 0.66% of the population) 1918 flu.

And during which medics found that severely ill flu patients nursed outdoors recovered better than those treated indoors. A combination of fresh air and sunlight seems to have prevented deaths among patients; and infections among medical staff. [31]

Finally, last but not least, the long-term cost for the questionable[32]“cure” - as meaning preventing deaths via the stay-sheltered COVID captivity - will be more costly in lives and money including psychosocial consequences[33] than a more moderate response that would allow for a faster rise in cases but a better decrease and overall a more healthy populace in the long run. [34][35][36]

Economically, estimates project total losses in state and local revenue of up to 45 percent, effecting 90,000 nonfederal-government entities that provide and pay for most of the government services that Americans receive.[37] And while states look to the Federal government to bail them out, the additional costs and declining revenues stemming from Covid-19 are expected to produce a 2020 budget deficit in excess of $4.2 trillion.[38]

And most of government income comes from taxes, via businesses and those who are employed ( income taxes, payroll taxes, and corporate taxes)[39], yet businesses are failing across America, and in New York alone the governor stated that small businesses constitute “90 percent of New York's businesses” and “more than 100,000 have shut permanently since the pandemic hit.”[40]

Moreover (as of May 20), with 2.43 million in America filing for an unemployment,[41] the rate is at least 20%.[42] Also, according to one meta-analysis of 42 studies involving 20 million people, the risk of death increases 63 percent when one loses their job, and that for every one percentage point increase in the unemployment rate, there are 37,000 deaths, mainly from heart attacks, but another 1,000 from suicides and another 650 from homicides.[43]

And as concerns just suicide, we have reports such as “Calls to suicide and help hotline in Los Angeles increase 8,000% due to coronavirus,”[44] and “Doctors at John Muir Medical Center in Walnut Creek say they have seen more deaths by suicide during this quarantine period than deaths from the COVID-19 virus,”[45]

Yet while we seek to save lives, 7,000 Americans die every day in the US from a wide range of causes [46] - besides over 2,000 a day being slain in the “quarantine” of their mother’s womb[47] - my prayer is that all sinners will come to repentance and faith in the risen Lord Jesus and be baptized and follow Him.

Hope this helps. PeaceByJesus

Footnotes

[1] STAGGERING: Nursing Home Residents Account for a Whopping 43.4% of COVID-19 Deaths, Even Though They're Less Than 1% of the U.S. Population

[2] Coronavirus Outbreak: Daily Updates

[3] https://www.washingtonpost.com/outlook/2020/04/20/we-tested-all-our-patients-covid-19-found-lots-asymptomatic-cases/

[4] Coronavirus clue? Most cases aboard U.S. aircraft carrier are symptom-free

[5] In four U.S. state prisons, nearly 3,300 inmates test positive for coronavirus -- 96% without symptoms

[6] The basics on the coronavirus: What you need to know as the US becomes the new epicenter of COVID-19

[7] CDC: 80 percent of US coronavirus deaths are people 65 and older

[8] New York Coronavirus: 361,266 Cases and 28,480 Deaths (COVID-19 )

[9] Hospitalization Rates and Characteristics of Patients Hospitalized ...

[10] Technical Notes: Provisional Death Counts for Coronavirus Disease (COVID-19)

[11] N.Y.C. Death Toll Soars Past 10,000 in Revised Virus Count

[12] Fact check: Hospitals get paid more if patients listed as COVID-19, on ventilators

[13] As US coronavirus death toll mounts, so does the belief by some that it is exaggerated

[14] Death Toll Conspiracy: Why Conservative Media—And Soon, Possibly Trump—Are Doubting Coronavirus Mortality Figures

[15] Pennsylvania Takes Hundreds of 'Probable' COVID Deaths Off Books After Coroners Come Forward

[16] Colorado's state health dept. revises method of counting COVID-19 deaths; 878 deaths as of Friday - KRDO

[17] Case data | Colorado COVID-19 Updates

[18] How are COVID-19 deaths counted?

[19] Risk of coronavirus spreading in schools is 'extremely low' study finds

[20] https://www.aol.com/article/news/2020/04/17/sunlight-destroys-virus-quickly-new-govt-tests-find-but-experts-say-pandemic-could-last-through-summer

[21] https://www.usnews.com/news/national-news/articles/2020-04-23/us-official-sunlight-heat-humidity-could-help-kill-coronavirus

[22] Doctors raise alarm about health effects of continued coronavirus shutdown: 'Mass casualty incident'

[23] How States Turned Nursing Homes Into ‘Slaughter Houses’ By Forcing Them to Admit Discharged COVID-19 Patients | Jon Miltimore

[24] New York vs. Texas: NY Has Nearly 50 Times More COVID-19 Deaths Per Capita | Ryan McMaken

[25] CA Gov. Frees Seven ‘High Risk’ Sex Offenders, Orders Beaches Closed, All In Same County - LaCorte News

[26] Almost 4,000 inmates released from IL prisons, 64 convicted of murder

[27] One Third Of Jail Inmates Nationwide Set Free in Unprecedented Coronavirus Jailbreak - Big League Politics

[28] Induced Abortion in the United States

[29] Spanish flu - Wikipedia

[30] 1957-1958 Pandemic (H2N2 virus)

[31] Coronavirus and the Sun: a Lesson from the 1918 Influenza Pandemic

[32] Analysis raises questions about coronavirus shutdown's effectiveness

[33] Years of life lost due to the psychosocial consequences of COVID19 mitigation strategies based on Swiss data

[34] Stanford University doctor: 'You are mistaken' if you think coronavirus lockdowns provide safety

[35] Thanks to COVID-19, Social Security’s day of reckoning may be even closer than we thought

[36] Workers opt for unemployment as benefits exceed job pay

[37] America’s Next Crisis Is Already Here

[38] Coronavirus Budget Projections | Manhattan Institute

[39] Who Really Pays Uncle Sam's Bills?

[40] Coronavirus Forces 100K NY Small Businesses To Close Permanently

[41] United States Initial Jobless Claims

[42] Don’t Be Fooled By Official Unemployment Rate Of 14.7%; The Real Figure Is Even Scarier

[43] Studies: The Shutdown Is NOT Lives Vs. Dollars, It’s Lives Vs. Lives - The Revolutionary Act

[44] Calls to suicide and help hotline in Los Angeles increase 8,000% due to coronavirus

[45] Suicides on the rise amid stay-at-home order, Bay Area medical professionals say

[46] QuickStats: Average Daily Number of Deaths, by Month — United States,

[47] Induced Abortion in the United States

Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.