Coronavirus May Not Be As Deadly As They Say – Stanford Medicine Questions!

Is the Coronavirus as Deadly as They Say?

Current estimates about the Covid-19 fatality rate may be too high by orders of magnitude.

A line at an emergency room in Brooklyn, N.Y., March 19.

PHOTO: ANDREW KELLY/REUTERS

If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high.
Fear of Covid-19 is based on its high estimated case fatality rate—2% to 4% of people with confirmed Covid-19 have died, according to the World Health Organization and others. So if 100 million Americans ultimately get the disease, two million to four million could die. We believe that estimate is deeply flawed. The true fatality rate is the portion of those infected who die, not the deaths from identified positive cases.
The latter rate is misleading because of selection bias in testing. The degree of bias is uncertain because available data are limited. But it could make the difference between an epidemic that kills 20,000 and one that kills two million. If the number of actual infections is much larger than the number of cases—orders of magnitude larger—then the true fatality rate is much lower as well. That’s not only plausible but likely based on what we know so far.
Population samples from China, Italy, Iceland and the U.S. provide relevant evidence. On or around Jan. 31, countries sent planes to evacuate citizens from Wuhan, China. When those planes landed, the passengers were tested for Covid-19 and quarantined. After 14 days, the percentage who tested positive was 0.9%. If this was the prevalence in the greater Wuhan area on Jan. 31, then, with a population of about 20 million, greater Wuhan had 178,000 infections, about 30-fold more than the number of reported cases. The fatality rate, then, would be at least 10-fold lower than estimates based on reported cases.
Next, the northeastern Italian town of Vò, near the provincial capital of Padua. On March 6, all 3,300 people of Vò were tested, and 90 were positive, a prevalence of 2.7%. Applying that prevalence to the whole province (population 955,000), which had 198 reported cases, suggests there were actually 26,000 infections at that time. That’s more than 130-fold the number of actual reported cases. Since Italy’s case fatality rate of 8% is estimated using the confirmed cases, the real fatality rate could in fact be closer to 0.06%.
In Iceland, deCode Genetics is working with the government to perform widespread testing. In a sample of nearly 2,000 entirely asymptomatic people, researchers estimated disease prevalence of just over 1%. Iceland’s first case was reported on Feb. 28, weeks behind the U.S. It’s plausible that the proportion of the U.S. population that has been infected is double, triple or even 10 times as high as the estimates from Iceland. That also implies a dramatically lower fatality rate.
The best (albeit very weak) evidence in the U.S. comes from the National Basketball Association. Between March 11 and 19, a substantial number of NBA players and teams received testing. By March 19, 10 out of 450  players were positive. Since not everyone was tested, that represents a lower bound on the prevalence of 2.2%. The NBA isn’t a representative population, and contact among players might have facilitated transmission. But if we extend that lower-bound assumption to cities with NBA teams (population 45 million), we get at least 990,000 infections in the U.S. The number of cases reported on March 19 in the U.S. was 13,677, more than 72-fold lower. These numbers imply a fatality rate from Covid-19 orders of magnitude smaller than it appears.
How can we reconcile these estimates with the epidemiological models? First, the test used to identify cases doesn’t catch people who were infected and recovered. Second, testing rates were woefully low for a long time and typically reserved for the severely ill. Together, these facts imply that the confirmed cases are likely orders of magnitude less than the true number of infections. Epidemiological modelers haven’t adequately adapted their estimates to account for these factors.
The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.
This does not make Covid-19 a nonissue. The daily reports from Italy and across the U.S. show real struggles and overwhelmed health systems. But a 20,000- or 40,000-death epidemic is a far less severe problem than one that kills two million. Given the enormous consequences of decisions around Covid-19 response, getting clear data to guide decisions now is critical. We don’t know the true infection rate in the U.S. Antibody testing of representative samples to measure disease prevalence (including the recovered) is crucial. Nearly every day a new lab gets approval for antibody testing, so population testing using this technology is now feasible.
If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible. Elective procedures will need to be rescheduled. Hospital resources will need to be reallocated to care for critically ill patients. Triage will need to improve. And policy makers will need to focus on reducing risks for older adults and people with underlying medical conditions.
A universal quarantine may not be worth the costs it imposes on the economy, community and individual mental and physical health. We should undertake immediate steps to evaluate the empirical basis of the current lock downs.
Dr. Bendavid and Dr. Bhattacharya are professors of medicine at Stanford. Neeraj Sood contributed to this article.
Japan:
Japan, without a lockdown, is doing fine (1,193 cases and 43 deaths as of March 24). In the US, 2 weeks of reduced human contact might be considered quite an economic sacrifice to the covad 19 ‘god,’ 4 weeks may be a near-suicidal sacrifice, and over 4 weeks may well be suicide. The old in Japan ‘takes their chances’ and there is little reason to believe the old in the US cannot do the same (after all, the vast majority of the old have gotten that way by being prudent, they will just have to be more prudent for a while). Society should not be destroyed to keep covad 19 at bay, rather, it is likely coming no matter what we do (although some treatments might just reduce its power enough to allow us to move freely again). If we destroy the economy we destroy the possibilities of conquering or largely conquering it, not to mention our children’s future. Modernity has enabled us to live far longer than our great, great, great grandparents. Without our wonderfully complex and rich society, modernity shrivels.

Truman’s Famous Buck Is About To Stop Again With the President

The near-term future of America’s physical and financial health now depends on weighing public-health and commercial data in a gigantic cost-efficiency study as disease and economic recession compete as the principal public enemy and the main call upon the nation’s human and financial resources. This was a foreseeable stage but is on us more quickly than had been generally expected.
In such an unprecedented crisis, the command decisions of the president will be determining, and he clearly signals that the time to choose is close. In this official process, where one would have hoped for bipartisanship and the smooth coming together of both parties in the national interest, the Democrats have walked off the table, and their presumptive presidential nominee treated us to a waxen live-stream from a little podium in his living room in Delaware on Monday, a nostalgic dip into rank amateurism.
Harry Truman’s home movies from Key West in his Hawaiian shirts look more presidential than Joe Biden frantically signaling the cameraman with what he thought to be an invisible hand as he pretends to be an alternate president. And in Congress, the administration’s $2 trillion relief bill, backed by a $4 trillion Federal Reserve liquidity facility, was stalled for two days by the far-left House caucus that propelled Speaker Nancy Pelosi into the spurious impeachment fiasco.
They sought concessions to labor unions, diversity requirements in employment standards among beneficiaries, the imposition of parts of the Green Terror, including large acquisitions of solar panels and windmills, abortion subsidies, and $300 million for the National Endowment for the Arts, a worthy but at this point somewhat esoteric cause. This is profoundly unserious. The Democratic tactics will assure that the president gets all the credit for it.
The Trump-hating press and its desperate Democratic allies don’t dislike the president any less because there is a public-health crisis, and their principal effort has been to stir up and maintain a state of public fear that grips the country while they snipe and carp at any shortcoming they can discover or invent in the administration’s response to the crisis. The pure fiction that President Trump had disbanded the federal government’s pandemic response group is an example of that.
So are attempts to blame Mr. Trump when individuals self-medicate disastrously when they have mistakenly thought they were swallowing a remedy the president had recommended. Now that the numbers of coronavirus sufferers are taking on a pattern, a possible ameliorative treatment of the coronavirus is being distributed in New York, and testing will increase to 150,000 people a day next week, the fear-mongers are howling that any relaxation of the virtual lockdown of the country will cause nightmarish numbers of needless dead.
Some of those screaming this from the cyber-rooftops are doubtless sincere. But some are trying to provoke as much economic damage as possible to hang around the president’s neck on Election Day.
The United States is now outdone only by Germany and Canada, among countries with sophisticated public-health systems that publish believable numbers, in the small proportion of reported cases who die from the coronavirus. This was 674 people out of 51,542 cases reported, as of late afternoon Tuesday, or 1.25% of identified cases, and if those who are immune-challenged are removed from that figure, the percentage descends to less than half of 1 percent of the identified cases.
Even though most of the people tested appeared to have possible coronavirus symptoms, only a little more than 15% of those tested have tested positively. Because the United States is ramping up its treatment capabilities so quickly, it has an inordinate number of the world’s reported cases, 23% of the world’s new cases reported on Monday, though it only has about 4% of the world’s population, but the world fatality rate is about 4%, more than three times the American rate.
The disease is still spreading unavoidably, but if care is taken to insulate the elderly and infirm from contact, the mortality rate descends to a point not greatly above seasonal flu fatality numbers.
Though it is hard to be precise about it, less than 1% of the adult population of the U.S. have apparently reported coronavirus-like symptoms; of those, about 20% have been tested; of those, about a quarter have tested positive; and of those, apart from clearly vulnerable people, fewer than half of 1% have died.
In epidemiological terms, this is a very serious penetration of the population by a very nasty virus, but it does not justify continuing the extreme restrictions on the economic life of the country, and specifically this lethal threat to the economic well-being of tens of millions of Americans.
All lives are precious, and it is morally offensive to be forced to compare the cost in lives of the pandemic against the economic cost of extending maximum exposure-reduction measures. Democratic Party spokespeople are uniformly advising against premature relaxation of controls of travel and assembly as the president speaks of aiming for a staged reopening, starting with allowing people to go to church on Easter, April 12.
The concern is that a premature relaunch of normalcy could bring a double-top on the virus and bring the fatality rates back up. Obviously, any return to normalcy will be in stages, and the next step in determining the way forward will be the president outlining the steps of restored economic life, which could vary between regions.
As long as the President can get a reasonable number of the scientific community, some of whom seem to have had a propensity to think the enemy is only a bacillus and not economic suicide, to agree that the steps he takes, sequentially and tentatively, are justifiable with careful monitoring, it will be hard for his enemies to ambush him. Psychotic press cases await any opportunity to tear the President to pieces, no matter the facts or the public interest.
To the intense irritation of his enemies, who have engaged in great merriment mocking the evolution of the president’s views about the coronavirus and some of his communication lapses, he has led effectively, and the generally rather hostile Gallup polling organization reported on Tuesday that Mr. Trump has the support of 60% of Americans on this issue and has reached a high point of approval generally at 49%.
The response to the absence of testing facilities and the mobilization of the resistance to the pandemic has been so swiftly and smoothly conducted with the governors irrespective of partisan matters, he is carrying and leading opinion, as he should.
On Tuesday evening, he referred to winning the battle with “the invisible enemy” and reaffirmed Easter as his target date for beginning to relax some restrictions, but was careful to put humanitarian concerns ahead of commercial ones. He had Dr. Anthony Fauci of the White House Coronavirus Task Force standing beside him and addressing the press, squashing reports that there were some key differences between them.
Anyone can see the progress the country has made in addressing this problem in the two weeks since it was really taken in hand, including the swift assembly of an astonishingly comprehensive financial-relief program. Joe Biden’s discountenanced performance as he connected with the nasty, noisy morons on the ghastly television experience “The View” on Tuesday is comprehensible: This was his sequel to the farce he delivered on Monday at the podium placed in his living room.
President Truman spoke nothing but the truth when he said the buck stops with the president. At times like this it is an onerous burden that, if successfully discharged, rightly raises the status of the person who leads the nation successfully in great crises. The vivid Democratic contemplation of Donald Trump’s failure in this crisis is, with reason, giving way to the unspeakable fear of his success.

 

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