Thursday, March 19, 2020

CDC using questionable Covid-19 mortality rate

The federal Centers for Disease Control is giving the public a questionable Covid-19 death rate, a news report indicates.

JusttheNews talks to the CDC
https://justthenews.com/politics-policy/health/coronavirus-death-rate-drops-better-math-better-treatment-or-more-testing

JusttheNews asked the CDC how it calculated the Covid-19 fatality rate. Though JusttheNews did not comment on the CDC's reply, the CDC implied that it was using an inaccurate, inflated rate while realizing that that rate was misleading, but not pointing that fact out.

The CDC's response to JusttheNews:
CDC: Mortality for Covid-19 appears higher than for influenza, especially seasonal influenza. While the true mortality of Covid-19 will take some time to fully understand, WHO currently estimates that the crude mortality ratio is between 3 percent and 4 percent. For seasonal influenza, mortality is usually well below 0.1 percent. However, mortality is to a large extent determined by access to and quality of health care.

CDC: Of the more than 153,500 people who have been infected worldwide, more than 5,700 have died. That's a death rate of about 3.7 percent.
The 3.7% figure represents the ratio of deaths to confirmed cases. But, when viruses spread, there are usually large numbers of unreported cases, as seems to be true for Covid-19. When the CDC says that "the true mortality rate" will take time to understand, it means that it is not factoring in unreported cases -- which would drastically reduce the mortality rate.

Insofar as its claim that the death rate "appears higher then for influenza," it offers no scientific substantiation of that belief.

Notice that on a CDC influenza page, the agency makes sure to adjust the rate in accordance with estimates of non-reported cases.

CDC flu estimates
https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm

"Because influenza surveillance does not capture all cases of flu that occur in the U.S., CDC provides these estimated ranges to better reflect the larger burden of influenza," the CDC says.

On another page, the 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.

That is a death rate of about 0.1 percent after adjustment for the estimate of unreported cases. For verified cases, the death rate is 0.2 percent.

So it is true, for verified cases, that Covid-19 appears far more deadly than seasonal flu (18.5 times more deadly). But, because Covid-19 yields few or no symptoms among a great many non-elderly persons, it cannot be precisely matched to flu.

There is some possibility that Covid-19 is 10 times more deadly than routine flu. But, there is also a possibility that is not nearly as deadly as flu with respect to the entire population.

And, it should be observed that the infirm and the elderly have always been targets of respiratory deaths associated with influenza. 

(Latest figures put the number of cases worldwide at 200,000 with some 8,000 deaths. The "crude," uncorrected ratio is 4%. At 4(200,000), for an estimated 800,000 cases, the death rate is about 1 percent, which is not significantly different from 0.92 percent for the previously given figures.)

Dr. Nicholas A. Christakis, a Yale sociology professor and physician, says that the visible virus rate is about one-quarter of the actual rate.

Christakis favors social distancing
https://www.youtube.com/watch?v=GrPUqLumDAU

In that case, we have 4(153,000) = 614,000, which would put the estimated mortality rate at 0.92 percent. This figure is comparable to the typical seasonal flu rate, as given by the CDC, of "well below 0.1 percent." (An estimated rate of undetected Covid-19 deaths would increase the overall death rate somewhat, though such cases are unlikely to slip past modern medical surveillance.)

Still, Christakis says that inadequate testing capacity means that the mortality rate is difficult to ascertain. The mortality rate rises sharply with age, he warned.

Christakis told video personality Dave Rubin, "Keep in mind that most people infected by this pathogen do fine. The great majority of people will have no symptoms or will have minor symptoms. Some people, however, maybe 25 percent, overall will get sick. And of these maybe 5 percent will get seriously ill."

Christakis cited Chinese research that correlated cool, dry weather with the severity of transmission and said he believes fairer weather in the United States will probably yield "some reduction" in cases but that the change would not be "definitive." He predicted the virus would follow the pattern of seasonal influenzas, which tend to diminish during the summer but then head to countries below the equator, where winter encourages their continuation. So, as the northern hemisphere cools in the fall, these viruses return to afflict those in northern latitudes. Expect the same of Covid-19, he said.

He pointed out that when a virus is spreading exponentially, there is a calm before the storm. All seems peaceable and then a sudden surge occurs. That is, if there are two cases locally for a week or so, it could suddenly become apparent that there are now 32 cases. On the other hand, social distancing and other factors may prevent exponential growth.

James R. Conant, PhD., a San Diego mathematician, responded to a previous version of this post with this observation:
Look at Italy if you want to see what lies in our future. Many people think the 3.7 rate is an underestimate since actual death rate should be calculated with the total number of people at the time of infection and not the total number at the time of death. With exponential growth, this difference is significant.
The CDC however is not basing its public estimates in the manner outlined by Conant.

Dr. Jacob Glanville, a computational bioengineer, told Fox News that though social distancing is helpful, it won't be enough. The Covid-19 virus is "much more deadly" and "much more infectious" than are flu viruses, he said. Glanville's company, Distributed Bio, is working on an antibody treatment for knocking out Covid-19 and has also been working on a broad-spectrum flu vaccine. Glanville had no opportunity to cite his source for those qualitative comparisons.

Christakis, MD, PhD, MPH, is a sociologist and physician who conducts research in the areas of social networks and biosocial science. His current research is mainly focused on the social, mathematical, and biological rules governing how social networks form (“connection”), and the social and biological implications of how they operate to influence thoughts, feelings, and behaviors (“contagion”). 

A Yale site says Christakis's lab uses both observational and experimental methods to study these phenomena, exploiting techniques from sociology, computer science, biosocial science, demography, statistics, behavior genetics, evolutionary biology, epidemiology, and other fields.
Virus kills 3 who attended family affair in New Jersey
A New Jersey mother died from Covid-19 without knowing that her two children also got infected and died shortly before she did, The New York Times reported.

Grace Fusco, 73, died Wednesday and was unaware of the deaths of her oldest son and daughter from Covid-19, the disease caused by Covid-19. A relative told the newspaper that four other children also have coronavirus and remain hospitalized -- three in critical condition.

The infections appeared to have originated from a family dinner this month, the Times reported. It said the first person to die from Covid-19 in New Jersey attended that gathering. Grace Fusco's oldest daughter, Rita Fusco-Jackson, 55, of Freehold, New Jersey, died Friday. Shortly afterward, the family learned she had Covid-19. Grace Fusco's son, Carmine Fusco, of Bath, Pa., died just before his mother Wednesday.

Nearly 20 other relatives are quarantined at their homes and are grieving the loss separately, The Times said.

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