Med prof: There are ‘major problems’ with current coronavirus mortality estimates

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While I suspect that there’s a lot to be said for what’s called the Oxford Model in the UK (as opposed to the Imperial Model, after Imperial College, London), where there have been a lot of ‘mild’ cases around for some time (some of us might have personal reasons to suspect it 😬), the important death rate, going forward, is the one our various health systems can cope with.
 
mrad25 said:
Interesting article. Is the virus more widespread with a lower death rate estimates or less widespread with higher death rate estimates. I think personally it’s more widespread. Lack of universal testing, how testing registers positives, testing times and strict guidelines to get tested are factors.
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That is fair. But, …

Estimates form the cruise ship incubator are that about 50% of people infected showed no symptoms. If we start with a novel, anticipate herd immunity at ~80% infected, half of the 80% showing symptoms when infected, 5% of those reaching serious condition, and 16% of those dying (the latter two number of being typical at Wordlometer), that would be about 2 million dead in the US. And many more death that stem from the over saturation of the health care system if there is not flattening.

To lower that number by a factor of ten - apart form better success in health care, vaccine development, etc. - one would have to assume that only one in twenty infected show symptoms. To reduce this to a common seasonal influenza number, one would have to assume that less than one in 100 infected show symptoms. Is there any factual basis for such assumptions?
 
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Maybe. Check this out from New York:

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The 2m potential death toll in the US is about 0.61% of the current US population. But the death toll in NYC as calculated from this chart was 0.012% as of yesterday. NYC is the worst hit city. Extrapolate the 0.6% on their population (estimated at about 8.5m in 2019): that represents about 51,300 deaths. As bad as it has been in NYC, we are very much a long way from 51k deaths.

What we don’t know at this point is how many have been infected and didn’t show it. Only antibody tests will show that, what’s the deal with getting those out? They’re every bit as important as the virus tests are. Because it is now more than vital that we enumerate as best we can just what is out there before we can start making rational decisions about shutting down the economy (and possibly induce a new Great Depression with its own deleterious effects). The current decision making has been mostly fear based since we simply haven’t had sufficient data and the media certainly hasn’t helped with its prattling.

I’d be agitating for two things right now: masks for everyone and anti-body tests for all communities. Do random samples everywhere, enough of these samples should give us some confidence as to the levels of infection in the wider population.

I think Covid-19 has been running around in the US at least since mid-November as I have been seeing numerous anecdotes about an illness that was very much like Covid-19 that struck people before the holidays. Given the low level spread in China that likely took place before the doctors in Wuhan figured out what they were dealing with and set off the first alarms, it is almost all but certain Italy and the US were seeded with the virus months before the first confirmed cases in January in Seattle and Los Angeles. But we don’t know the extent of this, hence we are dealing with very incomplete data even now. And possibly making bad decisions on that basis.
 
Zzyzx_Road said:
I’d be agitating for two things right now: masks for everyone and anti-body tests for all communities. Do random samples everywhere, enough of these samples should give us some confidence as to the levels of infection in the wider population.
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There’s a good podcast episode of Uncommon Knowledge which interviews Dr Jay Bhattacharya, which points this out exactly. You can watch the interview here:


The denominator in the mortality rates is very uncertain, and the best way to improve that is to do the antibody tests. He also expands on this in his WSJ article:


The WaPo reports on this as well, noting that Dr Bhattacharya’s antibody pilot program will test Santa Clara and LA counties.

https://www.washingtonpost.com/news...2020/04/01/the-health-202-serology-tests-to-p(name removed by moderator)oint-number-of-u-s-coronavirus-infections-are-key-to-reopening-country/5e83736988e0fa101a757059/

Of interesting note from this article, the London estimates and University of Washington (boooo!), report wildly different deaths. The former predicts 1.1M, while the latter only predicts 84k. And the administration is 100k-200k. This further casts the denominator in doubt.

The antibody tests are a key step in evaluating the infection rates.
 
Suudy said:
. This further casts the denominator in doubt.
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The UW derives from an analysis of death rates, not the usual SIR model.
The London number of millions came was contingent on a lack of mitigation.
 
I agree it is absolutely critical to find that denominator. Now more than ever.

For those who don’t know, Santa Clara County is in California along with LA County. These two are excellent starts for this kind of testing as these counties were among the first to get confirmed cases. Yet neither county, nor the state is at the level of NYC. So knowing the denominator there would tell us a lot.
 
dvdjs said:
The UW derives from an analysis of death rates, not the usual SIR model.
The London number of millions came was contingent on a lack of mitigation.
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I should point out neither model knows the denominator. Many assumptions were made that are still with us and informing our policies.
 
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dvdjs said:
The UW derives from an analysis of death rates, not the usual SIR model.
The London number of millions came was contingent on a lack of mitigation.
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That doesn’t mean the value of the denominator is not in doubt. There are competing models. We don’t have enough data to know which one is correct, if any of them are.

What do you mean by “lack of mitigation.” Note the article states that the London model the 1.1M deaths “with trhee months of social distancing measures , including closing all schools and universities, isolating infected patients and ordering household quarantines.” And the UW model also was “based on the assumption that people will continue practicing social distancing through May.”

Are there other mitigations to which you are referring? Or are you referencing that the London model says the number could double without social distancing?
 
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dvdjs said:
To lower that number by a factor of ten - apart form better success in health care, vaccine development, etc. - one would have to assume that only one in twenty infected show symptoms. To reduce this to a common seasonal influenza number, one would have to assume that less than one in 100 infected show symptoms. Is there any factual basis for such assumptions?
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The alternative is to have two populations, keep the infection rate low in the at risk population and let it rage (with a flat curve) in the healthy population.
 
I’m hoping it has been more wide spread than originally believed. That’s obviously just a hunch though.

In my family my brother in law had around a dozen meeting with various Chinese investors in San Franciso very early in the year. After the meetings he developed the symptoms mentioned for the Wuhan virus. My sister and one of her son’s caught the same cold. So my brother in law and family believe there is a good chance they had the COVID 19. Of course there is no way to knowing for sure as they didn’t go to their doctors to be tested. There wasn’t as much concern about the disease then. Their symptoms were mild too.
 
Yea my sister in law is very healthy, no underlying conditions, just turned 40, was a professional runner and has been sick for 20 days now, but feels like she’s finally getting better. She’s had a wide range of symptoms from puffy eyes, then a little runny nose, then a dry persistent cough, then a sore throat, then some minor chills, then headaches, then a sore throat again, then body aches, then ear aches, then her lungs/chest hurting then no cough, then body aches again. Just the entire kit and caboodle except she doesn’t think she ever had a fever, and no linear line of the symptoms but the cough was the biggest one. When her chest/lungs started hurting about day 14 in she called her Dr back and they gave her azithromycin, which has helped with the pressure in her lungs. Her cough has stopped, lungs feel better but still having some minor body aches, sore throat issues. She’s been self isolating now for 20 days! I read that people can still shed the virus after being infected up to 36 days, I think there was a man in China who did…which is scary so these additional 30 day guidelines are very important.

Right now without antibodies it’s impossible to know what the reality is, because we have no idea how many have been infected. That means “experts” are flying blind, too. An undetermined number of those who pick up the virus being either asymptomatic or having mild symptoms that mimic some little respiratory thing and they don’t even get tested. That’s why estimates and predictions have been all over the map.
 
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In early/mid February, myself and a couple of friends got this really, really weird 'flu, a kind of “what on earth was that all about” experience (it’d have been ‘wtf . . .’ if we weren’t nice middle class people) because it was very different from what you’d expect and very individual, same mix of symptoms, different extent (I coughed less but got more exhaustion and joint pain but I’m ten years older than the others). Then the whole Covid-19 thing started in earnest, descriptions of the symptoms became better known and it became a case of “you don’t think what we had was . . . ?”

Then it emerged that one of us was not enough degrees of separation from the wife of a guy who’d spent several weeks in China and returned, at the end of January, with a very nasty 'flu. So now we think that it’s likely we’d had ‘mild’ cases of it.

If I had a ‘mild’ case of it, I can tell you that you really, really don’t want it. I may have just passed 50 but I’m very fit for my age with a low normal BMI etc, I spent two weeks in bed and it took me about three weeks after that before I was back to some kind of normal energy level.

[Fortunately, my husband was away for the early stages and our home has a kind of annex with a guest bedroom and utility room with a minor kitchen, I’d migrated to it and had spent most of the time watching box sets (falling asleep in front of box sets). Before he got back, I’d phoned him and declared myself a ‘bug heap’ and for him to keep away (not unusual when I’m ill) from the annex.]
 
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There are cases where people with the virus died due to underlying conditions.
 
That sounds tough. I heard people having really bad coughs, sore throats, and some of the mild symptoms like the malaise and loss of smell and taste. It does sound highly like the symptoms of the corona virus. You should have the antibody test when they become available. Glad you are feeling better.
 
Could very well be since those with underlying conditions seem to be most vulnerable against the Coronavirus.
 
mrad25 said:
You should have the antibody test when they become available. Glad you are feeling better.
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Thank you.

There are problems with depending on tests though, for example, I’ve been doing the shopping for a couple of elderly, vulnerable people and I’m terribly concerned about transmitting the virus as part of the physical process of shopping itself. It’s all very well doing all the payments ‘contactless’ and shopping 2 metres apart from everybody else but what if the virus was on their can of beans because the shelf-stacker is about to start feeling hot?

Transmission problems are going to remain until there’s a vaccine/anti-viral solution, even with ‘herd immunity’.
 
Kaninchen said:
There are problems with depending on tests though, for example, I’ve been doing the shopping for a couple of elderly, vulnerable people and I’m terribly concerned about transmitting the virus as part of the physical process of shopping itself. It’s all very well doing all the payments ‘contactless’ and shopping 2 metres apart from everybody else but what if the virus was on their can of beans because the shelf-stacker is about to start feeling hot?
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They should probably let the non perishables just sit in their bags for a couple days, which will likely deactivate any topical virus.

And just wash the perishables before refrigerating, then sanitize all surfaces and hands.
 
I’ve been wiping everything down with a bleach/water solution that comes in from the grocery stores or any other place for that matter. I know the grocery store workers are working hard with sanitizing everything but you never know who is touching what on the shelves with hands or even gloves. I also pull everything out if I can from the outer food containers and trash/recycle the plastic/paper containers outside the house. It’s a pain in the you know what but just taking precautions because I work as a Nurse with the elderly. You never know what you can track in from outside, although they “say” that transmission from surfaces is much more rare.
 
mrad25 said:
I know the grocery store workers are working hard with sanitizing everything but you never know who is touching what on the shelves with hands or even gloves.
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It seems to vary somewhat, some supermarkets seem to have done more training and put in more effort but we are in the learning stages after all.
mrad25 said:
It’s a pain in the you know what but just taking precautions because I work as a Nurse with the elderly.
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That’s the problem, I can’t be sure that they’re following guidance and, after my experience as a fit person, the infirm worry me a lot - and less than a micron is less than a micron.
 
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