Antibody Tests Point to Lower Death Rate for the Coronavirus Than First Thought
npr.org
npr.org
> "The current best estimates for the infection fatality risk are between 0.5% and 1%," says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security.
> That's in contrast with death rates of 5% or more based on calculations that included only people who got sick enough to be diagnosed with tests that detect the presence of virus in a person's body.
> And the revised estimates support an early prediction by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a leading member of the White House coronavirus task force. In an editorial published in late March in The New England Journal of Medicine, Fauci and colleagues wrote that the case fatality rate for COVID-19 "may be considerably less than 1%."
Unless “First Thought” simply refers to people who are unfamiliar with how figures such as CFR are calculated. I’ve been seeing the 1% number repeated by scientific figures for months.
Here is a Medium article from a month ago saying the same https://medium.com/@gidmk/what-is-the-infection-fatality-rat...
> From the 13 studies — including 4 models, 4 observational studies, and 5 pre-prints of one kind or another — there was an overall estimate of 0.75% infection-fatality rate, with the 95% confidence interval ranging from 0.49% to 1.01%.
> Modeling is a helpful tool to try to account for missed cases, such as those that are mild cases potentially missed in current surveillance activities, and the time lag between onset and death. Using an estimated number of total infections, the Infection Fatality Ratio can be calculated. This represents the fraction of all infections (both diagnosed and undiagnosed) that result in death. Based on these available analyses, current IFR estimates range from 0.3% to 1%. Without population-based serologic studies, it is not yet possible to know what proportion of the population has been infected with COVID-19.
https://www.who.int/docs/default-source/coronaviruse/situati...
"Using an estimated number of total infections, the Infection Fatality Ratio can be calculated. This represents the fraction of all infections (both diagnosed and undiagnosed) that result in death. Based on these available analyses, current IFR estimates range from 0.3% to 1%."
And then:
"Without population-based serologic studies, it is not yet possible to know what proportion of the population has been infected with COVID-19."
So even without the population-based antibody (that is what "serologic" means) data, and only using the Chinese data "as of 11 February" available to the WHO the estimate was quite good. The range depends of course also on the age structure of the population -- the countries with much more young people would have closer to the lower number, the others closer to the higher.
1) Edit: the parent post quoted the same segment later too
https://www.bbc.com/news/world-asia-51938035
There have been some doubts regarding the accuracy of later numbers:
https://fortune.com/2020/04/24/china-coronavirus-data-real-l...
https://www.medrxiv.org/content/medrxiv/early/2020/05/18/202...
Other reports were using CFR, which isn't alarmism.
Politically it's also easier to make changes when one highlights the dangers. Not alarmist but certainly manipulative. Fear works and by being alarmed we have saved lives.
By quoting 5%, the author of the story is conflating case fatality rates (percentage of diagnosed people) with death rates (percentage of infected people).
The only story here is that a surprising fraction of the media and policy makers are completely incapable understanding basic statistics.
https://www.cbsnews.com/news/cdc-warns-that-half-of-coronavi...
Once one starts thinking about indirect deaths, especially those caused by attempts to contain the virus, the picture becomes much murkier. And of course, all of this is being done under circumstances of grave uncertainty.
We'll likely never really know. My guess, though, is that the "lockdown" is probably working against us, at least at this date. And clearly some containment measures, like moving infected people into care homes for the old and disabled, appear in retrospect to have been disastrous.
In the US, it is spreading uncontained, because we don't test and trace in any meaningful way. The question is when do we confront that reality and stop pretending otherwise?
It appears people's acceptance of "flattening the curve" for ventilators has morphed into waiting for a vaccine, which normally takes 18 months.
As I've said before, the US needs to test and trace just nursing homes/hospitals and stop the lockdown otherwise, since the mortality rate for younger people is near zero. The US economy is not setup for tens of millions of long-term unemployed people.
In the case od Newsom's reopening slides, I'd like to see dates attached to each slide instead of non-specific "when adequate testing is available", which may never be true in the US. (By omitting dates, Newsom preserves his White House run at the expense of California residents.)
Several Asian countries csn do 100% of the tests they need because corona was not "uncontained."
The US would need to be able to do 10-50 million tests per day to get there, plus tracing. Hope is not a strategy.
There are roughly 110M people in that age group in the U.S. so that would mean 21000 deaths if the virus would spread as widely throughout the U.S. as it has in NYC (which is estimated to be around 25% of the population).
21000 deaths is not "near zero", nor is the population aged over 45 primarily found in nursing homes.
I'm not sure what your contrived narrative is, but actually it is near zero, far less than several other causes of death. (The annual mortality rate is over 1,000 per 100,000, so 19 per 100,000 is a round-off error.)
"He noted that between January and April in 2018, more than 234,000 people in the United States died of heart disease and nearly 199,000 died of cancer. So far during the coronavirus pandemic, there have been about 16,700 Covid-19 deaths in the United States, according to the latest data from Johns Hopkins University."
https://www.cnn.com/2020/04/10/health/coronavirus-not-leadin...
Even auto deaths are higher at 37,461 in 2016:
"For 2016 specifically, National Highway Traffic Safety Administration (NHTSA) data shows 37,461 people were killed in 34,436 motor vehicle crashes, an average of 102 per day."
https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in...
There is nothing the US can do to get to zero deaths from corona, so a more pragmatic public health policy is needed than "lock 300 million people down for years."
In any case, these tactics, namely cherry-picking, callousness towards human life, and flippant dismissal of the points of others, make it very hard to have a discussion here. It does not seem like the posts are being made to debate but instead pummel into submission.
Finally, there have been over 100,000 Covid-19 deaths in the US. Each one of them a human who could have not died from Covid-19.
Within age cohorts, COVID’s death rate is approximately the same as the chance of dying from other causes in the next 12 months.
Put another way, you should be less worried about COVID than you are about dying of something else before Jun 2021.
Is that not significant?
It would be around the murder rate in Cincinnati (if all victims were 18-45 and the infection rate was equal to NYC)
I don’t have a narrative - I don’t pretend to know what the best course of action is.
But I am pointing out some of the glaring factual errors repeatedly made by people who are dismissive of the severity of this disease.
In particular, the whole-population rate is <= 0.5%. (International agencies and other governments say 0.5%, the CDC says (1-.3)*.4%).
That includes asymptomatic and undiagnosed people. Case fatality rates only include diagnosed cases. Clearly, if you are diagnosed with the virus, you are more likely to die from it than an asymptomatic person, or a person with minor symptoms that doesn’t bother to call a doctor.
It is true that, at 100% infection rate, it would be the leading cause of death this year. The thing is, it’s a one time hit to life expectancies, so it’s not really comparable to the other risks.
That means it can be the number one cause of death, even though 99.5% of the people that catch it will recover and die of something else.
No. There were 652 confirmed deaths and 129 probably deaths in NYC in the 18-44 age group. If there are 3 million people in that age group in NYC (my estimate, look up if you want the exact number) that gives a confirmed death rate of 21.7 per 100k and confirmed + probable death rate of 27 per 100k. Close enough.
But I'm not going to debate inaccurate corona statistics with a pedant on HN.
The mortality rate for young people is less than 1% - low for a pandemic. Ebola is 50% and up, and recurs every other year.
> it’s a one time hit to life expectancies
For people who actually get acutely sick from corona. I agree the 5% or so of people who get acutely ill will have a shortened lifespan, but there's no data for the other 95%.
There's a presumption there that everyone is equally susceptible to the virus at any given viral load. There are likely people whose bodies are inhospitable enough to the virus that it never reaches a titer enough to trigger any sort of test. What percentage of the population is this? 1%? 20%? 60%?
If it were allowed to spread uncontained, death tolls would certainly be higher. But can we really say "several times"? I'm not sure. Maybe, 1x more, on account of if california were as bad as new york. But still, we don't really know.
Apparently the antibody tests suck wrt accuracy.
[0] - https://www.cbsnews.com/news/cdc-warns-that-half-of-coronavi...
Here's what I have posted here exactly a month ago, referring to the article from Guardian from April 4th:
--
The "false positives" are "especially significant with these antibody tests, so with the low numbers of positives it's extremely important to evaluate if the claimed values are more than noise artifacts of the tests themselves. It is also important to be aware of the scenarios for which the use of the apparent test results is not reasonable.
Moreover, here's what happened in the UK a few weeks ago:
https://www.theguardian.com/world/2020/apr/09/uk-government-...
"None of 3.5m home tests ordered have so far been accurate enough to detect coronavirus immunity"
UK got 3.5 million(!) unusable antibody tests.
https://www.bmj.com/content/369/bmj.m1449
"John Newton, Public Health England’s director of health improvement, said:
"A number of companies were offering us these quick antibody tests, and we were hoping that they’d be fit for purpose, but when they got to test, they all worked but were just not good enough to rely on.
“The judgment was made [that] it’s worth taking the time to develop a better antibody test before rolling it out, and that is what the current plan is.”
"Newton told the committee that the tests trialled so far had lacked sufficient sensitivity to identify people who had been infected. “We set a clear target for tests to achieve, and none of them frankly were close.”"
--
Since then, Roche actually made an antibody test which according to them, in laboratory conditions, doesn't have false positives. I haven't seen the independently done confirmation, but personally, I wouldn't use anything else.
There are still a lot of bad antibody tests in circulation.
Also, the estimate that the death rate is close to 1% was known since... seems like forever in this times: on Diamond Princess ship there were a lot of old people and the death rate was under 2% so adjusting to the population structure (where there are more younger people than on the ship) it was obvious even then:
https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_D...
But it was also obvious that it's something like 10 times more deadly than flu.
What was also known is that once the health system is overwhelmed the death rate would be much more than 1%, and that is also what was observed in Italy. And that is the reason for having the goal of "flattening the curve": not allowing to have more cases than the whole system could handle.
https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scena...
Their best guess scenario is 35% asymptomatic. Of the symptomatic the rate is 0.05% for those under 50. All ages is 0.4%.
Unless this is revised substantially downward as we get more data, there is no clear return to normalcy without a vaccine.
By all means, everyone should try and find ways to thrive inside, and wear a mask when they go out. I see people propose that in-person social activity should just be forbidden or strongly discouraged until a vaccine comes - that would be a severe and harmful overreaction.
It's surely not. Even the "normal" averages include people who have big problems. If you are an individual who is not in the group of people with big problems, and if the virus can make you sick, your risk gets up significantly, as soon as you risk being infected. Because, for example, you can know that you personally aren't in the risk group of people tending to commit suicide.
The currently known estimate of "people who get the virus and have no recognizable symptoms during all phases of infection" is just around 20% across all the age groups. Knowing that younger than 45 aren't being only 20% of population, it doesn't sound so trivial.
The same (that one can know that catching virus increases risk) is for some of the people with big problems, even if they are young: it is known that some of those (who have some big problems) are hit much stronger by the virus, e.g. those with diabetes: without the virus they can safely expect to live for decades more, with the virus, they can immediately expect much less. And no, not only overweight people have diabetes.
And the above analysis is only for young people. But being old enough (and that is even for those being above 45) and catching the virus increases the risks of permanent health damage or death many times, according to all statistics we have.
Finally, no age group can expect to have "no problems" as soon as the health system collapses, and that is why the strict measures were introduced in most of the world -- it is a reasonable goal to avoid that much.
The health system does need to be prevented from collapsing, but that can be achieved with measures much less severe than "no socializing". Strict lockdowns may have been necessary before, but they're not necessary now, which is why they're being rolled back pretty much across the globe.
No again, as I've argued, you just can't use averages across the whole countries to estimate individual increase of risk so simple as you suggest, as your statement was
"on the individual level, it's about the same risk of death as you face over a normal year."
Everybody knows his own risk, and it's surely not "2 normal years" for most of the people. I've given the examples for somebody who is young but not suicidal, for somebody who is young, fit and with diabetes, for somebody who is fit but older etc. What you argue is plainly wrong calculation:
According to your logic, if the average number of children per grown up person in my country is 1.2 I should personally have 1.2 child. It doesn't work that way. In reality, one person knows that he will never have children, another that she will have 2 etc.
Edit: responding to the reply below this writing: "What I see people saying" .. "That every single person in the country should live a life of isolation for the next year to minimize the chances they get the coronavirus." -- who is claiming that and where actually? And even if you "see that" somewhere (not on HN I'd guess) it doesn't change the fact that you claimed an "individual risk" of "2 years" for practically everybody, which is, as I believed I've proven up to now, obviously wrong.
What I see people saying is that the average Joe, even the 35 year old peak of his health Joe, is at extreme risk. That every single person in the country should live a life of isolation for the next year to minimize the chances they get the coronavirus. I don't think there's any plausible risk weighting where that's true.
Our only advantage is a higher level of preparedness in terms of testing, tracing and standards of care for the sick.
That should allow us a greater level of freedom than at the height of the lockdown, especially in less hard hit areas if testing and tracing can be relied upon to catch flare ups early.
All that doesn't change the fact that 100% business as usual will eventually require either a vaccine, an effective treatment, or a large number of deaths.
EDIT: Can't believe I have to say this here, but the downvote button is not a "dislike". If you disagree, engage in a discussion please!