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Discussion - Estimating the CFR for 2019-nCoV

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  • Discussion - Estimating the CFR for 2019-nCoV

    It's stupid to say Wuhan Coronavirus has just a 2% death rate. Most articles I read on the internet state something like this. 300 confirmed cases 6 deaths equals 2% death rate. This is ridiculous because a lot of the 400 just caught the virus and it might be two to three weeks before they die. Does anyone know how many of the original cluster of 15 discovered in Wuhan on Dec 31 2019 have died? I can't find that info on the internet. It would seem to me that the death rate should be calculated based on how many of the original 15 are now dead. This would be a whole lot more accurate that dividing the number of known fatalities from the disease by how many now have it. We need to know how long it takes for the patient to die after contracting the disease also to make half way accurate death rate assumptions. Does anyone know how many of the original 15 have died? Please include a link.
    Last edited by Laidback Al; January 24th, 2020, 12:31 AM. Reason: Change thread title for clarity

  • #2
    Even with such a small number any calculations are moot. Up to yesterday there were 17 deaths from an estimated 4,000 cases. That would put the low end cfr at .4%. Looking at the resolved cases, data is somewhat less available. 30 cases have been listed as cured and 18 fatal. Thus the cfr of resolved confirmed cases is 38%. The reality is somewhere between those extremes, but may also be even lower than .4% if the cases estimate gets remodeled. In other words - it's too early to call.
    Twitter: @RonanKelly13
    The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

    Comment


    • #3
      Wilderness Retreat, you are correct that current estimates for the Case Fatality Ratio (CFR) will not mirror the final CFR after this outbreak is over. The actual CFR for the 2019-nCoV will only be determined once all of the cases are reviewed and the all of the deaths have been tabulated.

      However, at this stage, early in the epidemic, people want information, even if it is wildly inaccurate. People feel more in control of their situation if they have some perspective on what might be ahead.
      http://novel-infectious-diseases.blogspot.com/

      Comment


      • #4
        Thanks Al and Ronan,
        38% on face value seems be the more plausible. I assumed that if 6 of the original 15 died already it would equate to 40% however the people that know the answer to this seem reluctant to tell us...probably for fear of mass panic. The fact that the CDC is not revealing this number scares the bejesus out of me.

        Comment


        • #5
          In general, it is worth remember that during the initial outbreak of MERS-CoV, many of the deaths were cases associated multiple chronic conditions which may have factored into their deaths. The actual CFR at this stage is not really important. What we need to watch for is that perfectly health individuals in the a prime of their life begin to die at an alarming rate.
          http://novel-infectious-diseases.blogspot.com/

          Comment


          • #6
            You're right but I'm still frustrated that no real stories are being submitted on the internet about the original 15. How many died so far? It would seem to me that if 1 died 10 days after they were diagnosed and 6 died 10 days after that, it would be reasonable to calculate that ever ten days the death toll jumps six fold. If this rate continues by April 30 2020 over 2 billion people will be dead from the virus. The fact that the number is being concealed is very disturbing.

            Comment


            • #7
              Actually i should have worded it: 1 dead after 10days, 6 dead after 20 days of original cluster discovered.

              Comment


              • #8
                The number is not being concealed to protect us from the truth. These governmental health agencies don’t have enough information about the overall dimensions of this epidemic. There are currently at least 17 reported deaths from China, among hundreds of infected individuals. At this stage, these underfunded health agencies are doing their best to contain the spread of this outbreak and then secondarily try to derive the epidemiological statistics. The most you can do now is continue to watch and see if the number of deaths relative to the number of new infections is rising at a faster rate.
                http://novel-infectious-diseases.blogspot.com/

                Comment


                • #9
                  It still doesn't make sense for such an easy statistic not to be revealed. It would seem to be the most valuable number for folks to use to try to decide whether to start home schooling their kids. It's criminal in my mind for these government agencies to withhold this information. You know they have it and it's not like that can't afford the ink. How many of the original cluster of 15 have died and what days did they die? So simple and requiring next to zero to print it and yet being kept a secret IMHO. These government agencies as you say "don't have enough information" but you know darn well they have the information I seek and others should be seeking too.

                  Comment


                  • #10
                    Your advice to watch the rate of death as compared got the number of new infections is a flawed way of doing math. It is valuable info but until we know the average days it takes from contraction to death, that number is meaningless or if not completely meaningless... still not an accurate predictor. The most accurate predictor is how many of the original cluster of 15 has died. Do you have a source that I might find these numbers? Doesn't it bother you that they are not being made public? 10,000,000 could be infected in a week but if it takes 3 weeks on average before a person dies from the virus, then it follows that the number we need is how many are dead after three weeks if the number of confirmed cases was only one million three weeks ago. Time to go to work on the farm. Thanks for your info and i Hope to hear back from you.

                    Comment


                    • #11
                      During the bird flu scare between 2005 – 2009 we discussed many ways about preparing for a pandemic. A real concern for each and everyone of us is ourselves and our family. At this stage, it is a still a localized epidemic in China. As of yesterday, all of the cases reported from countries other than China were imported from China directly. There have not yet been any cases of human to human transmission reported in these foreign countries.

                      I personally do not make prep decisions based on the statistics from other countries. At this time I am now reviewing my prep stockpile and being ready to shelter-in-place in the event that I start seeing human-to-human transmission in my own country.
                      http://novel-infectious-diseases.blogspot.com/

                      Comment


                      • #12
                        These were the 17 people who died, which I posted yesterday...I think it is too early to est. a CFR:
                        Government report:


                        Epidemic situation of new coronavirus infection on January 23, 2020

                        Published: 2020-01-23Source : Health Emergency Office

                        As of 24:00 on January 22, our committee had received a total of 571 confirmed cases of pneumonia of new coronavirus infection in 25 provinces (autonomous regions, municipalities) in China, including 95 severe cases and 17 deaths (all from Hubei Province).

                        A total of 393 suspected cases were reported in 13 provinces (autonomous regions and municipalities).
                          At 00:00 on the 22nd, 24 provinces (autonomous regions and municipalities) reported 131 new confirmed cases and 8 new deaths, of which 5 were males and 3 were females, with the exception of 1 except 53 years old, and the rest were 65 Elderly people over 5 years old and 5 cases over 80 years old have chronic and basic diseases such as postoperative cancer, liver damage, hypertension, coronary heart disease, diabetes, and Parkinson. 13 provinces (autonomous regions and municipalities) reported 257 new suspected cases. A total of 25 provinces (autonomous regions and municipalities) reported epidemics nationwide, and 4 provinces including Hebei, Liaoning, Jiangsu and Fujian were added.
                          Confirmed cases reported overseas: 1 case in Hong Kong, China, 1 case in Macau, 1 case in Taiwan, China; 1 case in the United States, 1 case in Japan, 3 cases in Thailand, and 1 case in South Korea.
                          At present, 5897 close contacts have been traced, 969 people have been released from medical observation, and 4928 people are still receiving medical observation.




                        Introduction of 17 deaths




                          1. Zeng XX, male, 61 years old, has a history of liver cirrhosis and myxoma. Fever started on December 20, 2019, with cough and weakness. She was hospitalized in the Department of Respiratory Medicine of Wuhan Puren Hospital on the 27th, transferred to the ICU on the 28th, was endowed with mechanical intubation on the 30th, and transferred to the ICU of Jinyintan Hospital on the 31st; Shock coma when entering. On January 1, ECMO support, anti-infection, anti-shock, and corrective acid symptomatic supportive treatment. At 20:47 on January 9, the heart rate of the patient suddenly became zero, and the ECMO blood flow rate decreased rapidly to 0.2 liters / minute. Rescue immediately. By 23:13, the heart rate was still 0, and clinical death was announced.
                          2. Xiong XX, male, 69 years old, was admitted to Wuhan Red Cross Hospital for 2 days due to fever and cough for 4 days, and exacerbated with dyspnea. On January 3, 2020, a tracheal intubation was connected to a ventilator to assist breathing. Myocardium The enzyme profile persists. Transferred to Jinyintan Hospital on January 4. Admission diagnosis was acute respiratory distress syndrome, respiratory failure, severe pneumonia, unconsciousness, pleural effusion, and aortic atherosclerosis. A CT scan of the patient's chest revealed large ground-glass opacities in both lungs. ECG: ST segment changes. After admission, he was treated with intensive care, ventilator-assisted breathing, prone ventilation, and symptomatic and supportive treatments such as CRRT, anti-infection, and liver protection. His condition did not improve. Septic shock, microcirculation failure, coagulation dysfunction, and internal environment disorders Sexual aggravation. At 00:15 on January 15, the patient's heart rate dropped to 0, and norepinephrine, epinephrine, pituitary, and dopamine were continuously pumped into the anti-shock therapy. The patient failed to recover spontaneous breathing and heartbeat until 0:45. The electrocardiogram at the bedside showed total cardiac arrest, and clinical death was declared.
                          3. Wang XX, male, 89 years old, has a history of hypertension, cerebral infarction, and cerebral softening. Due to urinary incontinence, she was referred to the Department of Urology, Tongji Hospital on January 5, 2020, and was transferred to the emergency department on January 8 due to drowsiness and unconsciousness. The examination revealed lung infection (viral pneumonia) and acute respiratory failure. On January 8th, a physical examination revealed that the patient had 77mmHg and showed hypoxia. Lung CT showed double lung patch shadow, bilateral pleural effusion, and pleural adhesion. Blood routine showed a progressive increase in white blood cell count and a low lymphocyte count. On January 9th, he was transferred to the outpatient clinic for emergency treatment and was given symptomatic supportive treatment. On January 13, the ventilator was assisted with positive pressure ventilation. Drowsiness occurred on January 14th. With ventilator-assisted ventilation, blood oxygen saturation fluctuated between 50% and 85%. Entered the Infectious Diseases Ward on January 15. Before transfer at 10:30 on January 18, Bp140 / 78mmHg, SPO2 85% under non-invasive ventilator-assisted ventilation. During the transfer, the patient suffered a respiratory arrest, continued rescue for 2 hours, and the treatment was invalid. The clinical death was announced at 13:37 on January 18, 2020.
                          4. Patient Chen X, male, 89 years old, had previous hypertension, diabetes, coronary heart disease, frequent premature ventricular contractions, and coronary stent implantation. The patient developed symptoms on January 13, 2020. There was no obvious inducement of asthma 4 hours before the consultation, and he felt dyspnea and no fever. On January 18, she went to the emergency department of Wuhan Union Medical College for treatment due to severe breathing difficulties. The patient was old and had a positive pathogenic examination of Chlamydia pneumoniae, no A and B flow, a new coronavirus positive, and CT of the lung: typical changes in viral pneumonia. At 23:39 on January 19, 2020, his condition deteriorated, and the rescue died.
                          V. Li XX, male, 66 years old, previously had COPD, hypertension, type 2 diabetes, chronic renal insufficiency, ascending aortic artificial aorta replacement in 2007, abdominal aortic stent placement in 2017, Cholecystectomy, multiple organ damage. The patient was admitted to Wuhan Iron and Steel General Hospital on January 16, 2020 for 6 days due to intermittent cough, headache, fatigue and fever. Chest CT on January 16 showed bilateral pneumonia, fibrosis of the left upper lung, and nodules of the left upper lung. Dyspnea occurred on January 17 and blood gas analysis revealed type 1 respiratory failure. Symptoms such as oxygen inhalation, anti-infection, anti-virus, and sputum treatment were given. At 10:10 on January 20, the patient suddenly reduced the finger pulse oxygen to 40%. He had been given non-invasive ventilator-assisted ventilation. The patient was again informed of severe respiratory failure, and asked again whether to undergo tracheal intubation. . At 10:35 on January 20, the condition deteriorated and the rescue died.
                          6. Wang XX, male, 75 years old, was admitted to Wuhan Fifth Hospital at 17:19 on January 11, 2020 due to fever with cough, sputum for 5 days, and vomiting for 2 days. Previous history of hypertension and hip arthroplasty. The admission temperature was 38.2 C, accompanied by fatigue, anorexia, cough, nasal congestion, dizziness, and headache. There was no obvious chills, chills, and sore muscles and joints. A CT of the chest revealed an interstitial lung infection.
                          After being admitted to the hospital, she was in critical condition and was given oxygen, anti-infection, anti-virus, phlegm, fever, and fluid rehydration as appropriate. The patient's condition worsened progressively, and she was transferred to the ICU on January 15 for mechanical ventilation. At 11:30 on January 20, the family members expressed their understanding of the condition and are now required to stop the ventilator and pull out the tracheal tube for observation. The tracheal intubation ventilator assisted breathing and CPR rescue are no longer required. He was pronounced dead at 11:25 on January 20.
                          7. Yin XX, female, 48 years old, had previous diabetes and cerebral infarction. On December 10, 2019, there was no cause of fever (38 C), sore body and fatigue, and cough and sputum gradually appeared. Anti-infective treatment in primary hospitals did not improve for 2 weeks. On December 27th, chest tightness and shortness of breath occurred. After the activity, it was obvious. Tongji Hospital was given non-invasive ventilation and conventional anti-infective treatment. The condition still worsened. On December 31st, she was transferred to Jinyintan Hospital and given symptomatic treatments such as high-flow oxygen inhalation of nasal catheter. Hypoxia condition has not improved significantly, and the condition is still worsening. On January 14, 2020, chest CT showed diffuse mechanized changes in both lungs, some with traction bronchiectasis, especially in the lower lungs. At 11:50 on January 20th, tracheal intubation was performed, and analgesia and sedation were given. The terminal oxygen saturation and blood pressure continued to decline, and then the heart rate decreased. Eventually, the rescue failed.
                          8. Liu XX, male, 82 years old, was admitted to Wuhan Fifth Hospital at 15:41 on January 14, 2020 due to chills and soreness in the whole body for 5 days. She was given ECG monitoring, non-invasive ventilator assisted breathing, anti-infection, anti-virus and symptomatic treatment. On January 19, he had unclear speech, and his left limb was weak. Considering a stroke, the disease progressed, and respiratory failure continued to worsen. At 00:30 on January 21, the patient's sudden heart rate decreased progressively, the heart sounds were not heard, the aortic pulse disappeared, and he was rescued immediately. The family members still refused mechanical ventilation of the intubation and continued rescue. The heart rate remained unrecovered. The clinic was announced at 1:18 death.                                                                
                          Nine, Luo XX, male, 66 years old, no inducement cough on December 22, 2019, mainly dry cough, no fever; December 31, chest tightness, shortness of breath, obvious after the activity, went to the central hospital for treatment; 2020 He was transferred to Jinyintan Hospital on May 2nd, and his imaging findings showed diffuse lung lesions with "white lung-like" changes. After admission, symptomatic treatment such as nasal high-flow oxygen was given. Refractory hypoxemia is difficult to correct. At 10:00 on January 12, the tracheal intubation ventilator assisted breathing, sedation, body temperature of 36.7 C, respiratory distress, and continued active antibacterial treatment. On the day, the oxygenation of the patient did not improve significantly. The inspiratory oxygen concentration of the ventilator had been reduced to about 50%, and the partial pressure of arterial oxygen was 80mmHg. The patient had a long course of disease, extremely poor immune function, and there was a risk of septic shock. At 9:50 on January 21, the rescue failed.
                          X. Zhang XX, male, 81 years old, was admitted to Wuhan First Hospital on January 18, 2020 due to fever for 3 days. Admission to the chest CT showed infectious lesions in both lungs. Considering viral pneumonia, the patient's renal function and pulmonary infection continued to worsen. On the morning of January 22, 2020, consciousness gradually appeared, and the respiratory heart rate and blood pressure continued to decline. He refused rescue measures such as chest compressions and tracheotomy. The patient stopped breathing at 10:56 on January 22 and declared clinical death.
                          Eleven, Zhang XX, female, 82 years old, has a history of Parkinson's disease for 5 years, orally takes Medopa. Onset on January 3, 2020, he was diagnosed with "viral pneumonia and respiratory failure" on January 6 at the Integrated Traditional Chinese and Western Medicine Hospital of Hubei Province due to "fever, cough, chest tightness and fatigue". He was transferred to Wuhan Jinyintan Hospital on January 20, and his condition was progressively worsened. On January 22, he was treated with tracheal intubation ventilator to support treatment, and his respiratory failure did not improve. On January 22, 2020, he was declared invalid by rescue at 18:00. .
                          Twelve, week XX, male, 65 years old, January 11, 2020 due to shortness of breath accompanied by fatigue for 3 days, increased 3 days into Wuhan First Hospital. At the time of admission, the patient had difficulty breathing, chest tightness, shortness of breath, and acute illness. He was diagnosed with severe pneumonia, acute respiratory failure, and liver damage. At 19:00 on January 21, a decrease in heart rate and blood pressure, disappearance of light reflection by both pupils, and immediate treatment of tracheal intubation, artificial chest compressions, cardiac strengthening and other treatments. At 19:54, the autonomic rhythm was not restored, and clinical death was declared.
                          Thirteen, Hu XX, female, 80 years old, became ill on January 11, 2020. He was admitted to China Resources Wuhan Iron & Steel General Hospital on January 18, 2020 due to fever, cough, wheezing, and dyspnea. He was transferred to Wuhan Jinyintan Hospital on January 20, 2020 because of a new coronavirus positive. He has a history of hypertension for more than 20 years, a history of diabetes for more than 20 years, and a history of Parkinson's disease. After admission, she was in critical condition, intensive care, anti-infection, ventilator-assisted breathing, and symptomatic supportive treatment. However, the patient's condition did not improve, persistent hypoxemia, unconsciousness, mechanical ventilator-assisted breathing, invalidated after rescue at 16:00 on January 22, 2020, and clinical death was declared.
                          14. Lei XX, male, 53 years old. He had been treated in a community hospital for fever in early January, but it was not effective after a few days of treatment, and fever, cough, and chest tightness worsened. On January 13, 2020, he went to the emergency department of Tongji Hospital. CT showed bilateral lung infection and respiratory failure. He was critically ill on January 18 and was treated with non-invasive ventilator support. On January 20, 2020, he was transferred to Wuhan Jinyintan Hospital for isolation and treatment. . He was admitted to hospital with anti-infection and anti-shock, ventilator-assisted respiratory support treatment, and the patient's condition did not improve. Respiratory failure continued to worsen. At 4 o'clock on January 21, the rescue was invalid, and clinical death was declared.
                          XV. Wang XX, male, 86 years old, was admitted to Xinhua Hospital on January 9, 2020 due to fatigue for one week. No fever, diabetic hypertension, and colon cancer 4 years after surgery. After admission, CT of the lungs showed multiple ground glass shadows in both lungs, obvious hypoxia, difficulty in eating, rapid breathing, and lethargy. The family refused to be intubated and only inhaled oxygen through the nose. At 17:50 on January 21, 2020, the heartbeat stopped breathing and declared clinical death.
                          16. Yuan XX, female, 70 years old. On January 13, 2020, the city's No. 1 Hospital was owing to the continued high fever. At the time of admission, he had blurred consciousness, acute illness, weakened heart sounds, and thick breathing sounds in both lungs. Imaging results showed severe pulmonary infection. Consider severe pneumonia with severe respiratory failure. That is, symptomatic treatment such as active anti-infection and oxygen inhalation is given, but respiratory failure is difficult to correct. The patient was pronounced dead on January 21, 2020 due to respiratory failure.
                          17. Zhan XX, male, 84 years old. The patient was admitted to the Fifth Hospital of the City for 3 days due to fever, cough and wheezing at 17: 4 on January 9, 2020. Previous history of chronic bronchitis, unstable angina pectoris, coronary stenting, hypertension, gastrointestinal bleeding, renal insufficiency, hyperlipidemia, hyperuricemia, lacunar cerebral infarction. Due to the exacerbation of the disease and persistent high fever, the patient was transferred to the ICU on January 18th for anti-infection and symptomatic supportive treatment. At 10:16 on January 22, the patient stopped breathing, his heart rate gradually slowed down, and clinical death was announced at 10:52.


                        http://www.nhc.gov.cn/yjb/s3578/2020...ed2e3c8a.shtml

                        Comment


                        • #13
                          Shiloh,
                          thanks so much for posting the records of the first 17 fatalities. I noted 4 of these 17 had symptoms prior to Jan 1. Dec. 31 was the day that the WHO stated that a cluster of 15 with the virus had been identified. In simple terms not factoring in age and health before each of these patients caught the virus, 4 out of 15 died. That translates into 27% to 28% death rate. These 4 individuals survived longer than the average patient after developing symptoms hence the average time from getting the symptoms to dying is probably not 27% maybe as low as 20% (I didn't do the math). I assume most of the patients were sick for some days before being put in the hospital and indeed this story does mention some of the days patients were sick before going to the hospital but other cases are not so clear. Roughly speaking the average of all victims that died from the virus, died was about 16 to 18 days after symptoms began. If we use 17 days it gives us a starting point to reverse calculate the percentage of people dying. For example if there were 400 cases detected on the day that 17 people died, we shouldn't divide 400 into the 17 deaths to find the percentage of deaths. We should go back 17 days, look at the number of confirmed cases at that time and divide that number into 17. I don't know it off the top of my head but I will research after this post, to get a reasonably close death rate.

                          Comment


                          • #14
                            On Jan 5, 2020....59 cases of Wuhan Corona Virus were confirmed. 17 days later (the average amount of days that patients took to die) the fatalities totaled 17. 17 divided by 59 translates roughly into a death rate of almost 29%. Between this mathematical fact and the fact that of the first 15 cases discovered 27% have already died and more in that group might still die, I think it's a pretty realistic expectation that the death rate could easily be between 25% and 30%. If just 10% of the population dies, can you imagine the disruptions in society that will occur? People won't go to work, movies, sporting events, travel etc... truckers won't deliver food. Good luck to all. The first case that reaches Hawaii will be the day we as a family will make some drastic changes. We already grow enough food to survive, but we'll be taking our son out of school and other safety measures. Good luck to all and thanks for helping me with my question.

                            Comment


                            • #15
                              This was the 18th death:



                              Second confirmed case of new type of coronavirus pneumonia confirmed in Hebei, dead after rescue
                              Beijing News Express According to the Hebei Provincial Health and Health Committee's report, on January 23, Hebei was diagnosed with the second case of pneumonitis infected with a new coronavirus.



                              Patient Chen, male, 80 years old, from Nanpi County, Cangzhou City. He had lived in Wuhan for more than 2 months. After returning to Nanpi County, he developed chest tightness and dyspnea. He was admitted to the hospital for isolation and treatment, accompanied by hypertension, chronic bronchitis, and lung qi. Swelling and other basic diseases, the rescue died on January 22 and died. On January 23, the provincial and municipal expert groups confirmed the confirmed cases based on a comprehensive assessment of the new coronavirus nucleic acid test results and medical record data. As of 17:00 on January 22, all 76 close contacts have taken isolated medical observation measures. There are no abnormalities such as fever.



                              Editor Jia Congcong
                              http://www.bjnews.com.cn/news/2020/01/24/678676.html


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