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Discussion - Estimating the CFR for 2019-nCoV

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  • #16
    Shiloh, thanks
    Are you worried yet? I noticed that the older the person the sooner they died on average. I wonder how many young people in the original 15 are still sick.

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    • #17
      Am I worried? On a scale of 1 to 10, I am about a 6 or 7...and am calm about the current situation and try to keep myself and others informed. Still too early to tell where this is heading. I am not in China, which would be a totally different story.

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      • #18
        Originally posted by WildernessRetreat View Post
        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.
        But for every hospitalized confirmed cases there could be 10 or a 100 cases of people who just got the sniffles, never got hospitalized and never got tested. The most recent modelling suggested that 4,000 people were infected by Jan 18th. https://www.imperial.ac.uk/mrc-globa...n-coronavirus/ This would cut your calculated cfr by one or two orders of magnitude. I also note that there was not an exponential increase in fatalities reported today. I'm not in lockdown and I think that we still have a couple of weeks before that decision needs to be made.
        Twitter: @RonanKelly13
        The views expressed are mine alone and do not represent the views of my employer or any other person or organization.

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        • #19
          WHO discusses here how they estimated the case fatality ratio of SARS in 2003:

          Update 49 - SARS case fatality ratio, incubation period

          7 May 2003

          Case fatality ratio

          WHO has today revised its initial estimates of the case fatality ratio of SARS. The revision is based on an analysis of the latest data from Canada, China, Hong Kong SAR, Singapore, and Viet Nam.

          On the basis of more detailed and complete data, and more reliable methods, WHO now estimates that the case fatality ratio of SARS ranges from 0% to 50% depending on the age group affected, with an overall estimate of case fatality of 14% to 15%.

          The likelihood of dying from SARS in a given area has been shown to depend on the profile of the cases, including the age group most affected and the presence of underlying disease. Based on data received by WHO to date, the case fatality ratio is estimated to be less than 1% in persons aged 24 years or younger, 6% in persons aged 25 to 44 years, 15% in persons aged 45 to 64 years, and greater than 50% in persons aged 65 years and older.

          A case fatality ratio measures the proportion of all people with a disease who will die from the disease. In other words, it measures the likelihood that a disease will kill its host, and is thus an important indicator of the severity of a disease and its significance as a public health problem. The likelihood that a person will die of SARS could be influenced by factors related to the SARS virus, the route of exposure and dose (amount) of virus, personal factors such as age or the presence of another disease, and access to prompt medical care.

          Many factors complicate efforts to calculate a case fatality ratio while an outbreak is still evolving. Deaths from SARS typically occur after several weeks of illness. Full recovery may take even longer. While an epidemic is still evolving, only some of the individuals affected by the disease will have died or recovered. Only at the end of an epidemic can an absolute value be calculated, taking into account total deaths, total recoveries and people lost to follow-up. Calculating case fatality as the number of deaths reported divided by the number of cases reported irrespective of the time elapsed since they became ill gives an underestimate of the true case fatality ratio.

          One method of overcoming this difficulty is to calculate the case fatality ratio using only those cases whose final outcome – died or recovered – is known. However, this method, when applied before an outbreak is over, gives an overestimate because the average time from illness onset to death for SARS is shorter than the average time from illness onset to recovery.

          With these methods, estimates of the case fatality ratio range from 11% to 17% in Hong Kong, from 13% to 15% in Singapore, from 15% to 19% in Canada, and from 5% to 13% in China.

          A more accurate and unbiased estimation of case fatality for SARS can be obtained with a third method, survival analysis. This method relies on detailed individual data on the time from illness onset to death or full recovery, or time since illness onset for current cases. Using this method, WHO estimates that the case fatality ratio is 14% in Singapore and 15% in Hong Kong.

          In Viet Nam, where SARS has been contained and measurement is more straightforward, case fatality was comparatively low, at 8%. One explanation for this is the large number of total cases that occurred in younger, previously healthy health care workers.
          ...
          https://www.who.int/csr/sarsarchive/2003_05_07a/en/
          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
          -Nelson Mandela

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          • #20
            China’s National Health Commission now states 25 deaths

            https://abcnews.go.com/Health/wireSt...eadly-68468998

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            • #21
              The above issues are of course part of the uncertainty. But the big elephant in the room is the unknown denominator of how many undiagnosed cases there have been. It's obvious that more than just the 600 or so confirmed cases have been infected. Is it twice than number? Then this virus might have the CFR of SARS. Is it 6000? Then this virus probably has about the CFR of the 1918 pandemic virus. Is it 600,000? Then this virus might have a CFR closer to that of seasonal flu.

              One good sign is that we're not seeing family clusters of fatalities like we did for SARS, Ebola, and H5N1.

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              • #22
                Originally posted by alert View Post
                The above issues are of course part of the uncertainty. But the big elephant in the room is the unknown denominator of how many undiagnosed cases there have been. It's obvious that more than just the 600 or so confirmed cases have been infected. Is it twice than number? Then this virus might have the CFR of SARS. Is it 6000? Then this virus probably has about the CFR of the 1918 pandemic virus. Is it 600,000? Then this virus might have a CFR closer to that of seasonal flu.

                One good sign is that we're not seeing family clusters of fatalities like we did for SARS, Ebola, and H5N1.
                Alert, thanks for reminding us that we don't known what we don't know. You point about watching for deaths among among small clusters is a good one. It appears that most clusters of H5N1 from 1997 to about 2014 were small, about 3 persons per cluster. However, the CFR for these clusters is about .52. Whether these numbers are applicable to the 2019-nCoV outbreak is unknown at this time.
                http://novel-infectious-diseases.blogspot.com/

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                • #23
                  In addition to confirmed deaths, there have likely been pneumonia deaths from corona virus that were never tested. I’m particularly concerned about the incubation period and H2H transmission. Even if the cfr is low, if it transmits efficiently, there could be large numbers of deaths globally.
                  "I know God will not give me anything I can't handle. I just wish that He didn't trust me so much." - Mother Teresa of Calcutta

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                  • #24
                    As deadly as the the 1918 influenza pandemic was, it only had a CFR of a little over .025, 2.5%. see: https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article

                    Even a low CFR can have a extremely large impact if enough people become infected.
                    http://novel-infectious-diseases.blogspot.com/

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                    • #25
                      A novel coronavirus (2019-nCoV) causing severe acute respiratory disease emerged recently in Wuhan, China. Information on reported cases strongly indicates human-to-human spread, and the most recent information is increasingly indicative of sustained human-to-human transmission. While the overall severity profile among cases may change as more mild cases are identified, we estimate a risk of fatality among hospitalised cases at 14% (95% confidence interval: 3.9–32%).

                      full article


                      https://www.eurosurveillance.org/con...#html_fulltext

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                      • #26
                        These were some more deaths as of yesterday:
                        105 New Pneumonia Cases Infected by New Coronavirus in Hubei Province

                        According to the CCTV News client news, from 00:00 to 24:00 on January 23, 2020, 105 new cases of pneumonia with new coronavirus infection were added in Hubei Province (70 new cases in Wuhan, 7 new cases in Jingmen City, and Jingzhou City 2 cases were newly added, 22 cases were found for the first time in Xiaogan City, 2 cases were found for the first time in Xiantao City, 1 case was found for the first time in Yichang City, and 1 case was found for the first time in Shiyan City). There were 7 new deaths in the province (including 6 in Wuhan and 1 in Yichang). Three cases were cured and discharged from Wuhan.



                        As of 24:00 on January 23, 2020, Hubei Province has reported a total of 549 cases of pneumonia caused by new coronavirus infection (including 495 in Wuhan, 22 in Xiaogan, 12 in Huanggang, 8 in Jingzhou, 8 in Jingmen, 2 cases in Xiantao City, 1 case in Yichang City, 1 case in Shiyan City), 31 cases have been cured and 24 cases have died. At present, 494 patients are still being treated in the hospital, of which 106 are critically ill and 23 are critically ill. They are all under isolation treatment at designated medical institutions. A total of 3,653 close contacts have been tracked, 877 medical observations have been lifted, and 2776 people are still receiving medical observations.


                        Zhao Moumou, female, 85 years old, had orthostatic hypotension, hypothyroidism, systemic osteoarthritis, ischemic necrosis of the femoral head, etc. On November 26, 2019, because of intermittent palpitation for 1 year, and his symptoms worsened, he was admitted to the Provincial Hospital of Traditional Chinese Medicine for treatment. On January 21, 2020, the patient's condition further deteriorated, and the rescue was invalid at 18:50 and he was declared dead.


                        Yin Moumou, female, 69 years old, had no previous special medical history. She was admitted to Wuhan Union Medical College Hospital on January 14, 2020 due to "fever, cough and muscle soreness". Later, due to the detection of a new type of coronavirus nucleic acid positive, she was transferred to Wuhan Jinyintan Hospital on January 20, 2020. After admission, she was in critical condition, was in intensive care, was given high-flow oxygen, and her condition did not improve. On January 22, 2020, nocturnal respiratory failure aggravated, and clinical rescue was announced at 3:25.


                        Li, male, 36 years old, was admitted to the hospital on January 9, 2020 for "fever with fatigue for 3 days". At the time of admission, the patient had a high fever. A chest radiograph showed bilateral lung infection, elevated white blood cells, and was diagnosed with viral pneumonia. He was given symptomatic treatment of oxygen inhalation, anti-virus, anti-infection, phlegm elimination, and anti-inflammatory treatment. At 12:20 on January 23, a sudden decrease in heart rate, cardiac arrest, and blood pressure decreased. At 13:45, a cardiac arrest occurred and clinical death was announced to the patient's family.


                        Zhang Moumou, male, 73 years old, was admitted to the Intensive Care Unit of the Western Union Hospital on January 5, 2020 because of "fever, cough, and dyspnea for 7 days." Admissions were mainly diagnosed with pulmonary infection and respiratory failure. Mechanical ventilation for tracheal intubation was performed on January 16. On January 22, the family signed off to abandon the rescue, pulled out the tracheal intubation, and stopped using the ventilator. Clinical death was announced at 18:23 on January 22.


                        Shao Moumou, female, 70 years old, became ill on January 18, 2020, and was admitted to Wuhan Youfu Hospital for Respiratory Medicine due to "fever for 3 days". Admitted to the hospital to diagnose pulmonary infection and schizophrenia. Admitted to the hospital for oxygen, anti-infection, phlegm and asthma, antiviral and other symptomatic supportive treatment. At 22 o'clock on January 22, the patient's condition worsened. At 0:25 on January 23, a sudden bleeding from the mouth and loss of consciousness occurred. At 0:45, the rescue was invalid and clinical death was announced.


                        Mr. Liu, male, 81 years old, had previous coronary heart disease, hypertension, diabetes and tuberculosis. On January 13, 2020, he was admitted to the hospital with a 4-day fever. At 6 o'clock on January 18, the patient suddenly had dyspnea, and was continuously given oxygen and ECG monitoring. On January 21, the patient began to experience a decrease in heart rate, and oxygen saturation and blood pressure could not be measured. At 9:38, clinical death was declared due to various diseases such as viral pneumonia, multiple organ failure, septic shock, and pulmonary infection.


                        Zhang Moumou, female, 65 years old. On January 13th, he was admitted to the third department of Yuan'an County Traditional Chinese Medicine Hospital on his own. He was diagnosed with "primary bone marrow fibrosis and pulmonary infection" on admission. There was no remission after anti-infection treatment. On January 15th, he was transferred to the city center hospital to be admitted to the hospital's hematology department for treatment. After being consulted by the city expert group on January 19, he was transferred to the third city hospital for isolation and treatment. On January 23, the Hubei Provincial Center for Disease Control and Prevention had a positive nucleic acid test result, and a new coronavirus-infected pneumonia was confirmed. At 18:00 on January 23, a sudden decrease in finger pulse oxygen and respiratory arrest occurred, and clinical death was announced at 18:26 after rescue.


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                        • #27
                          The Lancet : 41 known cases symptoms chart:

                          https://mobile.twitter.com/TheLancet...19987746312193

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                          • #28
                            I was beginning to be concerned by the fact that most of the cases are still ill, but according to the above link, only 7 of the first 41 cases are still ill (with 6 deaths and 28 recoveries). The reason that a majority of cases nationwide (or worldwide?) appear to still be ill seems to be that most cases have more recent onset. Six deaths in 34 cases with known outcome would be a 18% CFR, which is right around what SARS had in places like Hong Kong or Toronto, but it's obvious that those 41 are just the most severe cases found to that point. How many human infections would it take to reduce those six deaths to a more reasonable CFR? Probably two orders of magnitude (i.e. it would require those cases to be the most severe of 3,400 human infections)….

                            Let's not also forget that in 2003 SARS, there were a few cases with very long hospitalizations (>2 months) that survived, usually the result of complications such as hospital-acquired co-infections. When the July 14, 2003 blackout hit Toronto, more than a month after the isolation date of the last case, something like 6 or 7 patients were still ill in isolation. It's not clear what would happen to such cases in the event of a pandemic where that degree of care was not available to most.

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                            • #29
                              Originally posted by alert View Post
                              I was beginning to be concerned by the fact that most of the cases are still ill, but according to the above link, only 7 of the first 41 cases are still ill (with 6 deaths and 28 recoveries). The reason that a majority of cases nationwide (or worldwide?) appear to still be ill seems to be that most cases have more recent onset. Six deaths in 34 cases with known outcome would be a 18% CFR, which is right around what SARS had in places like Hong Kong or Toronto, but it's obvious that those 41 are just the most severe cases found to that point. How many human infections would it take to reduce those six deaths to a more reasonable CFR? Probably two orders of magnitude (i.e. it would require those cases to be the most severe of 3,400 human infections)….
                              .
                              Serious question - wouldn’t the CFR increase there are more deaths due to unavailable respirators..etc. when health services are overrun? Seems an increase of infections starts to increase CFR at some point when finite resources are included.

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                              • #30
                                On Jan 10, 2020 Confirmed cases was 41... From records of the first 17 deaths, the average days from contraction to death was about 17 days...On Jan. 25, fifteen days after Jan 10 when 41 cases were confirmed, 41 were reported dead from the virus. We know it's not killing 100% of the confirmed cases but this also tells us that a lot more people are sick than are being listed as confirmed carriers. At one time I was under the impression that there were only 15 confirmed in the original cluster. I can't find that story anymore. Most stories say there were 27 cases of pneumonia on Dec. 31 2019 in Wuhan. (i couldn't find out how many of those cases were confirmed Wuhan virus). Either way we're looking at a death rate that is so high that it will drive the world economy to it's knees, somewhere between 12% and 30% could die after contracting this virus. This is a farmers math project, so don't hate me if I'm wrong.

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