Discussion - Estimating the CFR for 2019-nCoV

[Vibrant62]

Do we have onset dates for DP cases? Does anyone know where these can be found? This is still probably the best epidemiological insight we are going to have at the moment. Also would be useful if we knew exactly what the passenger and crew age distribution was... I am guessing there will be more fatalities in the coming days, bearing in mind that the data suggests it is more usually a 2-3 week period from symptom onset to death? This data may also may be confounded if cases that have subsequently developed after passengers disembarked in Japan or returned elsewhere are not included in the original DP numbers (i know there have been some)

[sharon sanders]

"Globally, about 3.4% of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1% of those infected."

https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---3-march-2020

[kiwibird]

The list of Dates and Victims ages is from the Italian thread. Apologies for the confusion.

[kiwibird]

Japanese press releases here if it helps: https://www.mhlw.go.jp/stf/houdou/index.html

Oh sorry Ronan - they were the ages of the Italian victims. I really didn't make that clear. But thank you for the Japanese ones.

[Ronan Kelly]

Thank you Al and Ronan. I have been trying to find the ages and cannot account for 10 people.

Japanese press releases here if it helps: https://www.mhlw.go.jp/stf/houdou/index.html

[Ronan Kelly]

There several current estimates for the case-fatality rate of COVID-19.

Thanks Al - great info. As the current cfr's are all being calculated with conf deaths/conf.cases they are all limited by the testing regime of the country involved which may or may not be missing milder cases. It seems to me that the South Korea has the most comprehensive regime right now and has selected an entire population of 200,000 church members that it is determined to test. As such it is reporting cases that other surveillance methods might be missing and has by far the lowest fatality rate of 0.5%. Similarly with Diamond Princess, a captured tested population, probably skewed to the older age group, which includes lots of asymptomatic people has a cfr of 0.85%. Both SK and DP numbers may increase as cases resolve, but these two give us a baseline minimum for the cfr. At a minimum, 0.5% of cases look likely to be fatal - 4 to 5 times the rate of flu. That should give anybody pause about the effect of a general outbreak in the US. I think that an overall infected fatality rate of 0.5-1% is more probable for this disease and that in itself will tax health care systems severely.

[kiwibird]

Thank you Al and Ronan. I have been trying to find the ages and cannot account for 10 people.


22nd Feb 77 years and 78 years
23rd Feb 68 years
24th Feb 84 years, 88 years, 62 years, 80 years
25th Feb 84 years, 91 years, 83 years, 76 years
26th Feb 69 years
27th Feb 88 years, 88 years, 80 years
28th Feb 85 years, 77 years, 80+ years, 80+ years

Also there are sadly two further victims from the Diamond Princess, a lady in her 60's from Tokyo and an elderly Australian man, as well as the lady in her 70's also from Tokyo whom you noted here Ronan -

Ronan Kelly
Editor, Senior Moderator

• Join Date: Aug 2009
• Posts: 37587

#69
February 28th, 2020, 10:31 AM
About death of patient associated with cruise ship under quarantine at Yokohama Port
　Today, February 28, a cruise ship-related patient who has been quarantined at the Port of Yokohama has died. I pray for the soul of the deceased.
When reporting, please give due consideration to the privacy of the deceased and the bereaved.

Patient (5th death)
1 Outline

(1) Age: 70s
(2) Gender: Female
(3) Place of residence: Tokyo
(4) Basic illness: Hypertension, Diabetes

[Laidback Al]

There several current estimates for the case-fatality rate of COVID-19.

A. February 24, 2020
“Case-fatality rate 2.3%” Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China

B. February 28, 2020
“The CFR outside of Hubei, although based on limited data, is much lower, likely no higher than 1% to 2%, “ COVID-19—New Insights on a Rapidly Changing Epidemic

C. February 28, 2020
“…the currently reported case fatality rate is approximately 2%” Covid-19 — Navigating the Uncharted

When discussing the CFR for COVID-19 in various countries, we need to consider the median age of a country’s population. As noted by the authors in A above, older people, usually with existing comorbidities, have a higher death rate. The table below presents the information on five countries outside of China with the highest number of cases. These countries account for about 78% of all COVID-19 cases outside of China. Among these countries, 77 people have died (through February 29, 2020), about 90% of all coronavirus deaths reported from countries outside of China.

While the current ratio of deaths to reported cases is not an accurate measure of the CFR in these countries, it is a rough proxy measure. As shown in the table, there are slightly higher ratios for countries with aging populations, although the high death rate in Iran is an outlier. The overall population pyramid in a country will have a skewing effect on the CFR for that country. However the current ratio of deaths to cases cumulatively in these five countries is at 1.7%, within the range suggested by the studies above.

[kiwibird]

Shiloh
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• Join Date: Feb 2008
• Posts: 55788

• #99

Yesterday, 01:23 PM
Source: https://www.ansa.it/canale_saluteebe...6910a141e.html

821 are infected in Italy with Coronavirus. The new data was provided by Commissioner Angelo Borrelli during the press conference to the Civil Protection. The number also takes into account the 21 victims - 4 more than yesterday - and the patients recovered. "Today's deceased are over eighty and one over seventy. I would like to specify that they did not die from coronavirus or as a consequence. This is a job that the Istituto Superiore di Sanit? will do. When you have the data, you will communicate it to us," said Borrelli, during the press point at the Civil Protection headquarters. "The important fact - he added - is that half of the infected (412) are people who are asymptomatic, or with very slight symptoms and therefore do not need hospitalization. They are in fiduciary home isolation. Another 345 people are hospitalized with and 64 are hospitalized in intensive care. " "The assistance to the population continues, on Monday the post office will reopen in some municipalities to pay pensions. In the red areas, life will continue regularly".

If you look at the figures from the 28th, yesterday, and we believe they will be accurate - then the 821 with a CFR of 2.5% would give 20.5 and it unfortunately shows 21 victims.
Perhaps the confirmed cases on the Diamond Princess were only recently infected?

[Ronan Kelly]

I've been looking at the 705 positive cases from the Diamond Princess that remained in Japan. 6 have died (0.85%), but 36 were listed as in serious condition, so that number may yet increase.

[Ronan Kelly]

The only problem with the Italian figures is a report on 2/28 that said they were changing the counting system to exclude the asymptomatic cases even if they were positive.

"The idea of the ministry is therefore that of not communicating any asymptomatic cases to the international bodies that deal with the epidemic, that is, people who are positive to the swab but do not have any health problems. These infected represent between 40 and 50% of all cases reported at this time. "

https://www.repubblica.it/cronaca/2020/02/28/news/cambia_il_metodo_di_conteggio_esclusi_i_positivi_asintomatici-249765660/

[kiwibird]

Unfortunately there are current figures showing Italian rates of infection and, sadly, many have passed away due to the Covid-19 Coronavirus.

From the Italian figures which appear to be incredibly thorough and accurate with vigorous testing of even asymptomatic people I have tried to document the sequence of events.

We understood that you would normally need two weeks to get to a severe state -- that would make 16th February to compare todays CFR to (29th February). On the 16th there weren't even 29 people in Italy identified as being positive for Covid-19, (29 is the current number of fatalities). There are reports of people developing symptoms around the beginning of the month however and this might explain the shortened timeframe.

We have to move to the 21st (pm) before we see 35 cases confirmed. Two people had died, earlier - by the 16th. This would give an initial 6% CFR.

On the 23rd am there were 132 Confirmed cases including 26 severe cases and 4 deaths. - 20%severe and 3% CFR.

27th February 650 Confirmed cases, 17 deaths. CFR 2.5%

29th February 1139 Confirmed Cases, 29 deaths 2.5% CFR. Also known that there are 48% need to be hospitalised and 10% of those need intensive care.

I am very aware that these are not statistics but reflect the sad reality of peoples lives. I really hope that people who are affected, both victims, their families and loved ones - and healthcare workers, will understand that I am really sorry for their loss and suffering. It is important that we take a step back and look at the pattern of illness involved with this new virus in order to know what the world that has so far remained relatively untouched has in store so we can better prepare.

Any help with correcting any misunderstood figures would be appreciated.

[curiosity]

Since this new virus is a big risk mostly for older seniors and health compromised people, I'd like to know what the mortality rate for that population would be over the next year if the virus were taken out of the equation. Is it already close to 2%? That might put some perspective on the situation. Of course, the compression of mortality into a tighter time frame is still going to put a strain on the health care system.

Also, in US, almost 3,000,000 people die from all causes annually. A CFR 2% with 30% attack rate would double or triple that number.

[curiosity]

Since this new virus is a big risk mostly for older seniors and health compromised people, I'd like to know what the mortality rate for that population would be over the next year if the virus were taken out of the equation. Is it already close to 2%? That might put some perspective on the situation. Of course, the compression of mortality into a tighter time frame is still going to put a strain on the health care system.

Recent epidemiological study of over 40,000 patients in China revealed a much higher CFR for persons over 70. gsgs posted a pdf version in one of the discussion forums.

In this study, adding all CFR rates from three categories - 60-69, 70-79, and 80+, then dividing by 3 to get an average - the CFR was 8.8%

The good news for younger than 60 is the CFR drops considerably. However, the emotional toll of losing parents and grandparents will be profound.

Additionally, one of the biggest concerns and game changers is the ability for any area to manage the severe and critical cases before being overwhelmed. Once the system is saturated, the CFR will increase significantly. China's system worked very well and they keep reinforcing resources and staff. I am not confident most countries can do the same.

[Emily]

Since this new virus is a big risk mostly for older seniors and health compromised people, I'd like to know what the mortality rate for that population would be over the next year if the virus were taken out of the equation. Is it already close to 2%? That might put some perspective on the situation. Of course, the compression of mortality into a tighter time frame is still going to put a strain on the health care system.