Discussion - Estimating the CFR for 2019-nCoV

[mscox]

That is an interesting read, however it must be read with caution. What it implies is more correctly stated as follows:

Within a given population who contract covid-19 and for whom health facilities are available to treat severe and critical cases as required. Then the natural CFR will be roughly 0.5% (or 10x the flu). The absolute key part of that statement is the health system being available and functional.

If you allow the virus to infect too many people, too quickly, then expect the CFR to rapidly (order of magnitude, so 10x again) jump up as the health system overloads. This is why OUR governments need to urgently implement social distancing measures to flatten the curve!

 

[JJackson]

Re the Diamond Princess.
N.B. I have only read what is posted above.
Fortunately for the passengers and crew, but unfortunately for calculating the CAR, the index case was identified before the 2nd generation cases showed. This allowed testing and quarantine/social distancing which will have protected many passengers from exposure which in turn will make their 17% estimate low. It does however show that this figure is more than achievable in the world at large. Pick what ever CFR you like and apply it to 17% of your population and that is how many dead you will have. The CAR could be twice this or more. How you manage to spread those deaths over time will determine if your CFR remains a constant, if you exceed your ICU/mechanical ventilator surge limit you must expect every case there was not room for to die - ICU triage by that point is not going to give space to anyone it is unlikely to save or who had a fighting chance without it. In a badly managed wave peak your x ICU beds may have 10x or more patients who meet admission criteria.

 

[cartski]

I wonder if it is more informative to determine likely CFRs based on social/economic cohorts and accessible health system level.

For example, billionaires would have private hospitals in their mansions, so CFR 0.01

Middle clause would have health insurance hospitals, so CFR 0.005

Low class would have Medicare services, so CFR 3.0

Then assume 70% of cohort gets infected regardless of class.

Has anyone seen or heard of something like that?

J.

 

[JJackson]

Cartski those numbers would be useful particularly if they include a figure for patients who get zero assistance. The Imperial epi calculations seem to indicate a best case scenario with 8 times as many patients needing ICU as there is capacity for in wave peaks (worst case model 30x). The numbers you give for CFR in the wealthy are IMO very optimistic I do not think good patient care has been missing for the bulk of cases to date so an 80 year old billionaire probably will not differ from anyone else who got a critical care bed of similar age. I know it does not feel like at the moment but this epidemic is in its initial stages with the scope to get a great deal worse if not managed aggressively.

 

[Ronan Kelly]

systematic review and meta-analysis of published research data on COVID-19 infection-fatality rates

Gideon Meyerowitz-Katz, Lea Merone
doi: https://doi.org/10.1101/2020.05.03.20089854
This article is a preprint and has not been certified by peer review [what does this mean?]. It reports new medical research that has yet to be evaluated and so should not be used to guide clinical practice.

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Abstract


Introduction: An important unknown during the COVID-19 pandemic has been the infection-fatality rate (IFR). This differs from the case-fatality rate (CFR) as an estimate of the number of deaths as a proportion of the total number of cases, including those who are mild and asymptomatic. While the CFR is extremely valuable for experts, IFR is increasingly being called for by policy-makers and the lay public as an estimate of the overall mortality from COVID-19. Methods: Pubmed and Medrxiv were searched using a set of terms and Boolean operators on 25/04/2020. Articles were screened for inclusion by both authors. Meta-analysis was performed in Stata 15.1 using the metan command, based on IFR and confidence intervals extracted from each study. Google/Google Scholar was used to assess the grey literature relating to government reports. Results: After exclusions, there were 13 estimates of IFR included in the final meta-analysis, from a wide range of countries, published between February and April 2020. The meta-analysis demonstrated a point-estimate of IFR of 0.75% (0.49-1.01%) with significant heterogeneity (p<0.001). Conclusion: Based on a systematic review and meta-analysis of published evidence on COVID-19 until the end of April, 2020, the IFR of the disease across populations is 0.75% (0.49-1.01%). However, due to very high heterogeneity in the meta-analysis, it is difficult to know if this represents the "true" point estimate. It is likely that different places will experience different IFRs. More research looking at age-stratified IFR is urgently needed to inform policy-making on this front.
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https://www.medrxiv.org/content/10.1....03.20089854v1

 

[kiwibird]

https://flutrackers.com/forum/forum...-case-fatality-rates-of-the-covid-19-pandemic

Interesting article posted by Tetano - many thanks Tetano - I was surprised to see Germany had such a high cfr. Am I reading it correctly. Germany has had a great run with testing and has been very thorough with track and trace - so I would assume their numbers are very accurate.