Discussion - Estimating the CFR for 2019-nCoV

[Laidback Al]

Then it would seem that the CFR can increase over time as health networks become saturated.

If this outbreak becomes a pandemic then relating the number of deaths to the CFR for the coronavirus will be misleading. When hospitals become over crowded, and the entire health system is stretched to the limit, we can expect many deaths that are not directly related to the disease. Even during a pandemic people will experience life threatening diseases and traumatic injuries. If these people fail to get needed treatment, they will die. These deaths will be collateral damage from a pandemic.

 

[AnnaLisa]

If this outbreak becomes a pandemic then relating the number of deaths to the CFR for the coronavirus will be misleading. When hospitals become over crowded, and the entire health system is stretched to the limit, we can expect many deaths that are not directly related to the disease. Even during a pandemic people will experience life threatening diseases and traumatic injuries. If these people fail to get needed treatment, they will die. These deaths will be collateral damage from a pandemic.

I'm wondering if we can assume any stats are accurate at this point. It seems the system has collapsed. I imagine the body count will provide answers but what are the chances we will get the truth. I doubt that swabs or blood were done on untested mortality.

 

[etudiant]

I'm wondering if we can assume any stats are accurate at this point. It seems the system has collapsed. I imagine the body count will provide answers but what are the chances we will get the truth. I doubt that swabs or blood were done on untested mortality.

Xinhua reports that 150 medical workers from the Army Medical University are being flown to Wuhan, so obviously the crisis is getting militarized. Given reports of bodies in the streets, that seems unavoidable. However, a detachment of 150 is a pittance given the scale of the problem, with 50MM people in quarantine.
Possibly there is no readily deploy-able pool of medical staff that has training for managing highly infectious diseases. Whatever the reason, the modest support measures to date indicate that the quarantined areas are essentially on their own.

 

[AnnaLisa]

Xinhua reports that 150 medical workers from the Army Medical University are being flown to Wuhan, so obviously the crisis is getting militarized. Given reports of bodies in the streets, that seems unavoidable. However, a detachment of 150 is a pittance given the scale of the problem, with 50MM people in quarantine.
Possibly there is no readily deploy-able pool of medical staff that has training for managing highly infectious diseases. Whatever the reason, the modest support measures to date indicate that the quarantined areas are essentially on their own.

It would necessarily any different in the US if that had occurred here. It was and is an overwhelming event.

 

[etudiant]

It would necessarily any different in the US if that had occurred here. It was and is an overwhelming event.

Entirely agree, think it would be worse here given our social tensions. Unfortunately, we may find out, this virus appears able to leap national boundaries with ease.

 

[gsgs]

do we agree, that there must be ~100k cases already and that consequently the CFR must be low ?
The counts are only for the severe, reported cases. Now hopefully the mild cases did develope immunity

 

[alert]

Low is a relative term. What counts as low for this outbreak? 3%? 0.3%? 0.03%?

There have still been more deaths than discharges (56 vs. 49) in China, and that's probably still true worldwide. I'm not willing to estimate a CFR until we start getting at least a few hundred recoveries of confirmed cases.

 

[Vibrant62]

I'm wondering if we can assume any stats are accurate at this point. It seems the system has collapsed. I imagine the body count will provide answers but what are the chances we will get the truth. I doubt that swabs or blood were done on untested mortality.

I think a better idea will be had if/when it starts infecting large numbers in a country outside China, but even then numbers may be artificially kept low. Governments fear social unrest and panic more than anything else, and so i wouldnt hold your breath on getting real data until such time as it is a) unavoidable and the truth cannot be hidden, or b) after the event.

In addition to this there are practical limitations when the numbers involved are large... interesting data in this video.
https://www.youtube.com/watch?v=m6S51KPWKCY&feature=youtu.be

 

[gsgs]

Low is a relative term. What counts as low for this outbreak? 3%? 0.3%? 0.03%?

There have still been more deaths than discharges (56 vs. 49) in China, and that's probably still true worldwide. I'm not willing to estimate a CFR until we start getting at least a few hundred recoveries of confirmed cases.

that is ignoring the possible/likely unconfirmed cases, though. What will/would happen in a mass-outbreak , that's the question.

 

[Emily]

https://www.usatoday.com/story/news...deadlier-than-wuhan-china-disease/4564133002/

“When we think about the relative danger of this new coronavirus and influenza, there’s just no comparison,” said Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center. “Coronavirus will be a blip on the horizon in comparison. The risk is trivial.”

 

[Vibrant62]

I completely agree with the flu vaccination pitch - this is indeed a major issue and has not gone anywhere, but one does wonder how up to speed this individual is with the current data on WH-CoV 2019

 

[Thornton]

Already the behavioral aspects of the new virus spread are having a major psychological and economic impact that we can easily see increase many fold. Instead of discounting the risk by stating influenza is much worse, we can have dual purpose and use the rates of influenza and morbidity/mortality as an indicator of our effectiveness of control measures for 2019-nCoV.

 

[alert]

China discharged 43 patients today, bringing the total to 103. That's the largest number of discharges in one day to date by a wide margin. Over 96% of the confirmed cases remain in the hospital (and haven't died or been discharged).

I expect the number of discharges to rise sharply over the next two weeks, by which point we can hopefully estimate a CFR for this virus.

 

[AlanBaxter]

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.

But you can compare the ratio between places, and in Hubei it is about 3% and elsewhere it is about 1/10th that. Perhaps more significantly, the ratios are not getting closer to to each other with time. Although early days, if that difference keeps up, it discounts the "head start" theory. Also, outside Hubei, infection of contacts is quite a lot lower. An alternative hypothesis (and there are many) is that the first cases received much higher infectious loads at exposure (for example by eating contaminated food), resulting in more severe illness. If true, some of the H-H transmissions recorded in Hubei may actually be people infected by the same source (e.g. through a shared meal), or greater transmission due to higher viral titres.

 

[AlanBaxter]

Low is a relative term. What counts as low for this outbreak? 3%? 0.3%? 0.03%?

There have still been more deaths than discharges (56 vs. 49) in China, and that's probably still true worldwide. I'm not willing to estimate a CFR until we start getting at least a few hundred recoveries of confirmed cases.

There are probably a lot of mild infections being managed at home, & it wouldn't surprise me if followup of people with settling symptoms was relatively poor in Hubei.

 

[AlanBaxter]

Does anyone know if the roughly linear increase in confirmed cases is because testing capacity in China is running at capacity, or is it a characteristic of the epidemic?

 

[alert]

WHO today says that there are 82 confirmed cases outside of China, with no fatalities and only one severe case. Even if you assume the severe case has a 50/50 chance of dying (which is probably high), 0.5 deaths in 82 cases is about a 0.6% CFR.

If instead, you back only Hubei out of the global count, you're left with about 3900 cases and 9 deaths so far (with 71 confirmed recoveries).

Also, Zhejiang province now has 537 cases without a death (but only 9 discharges).

Both of these facts suggest to me that this virus might be milder than previously thought.

 

[curiosity]

Travelers outside China will be younger, more active. The CFR would not be same for this population as for general population. Although - .6 seems more palatable than others we have heard.

 

[kiwibird]

https://www.dailymail.co.uk/news/ar...-twitter_mailonline&__twitter_impression=true

Hong Kong-based news outlet Initium spoke to workers on the mainland who said bodies were being sent for cremation without being properly identified, he said.

'This means there are patients who died from the virus, but were not added to the official record,' Yang suggested.

https://twitter.com/i/status/1223047244590399489 Appears to show body bags in bins outside a crematorium. This is not confirmed by alternate sources yet.

Am looking for confirmation - but just stopped in my tracks with this post apparently saying cats were being affected by virus https://twitter.com/niepanxinglai with a retweet from https://twitter.com/loveumomwhowho - it may be that people have heard rumours about infected animals and destroyed them.

 

[kiwibird]

http://cn.ntdtv.com/gb/2020/01/31/a102765112.html google translated snip.. "NTD Beijing, January 31, 2020] Dr. Zhang Wenhong, director of the infection department of Shanghai Huashan Hospital, who became popular because he ordered party members to join the front line of anti-epidemic disease, once again spoke out, confirming that the international experts ’ estimates of the mainland epidemic were “ right ”. "