Discussion - Estimating the CFR for 2019-nCoV

[gsgs]

why should it be more brutal in Europe than in China ?
And the low CFR is not just outside China but outside Hubei,
in other Chinese provinces.
--------------------------------------------------------
some other ideas came to my mind ... could it be high-load water or food
contamination in Wuhan and respiratory low-load in other places ?
They probably would have found it already, if true.

 

[Pathfinder]

Translation Google

Wuhan pneumonia death rate lower than SARS? Virus Expert: Not necessarily

A new coronavirus from Wuhan, China triggered a global panic. The previous news was that although the virus is highly contagious, the fatality rate is not as high as SARS in 2003. Domestic virus expert Su Yiren said that it is still too early to talk about the fatality rate. According to the data, the fatality rate of the new Wuhan virus is not necessarily lower than that of SARS.

Current data from China show that the mortality rate of Wuhan pneumonia is about 2%, and the SARS mortality rate is about 15% according to global statistics. It is considered that although the current outbreak of Wuhan pneumonia is much larger than SARS, the mortality rate is relatively small. low.

Su Yiren said that it is currently difficult to know the exact death rate of Wuhan pneumonia. Although the outbreak in the mainland is 2 to 5%, it is difficult to see how many people are infected and died because the epidemic is not transparent.

However, according to previous studies submitted by mainland scholars to the New England Medical Journal, the fatality rate has reached more than 10%. Su Yiren said that in the future, the United States Department of Disease Control and World Health Organization personnel will be stationed in Wuhan, and there may be accurate data. The epidemic has just begun for more than a month, and it is too early to talk about the fatality rate.

Su Yiren also mentioned a special situation, saying that the SARS epidemic that year was high in Taiwan, but the mortality rate was high. Like in Vietnam at the time, patients were placed in a ventilated place and were not actively treated. The mortality rate was actually low. It was believed that steroids were given to patients in Taiwan at the time to rescue pulmonary fibrosis, but their immunity was reduced. At the same time, living in intensive care units also increased the risk of bacterial infection. Many patients died of infected sepsis. How to treat Wuhan pneumonia in the future needs to be discussed .

https://health.udn.com/health/story/120951/4318076

 

[hawkeye]

I can’t seem to get the original Lancet report to display. But here’s a Live Leak link.

11 out of 99 patients in control group in Wuhan died of coronavirus

[correct link posted - editor]

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30211-7/fulltext

 

[kiwibird]

Translation Google

Wuhan pneumonia death rate lower than SARS? Virus Expert: Not necessarily

A new coronavirus from Wuhan, China triggered a global panic. The previous news was that although the virus is highly contagious, the fatality rate is not as high as SARS in 2003. Domestic virus expert Su Yiren said that it is still too early to talk about the fatality rate. According to the data, the fatality rate of the new Wuhan virus is not necessarily lower than that of SARS.
........

Su Yiren also mentioned a special situation, saying that the SARS epidemic that year was high in Taiwan, but the mortality rate was high. Like in Vietnam at the time, patients were placed in a ventilated place and were not actively treated. The mortality rate was actually low. It was believed that steroids were given to patients in Taiwan at the time to rescue pulmonary fibrosis, but their immunity was reduced. At the same time, living in intensive care units also increased the risk of bacterial infection. Many patients died of infected sepsis. How to treat Wuhan pneumonia in the future needs to be discussed .

https://health.udn.com/health/story/120951/4318076

snip from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1904416/

"Summary of SARS cases with onset of illness from 1 November 2002 to 31 July 2003.[SUP]12[/SUP]

Area Number of Cases Sex Median age (range) Number of Deaths (%) Number of HCW[SUP]*[/SUP] infected (%) Date onset of first probable case Date onset of last probable case
M F
[TD="colspan: 1, align: left"]Australia[/TD]
[TD="colspan: 1, align: center"]6[/TD]
[TD="colspan: 1, align: center"]2[/TD]
[TD="colspan: 1, align: center"]4[/TD]
[TD="colspan: 1, align: center"]15 (1–45)[/TD]
[TD="colspan: 1, align: center"]0 (0)[/TD]
[TD="colspan: 1, align: center"]1 (16)[/TD]
[TD="colspan: 1, align: center"]26 Feb 03[/TD]
[TD="colspan: 1, align: center"]1 Apr 03[/TD]

[TD="colspan: 1, align: left"]Canada[/TD]
[TD="colspan: 1, align: center"]251[/TD]
[TD="colspan: 1, align: center"]100[/TD]
[TD="colspan: 1, align: center"]151[/TD]
[TD="colspan: 1, align: center"]49 (1–98)[/TD]
[TD="colspan: 1, align: center"]43 (17)[/TD]
[TD="colspan: 1, align: center"]109 (43)[/TD]
[TD="colspan: 1, align: center"]23 Feb 03[/TD]
[TD="colspan: 1, align: center"]12 Jun 03[/TD]

[TD="colspan: 1, align: left"]China[/TD]
[TD="colspan: 1, align: center"]5281[/TD]
[TD="colspan: 1, align: center"]2607[/TD]
[TD="colspan: 1, align: center"]2674[/TD]
[TD="colspan: 1, align: center"]Pending[/TD]
[TD="colspan: 1, align: center"]349 (6.6)[/TD]
[TD="colspan: 1, align: center"]1002 (19)[/TD]
[TD="colspan: 1, align: center"]16 Nov 02[/TD]
[TD="colspan: 1, align: center"]3 Jun 03[/TD]

[TD="colspan: 1, align: left"]Hong Kong[/TD]
[TD="colspan: 1, align: center"]1755[/TD]
[TD="colspan: 1, align: center"]778[/TD]
[TD="colspan: 1, align: center"]977[/TD]
[TD="colspan: 1, align: center"]40 (0–100)[/TD]
[TD="colspan: 1, align: center"]299 (17)[/TD]
[TD="colspan: 1, align: center"]386 (22)[/TD]
[TD="colspan: 1, align: center"]15 Feb 03[/TD]
[TD="colspan: 1, align: center"]31 May 03[/TD]

[TD="colspan: 1, align: left"]Singapore[/TD]
[TD="colspan: 1, align: center"]238[/TD]
[TD="colspan: 1, align: center"]77[/TD]
[TD="colspan: 1, align: center"]161[/TD]
[TD="colspan: 1, align: center"]35 (1–90)[/TD]
[TD="colspan: 1, align: center"]33 (14)[/TD]
[TD="colspan: 1, align: center"]97 (41)[/TD]
[TD="colspan: 1, align: center"]25 Feb 03[/TD]
[TD="colspan: 1, align: center"]5 May 03[/TD]

[TD="colspan: 1, align: left"]Taiwan[/TD]
[TD="colspan: 1, align: center"]346[/TD]
[TD="colspan: 1, align: center"]128[/TD]
[TD="colspan: 1, align: center"]218[/TD]
[TD="colspan: 1, align: center"]42 (0–93)[/TD]
[TD="colspan: 1, align: center"]37 (11)[/TD]
[TD="colspan: 1, align: center"]68 (20)[/TD]
[TD="colspan: 1, align: center"]25 Feb 03[/TD]
[TD="colspan: 1, align: center"]15 Jun 03[/TD]

[TD="colspan: 1, align: left"]Others[/TD]
[TD="colspan: 1, align: center"]221[/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"]13 (5.9)[/TD]
[TD="colspan: 1, align: center"]44 (17)[/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"] [/TD]

[TD="colspan: 1, align: left"] Total [/TD]
[TD="colspan: 1, align: center"] 8098 [/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"] 774 (9.6) [/TD]
[TD="colspan: 1, align: center"] 1707 (21) [/TD]
[TD="colspan: 1, align: center"] [/TD]
[TD="colspan: 1, align: center"] [/TD]

[SUP]*[/SUP]HCW = healthcare workers."

It would seem that Taiwan had a comparable success rate as other countries (note the China rate seems very low and formally ended as 7%). Did other countries offer steroid treatment and what was the relationship to recovery rate? Is this virus expert Su Yiren, previous Director of Taiwan Disease Control Agency, thinking that the steroids actually lower the immune system and cause a cytokine storm? I will see if I can find more information about their observations.As Director Su Yiren was Director at the time of the 2004 SARS outbreak perhaps this opinion is based in individual case observations????

This thread https://flutrackers.com/forum/forum...s/54924-cytokine-storm-vitamin-d-relationship discusses this - including this post from AlaskaDenise "Steroids

Corticosteroid medications such as prednisone, often prescribed to reduce inflammation, can reduce calcium absorption [77-79] and impair vitamin D metabolism. These effects can further contribute to the loss of bone and the development of osteoporosis associated with their long-term use [78-79]" from this paper http://ods.od.nih.gov/factsheets/vitamind.asp#h7

 

[kiwibird]

From Pathfinders original post - and the quote from Director Su Yiren - this still brings us back to Tetano's post about the use of Antivirals and Antibiotics as a successful treatment.

"At the same time, living in intensive care units also increased the risk of bacterial infection. Many patients died of infected sepsis. How to treat Wuhan pneumonia in the future needs to be discussed".

I note that one of the first cases of SARS 2003/04 in Hong Kong was treated, appeared to be recovered, and was sent home to his apartment in Amoy Garden (which was a primary cross contamination point of the SARS epidemic) and then fell ill again. This appeared to be a bacterial infection combined with dual influenza a and sars infection and unfortunately he did not recover from this. from - https://pmj.bmj.com/content/80/945/373

 

[Ronan Kelly]

Fatalities have now dropped to 35% of resolved cases 490/1392. In the US, influenza kills about 5% of those hospitalized. I know, that there's a lot of fog of war going on here, but I'm beginning to feel that the cfr on this will be between 0.1 and 1% when all is said and done. Especially if there are hundreds of thousands of milder cases in the general community. That's the big unknown here, how many milder cases are there?

 

[alert]

The 2003 SARS numbers for mainland China are corrupted for multiple reasons. The worst one is that over 1,000 of the 2,521 "probable" SARS cases in Beijing actually tested positive retrospectively for influenza (meaning they didn't have SARS), according to an article published that summer in the Straits Times. I tend to back out all of mainland China from the global numbers, leaving about 450 deaths in the remaining 2700 cases, for a CFR of about 16%, close to what was seen in Hong Kong and Toronto.

2019-nCoV doesn't have that CFR, fortunately. If it did, most global travel would already be shut down. My personal estimates right now are running between 0.4% and 4.0%, about four times what Ronan estimated above. We know that 5 of the first 15 cases in Hong Kong needed oxygen at some point, and at least 2 of the 11 in the US did as well. I don't think either one of those places is missing mild cases, which makes me think this virus is several times more severe than seasonal flu. But that's a huge range. At 0.4%, that's comparable to the 1957 H2N2 pandemic. That's something we know how to deal with, even without a vaccine. At 4.0%, that's twice the 1918 H1N1 pandemic. I'm not sure that's something we can handle.

 

[AlanBaxter]

[h=1]2019-nCoV Sudden cardiac death?[/h] Several of the not terribly convincing videos from Hubei showed sudden death in streets and hospitals, one in which a live subject fell to the ground in the street as if pole axed. An Indonesian colleague visiting Bali witnessed the same thing. Has anyone else seem/heard of a reputable report of sudden cardiac death associated with 2019-nCoV?

 

[kiwibird]

For discussion - I have not found a corroborating first hand report yet.

https://www.taiwannews.com.tw/en/news/3871594

TAIPEI (Taiwan News) — As many experts question the veracity of China's statistics for the Wuhan coronavirus outbreak, Tencent over the weekend seems to have inadvertently released what is potentially the actual number of infections and deaths, which were astronomically higher than official figures.

On late Saturday evening (Feb. 1), Tencent, on its webpage titled "Epidemic Situation Tracker", showed confirmed cases of novel coronavirus (2019nCoV) in China as standing at 154,023, 10 times the official figure at the time. It listed the number of suspected cases as 79,808, four times the official figure.
...snip

 

[kiwibird]

Further - snip - The number of cured cases was only 269, well below the official number that day of 300. Most ominously, the death toll listed was 24,589, vastly higher than the 300 officially listed that day.
....
However, the "internal" data held by Beijing may not reflect the true extent of the epidemic. According to multiple sources in Wuhan, many coronavirus patients are unable to receive treatment and die outside of hospitals.

A severe shortage of test kits also leads to a lower number of diagnosed cases of infection and death. In addition, there have been many reports of doctors being ordered to list other forms of death instead of coronavirus to keep the death toll artificially low.

 

[etudiant]

While the Tencent numbers are unofficial, they seem much more consistent with the desperate efforts of the Chinese government to control this outbreak. Based on these numbers, the cfr is at least 16%, vastly worse than the Spanish Flu or even SARS,

What is striking is that the number of new suspected cases rose by over 25%, while the number of deaths only increased by a little over 6%. That falls into line with the reports that deaths are getting attributed to non CoV related causes.

 

[alert]

Those "real" numbers might be some kind of coding bug. The article says that at least three different times, Tencent has posted really large numbers, then corrected them to the "official numbers". If this was some kind of leak, I'd think the Chinese government would have stopped it after the first time.

Not to mention, since CFR is actually calculated using only resolved cases, the "leaked" numbers above with 269 discharges and 24589 deaths would represent a roughly 99% CFR, which is clearly nonsense.

While I don't trust the official numbers, these leaked numbers seem less likely.

 

[kiwibird]

I am thinking that we will probably never know. If they are only testing and hospitalizing severe cases and roughly 20 - 25% are severe then that is going to be a statistically weighted group anyway. Compound this with the fact that people go to hospital to try and find a bed and have a thousand people lined up in front of them - turn round and go home - only to be excluded from the stats, confirmed, discharged or fatality, and this could be accurate - or miles out either way.

Quote "Netizens also noticed that each time the screen with the large numbers appears, it shows a comparison with the previous day's data which demonstrates a "reasonable" incremental increase, much like comparisons of official numbers. This has led some netizens to speculate that Tencent has two sets of data, the real data and "processed" data.

Some are speculating that a coding problem could be causing the real "internal" data to accidentally appear. Others believe that someone behind the scenes is trying to leak the real numbers."

I hope we will get more clarity from Hong Kong. Because they are a smaller and more independent community it should be easier to gauge.

 

[AlanBaxter]

Just for logical completion, someone behind the scenes could be trying to leak fake numbers. If true, it is hardly surprising they would be in Taiwan. Also, a fake source in Taiwan would explain the Chinese govt's failure to stop it. They could easily stop it if it were real, or if not in Taiwan; when it is both, it is a bit harder.

 

[kiwibird]

Yes - I see what you mean. Especially as it has happened a few times.

 

[etudiant]

Just for logical completion, someone behind the scenes could be trying to leak fake numbers. If true, it is hardly surprising they would be in Taiwan. Also, a fake source in Taiwan would explain the Chinese govt's failure to stop it. They could easily stop it if it were real, or if not in Taiwan; when it is both, it is a bit harder.

That does seem a more plausible explanation, if only because it is questionable whether the Chinese themselves would have accurate records, given the chaotic situation in Wuhan that is visible on the videos.
So the sad truth is that we have no real idea of the actual numbers, just that it is desperately bad in Wuhan. My heart goes out to them, they are fighting for us as well.

 

[kiwibird]

http://www.mychinanews.com/news/n/1/2413335 Machine translated
snip...
Hubei Provincial Health and Health Commission's official website reported on the 5th that from February 5th to 24:00, there were 2987 new cases of pneumonia, 70 deaths, and 113 discharges from the province. The reporter noticed that Ezhou, which borders Wuhan, had reported a total of 423 cases and 18 deaths as of 24:00 on February 5, 2020, with a fatality rate of 4.25%, exceeding Wuhan (4.09%). ....

 

[kiwibird]

Very interesting article on the figures coming from Deputy Director-General of Medical Administration Bureau of National Health and Family Planning Commission of the PRC, Jiao Yahui
https://www.taiwannews.com.tw/en/news/3873016

"...due to the lack of medical resources, the mortality rate in Wuhan has reached 4.9 percent. Meanwhile, the death rate for China as a whole is said to have remained at a steady 2.1 percent.

However, Jiao quickly contradicted her own statement about the mortality rate when she said the number of confirmed cases of novel coronavirus (2019-nCoV) in Wuhan has exceeded 20,000 and there had been 425 deaths, with 414 of the dead concentrated in Hubei Province, accounting for 97 percent of the total, reported the Broadcasting Corporation of China. She then pointed out this is a mortality rate of 2.1 percent, inadvertently revealing the number of deaths must have been significantly underestimated.

Again, contradicting the numbers and the official government dictated 2.1 percent mortality rate, she said the death rate in Hubei Province is 3.1 percent. She then added that Wuhan had the highest mortality rate in the province at 4.9 percent, and claimed the rate of death in the rest of the province had dropped by 0.16 percent.".....

"As early as January, netizens started to notice that government death tolls have routinely maintained an exact percentile for days on end. Many noticed that in the early days of reporting, the government put the death rate at 3.1 percent.

Jan. 22: 17 deaths / 542 infections = 3.1 percent
Jan. 23: 26 deaths / 830 infections = 3.1 percent
Jan. 24: 41 deaths / 1,287 infections = 3.1 percent

By the end of the month, the government apparently decided to set the new official mortality rate at 2.1 percent. As can be seen in the image below, the mortality rate was kept at a precise 2.1 percent, regardless of the numbers from Jan. 30 to Feb.

If this is the Government "spin" I can only conclude that 2.1 is the "optimistic" figure that is generated to ensure - "She claimed there are many cases in other provinces, but the mortality rate is quite low. She said the government is still confident the vast majority of these cases are minor, so there is no need to panic"

I have checked some of the figures quoted - am having trouble finding our actual numbers - someone probably has these easily to hand - but the two I have from a comparison graph - do tally with the 3.1%. Jan 22 (17 deaths per 542 confirmed) Jan 23 (26 deaths per 830).
The steady 2.1% quoted is suspicious even in the fact that the word "steady" is used.

The interview quoted was probably this one conducted in mandarin and quoted here;
[h=2]https://www.cnbc.com/2020/02/04/coronavirus-latest-updates-china-hubei.html
"7:20 pm: Fatality rate ‘should gradually decline’ - Chinese health officials[/h]
“I’m confident that it won’t require that long of a time period before the effects [of our efforts] will be evident, and Wuhan’s case-fatality rate should gradually decline,” Jiao Yahui, deputy director of the medical affairs and hospital administration of the National Health Commission, said Tuesday at a daily press conference in Mandarin, according to a CNBC translation.

Jiao pointed out that 74% of coronavirus deaths, or 313, are in the city of Wuhan, where there is a case-fatality rate of 4.9%. That’s primarily due to lack of hospital beds in the early days of the virus’ spread, she said. At that time, she said there were only three designated hospitals with 110 beds for the critically ill... "...snip


I have not found a full translated script and will continue to search... The interview was conducted February 3rd - so is almost old news now...

 

[Laidback Al]

I have checked some of the figures quoted - am having trouble finding our actual numbers - someone probably has these easily to hand - but the two I have from a comparison graph - do tally with the 3.1%. Jan 22 (17 deaths per 542 confirmed) Jan 23 (26 deaths per 830).
The steady 2.1% quoted is suspicious even in the fact that the word "steady" is used.

Based on the daily data published by Johns Hopkins University, the table below lists the daily ratio of deaths to confirmed case and daily recovered cases to confirmed cases in Hubei Province . There does appear to be a slight decrease in deaths each day relative to the number of newly infected cases. What should be disturbing is that so few cases are being recorded as recovered even though this outbreak began it exponential increases in cases in mid January.

 

[Ronan Kelly]

Based on the daily data published by Johns Hopkins University, the table below lists the daily ratio of deaths to confirmed case and daily recovered cases to confirmed cases in Hubei Province . There does appear to be a slight decrease in deaths each day relative to the number of newly infected cases. What should be disturbing is that so few cases are being recorded as recovered even though this outbreak began it exponential increases in cases in mid January.

The outbreak in China reached 2,744 confirmed cases on Jan 26. We reached 2,772 resolved cases yesterday. A gap of 12 days. We should see a significant increase in hospital releases over the next few days.