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The Coronavirus Is Far LESS Deadly than Reported

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coronavirus fatality rate

This week has been interesting. On the one hand, hard data is emerging showing that the Coronavirus is not nearly as deadly as the numbers previously reported and that the virus is wimpy when exposed to sunlight, but none of that data seems to be quelling the irrational panic. So let’s look at this data with a heavy heart for the fallen, but with a very clear mind.

The Fatality Data

Fatality rates for Coronavirus of 3-7 percent have been thrown around for months. This makes the average person believe that if they contract COVID-19 then they have a 1 in 15 to 1 in 30 chance of dying. This, of course, is enough to stoke irrational fear in any rational person. However, scientists have been saying for months that given that most people that get infected with the Coronavirus have no symptoms, these fatality rates are way overestimated. Let’s dig in.

The 3-7% mortality rate numbers have been due to the fact that we’re only testing the sick that show up to doctor’s offices or hospital emergency departments and not everyone who had the disease. However, both California and New York made efforts this week to publish the rate of asymptomatic/minimally symptomatic infection in their communities to try to get a better sense of the real fatality rate.

California’s Data

While I reported on this a few days back, I can now report a more accurate number since it’s been about three weeks since this data was reported. Hence we now have enough time for the critically ill to show up in the fatality data. Hence, the new mortality rate for Coronavirus in Santa Clara County California based on the reported data from Stanford University scientists and their public health department is 0.15%. (1,2)

New York’s Data

The difference between California and New York City is that the later experienced true health system overload where the former did not. Meaning New York had a shortage of PPE, ventilators, ICU beds, and healthcare workers to handle their surge. Hence, we can expect that their fatalities would be much higher.

This week’s reports demonstrated that tests revealed that the Coronavirus has infected 21.2% of New York City’s residents (5). Those that were tested were out of the house shopping in a grocery store. This is an infection rate many times the approximately 3-4% infected in Santa Clara, which makes sense given the public transport and apartment living so common in New York City. I did a rough calculation of the fatality rate when this data came out based on the population of New York City (5 counties) at 0.58%. Governor Cuomo had the statewide death rate at 0.5%, which didn’t include the fewer at-home deaths.

Are COVID-19 Deaths Being Over or Under-Reported?

The idea of whether the COVID-19 deaths are over or under-reported has become something of a political football this past two weeks. We know that health departments and the CDC are asking doctors to code deaths as COVID-19 if they believe that this was the cause, even if testing wasn’t available (from the CDC guidance document) (6):

“In cases where a definite diagnosis of COVID–19 cannot be made, but it is suspected or likely (e.g., the circumstances are compelling within a reasonable degree of certainty), it is acceptable to report COVID–19 on a death certificate as
“probable” or “presumed.” In these instances, certifiers should use their best clinical judgement in determining if a COVID–19 infection was likely.”

Hence, as a physician, knowing my colleagues and the fact that many hospitals will get reimbursed from approved Government grants based on the number of COVID patients treated, there would be pressure from hospital administrators to err on the side of COVID-19.

In addition, in epidemiology, there is the concept of “excess deaths”. This tends to get cleaned up after the pandemic is over as it takes a careful review of hospital charts and records. An excess death means that if not for COVID-19, the patient would not have died. However, you can see how all of this could get very complicated very quickly. For example, how should a patient be counted who was in the ICU already for respiratory illness or on their death bed in a hospice facility who contracted COVID-19? These deaths will eventually be subtracted from the COVID-19 total.

On the other hand, the case could be made that since a handful of people have been reported dying at home and that some cities like New York have not yet added these patients into their counts, that the COVID-19 deaths are under-reported. So who’s right? Time will tell.

More Data

Stanford’s Scott Atlas, M.D. a senior fellow in healthcare policy wrote an interesting editorial for “The Hill” a nonpartisan website that covers Washington politics where he shared the following information (3):

  • The NYC death rate for those 18-45 years old is 0.01%
  • Of all fatal cases in NY state, 2/3rds were over 70
  • 90% of all fatal cases had an underlying illness

Dr. Atlas also brings up the fact that people without COVID-19 are dying because they are not getting the needed medical care because of our COVID-19 focus.

How Robust is the SARS-CoV-2 Virus?

Early on there were reports that the virus could survive for days on plastic, which caused everyone to promptly disinfect the contents of their wallets. However, the National Biodefense Analysis and Countermeasures Center (NBACC) in Maryland performed some very sophisticated tests on viral durability this past week. They have a unique system where they can suspend a single water droplet containing the SARS-Cov-2 virus in a volume of air or on a surface and alter the temperature, humidity, and simulated sunlight and then retrieve that particle and look at how the virus fared. Here’s a slide from the NBACC White House Presentation on April 23rd:

nbacc coronavirus testing

Basically, in humid summer conditions like those in the Northeast or Southeast, the virus survived for one hour on a nonporous surface (it survives even less time on porous surfaces). However, that’s in the shade, because when you add summer sun into the equation, regardless of the humidity or temperature, it survives only 1-2 minutes! Hence, this virus will not do well outside in the summer. 

Stay Shut Down or Open Up?

No matter how you slice this new data, one thing is clear. If you contract COVID-19, there’s likely less than a 1 in 200 chance of dying from it. That’s about half the chances of you dying in a fatal car crash during your lifetime and yet we don’t have a second thought about getting into a car to go to the grocery store or doctor’s office.

So why did we close society down?

  • Because of the high death rates being reported of 3-7%. Those were inaccurate.
  • Because the healthcare system was unprepared for the surge of cases. That surge has passed and we have flattened the curve. Our healthcare facilities are now prepared. The PPE log jam has broken open. How do I know? Because my office orders from the same medical suppliers as everyone else and we’re having no issues getting PPE.
  • We don’t have enough testing! The US is performing about 1 million tests a week right now. Our tests per million inhabitants will soon surpass all other countries in the next 1-2 weeks. In addition, inexpensive finger stick serology tests are flooding US markets right now, which is one of the reasons that California and New York were able to test so many people so quickly.

Herd Immunity

Sweden has taken a different approach (4). While it has placed some restrictions like recommended social distancing, it’s schools are open and it’s restaurants have also continued to operate by following guidelines. The goal was to allow 60% or more of Swedes to get infected to build immunity. When that happens, it’s called “herd immunity” meaning that the virus burns itself out because it’s more likely than not that it will die in a host laden with antibodies rather than live to infect someone else. The Swedes believe they will get to that point by the middle of May.

What has this meant for Sweden? Their deaths are much higher than neighboring and smaller Denmark (2,192 vs. 418) (7). Swedish cases are fewer per million population than Denmark, but so is their testing. In addition, realize that “flattening the curve” by social isolation doesn’t really change the total number of people that will eventually die from Coronavirus (unless we can find a cure or effective treatment), it just pushes the cases further out and reduces the surge. So based on what we know, Denmark’s deaths will catch up and Sweden’s deaths will likely begin plummeting.

The upshot? The data is coming in and it’s not supporting that the Coronavirus should provoke irrational fear. Now that we know our foe, again, it’s time for sound public health policies based on that data. Let’s all have a heavy heart for those who have perished, but also a very clear mind about what’s real and what’s not.

______________________

References:

(1)  Bendavid E, et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California. medRxiv 2020.04.14.20062463; doi: https://doi.org/10.1101/2020.04.14.20062463

(2) Santa Clara Public Health. County of Satna Clara Emergency Operations Center. https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx. Accessed 4/25/20.

(3) The Hill. The data is in — stop the panic and end the total isolation. https://thehill.com/opinion/healthcare/494034-the-data-are-in-stop-the-panic-and-end-the-total-isolation. Accessed 4/25/20.

(4) CNBC. Sweden resisted a lockdown, and its capital Stockholm is expected to reach ‘herd immunity’ in weeks. https://www.cnbc.com/2020/04/22/no-lockdown-in-sweden-but-stockholm-could-see-herd-immunity-in-weeks.html. Accessed 4/25/20.

(5) New York Governor Press Briefing on April 23rd, 2020. https://www.pscp.tv/w/1DXGyeNNvmVGM Accessed 4/25/20.

(6) Centers for Disease Control. Guidance for Certifying Deaths Due to
Coronavirus Disease 2019 (COVID–19). Vital Statistics Reporting Guidance. Report No. 3 ▪ April 2020. https://www.cdc.gov/nchs/data/nvss/vsrg/vsrg03-508.pdf. Accessed 4/25/20.

(7) Worldometer. COVID-19 CORONAVIRUS OUTBREAK. https://www.worldometers.info/coronavirus/ Accessed 4/25/20.

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16 thoughts on “The Coronavirus Is Far LESS Deadly than Reported

  1. Dan

    Thank you for writing this. I wish the news would talk more about this. Sadly, they don’t. The frustrating thing is more people will just label people like myself as selfish for citing evidence like this to re open the population. The economic fallout will kill far more people than the virus ever could. It would be awesome if you could right a blog on that!! Thanks again for writing this!!

  2. Mike

    At a death rate of .5% that would be over 1.5 million fatalities in the US.

    1. Chris Centeno, MD Post author

      Except the actual death rate is likely closer to 0.1-2%. However, it was a good idea to close down for the short run to get the health system prepared. We did that, now it’s time to follow Sweeden’s model and work on limited smart exposures so that we can get to herd immunity. Flattening the curve doesn’t reduce deaths (unless you can come up with a cure), it just pushes them down the road.

  3. George Haeh

    The top line of the slide shows an indoor half life of 18 hours on a surface at 70-75 F and 20% humidity, typical conditions in a care home.

    Note that outside in the sun the half life is two minutes or less.

    Yet our politicians are closing our parks and beaches when it looks like our seniors would have a better chance of survival outdoors.

    Really the parks and beaches are the safest places to be.

    PS. Any aerosols are instantly dispersed by the lightest breeze.

  4. Not Albert Gitchell

    So we trashed our economy, hurt the livelihoods of millions of people, because of this?

  5. Dina Scarpone

    Thank you for putting the time in to write this up Dr. centenni.

  6. Michael Devaney

    Even at .1 to. .2 percent which might prove to be too low because data from Chins is to be taken with a grain of salt we are looking at 600 to 700 thousand fatalities under the herd immunity strategy.

    1. Chris Centeno, MD Post author

      Michael, no matter what we do to “bend the curve” we’re still looking at the same number of fatalities in the end. In the meantime, once you get to 60% immunity (herd) death rates go way down because the virus is more likely than not to end up in a host where it can’t survive. Hence your numbers are way off.

  7. Michael

    There are reputable health care professionals that say there is no guarantee one cannot be reinfected even if they show evidence of already having been infected. Perhaps the symptoms will be less severe but walking around thinking you have a free pass might put others at risk don’t you think?

    1. Chris Centeno, MD Post author

      I think we will need to study that, but there shouldn’t be any reason that COVID should behave differently than all other viruses and antibodies.

  8. Lorie

    Thanks for this intelligent article! I’ve been following the #s for a while, and have seen how they’ve fluctuated. The Stanford study gave me hope re: the lethality rate being lower than stated. The same thing actually happened in 2009 with the swine flu, where they estimated incredibly high death rates that were later revised. This is good news! And the caveats & cautions of course apply. Thanks again!

  9. Jim Bettcher

    In WA as of 11:59 p.m. April 28, 801 deaths; age 60+ are 34% of known positives; age 60+ are 91% of deaths. Many persons age 60+ have no underlying chronic disease, although the prevalence is certainly higher than younger people. It certainly appears that the over 60 crowd has a higher death rate from COVID-19 infections than the general population.

    Many cities, states, and countries are starting to show significantly higher general death rates than in previous years even after adjusting for known COVID-19 deaths. COVID -19 is the only current explanation.

    Anecdotally, many more health professionals treating COVID-19 patients are becoming seriously ill or dying than those treating influenza in previous years.

    The outbreaks in NYC and some other locations have so overwhelmed treatment capacity that some, perhaps many have died without adequate medical care.

    There are way too many unknowns yet to argue that we have overreacted as your analysis implies. We are only starting to gather what may be reasonably accurate death and infection rates.

    Additionally, your blog headline implies a much safer environment than does your N-99 mask innovation.

    Please don’t continue to publicly press this line of reasoning until the medical community better understand the virus, it’s effects and our vulnerabilities, and until we have sufficient, scientifically analysed data to make direct comparisons to other virus’.

    I love your stem cell research and writing about it. But I don’t like your headline or your conclusions which may lead other followers of your blog to dangerous, reckless ideas or behaviours with respect to COVID-19. Please reconsider your blogging on this topic.

    1. Chris Centeno, MD Post author

      Jim, I think you’re misunderstanding how I view COVID-19:

      1. A serious issue that can overwhelm our health system, so we needed to prepare. We are prepared, so check.
      2. Fatality is 2-5X flu and still being crystallized, but no “all-in” data supports fatality rate >1%.
      3. The difference between influenza A/B and COVID is the amount of healthcare system resources used, see #1.
      4. COVID deaths likely over rather than under-reported, but possible that’s reversed.
      5. Hence, we are protecting all of our patients and providers. This is why we built them N-99 masks and have taken other steps in the practice.
      6. We need testing, but we also have 30M Americans unemployed, which makes the 2.2M unemployed in the great recession look tame! Meaning, we are risking a great DEPRESSION with price deflation.
      7. I will also send an email to your account listed as we try to confirm.

    2. Chris Centeno, MD Post author

      Jim, thanks for confirming your email as we get quite a bit of spam. I think you misunderstand my position:

      1. This is a serious issue and we needed to prepare our healthcare system (see my previous statements to that effect). Check.
      2. This bug has a fatality rate of about 2-5X flu, depending on which numbers you use. That’s certainly a big deal as it also uses many more healthcare resources than flu and is harder to treat.
      3. Having said that, your lifetime chance of dying a car crash is definitely higher than dying of COVID-19 by 2-5X, depending on which fatality numbers you use. That should be GREAT NEWS to all.
      So rather than stoking fear, I chose to let people know what the numbers say. They then need to continue to follow whatever guidelines are in place locally. Having said that, they also have a right to protest those guidelines. That’s America,
      4. If we keeping making people afraid of their shadow, we will destroy our economy for many years to come. Hence, we need to reopen smartly and soon.
      5. On Masks, yes, we feel the need to protect patients and our providers. However, we didn’t want to take PPE from frontline workers, so we 3D printed our own. Again, a good thing.
      5. If you have any actual data you want to argue with, I welcome that debate. But throwing stones to make my readers afraid without any scientific citations is not helpful.

  10. KENT A CASEY

    Please add a discussion about the death rate for those 70 and older with and without underlying issues.

    1. Chris Centeno, MD Post author

      That could be a future blog, looking at age differences.

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