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Did We Just Blowup the Economy for a Bug with a 0.14% Fatality Rate?

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covid19 fatality rate

If you remember way back to my second Corinavirus post 6 weeks ago, I posted that the fatality rate of this coronavirus was far less than the media was reporting. Now a new Stanford study just supported that idea after testing a large sample of people in one community. The results look much like my initial thoughts, the death rate of coronavirus is nowhere near what has been reported. Let’s dig in.

The Basic Math Problem with Media Reported Mortality Rates

The media has reported all sorts of fatality rates for COVID-19. Everything from 1% (ten times more lethal than the average flu bug among all age groups) to 3-7%. The actual mortality rates reported back in early March outside of environments that were total chaos were 0.2%-0.65% (1-3). The current US rate based on our total tests versus total deaths is about 0.5%.

However, anyone with a medical or science background has known for quite some time that these numbers are fiction. Meaning that we know that there are huge swaths of people out there who had the bug and never had any or had very mild symptoms and who were never tested. Hence, the real math looks like this:

However, the real rate can only be determined once we know how many are positive for COVID-19 in a given community versus how many died. So what’s that REAL FATALITY number?

The Stanford Fatality Rate Based on New Data

A crew from Stanford decided to test more than three thousand people in Santa Clara County, California for antibodies to the novel coronavirus on April 3rd-4th. (4). THIS IS THE LARGEST DATASET TO DATE OF THE AVERAGE JOES AND JANES IN THE COMMUNITY. Based on various adjustments including for the test accuracy, the percentage of the population that tested positive for COVID-19 in Santa Clara ranged from 2.5-4.2%. Given that Santa Clara County has 1.93 million people, that means that the researchers estimated that 48,000-81,000 people were infected. If we split that in the middle, that’s about 64,500 people.

First, these numbers show that the virus had spread far wider than anyone had thought. About 50-100 times more widely. That means that you may well have had this virus and never knew it.

Second, there is a MUCH bigger story here. Why? The total number of people who have perished to date due to COVID-19 two weeks later, in Santa Clara county is 73 (5). Even if we add another 20 deaths for people now in the hospital, the total fatality rate is 93/64,500 or 0.14%! 

Comparing COVID-19 Fatality

What’s the fatality rate of influenza among all age groups? Depending on who is reporting the data, about 0.10% or less (6). The best flu fatality rates are in the 0.05% range, but higher death rates are reported, in particular in Asia.

So based on this new data, which is the most expansive to date, COVID-19 is about 2-3 times as lethal as a bad flu bug. Near as I can tell, this is a true statement based on the best available evidence. If you can debunk it with this Santa Clara data or a similar dataset where an entire community was randomly tested for the SARS-CoV-2 virus, please do so in the comments.

Will more data increase or decrease the fatality rate? That remains to be seen.

Why COVID-19 is MUCH WORSE than the Flu

First, as I have written, the SARS-CoV-2 virus is likely 2-3 X more lethal than the flu. However, COVID-19 is different than the flu. First, unlike the flu, it hits the elderly the hardest and it doesn’t seem to hit the very young. In addition, it also seems to kill seemingly random individuals who likely wouldn’t perish from the flu. That could be due to the “cytokine storm” I’ve discussed. In addition, this virus requires significantly more hospital resources than the flu in terms of ventilators and how quickly patients get severe. Meaning COVID-19 patients need emergency intubation much more frequently and unpredictably than severe flu patients, which creates a HUGE burden on the healthcare system and doctors.

So what we did to avoid the overload of the health system was the right thing. However, now that we have our health system prepared and ramped up, it’s time to clear the air and see where we are. Where’s that? We have a nasty bug that can kill quickly, but that kills at 2-3X the rate of the flu. Hence, it’s time to smartly open up the regions of our economy that are showing sharply declining cases or we’re creating bigger problems for ourselves.

The Post-COVID Economic Depression

The unemployment rate currently is believed to be about 17%. That will likely rise over the next few weeks as businesses that are hit hard by COVID shed employees once the Payroll Protection program expires. When was the last time we saw unemployment rates of 20%? The GREAT DEPRESSION in the 1930s. Hence, it’s time to take this new fatality data, begin widespread testing, and continue our clinical trials into effective treatments for COVID-19.

The upshot? This is a bad bug and I’m glad we closed it all down. However, it’s now time to safely begin opening up parts of the country and recognize the lethality of our foe with a very heavy heart, but an equally clear mind.

____________________

References:

(1) Kolate G. Coronavirus Is Very Different From the Spanish Flu of 1918. Here’s How. The New York Times. https://www.nytimes.com/2020/03/09/science/coronavirus-is-very-different-from-the-spanish-flu-of-1918-heres-how.html Accessed 3/10/20.

(2) Chinese Center for Disease Control and Prevention CCDC Weekly. The Epidemiological Characteristics of an Outbreak of 2019 Novel
Coronavirus Diseases (COVID-19) — China, 2020. Vol. 2. No. 8. http://weekly.chinacdc.cn/fileCCDCW/journal/article/ccdcw/2020/8/PDF/COVID-19.pdf

(3) Faust J. COVID-19 Isn’t As Deadly As We Think. Slate. https://slate.com/technology/2020/03/coronavirus-mortality-rate-lower-than-we-think.html Accessed 3/6/20.

(4)  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

(5) Santa Clara Public Health. County of Satna Clara Emergency Operations Center. https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx. Accessed 4/17/20.

(6) Iuliano AD, Roguski KM, Chang HH, et al. Estimates of global seasonal influenza-associated respiratory mortality: a modelling study [published correction appears in Lancet. 2018 Jan 19;:]. Lancet. 2018;391(10127):1285–1300. doi: 10.1016/S0140-6736(17)33293-2

Category: Coronavirus

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34 thoughts on “Did We Just Blowup the Economy for a Bug with a 0.14% Fatality Rate?

  1. Anshul

    Nice post Dr Centeno. While the Stanford study gives us a good insight on the true fatality rate, there appears to be a selection bias in the study, as these were the people who ‘chose’ to be a part of the study. Without proper randomization , the study might be providing an inflated infection rate.

    1. Chris Centeno, MD Post author

      Yes, that selection bias could have changed the fatality rate. In which direction, unsure…

  2. Sam

    “In a time of universal deceit, telling the truth is a revolutionary act” – George Orwell.
    The political-economy of the COVID-19 significantly outweighs its medical dimension. Influencing upcoming presidential election, indebting public (so called Aid Package), mandated vaccination (for the benefit of big pharma, etc), austerity measures (to the detriment of people), impoverishing people and laying the ground for the next big war are in the pipe line. As to the war/military dimension, it would be wise no to discount remarks of the Secretary of State in Press Briefing and how astoundingly the President reacted to it:
    – Secretary of State: We are in a live exercise here
    – President: You should have let us know
    – President: If you have any question for the Secretary of State do that because I like him to go back to State Department or as they call it the Deep State Department

    https://www.globalresearch.ca/secretary-state-mike-pompeo-admits-covid-19-live-exercise-president-trump-comments-i-wish-you-would-have-told-us/5707223

    https://www.washingtonexaminer.com/news/deep-state-department-trump-blasts-agency-workers-while-standing-next-to-secretary-of-state

    This degree of explicit dispute between the President of Sate and the Deep Sate is unprecedented. It is a hint that the people would likely be struggling with disruptive effects of political-economy of this crisis at least till November presidential election. And if you publically disagree with the (international) Deep State then you could potentially end up in Psychiatric Ward.

    https://www.globalresearch.ca/german-lawyer-sent-psych-ward-organizing-protest-against-covid-19-lockdown/5709685

  3. Leland J Hoepfinger

    How do the Stanford numbers compare to the cruise ship study or are they comparable?

    1. Chris Centeno, MD Post author

      Cruise ship fatality rate was 0.85%, but cruisers tend to be a decade older than the average age of the people in the community at large, so that makes sense as this disease hits the elderly harder.

  4. Scott Veix

    After all the ups and downs of this pandemic roller coaster we’ve all been riding, I have to pass along my most gracious thanks to Dr. Centeno and the folks who compile and publish this blog. The insights, information and plain old common sense that shows up in my inbox every day is seemingly the only stable source of reason among the advertisement pushing panic inciting media. Especially enjoy it when I get to nod my head in agreement as I read validation for the opinion I voiced in a debate earlier in the day. The numbers in today’s blog were one of those as I have been trying to relay the fact that fatality rate of tested is not the fatality rate of the disease. Thanks again!

  5. Jenna

    Thank you so much for your posts throughout this pandemic! I listen to Dan Bongino’s podcast and he linked to a couple of your blog posts then interviewed you, and I have read your posts ever since. I’ve been extremely selective about the sources of virus content I rely on because I don’t buy into the hysteria. You are straightforward and fact-based. Thanks again for being a reliable source of info that always brought me immense comfort during a time of massive fear mongering. Love your Gupta Fatality Rate lol. That’s exactly why I avoid the nuts!

  6. Chris Anderson

    Something I think you’re missing is the comparative infection rates: how likely are you to get the flu vs. how likely you are to get covid-19 (symptomatic or not). You’re talking about the fatality rate: the likelihood of dying given you are infected. What I care about is the likelihood of my or my family and friends dying, given we’re human beings and live in the U.S.. So suppose the infection rate for covid is 10 times that of the flu. Then the chance of a random individual dying from covid is 20 to 30 times their chance of dying from the flu. Does anyone have an estimate on the infection rate of covid vs. the flu?

    1. Chris Centeno, MD Post author

      R0 for flu=1-1.5, R0 for SARS-CoV-2 is about 2. So about 25% more. Given that this is a log metric, that could end up in many more deaths than the flu. However, R0 with social distancing for SARS-CoV-2 goes down to 1.

  7. John Grady

    What an immature and dangerous headline to promote your blog. The number of deaths even with the drastic measure implemented has exceeded yearly influenza deaths and we aren’t close to being through this pandemic. If you look at the number of weekly deaths Covid-19 now exceeds cancer and heart disease! I’m an ER doctor on the front lines. Obviously you haven’t seen the fear of people needing to be intubated, or staff members and Providers treating PUIs (people under investigation). This is NOT just another flu season.

    1. Chris Centeno, MD Post author

      John, yearly influenza deaths in 2017-18 in the US were 80,000. Current predictions for this pandemic through August in the US are 60,000. Heart disease deaths in the US are 647,000 a year, so the death rate of COVID-19 is nowhere near heart disease, which accounts for 1 in 4 deaths.

      That 60K number could have been higher without social distancing given the higher R0 and 2-3X fatality rate for COVID-19. Hence, we did the right things at the right time. As the blog clearly says, this is NOT the flu, it has a higher virulence and requires more healthcare resources including urgent intubation, so please read more than the headline.

  8. robert g davis

    In your last response you said we did the right things at the right time but your headline implies we destroyed the economy? So what did we do that we should not have done to prevent destroying the economy?

    1. Chris Centeno, MD Post author

      The right thing would have been the South Korean model, but we were not prepared like that… So we did place a thermonuclear bomb at the heart of the economy, but nobody could have prevented that catastrophe.

  9. David

    Chloroquine and its close relative hydroxychloroquine Zinc and ZPAC is it working if administered early? More Dr’s are saying it works. More are saying that ventilators are causing more damage than good. Skipping CPAP and BPAP. Why?

  10. Marguerite Eustace

    What exactly is ZPAC?

    1. Regenexx Team

      Hi Marguerite,
      Zithromax (azithromycin), also known as Z-Pak, is an antibiotic used to treat bacterial infections such as bronchitis, pneumonia, and infections of the ears, lungs and other organs.

  11. Paul Agostino

    It seems to me that you can chart the strength and behavior of a virus without testing the general population. Set and subsets: A certain number of infections will cause a certain number of hospitalizations, which will cause a certain number of deaths. The number of hospitalizations rises and falls at the same rate as infections. And so do the number of deaths. All three rise and fall proportionately. They have to. “New Deaths” is the most solid number, because if you died of coronavirus in the hospital, you got tested. Divide the number of deaths by the population number and you can chart how the virus is doing and in what direction it’s moving. If you want to break the study down into demographics, you use the deaths and population of a specific demographic. I learned my math at the racetrack. Thoroughbreds were my teachers. You study speed figures, past performances, and percentages. Reading the coronavirus graphs are a lot like reading the racing form. I started posting the numbers and my views on this pandemic when I saw the media was lying to the people about the death rate and trying to scare them into staying tuned for the commercials. If I knew that simple formula, they must have. And the disease-control people, too. Why didn’t anybody say anything? Next time, maybe they should hire some gamblers to chart the pandemic numbers instead of politicians, media members, and certain scientists. I’ve been doing it for over a month, and you can look it up. See the Headlock Press page on Facebook for more.

    1. Chris Centeno, MD Post author

      You do need to test the general population to get a fatality rate, but it is all simple math at this point.

  12. Paul Agostino

    So. This virus has spread 100 times faster than anybody thought and has only killed 73 people out of 2 million? Wouldn’t that also mean 100-times more people have been infected and recovered than previously reported? And wouldn’t that mean that 100-times more people are immune than were previously reported? Why in the world wouldn’t you have led with that and explained what it means to people who do not speak political-ese? Because, to me, it sounds like the people in Santa Clara County, and throughout the United States of America, are being quarantined under false pretenses. Who is responsible for misinterpreting this information and keeping us locked-down for nothing? Remember. You’re under oath.

  13. Douglas Kunce

    https://www.cdc.gov/H1N1flu/hospitalreporting.htm#b

    The numerator of the death rate is also problematic. The link above shows the death reporting guidance from the CDC during the 2009 H1N1 pandemic. A stark contrast to the guidance given for COVID.

    1. Chris Centeno, MD Post author

      Yes, that’s right, the authorities have decided to err on the side of over-reporting and figuring it all out at a later date, So there is likely over-reporting of COVID deaths right now versus under-reporting.

  14. Jamie

    Don’t you think it’s worth mentioning that we in Santa Clara have been on strict lockdown procedures for over a month now? Previous mortality estimates broadly touted by the media were worst case scenarios based not making efforts to mitigate the spread.

    1. Chris Centeno, MD Post author

      Lockdown impacts the R0 (the speed at which the virus spreads), but it does nothing to change the fatality rates (unless the healthcare system gets overloaded due to a sudden spike in cases like Italy). So being on lockdown wouldn’t impact these study results.

  15. Bill

    Thank you for the information, this is very helpful. I sure hope the fatality rate turns out to be MUCH lower so we don’t have to go through this again! Unfortunately the headline distorts the actual importance of this new data. It’s like looking back at the fact I never needed that life insurance policy I bought when the kids were little. It is important to all of us that we distinguish what is reported as fact from what is reported as opinion. Most of what I have seen in actual news media attempting to report facts goes to lengths to point out the weaknesses in the data. That is why ranges are reported. In the opinion media you don’t get that. If we took precautions based on the best data available at the time, looking back should be a learning experience not a blame game.

    1. Chris Centeno, MD Post author

      Bill, not blaming anyone. It’s my sense that we made the right moves to permit the healthcare system to get ready. However, now that it’s ready, it’s time to see how fatal or not this bug is or isn’t. For example, if the fatality rate is 1-2X influenza, then it’s time to err on the side of opening up smartly. If it’s 5X influenza, then we would err on the side of shutdowns. Hence, datasets like this one out of Stanford are critical in seeing what the actual fatality rate is or isn’t.

  16. Roger

    A peer review of the Santa Clara article (also from a Stanford professor) is here:
    https://medium.com/@balajis/peer-review-of-covid-19-antibody-seroprevalence-in-santa-clara-county-california-1f6382258c25

    1. Chris Centeno, MD Post author

      Regrettably, a magazine doesn’t count as “peer review”, but the issues brought up could impact the results. The group had already adjusted for the false positive and negative rate, but the recruitment or selection bias could be an issue. The state of NY has just begun to test its own group of 3K, so we’ll see what they report. In addition, there are millions of serum antibody tests about to be done over the next 30 days, so we’ll know soon enough.

  17. Russ

    Dr.Centeno, I wanted to know your thoughts on testing. First of all, do you believe when they test for antibodies that that information will be as useful as we are being told? Do antibodies equal immunity? Even if that were true, for how long would that immunity last? Wouldn’t each person’s immunity need to be appraised on all the other variables that might be effecting a given persons immune response. Age, diet, exercise, weight, pre-existing health conditions, and stress levels are just a few. Then there’s the actual test. Is it effective? How effective? Are some tests better than others? What about the problem of false positives or false negatives? Then there talking about an app or digital ID that each person would need to prove immunity. How do you prove immunity? Is that even possible? Then there’s the vaccine. That introduces a new set of problems. Who are the people testing for safety and efficacy? Are they conflicted? Can we trust them? What if the virus mutates? Is the vaccine still usable? I am not confident in the government regulators, agencies, and industry experts in addressing these issues? Are you?

    1. Chris Centeno, MD Post author

      Russ, we’re beginning to see fingerstick antibody tests get FDA EUA approvals based on large datasets of 1,000 or more, so these tests should be reliable. On immunity, how long that lasts, nobody knows. We are starting testing now and we plan to test everyone who demonstrates immunity type antibodies every two months to make sure they’re maintaining that immunity. On viral mutations, that’s always possible…

  18. David Smith

    Doctor you are very brave to wade into the fray with logic and reason. Do I understand correctly, simply that; the lockdown and distancing measures were successful, and therefore a good initial decision, for reducing the rate of infection only, but will do nothing to stop the number of infections or reduce the number of deaths? It seems to me that our current approach isn’t sustainable and therefore, will ironically end with this country not being able to protect anybody.
    I don’t hear much about the Swedish approach which is to put their resources emphasis on protecting the most vulnerable and allowing the rest of society to develop “herd immunity”. This is a plan toward success rather than delay.

    1. Chris Centeno, MD Post author

      David, I think the shutdown was wise because our health system wasn’t ready to deal with a spike in cases. Now that it is, we can hopefully pursue the S. Korea model where we have a functioning economy with vibrant testing and a healthcare system that can handle the caseloads. All “flattening the curve” does is to reduce the number of cases that need to be seen in ICUs during any given month.

  19. Roger

    If a post by an academic on medium.com doesn’t count as a “peer review” then a methodology that recruits by offering free tests on Facebook shouldn’t count as a “study”

    1. Chris Centeno, MD Post author

      Roger, Medium is a magazine and not a science journal (or more accurately a “blog host”). The Stanford study has yet to go through peer-review but was submitted, so we’ll see how that goes. In the meantime, the Stanford crew posted their results on the same pre-pub site as many COVID-19 papers. The recruitment through Facebook could introduce selection bias as I have written in other comments, so that’s a valid criticism of this study. However, recruiting for studies, especially population-based surveys, via Google ads, Facebook, and other digital media is pretty common these days. That used to happen via radio or TV, but given that both of those platforms have less exposure than Facebook, that’s caused many study coordinators to get creative in recruiting subjects.

  20. Donald Porter

    Are we experiencing the deadliest war ever to ecomomies not people?? Is it a Biological war ?

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