Coronavirus Statistics: Cases, Mortality, vs. Flu

Mendel

Senior Member.
Arabic countries have lots of cases, but claim extremely few deaths.
a) Your comparison is skewed, the median European country as per https://www.ecdc.europa.eu/en/cases-2019-ncov-eueea is Finland with 47 deaths per 1000 cases. Iceland has the low end at 5.5.

b) The Arab countries are in the exponential phase of the spread. Deaths lag case reporting by about two weeks, if the case number doubles in a week, you are underestimating by a factor of 4.

c) Demographics plays a huge role, the death count depends highly on how many people over 70 get infected. If you can protect the elderly, you're good; if early spread is among active, mobile people, you'll have few elderly. (Germany used to have a 0.5% CFR early on for those reasons.)

d) I don't know how many women in these counries cover their face for religious reasons, but a Niqab would work like a community mask. It'd be interesting to see infection rates by gender for these countries.
 

DavidB66

Active Member
I think these countries (Saudi Arabia, Bahrain, etc) are in an earlier stage of the epidemic than Europe. Their daily new infections only really started taking off around mid-April. People infected with Covid don't usually die quickly, so there is a time lag of at least a few weeks before a surge of infections turns into a surge of deaths. A better comparison might be with Iran, where the epidemic took hold in early March. The death rate as a proportion of infections there is about 6%. (Incidentally, Iran seems to be having a second wave of infections.)
There are a lot of oddities in the international data which I'm sure will keep epidemiologists in work for years to come. Why is the death rate so much higher in Belgium than the Netherlands, for example? I know the Belgians point out that their figures include all deaths, not just those in hospitals, but that doesn't seem nearly enough to explain the difference. A thought just crossed my mind that the Netherlands has euthanasia, so some of their potential Covid fatalities may already have been helped over the finishing line!
Another possible factor that is now gaining attention is Vitamin D. Since Vitamin D status depends on a combination of diet, exposure to sunlight, and skin pigmentation, it all gets quite complicated. There is a new article on the subject by Fiona Mitchell in The Lancet.
 

Mendel

Senior Member.
Another possible factor that is now gaining attention is Vitamin D. Since Vitamin D status depends on a combination of diet, exposure to sunlight, and skin pigmentation, it all gets quite complicated.
I only have a third-hand source for this, but I heard that vitamin D insuffiency can be caused by kidney problems. We know that Covid-19 can involve the kidneys, so maybe the vitamin D link may be a matter of a common cause, i.e. kidney problems preciting bad outcomes for Covid-19, and vitamin.D would just be a marker for that and not be directly involved.
 

qed

Senior Member
When one considers deaths per million, is the USA really doing that badly? They seem to be doing better than the UK, Spain, Italy, France, Belgium, the Netherlands, Sweden and Ireland?
1590261265388.png

Is this argument flawed?
 

Mendel

Senior Member.
When one considers deaths per million, is the USA really doing that badly? They seem to be doing better than the UK, Spain, Italy, France, Belgium, the Netherlands, Sweden and Ireland?
View attachment 40924

Is this argument flawed?
Yes, because you are comparing small countries with an entity the size of a continent. The EU as a whole has ~295/1M deaths, and I believe the "new deaths" numbers are dropping faster than the US's.
Belgium is the worst-hit country in the EU, and it still looks better than New York State. The median country in the EU is Hungary with 49 deaths/1M. The median state in the US is Missouri with 111/1M, and 4 US states are worse off than Spain and Belgium.
Article:
image.png

(The UK is doing about as badly as the US on terms of case numbers not trending down. I think it's because they're getting the same misinformation.)
If you take the US, and subtract NY, NJ, MA and CT from the daily new cases, is the graph going up or down?

P.S.:
Article:
Our estimates suggest that the epidemic is not under control in much of the US: as of 17 May 2020, the reproduction number is above the critical threshold (1.0) in 24 [95% CI: 20-30] states. Higher reproduction numbers are geographically clustered in the South and Midwest, where epidemics are still developing, while we estimate lower reproduction numbers in states that have already suffered high COVID-19 mortality (such as the Northeast). These estimates suggest that caution must be taken in loosening current restrictions if effective additional measures are not put in place.
 
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qed

Senior Member
I don't think I get that. What does country population size have to do with deaths per million? What is the correlation and why?

And can we say at least say that Europe and and the USA are doing similarly well?
 

deirdre

Senior Member.
I think it's because they're getting the same misinformation.
large cities skew predominately left politically. so where would they be getting this misinformation? I think now its most likely because people are tired of being cooped up after 2 plus months of lockdowns. and/or they need to work after 2 plus months of lockdowns.
 

Mendel

Senior Member.
large cities skew predominately left politically. so where would they be getting this misinformation? I think now its most likely because people are tired of being cooped up after 2 plus months of lockdowns. and/or they need to work after 2 plus months of lockdowns.
Article:
According to a new Yahoo News/YouGov poll, 44 percent of Republicans believe that Bill Gates is plotting to use a mass COVID-19 vaccination campaign as a pretext to implant microchips in billions of people and monitor their movements — a widely debunked conspiracy theory with no basis in fact.

The survey, which was conducted May 20 and 21, found that only 26 percent of Republicans correctly identify the story as false.

In contrast, just 19 percent of Democrats believe the same spurious narrative about the Microsoft founder and public-health philanthropist. A majority of Democrats recognize that it’s not true.

Yahoo Poll.png

Misinformation hits both sides of the aisle, this particular kind of misinformation just hits Republicans harder. (And that may just be a result of the educution level of the respective constituencies, Republicans are currently appealing more to the less educated.)
It spreads because of the common language: Trump says "we don't have the virus, it will go away", then Bill deBlasio says "we don't have the virus, go ride the subway", and the UK people see that and they're then not willing to take precautions either.

And they're getting it from social media, see my post on the "current events" thread: https://www.metabunk.org/posts/239278/
 

deirdre

Senior Member.
According to a new Yahoo News/YouGov poll, 44 percent of Republicans believe that Bill Gates is plotting to use a mass COVID-19 vaccination campaign as a pretext to implant microchips in billions of people and monitor their movements
so you think people in the UK and America are exposing themselves to coronavirus because they think Bill Gates wants to microchip them? Is the thinking that if they are naturally immune (antibodies) then they won't need his microchip vaccine? hhmmmm...

Trump says "we don't have the virus, it will go away"
and he did not say that. (speaking of spreading misinformation...)
 

Mendel

Senior Member.
so you think people in the UK and America are exposing themselves to coronavirus because they think Bill Gates wants to microchip them? Is the thinking that if they are naturally immune (antibodies) then they won't need his microchip vaccine? hhmmmm...
That is the CT I have data on, I assume it correlates with "the epidemic is a hoax", what Cynthia Brehm made the news with yesterday.
and he did not say that. (speaking of spreading misinformation...)
I'm paraphrasing, obviously.
Article:
Jan 22 "We have it totally under control. It's one person coming in from China, and we have it under control. It's going to be just fine."
Feb 10 "Looks like by April, you know, in theory, when it gets a little warmer, it miraculously goes away. I hope that's true. But we're doing great in our country."
Feb 13 "In our country, we only have, basically, 12 cases, and most of those people are recovering and some cases fully recovered. So it's actually less."
Feb 26 "When you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that's a pretty good job we've done."
Mar 5 "It's going to all work out. Everybody has to be calm. It's all going to work out."
Mar 10 "This was unexpected. ... And it hit the world. And we're prepared, and we're doing a great job with it. And it will go away. Just stay calm. It will go away."
Mar 11 "The vast majority of Americans, the risk is very, very low."

Mar 16 "If everyone makes this change or these critical changes and sacrifices now, we will rally together as one nation and we will defeat the virus."

Mar 24 "Easter is a very special day for me. And I see it sort of in that timeline that I'm thinking about. And I say, wouldn't it be great to have all of the churches full?"

The npr timeline I have sourced these quotes from contrasts them with the WHO communications over the same time span.
 

deirdre

Senior Member.
I'm paraphrasing, obviously.
you're reaching. and trying to hard to prove a speculation. you're trying to say something Trump said March 10th is the reason cases in the us and uk are going up NOW, even though on March 10th noone understood the severity of the disease and deaths that would follow. Now people do know. So the question is 'what is the reason cases keep going [up] NOW'. I stand by my original theory.
 

Mendel

Senior Member.
you're reaching. and trying to hard to prove a speculation. you're trying to say something Trump said March 10th is the reason cases in the us and uk are going up NOW, even though on March 10th noone understood the severity of the disease and deaths that would follow. Now people do know. So the question is 'what is the reason cases keep going [up] NOW'. I stand by my original theory.
Deirdre, you are losing the context, and that's why you misunderstand what I'm trying to say. My original statement was,
(The UK is doing about as badly as the US on terms of case numbers not trending down. I think it's because they're getting the same misinformation.)
I'm saying here that misinformation is a factor in behaving recklessly, and that the US and the UK are exposed to the same sources of misinformation.
You reply, large cities skew predominately left politically. so where would they be getting this misinformation?
I'm making the point that misinfomration is not exclusive to a political orientation, I'm saying that this misinfomration spreads via social media, and I gave examples of misinformation to illustrate the effect it might have: Trump says "we don't have the virus, it will go away", then Bill deBlasio says "we don't have the virus, go ride the subway", and the UK people see that and they're then not willing to take precautions either. Note that I used a politicians of both alignments in my example.
You then challenge my Trump example with and he did not say that.
So I give you quotes where Trump actually said "it will go away", and downplayed the amount of virus spread that was going on in the US at the time.

I am making the case that there are a lot of people out there who believe "the virus is a hoax", and cited Cynthia Brehm, who still believes that. I'm convinced that this belief causes reckless behaviour, and that misinformation strengthens this belief. It comes from many sources. Trump and deBlasio are just examples, there are many others, including right-wing media such as Fox News and others.

-----

Instead of acknowledging that Trump said that, and that your assertion that "he did not say that" was wrong, you are now shifting the argument to something that is even more offtopic, but equally wrong:
on March 10th noone understood the severity of the disease and deaths that would follow
But my NPR source (cited in my previous post!) directly contradicts this assessment because it contains the many severe warnings that the WHO issued. I have also showed another NPR timeline here on this forum.
Article:
March 11, 2020
“Bottom line, it’s going to get worse.”— Dr. Anthony Fauci

On March 9, Prime Minister Giuseppe Conte quarantined all of Italy.
On March 7, a participant of the Red Dawn mailing list wrote:
The emails can be downloaded via https://www.nytimes.com/2020/04/11/us/politics/coronavirus-red-dawn-emails-trump.html

Nancy Messonier of the CDC said on February 26:
Article:
I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. … I told my children that while I didn’t think that they were at risk right now, we as a family need to be preparing for significant disruption of our lives.”
— The CDC’s Messonnier, who warned that the government’s containment strategy would likely have to move to mitigation measures such as closing businesses and schools

Every competent public health official in the United States understood "the severity of the disease and the deaths that would follow" on March 10th. The data from February's Wuhan outbreak had shown the lethality of the disease and the age groups and other risk factors involved; Italy was showing that it could hit Western countries just as hard as it hit Wuhan.

To inform the public otherwise constituted misinformation. What Donald Trump and Bill deBlasio communicated was misinformation. Provably so.

I don't enjoy telling you that you got easily verifyable facts wrong. I wonder if you tried to verify them before you posted your statements.
 

deirdre

Senior Member.
Instead of acknowledging that Trump said that, and that your assertion that "he did not say that" was wrong,
it wasn't wrong. trump did not say what you admitted after was a paraphrase.

I'm convinced that this belief causes reckless behaviour, and that misinformation strengthens this belief. It comes from many sources.
and that is fine if that is your opinion. and I stand by my original opinion.

I don't care if you think Trump was/is the only one saying {my words} 'it might go away with warmer weather.' or if you think covid-19 will be with us forever. I already know how you feel. I disagree that old bad information has much to do with new cases NOW. I still think now, a bigger influence is people needing to get back to work or just sick of being cooped up for months on end. I don't understand why it is so horrible if I hold a different opinion to you. quoting me things from 2-3 months ago before the big outbreaks, isn't going to help change my mind.
 

deirdre

Senior Member.
New info from CDC reported
  • 1/3 asymptomatic
  • 40% transmit virus to others before they feel sick
  • .4% mortality rate for those with symptoms (subject to change)
https://boston.cbslocal.com/2020/05/22/coronavirus-cdc-symptoms-asymptomatic-mortality-rate/
 

Agent K

Active Member
CDC's "best estimate" "based on data received by CDC prior to 4/29/2020"
https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html

R0: 2.5
Percent of infections that are asymptomatic: 35%
Infectiousness of asymptomatic individuals relative to symptomatic individuals: Same
Symptomatic Case Fatality Ratio: 0.4%
Symptomatic Case Hospitalization Ratio: 3.4%
Percent admitted to ICU among those hospitalized: 0-49 years: 21.9%, 50-64 years: 29.2%, ≥65 years: 26.8%
Percent on mechanical ventilation among those in ICU: 0-49 years: 72.1%, 50-64 years: 77.6%, ≥65 years: 75.5%
Percentage of transmission occurring prior to symptom onset: 40%
Time from exposure to symptom onset: ~6 days (mean)
Time between symptom onset in an individual and symptom onset of a second person infected by that individual: ~6 days (mean)
Time to seek care (outpatient): 3–7 days: 50%
Mean number of days from symptom onset to hospitalization: 6-7 days
Mean number of days of hospitalization among those not admitted to ICU: 4-6 days
Mean number of days of hospitalization among those admitted to ICU: ~10 days
Mean number of days of mechanical ventilation: 5.5 days
Mean number of days from symptom onset to death: ~14 days
Mean number of days from death to reporting: ~7 days

I highlighted some interesting things, like the fact that hospitalized 50-64-year-olds are more likely to be admitted to ICU than those over 65, and deaths are reported after a delay of about a week.
The symptomatic Case Fatality Ratio of 0.4% appears to account for undiagnosed cases, so it's more like an Infection Fatality Rate. Otherwise, if you divide the ~2000 daily deaths by ~30,000 daily reported cases in April, you get a 6.7% CFR.

If the symptomatic IFR is 0.4%, and 35% of infections are asymptomatic and presumably not fatal, then the overall IFR is 0.26%, which would mean that 99K deaths resulted from 38 million infections, which would be 23 times greater than the 1.67 million reported cases. It would mean that 11.5% of the U.S. population has already been infected despite lockdowns, which is a higher percentage than the ~4% I've seen in various serology studies and projections, except in hot spots like NYC, where 27% may have been infected.
 
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Mendel

Senior Member.
New info from CDC reported
  • 1/3 asymptomatic
  • 40% transmit virus to others before they feel sick
  • .4% mortality rate for those with symptoms (subject to change)
The CDC is actually using ranges for these models, so it'd be appropriate to say
* 20%-50% asymptomatic
* 0.2%-1% symptomatic fatality rate

The fact that they are actually using these values for models means they're not ruling any of these values out yet.

The 40% value of "transmission before symptom onset" needs to be put in context with some other values.
Let's assume the "best estimate" of R0=2.5, Percentage of infections that are asymptomatic 35%, Infectiousness of asymptomatic individuals relative to symptomatic individuals 100%, from table 1, scenario 5 at https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-scenarios.html#table-1

Now let's take 100 infected persons. 35 of them are asymptomatic and infect 2.5*35=88 other people. 65 of them are symptomatic and infect 2.5*65=162 other people; 40% of these infections (0.4*162=65) occur before symptom onset, 97 occur afterwards. Note that in this scenario, on average, each symptomatic person infected one other person before they had symptoms!

In this scenario, 153 infections occur from indviduals that don't have symptoms, and only 97 occur from individuals that do. In this scenario, 61% of all transmissions come from individuals who don't feel sick!

These assumptions all apply in the "natural" state where the virus spreads in an unaware population. Once we became aware, for example, infections from symptomatic individuals probably dropped because people are now more careful when they have symptoms. Social distancing helps reduce asymptomatic spread; tracing and isolating contacts of symptomatic cases makes asymptomatic contacts aware that they might have the virus and hopefully keeps them from spreading it.
 

Mendel

Senior Member.
35% of infections are asymptomatic and presumably not fatal
Death is a symptom.

Your calculations neglect the age demographics. Basically, from the death count you can fairly well estimate how many people in the 65+ age group were probably infected, but for the younger age groups, we just don't know. And the serological studies mostly measure people from those younger age groups, so there's a disconnect there. The upshoot is, you can't take the death figures and compute the "true" number of infected unless you consider the age demographics. (Well, obviously you can, but it won't be reliable.)

The Diamond Princess symptomatic fatality rate for 65+ was 7/200=3.5% at the time of the study https://www.medrxiv.org/content/10.1101/2020.03.05.20031773v2 on March 8 (disregarding subsequent symptoms or deaths). Given that people with worse health stay in care homes and don't go on cruises, I'm doubting that the CDC scenarios with symptomatic fatality rates for that age group of under 3% are realistic.

A difficulty with the asymptomatic rate is that I don't know if an asymptomatic infection always causes a person to develop a specific antibody response. If that does not happen in many cases, the serological surveys won't count these people. These are studies that the Navy would be doing with their recent outbreak in a confined population that has been thoroughly PCR-tested, they should have a detected a large group of asymptomatic cases, and seroconversion in these cases should be observable.
 

Agent K

Active Member
In this scenario, 153 infections occur from indviduals that don't have symptoms, and only 97 occur from individuals that do. In this scenario, 61% of all transmissions come from individuals who don't feel sick!

These assumptions all apply in the "natural" state where the virus spreads in an unaware population. Once we became aware, for example, infections from symptomatic individuals probably dropped because people are now more careful when they have symptoms. Social distancing helps reduce asymptomatic spread; tracing and isolating contacts of symptomatic cases makes asymptomatic contacts aware that they might have the virus and hopefully keeps them from spreading it.
Right, this assumes that 40% of transmission "prior to symptom onset" only counts pre-symptomatic and not asymptomatic transmission, so adding asymptomatic transmission increases that percentage. Recognition of asymptomatic and pre-symptomatic transmission is what convinced public health authorities to advise or require everyone to cover their faces in public even if they don't feel sick.
 

Mendel

Senior Member.
Recognition of asymptomatic and pre-symptomatic transmission is what convinced public health authorities to advise or require everyone to cover their faces in public even if they don't feel sick.
That's the logic behind social distancing: that almost every spreader has spread the virus while not (yet) knowing they're infected, so we must require everyone to exercise caution because we can only stop the spread if the people who don't know they're infected are cautious.

The highest risk is extended meeting (15 mins) at 6 ft or closer (~5% attack rate under these conditions in a workplace setting has been documented in Munich), which is why reduction in contacts and distance is effective. Hand washing may not contribute much, but it doesn't cost anything and is generally beneficial.
My personal opinion is that the use of community masks or surgical masks is mostly psychological: people want to feel that there is a positive activity they can do to influence the epidemic even if it plays only a minor role.

Ultimately, the safe way out of the lockdowns is via contact tracing, as the WHO has been preaching and many countries and states have been implementing: close contacts of known infected people are precisely the persons who might be engaging in asymptomatic spreading, and if the local health officials can trace and isolate most of them, a lessening of "lockdown" measures does not lead to exacerbated spread. That is why NY state has made the availability of sufficient contact tracing teams a prerequisite to reopening for regions.

In a region where the case numbers are rising, that could indicate that contact tracing isn't working to stop the spread. But it could also mean that contact tracing detects outbreaks more thoroughly, so that will depend on the situation; and cases should go down eventially anyway. So that's the second set of criteria: new cases going down to levels that the contact tracing teams can handle, and are handling successfully.

I believe anything less risks creating second waves (or in some places, first waves).
 
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