A precise estimate of the case fatality rate is therefore impossible at present. — 2019-Novel Coronavirus (2019-nCoV): estimating the case fatality rate – a word of caution - Battegay Manue et al., Swiss Med Wkly, February 7, 2020
First, let’s breakdown fatalities by a few dynamics. Most fatalities have occurred so far in Hubei prefecture, specifically Wuhan, Specifically, the casualty rate in Wuhan is 2.9%, versus .4% for the rest of China (numbers as of 2/10). To look at fatalities temporally, the death rate was 17.3% in the earliest stages of the outbreak, and has gradually reduced to .7% in China.
One thing that is important to understand, is that early in outbreaks the case fatality rate, or CFR, is always grossly over-estimated, because people dying from severe symptoms associated with the virus or bacteria are rarely missed; all governments have at variety of well-developed protocols to catch these, especially during a pandemic. People who didn’t seek hospital attention, or were asymptomatic, meaning they did not display the specific symptoms of COVID-19, are nearly impossible to account for.
The most important and relevant is the fatalities by age and demographic:
AGE | Case fatality rate |
|---|---|
| 80+ | 14.8% |
| 70-79 | 8.0% |
| 60-69 | 3.6% |
| 50-59 | 1.3% |
| 40-49 | .4% |
| 30-39 | .2% |
| 20-29 | .2% |
| 10-19 | .2% |
| 0-9 | 0% (No reported child deaths) |
See the original data and table here.
And keep in mind, these numbers are still likely too high, and current treatment regimes have been developed in and outside China that have successfully reduced the case fatality rate of newer cases as well, whereas these numbers are heavily impacted by early cases in Hubei Province. Anywhere you are seeing a strangely high death rate in places like Iran or Italy, it’s a product of unreported cases (and Iran may be outright lying, given statistical analysis. Italy’s fatalities also reaffirm the pattern between 2/27-2/28, 7 people died. They were 88, 88, 80, 85, 77, and two others over the age 80.
To be 100% clear, all these numbers are several orders of magnitude above the flu. COVID-19 has a very unique pattern right now: it is quite virulent for patients over 70, and for those with cardiovascular conditions. The flu also ranges from 10 to 20 times more virulent for those over 65 as opposed to those under-65 (Flu Pandemic Mortality Rate) but COVID-19 is producing a worrying threat level to the elderly, and those with cardiovascular or lung conditions, as well as diabetics. But on the other hand, many young people who may, like my girlfriend’s daughter in Japan be having anxiety about dying of COVID-19, should calm down. My point to readers 10-39 is to be careful, (especially those with compromised immune conditions and pre-existing medical issues), but not to let this become a major source of anxiety. React. Don’t panic. For people 0-45 the overall case fatality rate is only about double that of the annual flu, which sits at roughly .1%, or 4-6 times the fatalities of influenza with 0-45 age group, given that influenza is also disproportionately fatal to 65+, just not to the degree of COVID-19, with the asterisk that the number of cases is substantially under-reported and the number of fatalities much less so.
Don’t panic, but be very worried. These numbers are all a lot higher than the flu. Additionally, the high frequency that COVID-19 sends otherwise healthy younger people to the hospital with pneumonia, is very worrying. It has the potential to swamp hospitals and consume up a massive amount of medical resources and time. Most of all, the fatality rate among the elderly and those with vulnerable health conditions, is serious and frightening alone. A pandemic is inevitable at this point. South Korea has over 2000 cases, Japan likely has tens of thousands, under-reported (more on that in another post), Italy, France, Germany, England all have widespread outbreaks and there has already been an asymptomatic infection in California, and case in Oregon, Washington, Chicago and elsewhere. What can you do to protect yourself and avoid spreading the disease further?
Step Wash Your Hands Often
You really should be doing this anyway. And not just soap, 3 second lather, 2 second running under water. then leave. A thorough 20 second rub down with the soap lather and an equal 15-20 second washing under the water spout after coughing, touching things in a busy public location, coming into contact with a sick person, before cooking or eating, and for me, whenever I come into contact with a lot of people. This alone reduces chance of transmission by 20%. Wash your motherfucking hands
Carry hand sanitizer. Use it often.
Do. Not. Touch. Your. Face.
This is my bad habit. I subconsciously touch my face incessantly. I’m working on fixing this. Medical workers going into quarantine zones are often trained by having Tabasco sauce put on their fingers. I’m not that desperate yet, but being mindful. Sometimes its even a matter of just thinking, then grabbing the inside of a shirt or collar to scratch at your nose or rub your eye.
Masks, Coughing, ETC
Wearing a mask can also moderately reduce your risk of catching a respiratory disease, especially if worn proper (avoid touching the surface of the mask or using unwashed hands to touch/adjust the mask or its mostly meaningless). But if you have the slightest feeling of being sick, a cough, a fever, etc, and you know, need to go out into a public place, wear a mask. It’s an effective way of stopping your infection from spreading. In addition, always cough or sneeze into the crook of your elbow. Avoid close contact with the elderly and at risk populations if you are sick or have been in contact with someone has been sick.
What does the future hold?
Vaccines are already being tested in both the U.S. and Japan. China and the U.S. are also developing novel treatments for COVID-19, neither of which has been fully tested yet, while other healthcare systems are also frantically researching better treatment as well. Part of the reason there are not more flu deaths is the ready availability of tamiflu and flu vaccines. COVID-19 can’t realistically be eliminated at this point, but we can make it a low fatality, manageable disease vector, like influenza. Vaccines probably won’t be realistically available until next year, but if people take extensive health precautions to avoid potential transmission, it is likely that as the summer months and the end of the typical cold and flu season end, COVID-19 cases (and their fatality rate) will drastically drop.
The US is a Shit-show
I think right as Democrats like Bernie and my Queen, Elizabeth “that’s universal childcare you jerk” Warren, are promoting Medicare for All, a pandemic is coming that is going to clearly show how dystopian and dysfunctional the U.S. healthcare system is. Especially a system that leaves so many people vulnerable and without access to medical care. Infectious diseases spread when you have people who don’t go to the doctor. Giving everyone health care is not just about their fundamental health care rights, if you’re a conservative who doesn’t believe in that, it’s about protecting the rest of the population. And people with insurance are going to see huge bill’s for COVID-19 testing, potentially unaffordable vaccines, and expensive treatment.
I find it too depressing to get into Trump’s incompetent response or the horror of Mike fucking Pence being (apparently) in charge of this response. Needless to say, the National Security Council has a fucking infectious disease division, led by experienced military and government officials for a reason, namely that infectious diseases are a critical national security issue, magnitudes above a 9/11, but Trump fired them. Just like he fired 40% of the CDC’s staff. Trump’s entire presidency is just a long string of pumping hundreds of billions of dollars more into the military while gutting jobs and funding for every other function of government, from measuring pollution, to education and student loan debt relief, to yes, public health, and international aid programs/support to WHO and the UN. His entire object is the object of a pathetic reactionary to make government functionally unworkable, and his administration is a group of dancing monkeys throwing shit at each other, making it no better run than his dozens of failed businesses. Watching this obsessively narcissistic sociopath more upset about the stock market and his own reelection than the lives of tens of thousands of Americans, makes me sick, and if there was any karmic justice in the world, Trump would get COVID-19 too, and for once in his privileged life, suffer like the rest of us.
I only hope and pray from Japan that things don’t get to bad in America, especially for many of the most vulnerable among us. Everyone, please do your part to protect those vulnerable people and yourself. Just don’t hoard. Keep perspective on the dangers. And keep fighting for healthcare for every single American while doing your part not to spread infections. (On that note, since asymptomatic infection has occurred, even if you don’t have symptoms, I would recommend wearing a mask on public transit or planes, purely to reduce your odds of unintentionally infecting a large group of people. Americans and Europeans need to get over their phobia/weird thing against face masks, Literally everyone in China and Japan wears them regularly during a normal flu season, and mostly to stop others from getting sick on crowded trains and city streets).