WHO's COVID Fatality Rate May Be 27 Times Too High, According to Prof's Analysis of Cruise Ship Data
What if we’re wrong about COVID-19?
We’ve been wrong before in underestimating it. If we’re wrong in overestimating it, would that make any difference?
New York Gov. Andrew Cuomo has generally acquitted himself well during the outbreak, but this one line of explanation for his virtual shutdown of his state drew a bit of attention: “This is about saving lives and if everything we do saves just one life, I’ll be happy.”
If this was all about saving just one life, would that justify tanking the stock market? Costing millions of jobs? Bankrupting scores of businesses?
We know, of course, this isn’t about one life.
However, we don’t know how many lives we’re saving.
We also don’t know what the fatality rate of COVID-19 is yet — and one Stanford University School of Medicine professor says we might have that last part massively wrong.
In a piece published last week in STAT, John P.A. Ioannidis, a professor of medicine and of epidemiology and population health, argued that data collected from the Diamond Princess cruise ship could mean the World Health Organization’s predicted COVID-19 fatality rate is way off base.
“The current coronavirus disease, Covid-19, has been called a once-in-a-century pandemic. But it may also be a once-in-a-century evidence fiasco,” he wrote.
He noted that short-term lockdown measures might be tolerable to people, but that long-term ones would be difficult to swallow. This is especially true when you consider the fact that there’s a debate over how reliable the data we have actually is.
“The data collected so far on how many people are infected and how the epidemic is evolving are utterly unreliable. Given the limited testing to date, some deaths and probably the vast majority of infections due to SARS-CoV-2 are being missed,” Ioannidis wrote.
“We don’t know if we are failing to capture infections by a factor of three or 300. Three months after the outbreak emerged, most countries, including the U.S., lack the ability to test a large number of people and no countries have reliable data on the prevalence of the virus in a representative random sample of the general population.”
“This evidence fiasco creates tremendous uncertainty about the risk of dying from Covid-19. Reported case fatality rates, like the official 3.4% rate from the World Health Organization, cause horror — and are meaningless. Patients who have been tested for SARS-CoV-2 are disproportionately those with severe symptoms and bad outcomes. As most health systems have limited testing capacity, selection bias may even worsen in the near future.”
That 3.4 percent figure comes from remarks by the WHO’s director-general on March 3, when he said the coronavirus “causes more severe disease than seasonal influenza.
“While many people globally have built up immunity to seasonal flu strains, COVID-19 is a new virus to which no one has immunity. That means more people are susceptible to infection, and some will suffer severe disease,” Tedros Adhanom Ghebreyesus said.
“Globally, about 3.4 percent of reported COVID-19 cases have died. By comparison, seasonal flu generally kills far fewer than 1 percent of those infected.”
However, Ioannidis pointed out that “[t]he one situation where an entire, closed population was tested was the Diamond Princess cruise ship and its quarantine passengers.
“The case fatality rate there was 1.0%, but this was a largely elderly population, in which the death rate from Covid-19 is much higher,” he added.
“Projecting the Diamond Princess mortality rate onto the age structure of the U.S. population, the death rate among people infected with Covid-19 would be 0.125%. But since this estimate is based on extremely thin data — there were just seven deaths among the 700 infected passengers and crew — the real death rate could stretch from five times lower (0.025%) to five times higher (0.625%),” Ioannidis continued.
“It is also possible that some of the passengers who were infected might die later, and that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.”
That’s obviously a huge range — and it’s not close to 3.4 percent.
Now, granted, the Diamond Princess was a unique situation. It’s impossible to extrapolate that to an entire population.
However, given how unreliable much of the data is when it comes to COVID-19, the Diamond Princess data is not something we should ignore.
Now, none of this is to say you shouldn’t take the coronavirus seriously. You should.
If images of spring breakers partying it up on the Floridian littoral weren’t enough to raise your blood pressure, you were either one of these misguided youths or you’ve simply lost all faith in humanity at this point.
Stay inside as much as possible. Wash your hands. Pay attention to the authorities.
However, if you’re one of the people for whom the exclamation “science!” is a frequent peroration, you should probably be more concerned about whether the global death rate for COVID-19 is closest to Italy’s (more than 9 percent as of Tuesday, according to Johns Hopkins University), the United States’ (under 1 percent) or the Diamond Princess’.
And yet, these people seem to take their cues from the media in terms of dealing with the coronavirus. Ioannidis’ analysis should be great news for the media — and yet, I haven’t seen him discussing it on CNN.
These numbers have huge implications.
After all, given the Diamond Princess data, the mortality rate that the WHO predicted could be 27 times too high. Even going five times higher than Ioannidis’ 0.125 percent figure only gives us 0.625 percent, which would make the WHO’s predictions five times too high.
This doesn’t mean the WHO isn’t right, but it’s an encouraging piece of news nonetheless.
Getting this right is doubly important when you realize the interruption to daily life that the coronavirus is causing.
“One can only hope that, much like in 1918, life will continue,” Ioannidis wrote.
“Conversely, with lockdowns of months, if not years, life largely stops, short-term and long-term consequences are entirely unknown, and billions, not just millions, of lives may be eventually at stake.
“If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe,” he concluded.
One only hopes we get it.
We can’t all afford to be Gov. Cuomos forever, after all.
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