Mortality Rate – CHRIS DAEL

Beth Israel Deaconess Hospital, Boston MA — Tim Pierce / CC BY (https://creativecommons.org/licenses/by/3.0)

Early in the COVID-19 pandemic there was much wishful, and perhaps to some degree magical thinking crying out that COVID-19 is “no worse than Flu!” Sadly and defying all logic and science, the cry remains prevalent today.

For those that care about numbers a recent pre-print article looks at the experience at one tertiary care center and compares several months of COVID-19 with five, count em’, five years of influenza patients. Bear in mind that this study has yet to undergo peer review but given the straight-forward nature of the comparative data I think it unlikely the results will change after publication.

Beth-Israel Deaconess Hospital in Boston looked closely at their COVID-19 patients who were admitted in March and April of 2020 and compared various metrics like ventilator use, vasopressor support (medications that keep heart output and blood pressure from dropping to fatal levels), renal replacement therapy (e.g. dialysis), ICU admission rate and death rate to influenza-positive patients who had been admitted over the previous five years.

From 2014-2019 there were 1052 patients admitted with Influenza. Compare that to 583 COVID-19 positive patients admitted in just the first two months of the pandemic. The average number of flu patients admitted over the typical 8 month season was 210, a total rapidly outstripped by the COVID-19 pandemic. The likelihood of requiring mechanical ventilation for flu patients was 8%, but the likelihood of being placed on a ventilator for patients with COVID-19-related respiratory failure was 31%. Over two months of 2020 174 COVID-19 patients were placed on ventilators compared with a total of only 84 influenza patients over the previous five years combined! The mortality for Influenza patients over the study’s five years was 3% compared with a 20% mortality for COVID-19 patients. Importantly, the percentage of patients without a pre-existing condition was higher for COVID-19 patients (20%) than for Influenza patients (4%) indicating that COVID-19 affects more healthy people than does Influenza.

I’ve posted a number of articles that get to this scientific truth–COVID-19 is more severe and more fatal than influenza. Unless I find particularly compelling data or an ingenious study, I’ll probably not post more on this topic; the data is in and COVID-19 is demonstrably more severe than the flu. Even with overwhelming evidence though, some, plagued by confirmation biases, will continue be data-denialists. They are not new; they have been with us throughout history and sadly they won’t convinced any time soon. You can’t after all, reason a person out of a position they weren’t reasoned into in the first place. To those who value data, this will come as an expected support for a growing mountain of data on COVID-19’s disease burden. The data doesn’t scare us, it informs us and with knowledge, free of dogma or preconceived notions, we will win the war against this very significant threat to human health.

Thoughts on COVID-19 May 13, 2020

The National Ensemble Forecast analyzes data from 12 different models to created an ensemble forecast/CDC

Predictive models for US deaths are beginning to coalesce around a projection of 110,000-115,000 deaths by June 6. By August 1st we’re looking at around 180,000 deaths.
Youyang Gu has used the data from his incredibly accurate COVID-19 model to calculate Infection Fatality Rate (IFR) of about 1% for the virus. The IFR is difficult to know during a pandemic and may not be fully fleshed out for years. The IFR is the percentage of people who die out of the total number of people who are infected (whether or not they are test-confirmed or symptomatic). Because we won’t know this data for some time the IFR is elusive during a pandemic. What Gu has done is use the accuracy of his model as a starting point and reference and then calculated curves based on IFRs from 0.2-1.5%. The IFRs that had the smallest variance from his curve came in around 1% (0.9-1.2). This is similar to other estimations of IFR from New York data which come in at around 0.91%. It would appear from these estimates (and make no mistake, they are estimates) that COVID-19 is approximately 10 times more deadly than flu–basically the estimate Dr. Fauci gave to Congress during his testimony. The Case Fatality Rate (CFR) is much higher than the IFR because it is a measure of deaths out of the total number of confirmed cases (e.g. only those cases that have tested positive for the disease and not the untested or the asymptomatic) and the mortality rate is lower because it is a measure of deaths as a part of the total population (i.e how many people died from a disease out of the entire population of the US). The term “mortality” is often used familiarly to describe the IFR and sometimes the CFR but it is important to know that they are all actually different measures of death due to disease. It should be noted that to focus solely on deaths in a pandemic is a myopic approach and doing so does not reveal a fully accurate picture of disease severity.
Cases in Orange County are increasing week to week (441-664-787) following the crowds converging on the beaches on April 25th and 26th. It’s concerning but at this point it’s nothing more than correlation; it’s not known if the crowding caused these increases. If a link exists, contact tracing may reveal it. The increase in cases could be related to an increase in testing as well as OC has been lagging behind other counties in the region. The increases in recent weeks could also merely be a statistical aberration and numbers could soon fall. It will be important to follow OC’s numbers either way as it has been a gathering point for people seeking the sun and, in some communities, for people protesting stay-at-home orders.