Slate has an opinion piece up by Dr. Jeremy Samuel Faust who is an ER doctor at Brigham and Women's Hospital. Honestly, reading his twitter feed, he comes across as a jerk, but here are his thoughts on why he believes the Case Fatality Rate of 1% - 2% is too high:
. . . In the early days of the crisis in Wuhan, China, the CFR was more than 4 percent. As the virus spread to other parts of Hubei, the number fell to 2 percent. As it spread through China, the reported CFR dropped further, to 0.2 to 0.4 percent. As testing begins to include more asymptomatic and mild cases, more realistic numbers are starting to surface.
. . . On the Diamond Princess, six deaths have occurred among the passengers, constituting a case fatality rate of 0.85 percent. Unlike the data from China and elsewhere, where sorting out why a patient died is extremely difficult, we can assume that these are excess fatalities—they wouldn’t have occurred but for SARS-CoV-2. The most important insight is that all six fatalities occurred in patients who are more than 70 years old. Not a single Diamond Princess patient under age 70 has died.
He wrote this opinion piece on March 4th so his info is a touch dated. Per Worldometer (as of March 14), 7 out of 696 cases have died. This is a CFR rate of 1%. I think what he also failed to mention in his article is that the deaths could increase as there are 15 people still in serious/critical condition. And that these individuals being largely the first cases being treated are likely getting the best possible care that others might not receive as hospitals start dealing with more and more cases.
Now I admit that using the Life Care Center of Kirkland as a counter example is a bad comparison as these individuals are not in the best of health, but I think it is still useful to see how bad it can get. Fox News reported on Friday, March 13th that 47 employees and 63 patients have tested positive for the virus. Of the employees, 72 were already tested and 18 more need to be tested. It looks like 24 in total still need their outcomes determined. Let's say another 15 test positive. So we would end up with a total of 62 employees and 63 patients testing positive.
A more recent article via KOMO mentions that 27 people have died. Both the Fox News and KOMO article appear to say all deaths are related to patients so we're talking a CFR % of at least 42.8% and probably going a little higher. Based on this LA Times article from March 9th, 3 of the employees are being hospitalized. I'll assume based on the article that none have died so far.
But even if there is a lower CFR % as Dr. Faust argues, there could be life long health issues for those who do recover. Hong Kong doctors have done follow-ups for those who have recovered. Via South China Morning Post:
Dr Owen Tsang Tak-yin, medical director of the authority’s Infectious Disease Centre at Princess Margaret Hospital in Kwai Chung, said doctors had already seen around a dozen discharged patients in follow-up appointments. Two to three were unable to do things as they had in the past.
This is a small sample size. We'll need to see how it plays out among a larger sample size and if it can be backed up with studies from other countries such as China and South Korea. Also, we need to see if this is a short-term or long-term health issue.
Another look into why Dr. Faust might be overly optimistic is via Statnews. An opinion piece by Liz Specht does some math. She argues that by the end of April, the US could see 1 million cases.
The majority of people with Covid-19 can be managed at home. But among 44,000 cases in China, about 15% required hospitalization and 5% ended up in critical care. In Italy, the statistics so far are even more dismal: More than half of infected individuals require hospitalization and about 10% need treatment in the ICU.
For this exercise, I’m conservatively assuming that only 10% of cases warrant hospitalization, in part because the U.S. population is younger than Italy’s, and has lower rates of smoking — which may compromise lung health and contribute to poorer prognosis — than both Italy and China. Yet the U.S. also has high rates of chronic conditions like cardiovascular disease and diabetes, which are also associated with the severity of Covid-19.
At a 10% hospitalization rate, all hospital beds in the U.S. will be filled by about May 10. And with many patients requiring weeks of care, turnover will slow to a crawl as beds fill with Covid-19 patients.
Now, of course, her 1 million figure might not take into account that all sports were basically cancelled the day after she wrote her opinion piece. Also, the fact, the more and more companies are telling their employees to work from home and schools are shutting down. I would assume that will have a significant impact on how quickly the virus spreads across America. On the other hand, movie theaters are still open and people are crowding into grocery stores.
As the current hotspots appear to be occurring in Italy and Iran right now, I decided to do some google searches on how many people die from the flu each year in these countries. I wasn't really able to find anything on Iran, but did find this Science Direct article that discussions Italy. Over a four year period from 2013/2014 - 2016/2017, 17,000 people died annually from the flu. As I'm writing this on Saturday, 21,157 have the virus and 1,441 have died. This will be an interesting statistic to follow to determine if the coronavirus is really worse than the flu.
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