Thursday, April 23, 2020

Testing, Infection, Mortality

Commenter ronlsb got on my case this morning for my post Schools, Hospitals, Lockdown, claiming I've changed my tune and urging that America should be reopened instanter. If not sooner:

Mark, you spent days reciting the views of health care "professionals" warning us how truly dangerous this virus is and by doing that in effect endorsing the drastic measures being foisted upon us by our bettors. [Sic. An interesting typo.] Now you seem to have changed your tune. The more we learn about how this virus has worked, the clearer it becomes that it is successful (for the most part of course) in attacking people with preexisting conditions. Leaving supermarkets to remain open around the nation with no measurable detrimental effects ought to be evidence enough to any thinking person that the reaction to this virus has been blown way out of proportion to the damage being done to our citizens. Reopen American and do it now!

I responded that I haven't changed my tune, that I've always maintained that the modeling doesn't strictly apply to the US with its unique "human geography", that I've also always maintained that the Wuhan virus is not as easily transmissible as, for example, seasonal flu, etc. All that means in my mind that I have been open to a more flexible approach--but cautiously so, because of the undoubted danger of the Wuhan virus and the lack of reliable information. Indeed, as I pointed out in Please Read This Re Covid19 Testing there has been a lot of tendentious reporting to go along with a lack of information.

I'd like to briefly follow up on that testing post by quoting a very informed comment by "brookwood" at FR--New York State Antibody Study Finds Infectino Mortality Rate At Least 5 Times Greater Than Seasonal Flu. Brookwood uses new data regarding the infection rate in NYC, which is significantly higher than the California "studies" that I cited:

Actually, 20,792 have died in New York State - see link below
Using a 13% infection rate and 2,700,000 cases, the Infection fatality rate is .8%, 8 times higher than seasonal flu. And the .1% seasonal flu mortality rate cited is based on cases with symptoms, it does not consider infections which could be detected by blood test but produce no symptoms. 75% of regular flu is asymptomatic so the infection fatality rate for normal flu is actually .025% Therefore Covid19 is 32 times as deadly as seasonal flu. Any questions?

Brookwood is making the same point I made regarding the CA studies--no other disease's case fatality rate is calculated by taking random sample in the general population. That whole methodology is extremely tendentious and intended to mislead in the direction of a preferred outcome. To the extent that a comparison is then made to flu rates, the comparison is of apples and oranges.

Here are some excerpts from at least two of his links (I exclude the CDC link). First from the UK study, which dates back to 2014:

“‘77% of flu infections’ have no symptoms, say experts,” reports ITV News. 
The news is based on a large community-based study carried out in England, which found that most people with influenza (“flu”) don’t have symptoms, and even if they do, only a small proportion go to a doctor. 
Participants provided blood samples before and after the influenza season, so that the amount of antibodies in the blood could be measured. They were then contacted every week so that cough, cold, sore throat, or any “flu-like illness” could be noted down. If any of these were experienced, participants were asked to complete a symptom diary and to take a nasal swab to test for the influenza virus. 
Approximately 20% of people had an increase in antibodies against influenza in their blood after an influenza “season”. However, around three-quarters of infections were symptom-free, or so mild that they weren't identified through weekly questioning. 
This is very much a “good news, bad news” story. It is good news in that so many people with a flu infection are spared the burden of a nasty infection. However, limiting the spread of a future pandemic could be challenging, as it would be unclear who is infected. 
This reinforces the importance of practising essential hygiene habits to stop flu spreading, such as frequent hand washing and cleaning surfaces so that they are free of germs – especially if there is an ongoing flu pandemic.

I understand, of course, that all those people touting the "low fatality rate" of the Wuhan virus are, at least in part, reacting to what they see as the overhyped prognostications for this pandemic. In reality, from an epidemiological standpoint there is nothing at all surprising in the fact that most people who come in contact with the Wuhan virus remain symptom free. It was always to be expected. The two main points to remember are these: 1) as brookwood points out, the Wuhan virus really is more deadly than seasonal flu, and 2) as I pointed out in the post on testing, most of those symptom free people are also likely to be immunity free. All this has to do with transmissibility, and that could change if the virus is allowed to spread freely by an unguarded "reopening", a reopening that isn't calibrated with these epidemiological considerations in mind. Especially if we have reason to believe a recurrence piggybacking on the "regular" flu season that will start up again in the fall.

Next up, from NR, How Many People Already Have COVID-19? The author starts out with some useful comments re the testing in California in elsewhere that seeks to get a handle on the prevalence of the Wuhan virus in the general population. In doing so he stresses the very real limitations on the methodologies followed. However, far more to the point, he adds:

Lastly, as numerous folks pointed out on Twitter throughout the day, New York City now has fatalities totaling more than 0.1 percent of its entire population — 0.1 percent being an important threshold because it’s the fatality rate of the flu. In other words, even if 100 percent of New York is infected and no one dies from here on out, the virus is more dangerous than the flu. So, while the fatality rate will likely be lower than expected, it won’t be too low.
Please note that--0.1% of the entire population.  That means the Wuhan virus--at least in NYC--is many times more deadly than any seasonal flu. Whether the NYC scenario can be repeated elsewhere is beyond my abilities to predict. Fortunately for the country, no other metro area has been remotely as hard hit as NYC. But that situation, even allowing for Cuomo's blunders re nursing homes and the subways, should give any responsible person pause.
(A random thought about flu comparisons, by the way: Two diseases with the same fatality rate can kill very different numbers of people. The flu kills tens of thousands each year despite the fact that about 60 percent of kids and 40 percent of adults are vaccinated and some other people have leftover immunity from previous years. If COVID-19 has a fatality rate of 0.1 percent and two-thirds of Americans get it because no one is immune, that will entail 220,000 deaths.)

So, again, I'm not changing my tune. I understand that we can't stay shutdown indefinitely as the Left is urging. I've always maintained both the differences between the Wuhan virus and the flu as well as the unique circumstances that make the US very different from other countries. I'm still urging caution and careful consideration.


  1. The demographics of the dead verses the asymptomatic?
    The dead are old and feeble. What percent in nursing homes.

    I assume the asymptomatic are younger. Let's see the demographics.

    A. u remove the older / informed from the denominator.
    B. we devlope preventive and treatments.
    C . Common sense distance.
    we could find a way thru.

    1. Roughly 20% of the dead were in nursing homes. However, in NYC the numbers were greatly exaccerbated by Cuomo's dumb policies. Overall, probably upper 40s% are > 70.

      In my area there are special shopping times in the early morning for seniors--so they can go in less of a crowd and masked up. Not so hard.

      Overall, I agree with what you're suggesting based on what we know for now. NYC and suburbs are a special case that needs to be studied carefully and the data needs to be released to the public. How did the disease get such a hold there?

  2. I would like to point something out. Flu fatality rates in the US are based on what I would consider loose estimates and assumptions. In the 2017-2018 season roughly 1,000,000 tests resulted in 200,000 positives. From that data they conclude that 36,000,000 people had the flu. here is a link . If we apply the same statistical assumptions to the Wuhan flu, the rates will change. You could then compare apples with apples. Jim

    1. "From that data they conclude ..."

      Actually, no. Here are two sites that explain the methods used to arrive at the estimates. The methods are based on many years of medical and epidemiological experience in dealing with flu-like illnesses and were not intended to be used in comparisons with other viral diseases. Obviously they lack that amount of experience with the 'novel' Wuhan virus--which, btw, is not a "flu" as you describe it.

    2. Sorry, here are those links:

  3. From what I have seen of 7 different Nursing / Assisted Living Homes in California - They just are not set up to prevent CoronaVirus Infections.

    I wonder what changes would be required to make them safer.

    1. Absolutely not. And in my bucolic suburban area, virtually all of the deaths are of people 80+ and a heavy percentage of those in nursing/assisted living facilities. I believe it was Titan 28 who suggested that most of the infection in such places comes from the workers. I wouldn't be surprised, although obviously visitors would be another source.

      As a practical matter, without turning such places into actual hospitals, overall public health is the best way to make the facilities safer.

  4. No one anywhere near us lives in the kind of beehives/rabbit warrens that New York City people - rich and poor - live in. There are apartments here, but most are not high rise. They are not jammed with people. They have windows that open. And our climate year round is conducive to opening windows.

    Most of us do not need public transportation. I believe that is a huge plus any time, but especially in times like this one. The only cab service in our area is pretty awful. We have used Uber twice several years ago.

    Our streets are not crowded with pedestrians. Nothing is really crowded unless it is a planned event.

    Grocery stores are now allowing seniors/disabled/pregnant women to have an hour to themselves first thing in the morning when the shelves are freshly stocked and the place is at its cleanest. We are issued freshly cleaned carts. We wear masks and most wear disposable gloves. The latter can be disposed of on the way out of the store. The stores are issuing new bags, free; taking our own bags is no longer OK.

    Families are attending church on video.

    Our libraries offer an amazingly wide selection of ebooks, free.

    It has taken us over a month to use 1/2 tank of gas…and our car is a bit of a guzzler of premium gas. Gas stations are mostly empty.

    Our banks have either drive-through service or drive-through ATMs.

    Almost all the restaurants we like offer some kind of delivery or curbside pickup.

    I’ll quit. You may already be asleep :-)

    1. Sounds pretty much like our life right now. It may be changing a bit very soon.

  5. Mark -- Just because some studies show a 0.1% mortality rate for the seasonal flu, how do we know the rate for seasonal flu can't be higher, including possibly multiples higher, in certain circumstances (age, population, underlying condition and co-morbidities, nature and conditions of transmission, hospital conditions and care, quality of treatment, time of year, etc.)

    I'm not convinced the NY statistics definitively prove that the Wuhan virus--at least in NYC--is many times more deadly than any seasonal flu.

    1. By the same token, if you take the Covid19 mortality rate for NYC alone and for people of a certain age and certain comorbidities I think the mortality rate would be astronomical. Much higher than the averaged out mortality rate that brookwood used.

      Anyway, brookwood was using official numbers. Feel free to suggest alternative numbers.

  6. This is a serious event and I think there was no choice but to go as we did. Some states, counties/parishes/municipalities do not have to be so dang jack booted about it, though. I do believe the civil rights issues eminate mostly from Democrat controlled areas, but not all.

    The issue now, as is happening, is to go on with life, to open up and figure it out on the fly. It's what we do.

    To change subjects a bit, this is a very good test run for biological warfare combined with sympathetic enemy supporters in government and media.

    Not saying this is that, but it demostrates how you can cripple nations very easily even if you sacrifice many of your own.

    Both the US and Chinese were working on this, here in the US and in China with the most recent being in Wuhan, China where this started.

    Been a long time since I donned a proper MOPP suit.

    1. A very prominent Russian molecular biologist was quoted today saying that the Chinese were doing "crazy" things at the Wuhan lab. He took a bit of a shot at the US for funding the Chinese. We were doing the same types of things and Fauci is the guy who approved the funding for Wuhan. The first time I listened to Michael Osterholm he made a reference to that type of research and how controversial it was. I hadda look it up back then.

    2. Fauci is a weird cat. He seems to be naive in media, but that doesn't jive with his experience, or, at least, doesn't seem to.

    3. I don't have any use for him.

    4. Indeed. I saw somewhere (can’t remember where) that he’s cozy with all the usual suspects — Bill Gates, George Soros, Clinton Foundation, etc.

    5. More suspects:

  7. I think the New Neo sums up it best ...

    "Presently the statistics aren’t pointing with any significant clarity to a pattern that can tell us what is best to do in terms of preventing more deaths, although it is clear that there has already been a great deal of economic damage and hardship as a result of those policies. The damage isn’t limited to economics, either; it almost certainly involves other health costs as well as mental health issues."

    And here we are.

    1. Thanks for the link--I agree with the sentiments she expresses.

      I was just listening to a fairly lengthy interview with Michael Osterholm with Mika and Joe. They tried to get him to trash Trump but, to his credit, he wouldn't take the bait.

      On the one hand Osterholm says we're in a war, not a battle, that the virus will come back in the fall and will keep coming back until 70% are infected (only about 5% nationwide now).

      OTOH, he maintains we need to find ways to open up "society not just the economy." He says that's where we need to be--coming up with strategies to slow the virus down while opening society to the max that's practical in the circumstances.

      It was a longish interview so I can't summarize here. I would have liked to ask some pointed questions. For example, he maintains that the virus is "highly infectious." He's the expert, but everything I hear--including from experts--says it requires 6ft./10min. We don't seem to be seeing a really rapid geographical spread right now, for whatever reason. I'd like to have challenged him a bit on that and some other things.

  8. In our part of Texas, 80 mi east of Dallas, there have been only 4 confirmed cases in our county. The 'one size fits all' policy is economically devastating to the rural communities. There remains confusion and bitterness because the whole population was treated as if it was in one big hot-spot, with all of the inherent restrictions, that were not necessary given our situation. If anything, resentment to the urban populations, to say nothing of the media and politicians, has grown...and not without some justification.
    Let's hope if there is an outbreak next fall, that the experience gained will not lead to another over-emotional, panic driven response that this one has generated.

    1. Osterholm is a smart guy, but that's the kind of thing I'd like to see an interviewer challenge him on. It seems to me that if the virus is as virulent as Dr. O. claims, then Americans are mobile enough that this should have spread throughout the country far more evenly. I've heard lots of very responsible public health officials--including in hotspots--say: 6ft./10min. To me, that means it's not so easy to pass the infection, and I've heard the same public health people say pretty much that. If you get it it's bad news, but for vast swathes of the country it's largely avoidable.

      In fairness, a virus is invisible and we don't know about the spread until people get sick and the cat's out of the bag. Still, I believe more transparency and trust would help a lot.

      Steve Sailer quotes at length from an article that says pretty much the same thing, after examing 54 "superspreader events".

  9. PowerLine Blog post that noticed where the Age Group Deaths are:

    1. Yes, but I think Hinderaker is drawing the wrong conclusions. I don't think it follows from the data that the virus is less DEADLY but that it's not as VIRULENT, i.e., easily transmissible, as thought. Re its deadliness or danger, it does appear that it is primarily a danger to seniors. Problem is that viruses continually mutate, as has this one. Thus in the case of the flu, the 2009 season targeted young people and passed over old people. Once established, endemic, nobody can say that it won't mutate into forms that are more virulent. His conclusion is that it's not a big deal, but I think he's mistaken about that.