Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Day 82: COVID-19 The Missing Chart
The chart above is a photoshop of a total and daily cases chart from the Our World in Data website. That website has a lot of good information about the status and progress of the pandemic. But it also stresses the importance of the missing data — total and daily infections:
What we want to know isn’t the case fatality rate: it’s the infection fatality rate
Before we look at what the CFR [Case Fatality Rate] does tell us about the mortality risk, it is helpful to see what it doesn’t.
Remember the question we asked at the beginning: if someone is infected with COVID-19, how likely is it that they will die? The answer to that question is captured by the infection fatality rate, or IFR.The IFR is the number of deaths from a disease divided by the total number of cases. If 10 people die of the disease, and 500 actually have it, then the IFR is [10 / 500], or 2%.
To work out the IFR, we need two numbers: the total number of cases and the total number of deaths.
However, as we explain here, the total number of cases of COVID-19 is not known. That’s partly because not everyone with COVID-19 is tested.
We may be able to estimate the total number of cases and use it to calculate the IFR – and researchers do this. But the total number of cases is not known, so the IFR cannot be accurately calculated. And, despite what some media reports imply, the CFR is not the same as – or, probably, even similar to – the IFR.
It is the infection fatality rate that is the key ratio for public health policy. When assessing risk to a population you need to know the probable likelihood and outcome of infection — how many mild cases, how many severe cases, and how many fatalities within a given population. Our lives are being held hostage to this lack of information and the suppositions of policy makers.
The closest thing we have to the needed information is the Diamond Princess population.
As of February 20, tests of most of the 3,711 people aboard the Diamond Princess confirmed that 634, or 17 percent, had the virus; 328 of them did not have symptoms at the time of diagnosis. Of those with symptoms, the fatality ratio was 1.9 percent, Russell and colleagues calculate. Of all infected, that ratio was 0.91 percent. Those 70 and older were most vulnerable, with an overall fatality ratio of about 7.3 percent.
But the makeup of a cruise ship is not representative of the demographics of most states or countries. And that is why the antibody test needs to be put into action quickly and comprehensively. We need to know how many people have been infected to give us context for how our society can live with COVID-19. Our government is going to protect us to death. Nancy Pelosi has warned President Trump not to restart the economy. And un-contexted data will always be there to support lock downs.
Americans, as a group, are more courageous than our politicians. It is time we demand to have the information we need, and to demand that self-government truly be self-government.
[Note: Links to all my CoVID-19 posts can be found here.]
Published in General
How many individuals don’t know the facts concerning their own health status? Elderly individuals generally know how old they are and most have some awareness of their infirmities. How many individuals under 50, for example, are obese and pre-diabetic or diabetic and don’t know those facts, or perhaps don’t know the significance of those facts, and have never been medically evaluated or counseled? I have no idea what these numbers are but when I was able to roam I saw many who might qualify.
I don’t disagree with the point, but I’d like to add a corollary.
From a worldwide IFR perspective, does anyone believe the numbers from Russia? And much has been made of the “reporting” from China. And there are likely some others. So it’s somewhat important to keep in mind that, as infections are very likely “under-detected,” so too are deaths under-reported.
Except maybe for some who were on death’s doorstep with a comorbidity but get counted as Covid-19 anyway.
Under-reported deaths in China might be balanced out by over-reported deaths in countries that make no distinction between dying with covid-19 and dying of covid-19.
When I was watching the initial outbreak reports, the thought occurred to me that it would be helpful to draw a circle around an area in China fifty miles from Wuhan and test everyone in it immediately and keep going back to that area over the period of infection to repeat the tests.
It’s too bad no one did that in any of the affected countries. It would have given us the rate of infections and deaths that we need to assess public policy.
I’m noticing a great many creative ways “essential businesses” are protecting their employees, their retail stores, and their customers. Let’s hope we have some information soon on the effectiveness of these measures so we can open more businesses.
The modelers continue to assume (the chart starts with 0 at December 31, 2019) a January, 2020 start date. The initial conditions that are be plugged into an epidemiological model include the number of cases at time 0. We keep thinking “1” (patient zero) or no more than a few. Then the models are calibrated using actual case data, and as you point out, we don’t really know for sure how many cases get missed. But, it’s also important for the policy makers to understand that starting a model from 1 and watching cases double every 3-5 days, gives one answer, but starting with thousands of cases on day one, and then calibrating the model with the same case numbers (that appear to have been doubled from a few days before) are doing no such thing.
We know the Chinese lied, question everything else.
Many are working on the essential question of total infections. One such person is Jay Bhattacharya, M.D., Ph.D. He was featured on the Ricochet Podcast entitled The One We Did On Video and on Uncommon Knowledge’s Questioning Conventional Wisdom in the COVID-19 Crisis, with Dr. Jay Bhattacharya. Very informative listening.
I realize that this type of counting is in dispute, but there is a counter-argument that the method of attributing deaths to Covid-19 is in keeping with standard practice. There are some recent posts on it here, only one of which I’ve succeeded in finding.
http://ricochet.com/745321/chicken-egg-heart-disease-covid-19/#comment-4751264
I am not a math whiz but ~36% of the world’s population is in just 2 countries — China and India. I don’t believe the case/death numbers from either place. I barely believe our own. Its going to take a lot of over counting in Europe and the US to offset any undercounts in China and India. And how reliable a count do you think is coming from everywhere else?
We have no freaking clue at this point as to how to live with COVID-19. We’re like a ship in the fog in an ice storm and an ocean full of ice bergs. We’ve cut our engines without knowing whether we can restart them and we’ve lost all maneuvering capability. We’re chipping at the ice forming on the decks and the rails and are hoping that by cutting our engines we will bump into an iceberg slowly enough not to breach the hull.
I hadn’t given much thought to Russia on this count, and was actually surprised to see a country that big had “only” about 146 million in population–ninth in the world. Still, the numbers reported from there seem absurdly low considering the number of countries with which they share a border. Perhaps everyone is hunched down in cubicles figuring out how to elect Trump in ’20.
It is odd to use two definitions of the word ‘case’ when distinguishing between IFR and CFR. (1) is a diagnosis by a medical expert and (2) is an instance of the infection. That whole quoted section needs a re-write.
Russia has gotten very serious about its lockdowns in the last few days. A couple weeks ago its lockdown was fairly loose, but that has been changing rapidly.
a) Russia doesn’t get nearly as many tourists flying in and out as does Italy.
b) Is Russia nearly as dependent on Chinese manufacturing as Western countries? If not, then they wouldn’t have nearly as many businesspeople flying back and forth.
c) Russia does a lot of business with China in terms of energy exports. Does that require a lot of face-to-face meetings?
I wager that if COVID-19 had hit during the heyday of the 1990s rush to open up the Russian economy, it would be a different story. Since Putin put the brakes on opening Russia up to the West, there’s fewer vectors for the virus to get in.
Maybe.
This is all well and good, but I’m not sure it explains how a country the size of Russia with most of its population centers part of Europe has reported, at present, a death rate of .7 per million and only 93 cases per million. I certainly get that there is authoritarianism at work, as well as vast areas of minimal population where social distancing is part of regular life, but those numbers seem very low–one could say ridiculously low.
Russia wouldn’t engage in disinformation, would they? Nah.
The diamond princess cruise ship represents a worst case scenario. Cruise passengers tend to skew older. Difficult to isolate or distance. I doubt people were wearing masks at the time. Infection rate 20 percent. Case fatality rate 1 percent. This is the model we should be using because it’s the closest thing to a controlled experiment we have. We can track all 3711 crew members and passengers
I’m not surprised at the low numbers coming out of Russia. The virus is not an equal opportunity infecter. It is wildly sporadic in the World as a whole, and within the borders of individual countries. Of the top ten most populous countries in the World, only the U.S. and China are majorly affected by the virus. The other top ten countries that have very few cases are India, Indonesia, Pakistan, Brazil, Nigeria, Bangladesh, Russia, and Mexico. Only Brazil is reporting enough cases and deaths to take any notice.
I think there might be weather factors that prohibit the virus’s spread, since nearly all of Africa, South and Central America, and most of Asia and the Middle East are little affected by this.
The tropics and southern hemisphere have had a different experience with the virus, so far. I’ve been keeping track of 33 countries, and here are the one’s that are largely tropical or equatorial. This is as of the today’s update one the Johns Hopkins site.
I was told climate and weather do not affect this virus. But your table seems to contradict what I’ve been told. Have I been lied to?
Not even close, is my belief on that comparison.
I doubt that. They’re not counting deaths the same way as anyone else.
This is like comparing “infant mortality” stats. In the US, still births count as births. Babies born alive but who don’t survive to leave the hospital count as births. In Europe, and most other countries, they don’t. So our denominator is vastly different than theirs, making us look bad.
Same with those school comparisons. In the US, we test everyone, whether they’re proficient at math or English or not. Japan? Korea? China? Europe? No. They separate out the “high-track” kids and test them, then compare their results against ours.
When the other team is cheating, most of the time, you quit.
But not with the WHO, apparently. With them, our “betters” are more than happy to make us look even worse, so that they get that sweet, sweet funding.
I’m downright sick of it. Especially since it’s being used to justify taking away our rights.
Sorry, but this is really upsetting for me.
The linked interview with Dr. Scott Jensen, a state Senator and physician in Minnesota, makes me wonder how honest our fatality rate for COVID-19 is. Is this just a state driven directive or nation wide? Https://youtu.be/lsRay1wInBg
We now have a study out of Germany showing an IFR of .37. 80% of the population of a town, Gangelt, were tested to get that result. Nothing is mentioned in the article about how the deaths are counted, which is such a big issue here. https://reason.com/2020/04/09/preliminary-german-study-shows-a-covid-19-infection-fatality-rate-of-about-0-4-percent/
And you really think that with people piling up in the morgues, the hospitals in New York City overwhelmed, the numbers of infected people continuing to rise, and the news media screaming about it constantly that the people will support a resumption of normal activities now?
Here in Texas the state did not adopt a policy of shutting down “non-essential” businesses, but a lot of businesses shut down anyway because people stopped going to them out of common sense. Restrictions imposed by local government have varied quite a bit. Other businesses can operate at a reduced level only because they take pains to address the crisis. I don’t see how a policy change at the state or national level will change that unless people can feel safe getting out and about.
A lot will depend upon how the President’s new task force presents a reopening. The MSM can be counted on to make it difficult, but probably not impossible.
At this point I don’t care about the numbers in China nor Russia. We’ve got enough here to work out what all of this means to us. The government should re-open the US economy but keep travel to China, as well as countries that allow travel to China, shut down.
I. AGREE.
Just like infant mortality, and school tests, we are unique, and we should use our statistic.
Not to say not learn from others, but lack of transparency and rampant dishonesty make a lot of data suspect.