The news has never been more painful and yet we can’t look away. But no one can see all the information that matters. At AIER, we are internally crowdsourcing vital information beyond what you can read on this site. Too often in a crisis, level-headed voices are drowned out by demagogues, shouting, and fear. Below you will find interesting and credible information that should inform the policy response.
Coronavirus: Is It Even Possible To Contain COVID-19?
By Alex Berezow, PhD
“Flu season lasts from October to March. In that five-month timespan, influenza will infect anywhere from 9 million to 45 million Americans each year. COVID-19 does not appear to be on that track, especially with summer approaching. (Warm weather is often lethal to respiratory viruses.) In the roughly two months the virus has been circulating in America, the number of confirmed cases is only roughly 3,700. Even if off by a factor of 100, the number of infections is two orders of magnitude less than the flu. The bottom line is that scientists don’t really know how the virus is spread.”
“The World Health Organization estimates that 80 percent of COVID-19 cases are mild or asymptomatic, underscoring the likely futility of containment measures. The only way to stop a virus that can spread so surreptitiously is to force every person on Earth to stay home for the next 14 days, which is the length of time necessary for quarantine, based on the virus’ incubation period.”
“The U.S. decision to ban flights from Europe is a containment tactic that will yield few practical results because the virus is already circulating in the United States. And there are still other international flights entering the U.S. that Europeans could use to gain entry. Given the spread of the virus to date, the economic hits incurred thus far, and all the other unknown factors regarding the nature of the virus, mitigation emerges as the most viable course of action that allows for an appropriate balance between public health and economic needs.”
Is the Coronavirus as Deadly as They Say?
By Eran Bendavid and Jay Bhattacharya (Stanford University)
If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified. But there’s little evidence to confirm that premise—and projections of the death toll could plausibly be orders of magnitude too high….
The epidemic started in China sometime in November or December. The first confirmed U.S. cases included a person who traveled from Wuhan on Jan. 15, and it is likely that the virus entered before that: Tens of thousands of people traveled from Wuhan to the U.S. in December. Existing evidence suggests that the virus is highly transmissible and that the number of infections doubles roughly every three days. An epidemic seed on Jan. 1 implies that by March 9 about six million people in the U.S. would have been infected. As of March 23, according to the Centers for Disease Control and Prevention, there were 499 Covid-19 deaths in the U.S. If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%, assuming a two week lag between infection and death. This is one-tenth of the flu mortality rate of 0.1%. Such a low death rate would be cause for optimism.
Coronavirus: U.S. Is Not The Next Italy
By Alex Berezow, PhD
“The second false narrative is that the United States is the “next Italy,” by which people (many of whom are Trump’s detractors) claim that the President’s mistakes will lead to millions of infections and possibly millions of deaths. To bolster their case, they point to Italy, an advanced nation whose healthcare system was overwhelmed by patients with COVID-19. The latest figures show nearly 28,000 infections and 2,158 deaths, for a case-fatality rate of 7.7%. That’s the worst in the world, even far worse than China and Iran.”
“At 34.7 ICU beds per 100,000 people, the U.S. has nearly three times as many as Italy and almost ten times as many as China. While this doesn’t guarantee a wonderful outcome, it demonstrates that the U.S. has a critical care infrastructure that surpasses that of other nations.”
Here’s what we know about the 100 people who’ve died in the US from coronavirus
By Nicole Chavez, Amanda Watts and Janine Mack
“The majority of people who have died were in their 60s, 70s, 80s and 90s. The youngest were in their early or mid-50s.”
“The deadliest cluster so far has been linked to a nursing home in Kirkland, Washington. More than 20 people who lived there and someone who visited the facility have died.
People who lived in other long-term care facilities in Washington, Florida and Kansas contracted the virus and died.”
“Diabetes, emphysema and heart problems were among the pre-existing conditions that some people suffered before they were diagnosed with coronavirus.”
99% of Those Who Died From Virus Had Other Illness, Italy Says
By Tommaso Ebhardt, Chiara Remondini, and Marco Bertacche
“More than 99% of Italy’s coronavirus fatalities were people who suffered from previous medical conditions, according to a study by the country’s national health authority.”
“The Rome-based institute has examined medical records of about 18% of the country’s coronavirus fatalities, finding that just three victims, or 0.8% of the total, had no previous pathology. Almost half of the victims suffered from at least three prior illnesses and about a fourth had either one or two previous conditions.
“More than 75% had high blood pressure, about 35% had diabetes and a third suffered from heart disease.”
“The average age of those who’ve died from the virus in Italy is 79.5.”
“According to the GIMBE Foundation, about 100,000 Italians have contracted the virus, daily Il Sole 24 Ore reported. That would bring back the country’s death rate closer to the global average of about 2%.”
By Richard A. Epstein
“Overlooked is the good news coming out of China, where the latest report shows 16 new cases and 14 new deaths, suggesting that the number of deaths in the currently unresolved group will be lower than the 5.3 percent conversion rate in the cases resolved to date.”
“From this available data, it seems more probable than not that the total number of cases world-wide will peak out at well under 1 million, with the total number of deaths at under 50,000 (up about eightfold). In the United States, if the total death toll increases at about the same rate, the current 67 deaths should translate into about 500 deaths at the end. Of course, every life lost is a tragedy—and the potential loss of 50,000 lives world-wide would be appalling—but those deaths stemming from the coronavirus are not more tragic than others, so that the same social calculus applies here that should apply in other cases.”
“Based on the data, I believe that the current dire models radically overestimate the ultimate death toll. There are three reasons for this.
“First, they underestimate the rate of adaptive responses, which should slow down the replication rate. Second, the models seem to assume that the vulnerability of infection for the older population—from 70 upward—gives some clue as to the rate of spread over the general population, when it does not. Third, the models rest on a tacit but questionable assumption that the strength of the virus will remain constant throughout this period, when in fact its potency should be expected to decline over time, in part because of temperature increases.”
“As of March 16, the data from the United States falls short of justifying the draconian measures that are now being implemented.”
“The World Health Organization recently declared coronavirus a pandemic at a time when the death count was at 4,000, presently being just over 6,500. It will surely rise no matter what precautions are taken going forward, but what is critical is some estimate of the rate.
“By way of comparison, the toll from the flu in the United States since October ran as follows: between 36 to 51 million infections, between 370 thousand to 670 thousand flu hospitalizations, and between 22 thousand to 55 thousand flu deaths. That works out to between roughly between 230,000 to 320,000 new infections per day, and between 140 to 350 deaths per day for an overall mortality rate of between 0.044 percent to 0.152 percent.”
“Clearly, the impact on elderly and immunocompromised individuals is severe, with nearly 90% of total deaths coming from individuals 60 and over. But these data do not call for shutting down all public and private facilities given the extraordinarily low rates of death in the population under 50. The adaptive responses should reduce the exposures in the high-risk groups, given the tendency for the coronavirus to weaken over time. My own guess is that the percentage of deaths will decline in Korea for the same reasons that they are expected to decline in the United States. It is highly unlikely that there will ever be a repetition of the explosive situation in Wuhan, where air quality is poorer and smoking rates are higher.
“So what then should be done?
“The first point is to target interventions where needed, toward high-risk populations, including older people and other people with health conditions that render them more susceptible to disease. But the current organized panic in the United States does not seem justified on the best reading of the data. In dealing with this point, it is critical to note that the rapid decline in the incidence of new cases and death in China suggests that cases in Italy will not continue to rise exponentially over the next several weeks. Moreover, it is unlikely that the healthcare system in the United States will be compromised in the same fashion as the Italian healthcare system in the wake of its quick viral spread. The amount of voluntary and forced separation in the United States has gotten very extensive very quickly, which should influence rates of infection sooner rather than later.”
“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. 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.”
“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%).”
“A population-wide case fatality rate of 0.05% is lower than seasonal influenza. If that is the true rate, locking down the world with potentially tremendous social and financial consequences may be totally irrational.”
“In some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise.”
Special Report: How Korea trounced U.S. in race to test people for coronavirus
By Chad Terhune, Dan Levine, Hyunjoo Jin, and Jane Lanhee Lee
“A week after the Jan. 27 meeting, South Korea’s CDC approved one company’s diagnostic test. Another company soon followed. By the end of February, South Korea was making headlines around the world for its drive-through screening centers and ability to test thousands of people daily.”
“The United States, whose first case was detected the same day as South Korea’s, is not even close to meeting demand for testing. About 60,000 tests have been run by public and private labs in a country of 330 million, federal officials said Tuesday.
“As a result, U.S. officials don’t fully grasp how many Americans have been infected and where they are concentrated – crucial to containment efforts. While more than 7,000 U.S. cases had been identified as of Wednesday, as many as 96 million people could be infected in coming months, and 480,000 could die, according to a projection prepared for the American Hospital Association by Dr. James Lawler, an infectious disease expert at the University of Nebraska Medical Center.”
“The administration of President Donald Trump was tripped up by government rules and conventions, former officials and public health experts say. Instead of drafting the private sector early on to develop tests, as South Korea did, U.S. health officials relied, as is customary, on test kits prepared by the U.S. Centers for Disease Control and Prevention, some of which proved faulty. Then, sticking to its time-consuming vetting procedures, the U.S. Food and Drug Administration didn’t approve tests other than the CDC’s until Feb. 29, more than five weeks after discussions with outside labs had begun.”
“As of mid-February, the federal government remained stuck in first gear. The CDC was the primary supplier of tests across much of the country, and other labs couldn’t immediately deploy their own without the FDA’s blessing.”
“Under increasing pressure, the FDA relented and removed many of the bureaucratic obstacles. On Feb. 29, the agency said public and private labs, including academic medical centers, could start using their own tests before the FDA had completed its full review. Laboratories had 15 business days to submit a completed application, which could be approved retroactively.”
“The Food and Drug Administration said late Monday that it will allow private companies to begin marketing coronavirus test kits directly to the public, in a new initiative to ease a chronic shortage of test kits.”
“Dr. Hahn said the FDA said also will allow individual states to approve new diagnostic tests, as it already has done for New York. He said that the state initiative is designed to make state authorities act as a surrogate to the FDA during the current epidemic.
“The Trump administration has been criticized for not having enough tests available. Initially all tests had to come from the Centers for Disease Control and Prevention. The FDA on Feb. 29 expanded testing to academic labs, but there are continuing complaints from people who say they can’t get tests.”
The death rate from the new coronavirus may have been lower than previously believed in the city in China where it originated, according to a new study, offering a hopeful sign for other parts of the world.
The study, published Thursday in the journal Nature Medicine, found that the death rate among people who had symptoms was 1.4% in Wuhan, China, as of Feb. 29.
That rate is lower than previous estimates of mortality rates for Covid-19, the disease caused by the new virus, in Wuhan and China overall. A report by an international mission of experts led by the World Health Organization reported last month that the mortality rate in Wuhan was 5.8% in the first several weeks of the epidemic.
The White House’s Dr. Birx has tamped down the more alarmist predictions, saying that the overall death rate seems to be converging on 0.7 percent. That’s still far above the 0.1 percent average for the seasonal flu; clearly we need better data on infections, mortality and risk-group profiles.
Purely in terms of personal health, the ultimate outcome depends upon two factors. First is what epidemiologists call “herd immunity,” or the degree to which the population develops immunity by virtue of having been infected and survived. The second and hoped-for factor is the development of an effective vaccine; unless and until we develop one, we will be working our way through the development of herd immunity, during which we must do everything to assure that the afflicted receive treatment and survive.
In terms of economic health — which is inextricably intertwined with personal health and life — we face the extraordinarily difficult challenge of balancing a terrifying health crisis with a virtually inevitable financial one. In the long-term, that financial crisis may be the greater of the two. And the only way to combat that future challenge and prevent it from becoming a greater life-threatening calamity is to restart the nation’s economic life as soon as possible.