Hospital Bed. Image Credit- Michael Koppel. License By CC 2.0

Lancet Study: Covid-19 Death Rate Lower Than Projected; Comparisons of Flu and Covid-19 Meaningless. Methodologies Contribute to Inaccurate Metrics: Stamford Professors

People keep saying Covid-19 can’t be compared to the flu. Yet it can.

In fact, any pathogenic disease can be compared to any other pathogenic disease, in terms of lives lost, totals of patients requiring hospitalization, and total number of cases reported.

We can even compare a pathogen-based illness to a health condition that is not caused by germs, such as cigarette smoking or extreme obesity, in terms of these metrics.

What people really mean, though, is that in comparison to the flu, the novel Coronavirus is far worse, and that is why we shouldn’t compare. They mean that it’s outside the range of similarity.

Hospital Bed. Image Credit- Michael Koppel. License By CC 2.0

Hospital Bed. Image Credit- Michael Koppel. License By CC 2.0

But this is also not true.

This is flawed thinking. Why? The reason lies in how the numbers of flu cases and Covid-19 cases are determined,and therefore tabulated.

Firstly, the number of total influenza cases is estimated at 45 million, for 2017.

Is this number correct? A study in 2017 in the United Kingdom by Claire Wenham, Elenanor Gray, et. al., researchers and physicians affiliated with University College London and University of Cambridge, Public Health England South Region Bristol, concluded that many people who believe that they have the flu, in fact do not.

And, the widespread practice by many of today’s physicians of not culturing a patient who presents as ill may result in gross over-estimations of how many flu cases there are among the public.

The study mentioned above called for individuals believing that they have been stricken with symptoms similar to those produced by influenza or the common cold to have swabs done. In fact, 65% of patients didn’t even have any virus at all, according to that study!

Of th remaining 35% that did have viral illness, not every patient even had the flu, but rather harbored other viruses, perhaps the common cold, norovirus, or possibly others.

However, the way in which total number of flu cases is estimated in the Center for Disease Control in the United States is pure extrapolation from available data, but in CDC models, the number of reported flu cases is multiplied by a factor of two, three and, five, depending upon the age group in question.

So, it’s clear that the total number of flu cases is not a number relying on any sort of scientific certainty, but rather rests on a methodology that lies more in guesswork. It’s not a figure rooted in scientifically verifiable data, just an estimate.

How many people actually get sick with the flu virus and don’t go to the doctor or the hospital, but merely stay home?

Chances are, this is a larger number of people than visit their internist or seek urgent care in the emergency room. This is especially so in younger age groups.

Only a small percentage of total hospitals testing for the flu in the CDC cohort are even considered in the estimated totals.

Further, only data from hospitals in thirteen geographic areas are used by the CDC in their estimation, and so that may not even be a large enough sample size to clearly represent the true number of patients in hospital for the flu.

So are the total flu case numbers too low or too high?

It is impossible to know, precisely, owing to the aforementioned considerations.

Now, Covid-19 cases are another story, altogether.

How many patients fall ill? How many are silent carriers, asymptomatic spreaders?

Testing has been scant, and asymptomatic patients, as well as patients becoming ill but not severely so before recovering, will therefore not be counted in the totals.

We’re only counting those individuals experiencing the worst symptoms, those seeking medical care.

Therefore, there can only be a far higher total number of Covid-19 infections, logically. Or is that not so?

Were airline crew members contracting Covid-19 at staggering rates? It’s not outside possibility, however, there are no widespread reports of such. We can only guess many are healthy younger individuals carrying the germ, with no ill effects.

And, what about the Diamond Princess cruise ship, one of the first outbreaks among U.S. citizens? Only one in five people tested positive, and that’s a scenario where the virus had the best conditions to spread. Further, half of people in all age ranges exhibited no symptoms, while testing positive.

So maybe the total number of cases of Covid-19 are higher than reported, but that the virulence is not as serious as reported.

This is all in sharp contrast to how flu cases are determined; with the flu, there are some factors that may encourage over-reporting, but there are still other factors that foster under-reporting.

Which set of factors sway the data set more in one direction than the other?

If only 35% of patients reporting influenza-like illness actually had any virus, not even necessarily the flu bug itself, the total number of patients reported to have the flu is likely far lower than believed.

However, the total number of flu sufferers, or those believing they are sick with the flu, not seeking medical care still might be incredible high, even if the same percentage of patients truly ill with viruses remains constant at 35%.

More people get sick and get bed rest and recuperate without incident than seek doctors care or visit a hospital.

Because we just don’t know how many people actually get the flu, it is impossible to determine what percentage become very sick, require hospitalization, or lose their lives with any sort of certainty.

And, for Covid-19, because the virus is grossly under-reported, due to the lack of availability of test kits, for one, and asymptomatic or low-intensity sufferers not seeking medical treatment,for another, the total number of cases is likely far higher, here and abroad.

Further, many older patients succumbing to the Covid-19 virus also have one or more co-morbidities. Are they dying from Covid-19 or other causes? We just don’t know for sure.

In China, those testing positive but remaining asymptomatic are not counted among the official case count.This further skews figures.

And it’s also possible that some patients are actually sick with Covid-19 and the seasonal flu, simultaneously.

Or, a weak yearly flu strain might leave a larger pool of susceptible individuals that eventually die from Covid-19, people who might have otherwise lost their lives to a stronger flu variant.

So is Covid-19 deadlier than the flu?

Perhaps; perhaps not. Out of the total number of patients hospitalized, the flu may be deadlier than Covid-19.

CDC’s preliminary data from the 2019 flu season reports 280,000 people hospitalized with 16,000 deaths.  That is a 5.8% death rate.

This is in contradistinction to the global rate of confirmed cases of COVID-19, which is 981,221.  Out of those cases, 50,230 have died.

The vast majority of tested cases are those who were presenting with severe symptoms and may have been hospitalized, since in many places, only those who exhibit the most severe symptoms are tested.

The death rate globally, then, is 5.1%.  However, when you remove Italy, which has an unusually large 10% death rate, the global death rate becomes 4.1%.

But it is also possible that far fewer people require hospitalization, or check in with their doctors, while the number of flu cases is staggeringly higher than reported.

That would mean that neither disease is as lethal as reports suggest.

From all appearances, we don’t yet know whether Covid-19 is deadlier than the flu. By next year, perhaps we will have sufficient data to determine this with greater certainty.

But now, patients who are ill will not be resuscitated if they have Covid-19. That will raise the number of reported Covid-19 deaths further.

What about “flattening the curve?”

While this is always best practice for every outbreak of pathogenic disease, Covid-19 propagation and infection curves only reflect an increase in identification through testing. The number of cases reported, therefore, does not represent the true total number of infected individuals, but rather only those having been tested.

So, wildly vertical curves do not show that the virus is suddenly spreading like wildfire, but rather that testing is increasing.

Does any of this mean that the Covid-19 virus is not deadly? Of course not. But it may not be the end of the world.

Let’s hope that the measures undertaken to stop the spread of the virus don’t do more harm than the virus, itself might cause, even in worst-case scenarios.

In other words, don’t despair; practice social distancing, but know this too shall pass.

Stanford University professor of epidemiology Steve Goodman explains, “The numbers are almost meaningless,” referring to the published numbers of Covid-19 cases. This is largely due to the high number of infected people who only exhibit mild symptoms, or no symptoms at all, and never get counted.

Michael Levitt, a Stanford University biology professor and recipient of the 2013 Nobel Prize in chemistry, claims that we may not be grappling with Coronavirus for as lengthy a time as feared.

“What we need is to control the panic…there are clear signs of slowed growth,” were Levitt’s precise words.

Dr. Levitt further elaborated in an interview with the Los Angeles times, “The real situation is not as nearly as terrible as they make it out to be.”

Why listen to yet another Nobel prize winner about something he might not know about?

For starters, his prediction was that China would hit its peak at 80,000 cases and 3,250 deaths. In fact, he was closer than mere chance could allow: Reports out of China show 81,588 cases and 3,291 deaths at what many believe is the peak of Covid-19 in China.

This contrast sharply with the projections of Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, stating that Covid-19 may cause 100,000 to 200,000 fatalities in the U.S. In an interview with CNN, Fauci claimed there would be “millions of cases” and precise figures could not be speculated upon because the Coronavirus pandemic is a “moving target…” Dr. Fauci further explains, “…we don’t rally have any firm idea…let’s just look at data that we have…”

Who is right? Who is wrong? It really doesn’t matter. No one is clairvoyant, and these are only projections. In any event, we have to do what we can to keep this virus from spreading.

Perhaps we can all learn something for next year’s flu season, too: Stay at home when you’re sick and stop spreading germs!

And now, The Lancet, an infectious diseases medical journal, published a study Monday that estimated a far lower death rate of only 0.66%.

This lowered estimate is far less than the extrapolated yearly flu virus rate of death, and the study suggests that the miscalculation was based precisely on one of the metric inaccuracies detailed in this article: That there are far more asymptomatic and very mild cases than was previously considered.

In the end, it’s good news. However, we must still remember that it’s essential to stop the spread of Coronavirus -and all viruses that spread in the community in Wintertime – to spare the lives of the elderly and those with heart, lung, and other preexisting complications.

Perhaps we did overreact? Only time will tell. Either way, this may usher in a new era of compassion for those members of our communities that are susceptible, and social distancing and other important practices to stem the spread of infectious disease, like handwashing, might be the best new trend.

But shutting down the world? Let’s hope that doesn’t become a yearly trend.

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