No Hair Blog: So how many COVID cases and deaths are there?
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So how many COVID cases and deaths are there?

The enumeration of COVID cases and deaths was always going to be problematic due to the issues with testing accuracy and availability. But, now, it's gotten political. The usual inaccuracy of epidemilogic measures (especially early in the course of an outbreak) have been weaponized, chiefly by conservative writers and mouthpieces. Right-wing news and opinion writers in the US have both been promulgating low number and accusing the "mainsteam" media of inflating them in order to ... well, do a whole number of things like make Trump look bad, impose some new world order, take away our guns, churches, and freedoms, etc.

It's not just the US. In Spain, right wing parties are accusing the government of reporting too few deaths and supressing reporting to hide the governmants' alleged incompetence. While here in the US, the right-wing blogosphere is pushing the narrative that the CDC and other are inflating COVID deaths to make Trump look bad (there are quite a few examples, such as this). The accusations depend of who's in power. This has been somewhat fact checked but the problem is that, by definition, epidemiologic measures are, well, epidemiologic. The actual number of COVID related cases and deaths is unknown.

And, to top it off, both Russia and China are mounting disunformation campaigns to further muddy the waters and create conflict. Russia-linked sites are pushing a number of narratives including that the COVID-19 pandemic is the result of spread for a Chinese virology lab, and now even FOX News is parrotting this so it's been picked up by Trump, Cotton, and other GOP figures. Vanity Fair ran a recent article detailing the history of this theory. China, meanwhile, is pushing the story that it was the US Army who made COVID as a bioweapon.

So we can expect that the mass media on the right cannot be trusted (I know, news at 11), the media such as it is on the left will not be heard, and the mainstream media will focus of the left-right batte and not the facts. So, then, how many cases of COVID are there and how many deaths?

First of all, no one knows how many COVID infections have occurred. Even in Iceland, where mass testing has been implemented, only about 1/3 of the population has been tested. In Taiwan and South Korea, it's about 10%. And in Europe and the US less than 1%. The prevalance of asymptomatic COVID infections is unknown. A recent study published in Science concluded that 86% of all COVID-19 infections were undocumented. Most were asymptomatic or minimally asymptomatic, but some were fatal. Many of these cases were characterized as deaths due to 'pneumonia and influenza' prior to and during the epidemic where testing was not performed. The number of COVID cases will probably never be known accurately until widespread serologic surveys are done some months from now, and those numbers will be based on inferences about the whole population based of testing a subset - that is, epidemiology and statistics.

This leaves aside the entire problem with testing accuracy, but that is a topic for another post. It also doesn't consider the failed implementation of testing and the limitation of available tests. I may be cynical but if one is to argue that the epidemic wasn't that bad and only count proven cases as your metric, then, what's the incentive to test widely?

So we could fall back on deaths as a measure of case number. Unfortunately, the case fatality rate (CFR) is unknown for COVID-19 and it will vary by population depending on the age-distibution. Areas, like Northern Italy, with an elderly population will have higher CFR than, say, Indonesia. Further, CFR already appears to be related to type of exposure. Health care workers who are exposed to very ill, symptomatic patients with respiratory disease are likely exposed to a higher viral load and may have a more fulminant course. Respiratory versus oral transmission may also affect CFR. If we assume, like Mr. Trump said, that "it's just a bad flu," then the CFR may on the order of 0.1-0.2%, or as Reason magazine recently opined, "it's not that bad." On the other hand, other coronavirus disease (SARS and MERS) had CFRs of 8% and 30%, so COVID could be worse. There is no good data, yet.

To further complicate matters, categorization of cause of death is subjective. Few people in the US have been tested. Large outbreaks with high fatality counts have been reported in nursing homes and post-hoc testing has identified COVID in residents and staff. Most of the deceased have not been tested. In France and Belgium, when presumed COVID deaths from nursing homes were added to the national figure, COVID-related deaths increased by 25-35%. Here in the US, a much smaller proportion of the population has been tested. Many deaths have been reported as pneumonia and influenza. And, there has been a large spike in P&I deaths since February despite the waning of influenza activity. Bloomberg and USNews have both published decent articles on these problems with measuring severity of the epidemic and the effect of any measures implement to curb it.

Plenty of room for argument, lies, and obfuscation, and I expect it from the adminstration. You know, their plan was perfect; the media and other bad people pointing out the problems is, by definition, fake news.

Posted by Gordon, No Hair Blog, April 16, 2020

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