[NOTE: I’ve decided this needs to be at least a two-parter, because there’s so much to be said. Here’s Part I.]
I haven’t written too many posts on the new coronavirus (COVID-19) because we know quite little, and much of what we read about it in the MSM probably is incorrect. Nevertheless, it’s what we have to work with right now.
You keep hearing “don’t trust the Chinese on this.” And I agree. But that also means that we can’t trust the people who at least theoretically know the most about it, because they’ve had the largest numbers of cases. And it also sets the scene for cinematic apocalyptic imaginings to rush in, ideas that many in the MSM are only too happy to entertain, the better to raise ratings and to hurt Trump. A twofer.
Prognosticators don’t want to be caught flat-footed if this becomes a much much bigger deal than it already is. People have learned more and more in recent years not to trust governments and bureaus and bureaucrats. So all of that is operating, too.
But here’s what I’ve gleaned so far.
First, some general statements. I’ve read that for infectious diseases, lethality and ease of contagion are ordinarily (not always) somewhat in opposition. That makes sense, because if a disease is quickly and highly lethal, the sufferer will have much less opportunity to be walking around with it in his or her most contagious stages, and therefore will tend to infect fewer people.
That’s why many illnesses that are highly widespread – take the common cold, which is called “common” for a reason – are usually mild (although tell that to the cold sufferer). And yet even such seemingly innocuous illnesses have some lethality, in that (for example) a cold can lead in the susceptible to pneumonia, which is far more likely to kill.
Pneumonia is something we’re all familiar with because, like the common cold, it’s reached a relatively stable rate of infection and, although far less common than the cold, it’s something not especially uncommon. And unlike COVID-19, it’s far from new. But pneumonia can kill, and you might be surprised to learn how often. Pneumonia statistics are as follows:
For US adults, pneumonia is the most common cause of hospital admissions other than women giving birth. About 1 million adults in the US seek care in a hospital due to pneumonia every year, and 50,000 die from this disease.
That’s a death rate of 5%. And not all these people are old or ill to begin with, either (see the link for more), although many are.
I’ve also seen discussions of the 1918 flu in comparison with COVID-19. The 1918 flu was a pandemic, both worldwide and more lethal than ordinary flu (which can also kill). And the death rate in 1918? The truth is that no one really knows what the death rate was in those who contracted the disease. One reason is that in those days, reporting rules were often nonexistent, even in the US. Here’s an account that focuses on the state of Washington, for example (the term “Spanish flu” is used in the excerpt, and although this is a misnomer it was a common term for it):
For several reasons, tracking the progress of the pandemic in the state with much accuracy is impossible. First, influenza was not a disease that had to be reported to state health authorities, at least not during its most virulent phase in the fall of 1918. Voluntary reporting was extremely sporadic, as will be seen. Deaths needed no diagnosis and were faithfully recorded, but overall tallies of the infected must be considered rough estimates, even when impressively specific.
Second, the flu in 1918 and early 1919 came in three distinct waves — a usually mild form in the spring and summer of 1918, followed by the deadly strain in the closing months of that year, and ending with a return of usually (but not always) milder disease in the early months of 1919, not fully tapering off until 1920.
To further frustrate public-health authorities, the Spanish flu killed both directly and by leaving victims vulnerable to secondary infections with bacterial pneumonia, which was often fatal even in the absence of the flu, particularly in the elderly or infirm. This muddled the causality picture. But because the Spanish flu had proven so stunningly contagious and pneumonia was so often found during autopsies of flu victims, the federal Census Bureau decided to use a single category in its mortality statistics for 1918: “deaths from influenza and pneumonia (all forms)” (Mortality Statistics, 1918). As frustrating as it is to epidemiologists and life-insurance actuaries, all statistical studies of the effects of the 1918 pandemic are riddled with uncertainty and approximations.
The difficulties are obvious. And that passage describes the situation in the US, which had relatively good reporting (and probably lower death rates as well) compared to so many other countries:
Although the death toll attributed to the Spanish flu is often estimated at 20 million to 50 million victims worldwide, other estimates run as high as 100 million victims—around 3 percent of the world’s population. The exact numbers are impossible to know due to a lack of medical record-keeping in many places.
What’s more – and what can be confusing – death rates can refer to two different things. The first one is the overall death rate from the disease in the general population, and the second is the death rate from the disease in all people infected with it.
More about the death rate in 1918, which not only is unknowable for sure but seems to have varied widely by country:
Worldwide, an estimate of the mortality of the 1918–1919 pandemic is 50 million deaths, with a range of up to 100 million deaths. Taking the 50 million figure, this was about 2.5% of the world population. By contrast, in the United States, mortality was on the order of 0.5%. Clearly, the rest of the world was struck more severely, on average, than the United States.
So, if 2.5% of the world’s entire population died (and that’s using the lower total death figure of 50 million), we can safely say that the death rate in those infected had to have been way higher. This estimate is that about a quarter of the world’s population contracted the 1918 illness, and the death rate in the entire population from it was 2.8%, which by my calculations would give a death rate in the infected of four times that, which would be somewhere (using 2.5% or 2.8%) between 10 or around 11 per cent. That’s very high, much higher than anything that’s been reported for COVID-19 so far. It seems that the 1918 flu had some highly unusual characteristic for flu, which was that it was both very contagious and unusually lethal. It also happened to have killed a disproportionate number of people in the prime of life rather than just the very old or very young, which does not seem to match the COVID-19 pattern so far either.
Most estimates I’ve seen so far about the death rate in COVID-19 are that it’s around 2.5% of people who are infected (not of the general population). However, there are several possible problems with this. One is that doctors may be missing a large number of mild or even asymptomatic cases, which would make the actual death rate much lower than that. Another is that it’s not just the death rate but the pattern of deaths that’s important. Most of the deaths have occured in the elderly and especially the very elderly. And almost all of them (so far) have been in China. Obviously, the death toll will keep rising, and not just in China, but we don’t know at what rate. We also don’t know whether the geographic pattern will continue, or whether reports that infection rates may be going down in China are true or not.
Italy has more cases than other countries in Europe right now. This is especially mysterious. But it may have something to do with this [emphasis mine]:
More than 3,000 tests for coronavirus have been carried out [in Italy] over the last few days, although authorities are still trying to identity “patient zero” – the person who brought the virus to the region. The first man infected, a researcher at Unilever, came down with symptoms after attending a dinner at which there was a colleague who had recently returned from China, who tested negative for the virus.
“The peak in Italy is partly due to all the tests being done,” said Roberta Siliquini, a former president of Italy’s higher health council. “We have found positive cases in people who probably had few or no symptoms and who may have overcome the virus without even knowing it.”
The Italian government has been criticised for hastily cancelling flights to and from China as, without coherence across Europe, people have been able to fly to other European cities and enter Italy from there.
That’s because Europe has open borders, so if some European countries are letting people in from China, this affects every country in Europe and it’s hard if not impossible to trace whether people have had any contact with anyone who recently came back from China.
I’ll add just one more thing, and then close Part I down, because it’s already way long. Despite rumors and even reports of transmission when people are asymptomatic, there’s no hard evidence of it so far. That doesn’t mean it’s not happening.