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Online Discussion: Tracking new emerging diseases and the next pandemic since 2005; Coronavirus COVID-19 Pandemic Discussion Forum.

We Should Call it SARS-2, CFR Really 10%?

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BabyCat View Drop Down
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    Posted: March 28 2020 at 6:47am

The official name for this novel coronavirus is 2019-nCoV-SARS-2, and it's appropriate. Essentially similar lower respiratory disease, but this time with a dramatically increased infectiousness. 

Alarmingly, it is now emerging that it may also have a similar CFR, perhaps even 10%. 

While it has been assumed by many that China has deliberately manipulated and lied about their official numbers (their CFR is now officially around 4.2%) it has been assumed that the actual CFR figure might be closer to 1-2% due to under-testing, and unknown asymptomatic cases (perhaps 50-75%), the "denominator" issue in the CFR. 

However, Italy and Spain's CFR, a mortality perhaps higher due to demographic factors and limited testing is now around 10%. 

We should all be watching this closely, particularly as the US significantly expands testing. If it IS 10% (especially concerning if hospitals and health care system is overrun), this may be even worse than most people are assuming. 

Please feel free to disagree, PLEASE! What am I missing here?


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DeepThinker View Drop Down
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Post Options Post Options   Thanks (1) Thanks(1)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 8:21am

Maybe the CFR of presenting cases is close to 10%, however I would argue that the majority of cases never present clinically, maybe the vast majority.


Basicly the only treatment you can get at the hospitial that you can't get at home is a ventilator.   In China 90% of people on ventilators died, in the USA 80%+ die.     So I don't think hospital beds make as much difference as some think.    

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Post Options Post Options   Thanks (0) Thanks(0)   Quote EdwinSm, Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 8:45am

It is hard to get at what the right balance is with this.  I see two major factors pullling the case fatality rate in different directions. 

The first as DT said is there is limited testing, so many mild case are missing.  This will push the CFR down. 

The second is, as I posted elsewhere about France, is that they are only testing live cases in hospitals, so if someone dies before testing they are not included, also they are not testing people who die say in nursing homes.  This pushes the CFR up.  


I am not sure how to balance these two, and where we can get better data.   In time the USA might give a better idea, now that testing is ramping up, but in that case we need to way several weeks to see what the death rate does and this is a lagging indicator (it takes time to die from this).   What is of concern to me is that the CRF is creeping up (world wide according to WHO statistics) the rate is now 4.6%, and China is reporting 4.0%.

Also a lagging indicator is that we have not seen hospital system collapsing (or like during some huricanes having people in care homes abandoned), and if they do then the rate will shoot up.


So, Kitten, I can see the final Infection Fatality Rate going either way, but at this stage is does seem to me to be heading higher.  [And it is barely starting to hit South America, and is even further behind in Africa]



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Post Options Post Options   Thanks (0) Thanks(0)   Quote BabyCat Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 8:46am

I also think there is a real possibility the CFR is under 1%, as many cases may not be presenting clinically, and resolved at home. Maybe many, many people have had it, and don't even know it. Serological testing (now developed and underway) will shine a light on this unknown. 

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BabyCat View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote BabyCat Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 8:48am

Quote


So, Kitten, I can see the final Infection Fatality Rate going either way, but at this stage is does seem to me to be heading higher.  [And it is barely starting to hit South America, and is even further behind in Africa]

Ah, you're so sweet, you called me kitten. 

Purr...

hahaha

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Post Options Post Options   Thanks (1) Thanks(1)   Quote DeepThinker Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 9:14am

Another thing to consider...   The Chinese test kits are only about 30% accurate.   Also it is well known that it is very difficult to a get a viral sample from a respiratory illness.   Most people that get influenza, if they are tested will come back negative.


So for every one confirmed case, I would guess we get 3 or 4 false negative tests.   Way more people have been exposed and/or gotten sick than most realize.

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Post Options Post Options   Thanks (1) Thanks(1)   Quote BabyCat Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 9:20am

Good to consider. 

Well, in any case, there have been in Italy, even with an extreme shutdown, nearly 10,000 deaths. Fact. Which would have have been much higher had no shutdown been in effect. Fact. Thus, shutdowns absolutely necessary to avoid far greater catastrophe. Fact. 

Remember when we said don't listen to the words, watch actions?

The US now just notified the Individual Ready Reserve, retired, and former active duty, for recall and call up. 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote CRS, DrPH Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 12:46pm

Originally posted by BabyCat BabyCat wrote:

I also think there is a real possibility the CFR is under 1%, as many cases may not be presenting clinically, and resolved at home. Maybe many, many people have had it, and don't even know it. Serological testing (now developed and underway) will shine a light on this unknown. 

This is correct.  Without testing everyone in the USA (or any country), we cannot establish a prevalence rate for the infection (number of cases circulating in the population); therefore, we can only come up with a CFR for cases who are symptomatic and sick enough to be hospitalized.   This is likely to be very high, 5% or higher.  

Many of these would be expected to die, due to advanced age, pre-existing conditions etc.  Once we get our damn testing up to speed and equivalent to South Korea, I think we'll find that many, many folks in the US have had asymptomatic illness with COVID-19 and are now immune, at least for some time period. 

Widespread inapparent infection and subclinical cases would be a good thing, as this builds up herd immunity and protects the vulnerable.  

Best advice I've heard is "act as if you already have it."  Be safe out there. 

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Sheep Lady Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 7:20pm

Originally posted by CRS, DrPH CRS, DrPH wrote:

Originally posted by BabyCat BabyCat wrote:

I also think there is a real possibility the CFR is under 1%, as many cases may not be presenting clinically, and resolved at home. Maybe many, many people have had it, and don't even know it. Serological testing (now developed and underway) will shine a light on this unknown. 

This is correct.  Without testing everyone in the USA (or any country), we cannot establish a prevalence rate for the infection (number of cases circulating in the population); therefore, we can only come up with a CFR for cases who are symptomatic and sick enough to be hospitalized.   This is likely to be very high, 5% or higher.  

Many of these would be expected to die, due to advanced age, pre-existing conditions etc.  Once we get our damn testing up to speed and equivalent to South Korea, I think we'll find that many, many folks in the US have had asymptomatic illness with COVID-19 and are now immune, at least for some time period. 

Widespread inapparent infection and subclinical cases would be a good thing, as this builds up herd immunity and protects the vulnerable.  

Best advice I've heard is "act as if you already have it."  Be safe out there. 

I think there is some bias here...why can't we call it flock immunity?  I am sick of being part of a herd...


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Newbie1A Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 7:33pm

Originally posted by Sheep Lady Sheep Lady wrote:

I think there is some bias here...why can't we call it flock immunity?  I am sick of being part of a herd...

psstt… hey Sheep Lady would ya rather be a chicken or a sheep, eh?

hmmm - both prey animals - I'd rather be something higher up on the food chain! bwahahahaaaa

If it's to be - it's up to me!
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BabyCat View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote BabyCat Quote  Post ReplyReply Direct Link To This Post Posted: March 28 2020 at 8:52pm

Pod immunity?

Gaggle immunity?

Troop immunity?

I got it.  


Pack immunity! 

Sounds cooler.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 29 2020 at 4:13am

Pride immunity.   Coz I am a lioness. ROAR!

ERCD
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Post Options Post Options   Thanks (0) Thanks(0)   Quote WitchMisspelled Quote  Post ReplyReply Direct Link To This Post Posted: March 29 2020 at 4:58am

What ever you guys decide is great for me.  Just don't name it after the multiple of  crows...

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 29 2020 at 7:55am

Got enough of those already, Witchy!!

I always thought "a parliament of crows" was the most insulting collective noun ever.

Poor crows!   

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Post Options Post Options   Thanks (0) Thanks(0)   Quote WitchMisspelled Quote  Post ReplyReply Direct Link To This Post Posted: March 29 2020 at 8:57am

Maybe different countries.. but here it's known as a murder of crows.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote Technophobe Quote  Post ReplyReply Direct Link To This Post Posted: March 29 2020 at 9:05am

Either way.........

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Post Options Post Options   Thanks (0) Thanks(0)   Quote interwebber Quote  Post ReplyReply Direct Link To This Post Posted: March 29 2020 at 10:57pm

Originally posted by CRS, DrPH CRS, DrPH wrote:

Originally posted by BabyCat BabyCat wrote:

I also think there is a real possibility the CFR is under 1%, as many cases may not be presenting clinically, and resolved at home. Maybe many, many people have had it, and don't even know it. Serological testing (now developed and underway) will shine a light on this unknown. 

This is correct.  Without testing everyone in the USA (or any country), we cannot establish a prevalence rate for the infection (number of cases circulating in the population); therefore, we can only come up with a CFR for cases who are symptomatic and sick enough to be hospitalized.   This is likely to be very high, 5% or higher.  

Many of these would be expected to die, due to advanced age, pre-existing conditions etc.  Once we get our damn testing up to speed and equivalent to South Korea, I think we'll find that many, many folks in the US have had asymptomatic illness with COVID-19 and are now immune, at least for some time period. 

Widespread inapparent infection and subclinical cases would be a good thing, as this builds up herd immunity and protects the vulnerable.  

Best advice I've heard is "act as if you already have it."  Be safe out there. 

My prediction is that this thing is a powderpuff. It looks likes all countries are peaking now way before predictions. This implies a large number of undiagnosed infections with natural immune responses combined with effective treatments of Hydroxychloroquine, Zinc and Zithromax to reduce the severity of the disease in countries that have a clue. I am willing to bet that all goes back to normal in a couple months as treatments ramp up. Really hope I am correct...

If you're not part of the solution, you're part of the problem!
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