Daily COVID-19 Briefing: 4/25/20

Top news, reports and insights for today:

  1. NEW FEATURE: Top headlines for today:
  • Older persons have different, atypical COVID-19 symptoms (Kaiser Health News)
  • FDA warns against anti-malaria drugs for COVID-19 promoted by President Trump (Business Times)
  • San Francisco thought they had 1918-19 “Spanish” Flu under control. Then it exploded after restrictions were lifted (NBC News)
  • Substance use disorders may be another high risk group for COVID-19 (Scientific American)
  • World Health Organizations warns that re-infection cannot be ruled out (Bloomberg)
  • New study shows promising anti-viral drug remdesivir is not effective against COVID-19 (Stat)
  • New study shows that as the case definition for COVID-19 changed in China, more cases were detected, highlighting importance of broadening the clinical indicators that should be considered (Lancet)
  • Experts emphasize that COVID-19 will be with us for months (Axios)
  1. Low agreement on U.S. Death totals
    Where do you look for information on the number of COVID-19 deaths in the U.S. and elsewhere? It should be straight forward to count deaths, even as we find increasingly that determining the fraction of Americans who are infected is a genuine hornet’s nest. According to WORLDOMETER, the U.S. has now experienced more than 52,843 deaths from COVID-19 as of noon today. Are we done? Not so fast. As the numbers grow, we increasingly see variation in the total death toll depending on where you look. The table below summarizes that variability as of noon on Saturday.
    What does this mean? This far into the epidemic, one might think that these discrepancies would be shrinking as we gain more experience, but that is not what we see. The average for these estimates is 47,500, but the standard error is a whopping 8,200 deaths! The high and low estimates disagree by 24,000. This means a couple of things: a) different reporting systems are not all using the same sources, b) CDC sites that use death certificates are so severely lagged that we shouldn’t be paying attention to them; c) whether or not a given reporting platform includes ‘probable’ deaths explains a big part of this discrepancy. It’s often difficult to tell what each site is doing with probable deaths. This is not a small issue. The New York Times data excludes over 5,000 probable deaths, and would be much more in alignment with the Johns Hopkins and Worldometer estimates if they were added. I believe that probable deaths should be included, because most probable deaths are people who died in hospitals (or outside hospitals) that had COVID-19 but weren’t tested or the test results were not available at time of death. Given the inadequacy of testing, particularly in hard-hit areas, it’s likely that the vast majority of “probable” deaths were COVID-19 infections. Add to this a false-negative testing rate of up to 30%, and the case for inclusion gets stronger. From a surveillance point of view, I am much more worried about undercounting deaths than over counting them.
Source:U.S. DeathsComments:
Worldometer52,843Highest estimate
World Health Organization44,053Only “confirmed” cases; source not clear
Wikipedia46,102State reporting, “probable” deaths not included
Johns Hopkins CSSE Dashboard52,782Confirmed & probable, CDC guidelines
CDC/National Vital Statistics System24,555Based on death certificates, severely lagged
CDC/Case updates48,816Includes some probable deaths + 4 US territories
Our world in data51,017ECDPC data
New York Times46,254Excludes 5,100 “probable” deaths in New York
European Centre for Disease Prevention and Control51,017Definitions not clear
COVID Tracking Project45,786Data from State public health authorities
Comparison of death totals across data sources as of 4/25/20
  1. Is COVID-19 worse than the seasonal flu? And other mass casualty events?
    Many people are still wrestling with the question of whether this disease is worth the hit our economy is taking. Isn’t this just like the flu? As states move toward re-opening, big questions emerge about whether we are over-reacting. All of this is understandable. But as Michael Osterholm recently said, we are in the 2nd inning of a baseball game. Take a good look at this new graph I spent the day making. I think it’s pretty impressive. This puts the COVID-19 death toll into a broader perspective. It says that by March 2, we had passed total U.S. deaths for Ebola. We passed SARS deaths around March 7. By March 28, we had exceeded the average deaths from influenza in March and April over the last 5 years. By April 6, we had more deaths than for all flu deaths in March and April for 5 years. By April 7, more people had died of COVID-19 in 5 weeks than all who died of 2009 Swine flu. And by April 21, COVID-19 had killed more Americans than died of influenza over the last 5 years combined. For further context, more us us died by April 10 than died in Ebola, SARS, Los Vegas shootings, the Gulf War, Hurricanes Andrew and Katrina, Swine flu, and the September 11 attacks. Combined.
    Bottom line: This is not like the flu
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