March 2, 2020, 10:00 a.m.
"Statistics is the only science that enables different experts using the
same figures to draw different conclusions." - Evan Esar
In this commentary, we hope to draw some conclusions from the myriad figures and data sets that have been used to define the current COVID-19 epidemic. The conclusions will hopefully be supported by the data we have
available to date and will not be used to predict or project out as to what the end state will or might be.
Because COVID-19 has been so frequently compared to the H1N1-1918 pandemic, we will highlight, where appropriate, corresponding data from that event.
What we know:
1. The first cases of COVID-19 were identified in Wuhan in late December, indicating initial exposures at least as early as mid-December 2019.
2. Wuhan is a city of some 10 million in Hubei province, with, in turn, a total population of over 50 million. The airport serving this area accounts for 2% of air traffic in China and roughly 2.5 million passengers per year travel into and out of Wuhan serving cities throughout China and the world. Additive to this is, of course, transport by rail bus, and automobile.
3. The province of Hubei was quarantined by Chinese officials as of January 23, at which time there were already almost 1000 cases and 25 deaths reported.
Given the time span from mid-December to late January, coupled with the number of clinical cases reported primarily bin Wuhan, it is not unreasonable to assume that thousands of exposed and/or infected individuals left Hubei prior to the lock-downand that global export of the virus had already occurred and additional cases outside of China was inevitable.
4. To date, there have been 80,026 total cases in China, with 2,912 deaths for a case mortality rate of 3.6%. Many, to include leading newspapers, have compared this to the estimated mortality rate for H1N1-1918 of 2.0 to 2.5%.
This is a totally inappropriate comparison as the 1918 rate is a population mortality rate,
not a case mortality estimate. If all of the China cases were in Hubei province, the
population mortality figure for that area would be 0.0002%. As many have said,
this is not the flu; given a current estimate of some 40 million cases of seasonal flu with
18,000-46,000 deaths in the US alone, influenza is a far greater threat to
the public's health than COVID-19.
5. One figure that has not received the attention it should is the percentage of cases classified as recovered which was approximately 18% 2 weeks ago and is now 51%.
6. Turning to the cases outside of China, there have been 9,772 with 157 deaths (1.6%) reported from 70 countries of which one-half have reported 5 or fewer cases with 16 reporting a single occurrence one-third report a single case. After almost threemonths of Global exposure this is hardly comparable to H1N1-2918 during which an estimated 25-30% of the world's entire population was infected within 6-7 months: 14% of the population of Fiji alone died within 16 days, Philadelphia recorded 759 deaths in one day and the mortality peaked in major capitals around the globe within weeks of one another.
To continue to compare COVID-19 to previous pandemics at this time is simply not supported by the numbers and simply adds to exaggerated public concerns and fear without any objective scientific basis. Yet, we continue to feed the cycle of inaccurate, irresponsible, sensationalized reporting that pours kerosene on the bonfire of public fear which in turn results in policies and reactions grounded more in politics than science, and which do far more socio-economic damage than that which we are purportedly protecting against. This in no way means to diminish the potential for COVID-19 to spread and to have significant clinical and public health impacts.
We have already seen this in Korea, Iran and Italy and can fully expect additional countries to experience the same. But we need to put the risks in proper perspective and, more importantly, calibrate our response in terms of what we currently know about Corona viruses in general and COVID-19 specifically.
As with SARS and MERS, we need to concentrate on case identification, appropriate clinical intervention and isolation, contact tracing and quarantine, as required, and not focus on keeping out what is already here.
The sooner we do this, the sooner we will start to heal the damages we have already self-inflicted on ourselves.