Cases pass 101,000 in 97 countries; one economist suggests “we should prepare for a short-term but severe global recession,” and right here in King County we have 11 people dead (which is more than in Beijing) and 58 confirmed cases. Which makes for a King County Case Fatality Rate (CFR) of 18.97%. This is not a useful number. More on that in a bit. Given that Seattle and surrounds are now in the bullseye of this epidemic, County officials have released what seems to me to be very reasonable advice. In terms of prevention, along with the usual sanitation and social-distancing advice, it boils down to:
- Cancel all events of more than 10 people
- people 60 and over: stay at home
- people with underlying health issues: stay at home
- people who are immunocompromised: stay at home
- loved one of any of the above? stay at home
- employers: tell your people to work from home
- schools: stay open unless you have confirmed cases
- Everyone: have plenty of the things you’ll need at hand in case you need to self-quarantine for a couple of weeks
Overall takeaway: don’t panic, but do prepare. Here in King County we’re taking this seriously. The University of Washington has closed their campuses and moved classes online. Amazon and Microsoft have told their workforces to stay at home where possible, and to cancel travel. The highways around here are like something from the 70s: open and unjammed. No one here is treating this as a joke or a drill.
So now let’s look a bit more closely at that eyebrow-raising CFR in King County. Has the virus mutated? No. There are two main reasons for it being so high right now:
- Genetic tests show that the SARS-CoV-2 virus has been circulating here undetected for about a month. In that time only a handful of people have been tested. It’s probable that there are a couple of thousand people right here in Seattle who already have COVID-19, but the only ones coming to our attention are the seriously ill ones. Survival among those seriously affected depends upon swift supportive treatment—so if you don’t know you’re sick, you’re not getting treated in time; you’re more likely to die.
- The densest cluster of cases is at a care home for the old and medically fragile: exactly the demographic who are most at risk of fatal consequences.
Let’s look at that last one—age and other factors that have an impact on mortality rates. The following info is sourced here and based on a report in the Chinese Journal of Epidemiology that followed 72,314 confirmed, suspected and asymptomatic cases in China until February 11.
Probability of dying of COVID-19 by age:
0-9 no fatalities
Probability of dying of COVID-19 by sex:
Probability of dying of COVID-19 by comorbidity:
cardiovascular disease 10.5
Type 2 diabetes 7.3
chronic respiratory disease 6.3
So if you’re an old man with a bad heart and lungs, well, you really don’t want to get this thing.
Now let’s look at testing rates per million of population (on March 2) and how that correlates with apparent fatality rates.
current CFR = 4.25%
tests per million: 386
current CFR = 0.65%
tests per million: 2,138
If you look at those numbers it seems if you get the virus in Italy you’re seven times more likely to die that if you get it in South Korea. But South Korea, with their free, drive-through testing stations are catching a much more representative sample of those infected. Their data is better. If they have better data, does this mean the mortality rate for COVID-19 is lower than we thought? No. It means many people in South Korea are in the early stages of infection. Expect that number to go up. But it might not go as high as we fear because the earlier you catch this illness and offer supportive treatment, the less likely the patient is to die—assuming you have enough hospital beds and enough equipment like ventilators.
Which is where I get to the depressing stuff. Countries like the UK have been doing a brilliant job of testing—but the NHS is already operating at capacity andm in some cases, over-capacity. The UK has an extremely low beds-per-population ratio, and their ICUs are operating at over 20% beyond recommended rates. A sudden influx of cases will break the system; people will die. There will be triage.
And here in the US, as of March 1, the number of tests performed per million was…1. Yes, one. One test for every million residents. So how many people in the early stages do you think we’re catching? And how many people are not coming forward because they can’t afford to see a doctor? And how many are still going into work because they have no paid time off? Many peoiple in this country believe they live in with the best healthcare in the world. And this could be true for those individuals who have money. But a pandemic is all about public health, and at the federal level this country’s health system is pitiful.
All I can say is, I am grateful for Washington State, for King County, and for the University of Washington. They declared a state of emergency, ignored the FHA, and started in-state testing. UW Virology came up with its own test and has the capacity to do 1,000 tests a day, and to ramp up that number very fast. Legislators are working on making sure there’s no out of pocket expense for testing. Yes, right now the apparent CFR is hair-raising, but because of our fine local systems, expect that number to not just fall but plummet in the next week or two. In this kind of event, I’m very very glad to be living in this city, in this county, in this state.
- Note 3.07.20, 13.06 -8 UTC: I corrected the King County numbers to reflect end-of-day Friday info. Those numbers are now worse: 15 dead and 71 confirmed cases, for a new CFR of 21.12%