Two weeks ago, I posted some data that I have been tracking to try to get a handle on the actual case fatality rate (CFR) of COVID-19, as well as trying to estimate the untested, unknown virus-positive population out there. This is an update with some interesting trends and new data, as well as my take on why the “missing cases” gap remains of critical importance.
The basic question I posed at the end of March, when deaths were still growing at a mind-numbing rate of 28% per day, was the strength of correlation between the ratio of deaths per reported cases, but lagged several days. The assumption here is that there is some average time that occurs between the time a COVID-19 case is reported and when a reported person dies. This graph, updated below, shows an interesting convergence and trend:
To interpret this graph, take the dark blue line, second from the top. This is the relationship of total deaths reported on any given date versus the number of total cases as of six days prior. In other words, this assumes that the average person who has died from COVID-19 was confirmed to have the virus six days prior. The general smoothing time progresses is the result of having much data overruling the outliers. The “Same Day” percentage keeps going up because the daily growth in deaths nationwide now exceeds the growth in the number of confirmed cases.
That trend differential may well be because of this natural lag between reporting and death. Indeed, the current daily growth rate of deaths nationwide is about where the daily growth in cases was six days ago. So, let’s use that number.
A couple of possibilities
The math is simple here. Assume that six-day lag between reporting and death, but also assume that the “true” CFR is only one percent, instead of the six percent that the six-day lag data suggests. Now, there have been over 550,000 cases reported in the U.S. to date. In order for our 1% CFR assumption to be true, then there must be or have been over 3.3 million total cases, in other words, coming up on three million unreported cases.
Too high, you say? The only way to bring this number down is to assume that the CFR for COVID-19 is much higher than that 1% figure. If the actual rate is 2%, then the number of unreported cases drops in half. A 2% CFR is a very scary number. This ain’t the seasonal flu, as some of my Facebook friends are still contending. If you think that we have tested and found even half of the cases, then we are still looking at an even uglier 3% CFR.
The testing scandal
One month ago, President Trump trotted out executives from CVS, LabCorp and Walmart to promise fast and convenient Coronavirus testing at massive levels. We are not even close. Bloomberg reports continued shortages of tests and supplies, with up to two-week lags between testing and results. Alexis Madrigal from The Atlantic reports that, while the state of Washington reports only an 8% positive rate for Coronavirus tests, New Jersey reports a “hit rate” in excess of 50%. This can only mean that New Jersey is not testing people until late in the game, with obvious symptoms, or as noted above, the reporting of test results is horribly delayed.
Iowa’s Bleeding Heartland blog published a post of mine yesterday where I note that, without massive testing on the scale promoted by economist Paul Romer and others, especially of front-line medical and customer service workers, then the huge elderly and immune-compromised populations of the United States are “throwing the dice” against bad odds every time they leave the house. If we “open up” the country without testing and tracking that “missing” population, the only rational option for these millions of people is months, perhaps years, of home confinement.
Jennifer Rubin of the Washington Post suggests that those politicians who most strongly advocate a quick opening of the “normal economy” should “go first” in volunteering for clinical medical trials and taking crowded public transportation. That won’t happen. Ministers who insist that God will protect their church meetings need to visit the hospitals and “lay hands” on dying COVID-19 patients. That won’t happen either.
I am fortunate to be able to “shelter at home” for some time to come; the “dice odds” with this virus are not at all good for my family. Much of the nation is not so fortunate. And we have wasted at least two months to federal government screw-ups and inaction on testing.