DOVID-19 Daily Update: 6%, Estimating the True Fatalities, and Immunity Levels

Estimating the True Fatalities from COVID-19:

Given that misinformation on that CDC 6% figure is making the rounds, I figure it's worth talking (again) about estimating the true fatalities for COVID-19.

The misinterpretation of the 6% figure is so obvious that I don't want to spend time on it here. But I do want to talk about what the true fatality burden might be (and how we might know).

The first source of data is the reported deaths. But those are problematic in many ways. 

For example: 

  •  How many people died at home of COVID-19, but were not counted? 

Given the way COVID-19 creates "silent hypoxia" we have reason to suspect that the number who die at home, uncounted, is high. 

But we can also ask:

  • How many of those who die with complications from COVID-19 would have died anyway? 

Despite the misinformation swirling around that question, at its hear it's not a completely unreasonable question to ask, since we know that COVID-19 primarily kills older people and people with underlying conditions. 

One of the best sources of data to answer this question will be "excess mortality" data.

There is a LOT we don't know about that data right now. It will take years to sort through all that.

Why is it so complicated? Here re just some of the issues involved:

  • We will need to look at the decline in things like automobile accidents as people stay home... and correct for that. 
  • We will need to account for the increase in deaths from things like suicide, abuse, murder, as well as from other usually preventable diseases as people stay home from hospitals, and miss routine checkups, etc. which all have impacts in the other direction. 
  • And then we have to account for all the "heart attacks" and "strokes" at home, that MAY have been COVID-19 related (and might not have been), while separating that from a potential increase in these things due to people missing checkups etc. 

So it's not trivial.

But what I can say from data like what we already have in Bergamo Italy is that excess mortality spiked HARD in March, right as the pandemic hit, and it spiked especially for men, and older people... (so it does look like it's COVID-19 causing this)... and the excess deaths there were double the reported COVID-19 deaths.

While it's especially pronounced in Bergamo, a similar pattern is visible throughout Europe:

(Source The Economist Excess Mortality Dashboard)

But in other countries, COVID-19 deaths roughly track all the excess mortality, and in a few, they exceed it slightly. This is mostly in countries that were less overwhelmed, or not as hard hit. Belgium is the exception, where they were hard hit, and excess mortality was high, but the official deaths roughly tracked all that excess mortality (meaning, Belgium did a superior job of tracking and counting every COVID-19 death). 

It's going to take years to accurately sort all this out. 

But I know people want me to speculate and make educated guesses. I am not opposed to that, if we are clear that this is what we are doing. 

My guess:

My INITIAL conclusion is that in HARD hit areas, COVID-19 deaths are under reported, often by about 50%... but in regions that were not hit as hard, they may not be under reported at all, or may be only under reported by about 10%. Simultaneously, some other factors (not driving as much) may be driving down normal mortality rates at the same time.

It's interesting to me that I have seen excess mortality decline in some regions during the lockdowns, before COVID-19 actually hit those regions, so we will likely need to adjust the baselines, but it's not clear how yet. I have also seen excess mortality decline after a wave of COVID-19 hits. That could possibly indicate locdown effects, or it could be that some of the most vulnerable died a few months earlier than they otherwise would have due to COVID-19, increasing deaths during the wave, and decreasing them after. 

Then we have regions of the world that aren't really reporting at all. These are regions with weak health care systems, and usually with weak economies, which are unlikely to initiate a lockdown. I suspect there are a lot of deaths from such regions that are not being reported. 

So it's complicated and it varies from place to place.

World wide, I suspect we are missing up to 50% of all deaths from COIVD-19. 

In more developed regions, it also varies but I think the average is that deaths are being under reported by somewhere between 5%-15%.

Tomorrow I want to address a similar question regarding the number of true infections and immunity levels. The true death tole may be under-estimated, but so is the true number of people who have been infected. 

More tomorrow. 

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