The lethality of COVID-19 should be driving our public health policy. Meaning, if this thing is really lethal we should be doing what we’re doing and erring on the side of staying shut down. If it’s much less lethal, we need to be thankful that we gave our health system a chance to catch up and erring on the side of opening everything up. So which is it? In addition, how does that risk compare to common surgical procedures?
The Tale of the Inflated Crude Fatality Rate
The CFR or Crude Fatality Rate for COVID-19 has been an awful lesson in how to start a panic. You know the ones you see at soccer stadiums where people get crushed to death becomes someone yells “fire”? Well, that’s what happened in the media with the CFR.
What is the CFR in an epidemic or pandemic? It’s the simple back of the napkin calculation of the total number of deaths divided by the positive cases. The problem is that in EVERY outbreak, early on, this number is ALWAYS wildly INFLATED because there is limited testing.
The CFR tale begins with the WHO. If you were not paying attention while reading the World Health Organization website early in the pandemic, you would have read that the CFR is 3-4% (1). That should have scared the heck out of anyone and lead to what we see today, abject panic. However, the WHO website really said:
“While the true mortality of COVID-19 will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%, the infection mortality rate (the number of reported deaths divided by the number of infections) will be lower.”
Hence, the WHO knew that the IFR would drop. While most everyone in the media took the bait and caused a panic, there were some smart science reporters who read the whole statement and reported accordingly:
- SLATE-COVID-19 Isn’t As Deadly As We Think
- HumanProgress-The Misleading Arithmetic of COVID-19 Death Rates
- NPR-Why The Death Rate From Coronavirus Is Plunging In China
- ABC News-Early mortality rates for coronavirus are likely misleading, experts say. Children and adults have done extremely well in terms of recovery, say doctors.
The CFR Today
Just like most other countries, the US has been ramping up testing in a big way. Our testing rate today is now 78,000 per million, surpassing early testing superstar Germany (56K/million) and the socialized medical system in Canada (59K/million) (2). Hence, we can expect the CFR to go down as the tests go up.
Based on John’s Hopkin’s data, what is the CFR this week? As of this writing, it’s 5.5% (116,140 deaths/2,104,346 cases) (8). That calculation is confirmed by the data on the CDC website (9). That means that the crude mortality rate is about 1 in 20. In addition, this number is hugely inflated, meaning the real fatality rate of everyone who got infected is MUCH lower. How low? Let’s dig in.
Old Infection Fatality Rates
The IFR is the Infection Fatally Rate. That’s the number that the average person would want to know. Meaning, if I get the virus while out and about, what are my chances of dying? In a virus where there are a significant number of asymptomatic cases, this number can only be calculated by studies that tested everyone in a general population.
Some early studies that tried to do that were conducted in New York and California and found:
- Santa Clara County California at 0.15% (3,4)
- New York at 0.5% (5)
Many more datasets are now being released, so researchers have begun to look at many of them and calculate the mean IFR. This morning I’ll go over an unpublished study placed on a preprint server by scientists at Stanford.
The New Infection Fatality Rate
This study comes to us from the Departments of Medicine, of Epidemiology and Population Health, of Biomedical Data Science, and of Statistics at Stanford (6). The authors are also part of the Meta-Research Innovation Center at Stanford. What did they do?
The researchers looked at COVID-19 studies with at least 500 people that were available as of June 7th, 2020. 23 studies were identified with positive testing rates of 0.1% to 47%. The mean IFR of people of all ages was 1 in 400 (0.25%). However, among people under 70 years old, the IFR was 0.05% or 1 in 2,000.
Comparing the COVID Death Rate to Spine Surgery
If you have back or neck pain, you may at one point have thought about spine surgery. What we do at Regenexx is help patients avoid back or neck surgery. However, it might be useful to compare the risk of dying from spine surgery to the risk of someone under 70 years of age getting infected with COVID-19 and dying.
So how does this COVID-19 IFR of 0.05% compare to spine surgery risk? Meaning, if you did sign up for spine surgery, is it more or less risky than getting infected with COVID-19?
The risk of dying from all spine surgery is 0.32% or about 1 in 300 (10). That means that the risk of dying from COVID-19 is about 7X less than spine surgery! In fact, the disparity is likely higher as the risk for spine surgery also includes the very old who are more likely to die from any surgical procedure. So if you would sign up to get your back or neck operated, you should have no issues tolerating the risk of contracting COVID-19.
Deaths by Age Group
I always get asked by patients leaving comments about how this data applies to them at their current age. Hence, I used the data from the CDC as of June, 10th, 2020, which I graphed above (7). Note that the vast majority of the deaths are in patients who are 65 and over.
The upshot? According to the scientists at Stanford, if you’re younger then 70, your chances of dying from a Coronavirus infection are about 1 in 2,000! That’s MUCH less than your risk of dying from spine surgery. That’s really good news if you’re the average person worrying about yourself or your family. That’s really bad news is you’re a media outlet trying to sell eyeballs to advertisers, which is why you will likely never find this story at one of those websites.
(1) World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 46. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200306-sitrep-46-covid-19.pdf?sfvrsn=96b04adf_4 Accessed 5/5/20.
(2) Coronavisus Worldmeter. COVID-19 CORONAVIRUS PANDEMIC. https://www.worldometers.info/coronavirus/ Accessed 6/17/20.
(3) Bendavid E, et al. COVID-19 Antibody Seroprevalence in Santa Clara County, California. medRxiv 2020.04.14.20062463; doi: https://doi.org/10.1101/2020.04.14.20062463
(4) Santa Clara Public Health. County of Satna Clara Emergency Operations Center. https://www.sccgov.org/sites/covid19/Pages/dashboard.aspx. Accessed 4/25/20.
(5) New York Governor Press Briefing on April 23rd, 2020. https://www.pscp.tv/w/1DXGyeNNvmVGM Accessed 4/25/20.
(6) Ioannidis J. The infection fatality rate of COVID-19 inferred from seroprevalence data. medRxiv 2020.05.13.20101253; doi: https://doi.org/10.1101/2020.05.13.20101253
(7) Centers for Disease Control and Prevention. Provisional COVID-19 Death Counts by Sex, Age, and State. https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku Accessed 6/17/20.
(8) Johns Hopkins University of Medicine. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE). https://coronavirus.jhu.edu/map.html Accessed 6/17/20.
(9) Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html Accessed 6/17/20.
(10) Poorman GW, Moon JY, Wang C, et al. Rates of Mortality in Lumbar Spine Surgery and Factors Associated With Its Occurrence Over a 10-Year Period: A Study of 803,949 Patients in the Nationwide Inpatient Sample. Int J Spine Surg. 2018;12(5):617-623. Published 2018 Oct 15. doi:10.14444/5076