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Figure 1. As of April 1st, for the US, Johns Hopkins currently reports 216,721 confirmed positive cases of COVID-19 and 5,137 deaths. US COVID-19 estimated Case Fatality Rate (CFR) had peaked at around 7.4% (03/03/2020) following a series of deaths in a nursing home in King County, Washington then fell to a low point of 1.2% on 03/21/2020 as testing rates picked up nationally. Following the low point on 3/21, US CFR began to rise again and currently sits at 2.37%. This trend is consistent with the “testing lag” hypothesis, and that states and federal agencies are now ramping up testing capacity to meet the true spread of the disease in the US. The sharp decline of US CFR from 7.4% to 1.2% highlights the importance of rapid COVID-19 testing to identify early-stage illness. Of the 201,354 (worldometers.info) active US cases, 5,005 (2.5%) of them are reported as critical or severe, a stark contrast for the expected 20% critical rate published by the World Health Organization (WHO), meaning that the chance of additional US fatalities is extremely high and that critical cases are currently under-reported. Experts have suggested that vast numbers of individuals are currently infected with the SARS-CoV-2 virus nationally and that increased testing has revealed the true scope of the disease. Recently, the US Federal Coronavirus Taskforce has embraced an anticipated fatality count of 100,000 to 240,000 US citizens, a conservative estimate based on the current trend of social distancing and state-wide “stay-at-home” orders limiting the spread of the disease (Source: Vox). This is critical because it represents an official endorsement from the US Federal Government that the novel coronavirus that causes COVID-19 is much more severe than the flu (Source: Vox).
Relative to other countries, the US had maintained a much higher CFR than South Korea (3-4% vs. South Korea's consistently less than 2% CFR), but as testing rates increased in the US and fatality rates caught up with confirmed case rates in South Korea, the two countries had converged to statistically similar CFRs (1.52% in the US vs. 1.42% in South Korea on 03/25/2020). However, the current trend in the US is an increase in CFR meaning that the scope of disease transmission in the US might still be underestimated, and US CFR is once again diverging from South Korea (2.37% in the US vs. 1.69% in South Korea).
Meanwhile, Italy has continued its trend of vastly outranking the world in deaths with a 11.91% CFR. At the time of this writing (04/01/2020), Italy has surpassed China by around 4 fold the number of reported deaths, making it the most impacted country to date in terms of clinical severity. Spain, France, and the US have also surpassed China in terms of reported deaths. Globally, the average CFR has been on an increasing trend, with the global CFR of 3.4% being having been breached since March 10th. Today, the global average CFR is 5.04%, an increase most likely driven by high fatality countries still experiencing the exponential phase of their epidemics, including Italy, Spain, Iran, France, the UK, and the US. As France and the UK enter their early to mid points in the epidemiological curve, they are currently experiencing high CFRs as well (7.00% and 7.89% respectively).
In contrast, both Germany and Australian CFRs have remained low (1.19% and 0.47% respectively), suggesting these countries might be better indicators of “best case” scenarios, as opposed to South Korea. I would expect an optimal testing scenario to yield CFRs similar to South Korea's 1.69%, although as previously mentioned Germany and Australia have demonstrated lower numbers are possible, but both of these countries might be much earlier in their epidemic phase compared to South Korea, which is no longer experiencing exponential growth. That being said, both Germany and Australia have seen recent upticks in their CFRs, which is evidence suggesting these countries are still in the early to mid phases of their epidemiological curves.
In terms of clinical severity of the disease, the CDC has recently published a report on fatality rate by demographic group in the US, which closely matches what was previously published by the WHO: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm. Current estimates of US national testing rates suggest at least 157,847 US individuals had been tested for COVID-19 (CDC+Public Health Labs combined), compared to South Korea's 431,743 tested as of 04/01/2020. (Data source: Coronavirus COVID-19 Global Cases by Johns Hopkins CSSE 02/27/2020-04/01/2020; worldometers.info; South Korea testing stats: https://www.cdc.go.kr/board/board.es?mid=&bid=0030; US Testing stats: https://www.cdc.gov/coronavirus/2019-ncov/testing-in-us.html).
Archived CFR Reports With Figures & Text: Archived COVID-19 CFR Reports
Table 1. IIRESS Labs running COVID-19 Estimated CFR (CFR) - 04/05/2020
|Country||Infections||Deaths||CFR||95% Confidence Interval|
|Italy||124632||15362||12.33%||(12.14 - 12.51%)|
|UK||41903||4313||10.29%||(10.00 - 10.58%)|
|Spain||126168||11947||9.47%||(9.31 - 9.63%)|
|France||89953||7560||8.4%||(8.22 - 8.59%)|
|China||82543||3330||4.03%||(3.90 - 4.17%)|
|USA||308850||8407||2.72%||(2.66 - 2.78%)|
|South Korea||10156||177||1.74%||(1.49 - 2.00%)|
|Germany||96092||1444||1.5%||(1.43 - 1.58%)|
|Australia||5550||30||0.54%||(0.35 - 0.73%)|
|Global||1249107||67999||5.44%||(5.40 - 5.48%)|
* Note, crude estimates of case fatality rates during an outbreak are expected to be variable and change as the outbreak/epidemic persists. Final numbers comparable to previous outbreaks will not likely be available until weeks or months after the epidemic phase of outbreaks in many countries has cleared. In the mean time, we use these figures to analyze and assess trends within and across countries to better understand the differences in response strategies of the medical infrastructure of each region. We believe using time-series data of the CFR during an outbreak is a useful metric and caution users not to over-interpret the statistic when making behavioral decisions related to the epidemic. For scientific analysis of CFRs, see the below section or click here.
|Current US Doubling Rate:||2-5 Days (mean = 3.4 days, n = 5, 95% CI = 2.3 - 4.4) (As of 04/05/2020)|
|Previous US Doubling Point:||286,720 confirmed cases (Occurred: 04/04/2020)|
|Next US Doubling Point:||573,440 confirmed cases (Expected: 04/07-04/09/2020)|
|Next Next US Doubling Point:||1,146,880 confirmed cases (Expected: 04/12-04/14/2020)|
Graph and methods below detail how the doubling point is calculated.
Figure 2. Current US COVID-19 doubling rate using the date of the first US death (2/29/2020) as the nucleation point for binning. Data through 3/24 is from Johns Hopkins CSSE. Data for 3/25-3/26 is the anticipated doubling point using a 2.6 day time frame based on the next anticipated point of 71,680 US reported cases. The rate had slowed recently to 3 days (3/13-3/16;3/20-3/23), but then increased again to a 2 day doubling time (3/16-3/18;3/18-3/20), suggesting that testing has started to catch up to existing infections, but that testing is lagged over the weekend (3/14-3/15). A 2.6 doubling time was determined by taking the average of doubling times from 3/4 through 3/23 (n = 9). Continued growth at a 2.6 day doubling time suggests that US testing is both picking up pace, as well as transmission rates via community transmission are continuing to occur at an exponential rate, meaning that current testing capacity is currently outpaced by a growth in infections as well as an already high existing undiscovered infection count. This would fit the model of COVID-19 having a higher R0 (“contagion factor”) than seasonal flu (1.4 to 3.8 of COVID-19 compared to 1.28 for seasonal flu). As the United States enacts sweeping “social distancing” rules and “stay-at-home” orders at both the state and federal level, the spread of COVID-19 is expected to begin slowing, but the extent of undiscovered infections is still currently unknown.
R0 Seasonal Flu: https://www.ncbi.nlm.nih.gov/m/pubmed/25186370/
Note: Not meant to be a statistical analysis of true biological doubling rate. This data visualization is meant to guide exploratory data analysis and not meant as a rigorous predictive model.
Archived Doubling Rates With Figures & Text: Archived COVID-19 Doubling Reports
Figure 3. Map depicting the spread and tranmission of seven nations: US, Mexico, Canada, UK, Ireland, Australia, New Zealand. Map source: Johns Hopkins CSSE: https://coronavirus.jhu.edu/map.html. Circle size is proportional to infection count (key on map image for each location).
General Pathology Reports:
Today's episode is a special feature episode of the Planetary News Radio. It is in times of great need that scientists and community members must join together to protect the community, whether that is at the national level, state level, city, or friends and family. As you all know, the coronavirus (COVID-19) has rapidly spread around the world, and we are seeing increasingly sweeping government responses to this outbreak, including quarantines, travel restrictions, and the bolstering of healthcare services. Listen to my status update on the pandemic here in Corvallis, Oregon, as well as a global perspective. For more coronavirus data analytics and updates, visit http://ncov.iiress.com. For transcripts and show notes, visit on the web at: http://www.iiress.com/planetary/podcasts.
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