
Covid-19: death rate is 0.66% and increases with age, study estimates - rwmj
https://www.bmj.com/content/369/bmj.m1327
======
nopinsight
Based on Diamond Princess data, where almost everyone was tested, the lower
bound of COVID19's IFR (Infection Fatality Rate) should be > 0.5% for
many/most countries.

This uses a data source independent from what the paper uses. Here's the
calculation...

Current Diamond Princess' CFR (Case Fatality Rate) is at 11 deaths / 712
infected = ~1.54%. Ten more are in serious/critical conditions, so it could
increase.

Since testing in DP was almost universal, IFR ~= CFR.

DP's demographics is representative of > 30% of population of many/most
countries. (See figure 1 here:
[https://wattsupwiththat.com/2020/03/16/diamond-princess-
myst...](https://wattsupwiththat.com/2020/03/16/diamond-princess-mysteries/))

Assuming no one in other age groups/health conditions in a country of interest
dies (unrealistic) and everyone from Diamond Princess who is in
severe/critical condition recovers (optimistic), population's IFR would be =
1.54%/0.3 = ~0.51%.

Also, cases from Diamond Princess have received good care. If the healthcare
system gets overwhelmed as has happened in many places, population's IFR would
shoot up to multiple times as high.

Thus, 0.5% is a lower bound for COVID19's IFR, unless a better treatment
protocol/medication is invented. Alternatively, if there are successful
measures to shield the elderly from getting infected, a region's overall IFR
could be lowered.

~~~
Retric
DP excludes the extreme elderly and sick. Remember, people in nursing care
don’t go on cruse ships. Further, it’s expected to see additional deaths. So,
such simplistic estimates are completely worthless from their data.

What it does do is provide estimates of the rate of infection vs obvious and
extreme symptoms. China’s CFR is over 4% and rising, but it’s known that they
missed a huge portion of the total case load.

PS: Further to estimate for the US population you need further adjustments.
China has a younger population than the US with only 10.8% of the population
being 65 and older, but they also have more air pollution etc.

~~~
fortran77
Obesity plays a big role in Covid-19 deaths. 33% of Americans are obese, and
65% are overweight. There's a possibility that more obese people take cruises
--it fits their lifestyles (unlimited food availability, and they don't have
to move much). So the DP data may be tempered by more obesity even though it
has less extreme elderly.

Also many of the crew got infected. So the amount of viral exposure may play a
big part. People who had to come in contact with dozens of infected
individuals every day may be the most vulnerable. This doesn't bode well for
retail grocery workers.

~~~
staz
> Many obese people take cruises--it fits their lifestyles (unlimited food
> availability, and they don't have to move much).

Do you have actual data on that or is this just your prejudice speaking?

~~~
jdm2212
Anecdata: I've taken three cruises over the last twenty years, and the obesity
rate on those was an order of magnitude higher than what I see in my everyday
life as a coastal yuppie -- the only other place I've seen that many people
who are that fat was at Disney in Orlando. But America as a whole has a way
higher obesity rate than what I see normally, so cruises might just be
representative of the country in general.

------
mabbo
Let's presume this death rate is accurate to within an order of 2- 1.33% to
0.33%. We can use that to do some interesting estimates on the true infection
rate.

[https://www.worldometers.info/coronavirus/](https://www.worldometers.info/coronavirus/)
(trust it if you like) says that the USA has (as of 2020-04-05T15:13:00Z) had
9,119 deaths- and I was going to say 8,486 but I refreshed the page and it
jumped to 9,119 because of course it did.

9,119 / 0.33% = 2,763,333 infections.

9,119 / 1.33% = 685,639 infections.

But, we also have to consider that death isn't instant- so add in everyone who
became infected in the last 5-10 days. That'll be a bigger number. The
reported number of infections because of limited testing is 320,828.

I think it's not unreasonable to say that probably 1m Americans have now been
infected by this virus. And the longer ago this comment was made, the more
likely that estimate is correct.

Edit to add: I trust the number of deaths more than the number of infections
because it's easy to say "don't come to the hospital to get tested if you
don't need to" but it's hard to say "let's pretend that dead body died of
something else".

~~~
rhacker
I believed we were at the 1M level about 3 weeks ago. I think we're at the 50
- 100M level at this point, but we won't see those numbers, ever. We will
probably see about 5-10M US infections in 3 weeks, which account for the
extremely small percentage of people getting tested, and at that point (in 3
weeks) the number of actually infected people will be at least 40% of the US
population. I think at that point it will also have waned quite a lot, but
we're just playing catch up with the vast numbers of people that are already
infected. For a lot of people there's easily hideable symptoms and people are
likely going to their grocery store jobs anyway.

~~~
jlmorton
That's ridiculous. We're only testing people with severe symptoms and telling
everyone with minor symptoms to stay home. We're not testing anyone without
symptoms. And the positive test rate is 18.6%.

------
mhb
Why is anyone interested in age independent of comorbidities? Yes - age and
comorbidities are correlated. But wouldn't it be more helpful as an actionable
guide to have statistics for death rate vs. comorbidity rather than, or in
addition to, age?

~~~
jschwartzi
Age is probably an excellent proxy for comorbidities.

~~~
mhb
Yes but that's not very helpful for a healthy 60 year old.

------
LatteLazy
Fatality rate with treatment is basically irrelevant at this point. We need to
know the hospitalisation rate, the ventilation rate and R0 under different
levels of lockdown. The actual rare of deaths will depend on these numbers,
0.66% is just the baseline.

------
drcode
It worries me that this study is relying on Chinese data.

~~~
jonplackett
Yeah, that seems foolish at this point.

Italy is doing a reasonable amount of testing and has more like 10% death
rate. Could there be 15X more infected in Italy than detected? Or is it that
they have mostly old people catching it? Seems like a large discrepancy either
way.

~~~
Leary
Meanwhile Germany has a 1.5% cfr, how did that happen. Did Germany underreport
deaths or Italy underreport cases

~~~
greedo
Germany's CFR has been steadily rising.

~~~
endorphone
Indeed, today it is 1.5%. 7 days ago it was 0.75%. 14 days ago it was 0.375%.
It has literally doubled each week.

------
H8crilA
Assuming good coverage of ICU care. What is it if there's ~zero equipment
available, at least when compared to the number of patients?

------
yread
Another lower bound on death rate estimated from Bergamo (of total
population): 0.44%

4500/1112187

[https://translate.google.com/translate?hl=en&sl=it&u=https:/...](https://translate.google.com/translate?hl=en&sl=it&u=https://www.agi.it/cronaca/news/2020-04-01/coronavirus-
eco-bergamo-stima-morti-8070220/&prev=search)

[https://en.wikipedia.org/wiki/Province_of_Bergamo](https://en.wikipedia.org/wiki/Province_of_Bergamo)

------
Alex3917
Your death rate is roughly double your 10 year mortality. So if you're in your
mid 30s and your risk of dying at any time over the next 10 years is 0.2%,
then your risk of dying if you get Covid-19 is 0.4%.

------
k__
I would love to see the numbers for people with pre-existing conditions,
smokers, alcoholics, etc.

~~~
dboreham
That doesn't really matter when the underlying problem is that your healthcare
system went offline.

------
badfrog
> It reported that 0.04% of 10-19 year olds would probably require hospital
> care—as would 1.0% of people in their 20s, 3.4% of people aged 30-39, 4.3%
> aged 40-49, 8.2% aged 50-59, 11.8% in their 60s, 16.6% in their 70s, and
> 18.4% of those over 80.

This is quite a bit lower than the 20% number that people have been using for
while.

------
crazygringo
Link to the actual paper:

[https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820...](https://www.thelancet.com/action/showPdf?pii=S1473-3099%2820%2930243-7)

Estimates are in the last column of Table 1 (page 5).

These seem roughly in line with CDC estimates for the US, see e.g. the first
chart in this article from 6 days ago which compares flu mortality rates with
COVID-19 per age bracket:

[https://www.businessinsider.com/coronavirus-compared-
seasona...](https://www.businessinsider.com/coronavirus-compared-seasonal-flu-
in-the-us-death-rates-2020-3)

To the (many) commenters here dismissive of the paper -- because in a
"foolish" way it relies on "doubtful" "suspect" "junk" "Communist" Chinese
data making it "not worth the paper it's written on" (all quotes from other
comments here) -- the authors specifically address "adjusting for demography
_and under-ascertainment_ ". The fact that they came to results similar to US
data, as long as their methodology wasn't cherry-picked, would seem to be a
good sign.

And remember -- _The Lancet_ is one of the most prestigious medical journals
in the world. They're not going to publish something "junk".

~~~
Jabbles
> And remember -- The Lancet is one of the most prestigious medical journals
> in the world. They're not going to publish something "junk".

Let's not resort to arguments of authority. They have, quite recently,
published junk.

[https://retractionwatch.com/2020/02/27/lancet-journal-
retrac...](https://retractionwatch.com/2020/02/27/lancet-journal-retracts-
letter-on-coronavirus-because-authors-say-it-was-not-a-first-hand-account-
after-all/)

~~~
JauntyHatAngle
That appears to be a letter to the editor, not a paper though.

~~~
endorphone
This isn't a peer reviewed paper. It's an extremely brief summary piece based
upon a complete absence of evidence and then suppositions.

And to what the guy above said, the Lancet infamously published Wakefield's
since debunked repeatedly claim that MMR vaccines cause autism. A paper that
has literally led to many deaths.

~~~
chimprich
That was a one-off that made international headlines because it was a rare
event. You'd generally trust stuff published in the Lancet; it gets thoroughly
checked.

This is work done by leading researchers in the field, in a top-class journal.
I'm going to trust it over random allegations on HN.

~~~
endorphone
It was an incredibly damaging one-off that has killed children. Clearly the
vast majority of their work is worlds better than that, but I was replying to
the appeal to authority that demands respect and belief for a work that itself
purports to be nothing more than a very rough estimate.

Nonetheless, this piece isn't "thoroughly checked" because there is nothing to
check. They took the deficient data from China and added suppositions to it.
It's neat, I guess, but meaningless.

This paper is not being taken as authoritative anywhere. No one is making
policy decisions on it. Zero ground-truth is changing because of it. Because
it's a cursory, superficial guesstimate (that is literally the most accurate
word) just to appease curiosity.

~~~
chimprich
> They took the deficient data from China and added suppositions to it.

I have more confidence in the Chinese data than that. They have no motive to
supply false data, and lots of reasons to make it accurate.

The data also seem to be consistent with the data emerging in the rest of the
world as judged by the experts who wrote the paper.

> This paper is not being taken as authoritative anywhere. No one is making
> policy decisions on it.

I doubt that. Some of the authors of this paper are also authors of the
Imperial study that has significantly influenced the UK government response.

~~~
endorphone
"They have no motive to supply false data, and lots of reasons to make it
accurate."

They are working with garbage data. They know this. They admit it. Then they
rationalize that they can invent real data out of it. And as an exercise that
is okay -- they state exactly what they are doing with very limited, poor
data. They haven't claimed it was more than it is.

This is not _the_ canonical statement on death rates, and compared to actual
emerging data is completely irrelevant.

"are also authors of the Imperial study that has significantly influenced the
UK government response"

The catastrophic and flippant UK response? The one that thought they would
obtain some "herd immunity" by doing nothing, and then realizing cases were
skyrocketing mimicked what other countries were doing? That UK?

This is not a compelling claim.

~~~
chimprich
> The one that thought they would obtain some "herd immunity" by doing
> nothing, and then realizing cases were skyrocketing mimicked what other
> countries were doing?

Yes, that one. This was the study that convinced the UK government to change
course from the original unrestrained herd immunity strategy.

------
avsteele
It relies critically on estimating the number of asymptomatic cases. To do
this accurately you need either the PCR test to report a positive for a long
time after contraction, or you need a serology-based test.

They are basing the asymptomatic case % from the Diamond Princess data and
assuming that all people who tested positive where the only ones who had
cornavirus. Is this warranted?

Has anyone seen any data on the period of time after contraction during which
the standard PCR test will return positive?

------
api
For reference seasonal flu is around 0.1% and also increases with age, so
Covid-19 is at least 6X as deadly as the flu.

This article also doesn't mention lasting effects. I have seen reports of
people with bad cases being left with lung damage but I have seen no
statistics on this. Everyone is focusing on mortality so I wonder if they're
bothering to collect this info. If it leaves a lot of people with pulmonary
scar tissue that's a big deal.

~~~
Fjolsvith
It will likely fall to a lesser amount as testing rolls out to a larger sample
size of the population.

~~~
Fjolsvith
Here's a source backing my assertion:

[https://news.ycombinator.com/item?id=22787076](https://news.ycombinator.com/item?id=22787076)

------
loftyal
They haven't done any widespread testing, they need to do complete antibodies
tests. how is it possible to know it

------
joncrane
I wonder how much the death rate for other diseases will rise due to an
overwhelmed heath care system.

------
brenden2
These numbers seem much more realistic versus the previous doomsday
predictions of 3%. To compare this to base rates, the age adjusted base rate
for deaths in the US in 2018 was about 0.7%[0]. Depending on how you look at
it, this is either really bad (i.e., 6x worse than the flu) or not that bad
(i.e., less deadly than death by any cause).

3% would have been really bad, that's more than 3x higher than the normal
death base rate.

[0]:
[https://www.cdc.gov/nchs/products/databriefs/db355.htm](https://www.cdc.gov/nchs/products/databriefs/db355.htm)

Edit: fixed wording for correctness.

~~~
pen2l
The comparison is meaningless and maybe anti-productive. What you're saying
harkens back to political fights about what are the numbers. The first
sentence of the article is:

The overall death rate from covid-19 has been estimated at 0.66%, rising
sharply to 7.8% in people aged over 80 and declining to 0.0016% in children
aged 9 and under.1

Nearly 8% death rate for folks over 80 is pretty remarkable. If people out
there start saying "it's just 0.7%! Less than the flu!" old people will not
take the precautions they need to. Because of the contagiousness of this
virus, it should be treated as the huge monster that it is by old folks.

~~~
dboreham
There should be a rule that anyone publishing percentages is required to also
publish the absolute number for their country. Based on comments I've read on
social media, many people simply can't reason about percentages: they post
about how the death rate is "only 1%" but are horrified when told that implies
2 million dead in the USA. One of those numbers seems very small to them while
the other seems unbelievably large. They're the same!

------
Cactus2018
FYI COVID-19 Cases by Age Grouping for Oklahoma State:

[https://coronavirus.health.ok.gov/](https://coronavirus.health.ok.gov/)

------
arrty88
For medical professionals, do they suffer worse because they come in contact
with many variations / mutations of the same virus?

~~~
iQuercus
At the cellular level it’s a numbers game. The more enemy combatants, the
sicker you will be. The more exposure to the virus, the more viruses you’ll
have in your body, the more intense the symptoms.

Hospitals don’t have great access to fresh flowing outside air. So as they
fill up with infected people the air just becomes a cesspool of virus.

------
steve_taylor
This is somewhat at odds with 21% of recorded outcomes so far having been
deaths. There would have to be a hell of a lot of undiagnosed cases to bring
that down to 0.66%.

~~~
jschwartzi
Iceland tested their entire populace and found several people who tested
positive but remained asymptotic while infected. Given that testing in most
countries is limited to people who can get into their doctor’s office the
people who get tested and who test positive have more severe symptoms. There
are probably a lot of people who have it and are spreading it unawares.

~~~
lsllc
It wasn't "several people", it was an estimated 50% asymptomatic (based on
sampling at least 5% of their population):

[https://www.cnn.com/2020/04/01/europe/iceland-testing-
corona...](https://www.cnn.com/2020/04/01/europe/iceland-testing-coronavirus-
intl/index.html)

~~~
pezo1919
I'm always sceptical with people said to be asymptomatic. It might be
asymptomatic for 3-28+ days. The existence of antibodies will be a better
measure.

------
winddude
Great who gives a fuck. The R0 is high 2-3. And the case fatality rate is 21%
in the world, and 65% in the US.

------
grej
From the abstract: “The estimates, calculated by researchers in the UK, used
aggregate data on cases and deaths in mainland China.”

\- Sadly this makes the paper not worth the paper it’s written on (or whatever
the data traffic fees are to serve it)

~~~
einarvollset
The paper uses data from expatriated foreigners from mainland China, so likely
a reasonable dataset.

------
eof
I’m no statistician, but I’m very doubtful of the numbers coming out of China.
I’d be interested to see how this changes with any given countries data
excluded. My suspicion is removing China’s would move the needle more than any
other country.

------
sam_goody
I have seen many articles with similar thoughts - that the death rate of Covid
is < 1%, similar or less than the flu and other well known viruses.

But, anecdotally, two close associates have died of Covid, and a neighbor is
now on life support. May he get better soon!

I (fortunately) have not heard of anyone even being put into a life-
threatening position by Flu. Asking a few friends, their experiences match
mine, though the victims differ.

Can someone with more understanding explain - are we just the exceptions, or
is there some reason that the anecdotal evidence is so far different from the
numbers?

~~~
LorenPechtel
Under 1% is still far above the flu.

And note that parts of Italy have excess mortality of 1% of the population
even though most of them aren't listed as Covid-19 deaths.

~~~
thebruce87m
Do you have links to data for excess mortality? I’m struggling to find any
localised data.

Here is country wide mortality data:
[https://www.euromomo.eu/index.html](https://www.euromomo.eu/index.html)

