
Antibody Tests Point to Lower Death Rate for the Coronavirus Than First Thought - intrepidhero
https://www.npr.org/sections/health-shots/2020/05/28/863944333/antibody-tests-point-to-lower-death-rate-for-the-coronavirus-than-first-thought
======
javagram
This headline doesn’t seem to match the body of the article:

> "The current best estimates for the infection fatality risk are between 0.5%
> and 1%," says Caitlin Rivers, an epidemiologist at the Johns Hopkins Center
> for Health Security.

> That's in contrast with death rates of 5% or more based on calculations that
> included only people who got sick enough to be diagnosed with tests that
> detect the presence of virus in a person's body.

> And the revised estimates support an early prediction by Dr. Anthony Fauci,
> director of the National Institute of Allergy and Infectious Diseases and a
> leading member of the White House coronavirus task force. In an editorial
> published in late March in The New England Journal of Medicine, Fauci and
> colleagues wrote that the case fatality rate for COVID-19 "may be
> considerably less than 1%."

Unless “First Thought” simply refers to people who are unfamiliar with how
figures such as CFR are calculated. I’ve been seeing the 1% number repeated by
scientific figures for months.

Here is a Medium article from a month ago saying the same
[https://medium.com/@gidmk/what-is-the-infection-fatality-
rat...](https://medium.com/@gidmk/what-is-the-infection-fatality-rate-of-
covid-19-7f58f7c90410)

> From the 13 studies — including 4 models, 4 observational studies, and 5
> pre-prints of one kind or another — there was an overall estimate of 0.75%
> infection-fatality rate, with the 95% confidence interval ranging from 0.49%
> to 1.01%.

~~~
nodamage
Here is a WHO report from February saying the same thing:

> Modeling is a helpful tool to try to account for missed cases, such as those
> that are mild cases potentially missed in current surveillance activities,
> and the time lag between onset and death. Using an estimated number of total
> infections, the Infection Fatality Ratio can be calculated. This represents
> the fraction of all infections (both diagnosed and undiagnosed) that result
> in death. Based on these available analyses, current IFR estimates range
> from 0.3% to 1%. Without population-based serologic studies, it is not yet
> possible to know what proportion of the population has been infected with
> COVID-19.

[https://www.who.int/docs/default-
source/coronaviruse/situati...](https://www.who.int/docs/default-
source/coronaviruse/situation-reports/20200219-sitrep-30-covid-19.pdf)

~~~
acqq
It is a report dated 19th February! Also note that this estimate is based
exclusively on the Chinese data(!) and that it practically confirms that the
Chinese data were usable for the estimates even as there were doubts spread by
the media and politicians. Specifically in the same report it is written (1):

"Using an estimated number of total infections, the Infection Fatality Ratio
can be calculated. This represents the fraction of all infections (both
diagnosed and undiagnosed) that result in death. Based on these available
analyses, current IFR estimates range from 0.3% to 1%."

And then:

"Without population-based serologic studies, it is not yet possible to know
what proportion of the population has been infected with COVID-19."

So even without the population-based _antibody_ (that is what "serologic"
means) data, and only using the Chinese data "as of 11 February" available to
the WHO the estimate was quite good. The range depends of course also on the
age structure of the population -- the countries with much more young people
would have closer to the lower number, the others closer to the higher.

1) Edit: the parent post quoted the same segment later too

~~~
skeletor_999
Another consideration is whether or not the Chinese data has been reliable at
later dates. The Chinese government did eject foreign journalists in March

[https://www.bbc.com/news/world-asia-51938035](https://www.bbc.com/news/world-
asia-51938035)

There have been some doubts regarding the accuracy of later numbers:

[https://fortune.com/2020/04/24/china-coronavirus-data-
real-l...](https://fortune.com/2020/04/24/china-coronavirus-data-real-lancet-
study/)

------
hedora
The estimate of the death rate has been 0.5% since Feb.

By quoting 5%, the author of the story is conflating case fatality rates
(percentage of diagnosed people) with death rates (percentage of infected
people).

The only story here is that a surprising fraction of the media and policy
makers are completely incapable understanding basic statistics.

------
dragonwriter
“CDC warns antibody testing still too inaccurate to use for coronavirus-
related policy decisions”

[https://www.cbsnews.com/news/cdc-warns-that-half-of-
coronavi...](https://www.cbsnews.com/news/cdc-warns-that-half-of-coronavirus-
antibody-test-results-are-wrong-2020-05-27/)

------
Finnucane
That seems roughly consistent with what surveys have shown in other countries.
But it still suggests that if the virus had been allowed to spread
uncontained, death tolls would be several times what they are now.

~~~
redis_mlc
> But it still suggests that if the virus had been allowed to spread
> uncontained

In the US, it is spreading uncontained, because we don't test and trace in any
meaningful way. The question is when do we confront that reality and stop
pretending otherwise?

It appears people's acceptance of "flattening the curve" for ventilators has
morphed into waiting for a vaccine, which normally takes 18 months.

As I've said before, the US needs to test and trace just nursing
homes/hospitals and stop the lockdown otherwise, since the mortality rate for
younger people is near zero. The US economy is not setup for tens of millions
of long-term unemployed people.

In the case od Newsom's reopening slides, I'd like to see dates attached to
each slide instead of non-specific "when adequate testing is available", which
may never be true in the US. (By omitting dates, Newsom preserves his White
House run at the expense of California residents.)

~~~
mdemare
There we go again. In NYC, 19 out of 100,000 people aged 18-45 died. (1)

There are roughly 110M people in that age group in the U.S. so that would mean
21000 deaths if the virus would spread as widely throughout the U.S. as it has
in NYC (which is estimated to be around 25% of the population).

21000 deaths is not "near zero", nor is the population aged over 45 primarily
found in nursing homes.

1)
[https://www1.nyc.gov/site/doh/covid/covid-19-data.page](https://www1.nyc.gov/site/doh/covid/covid-19-data.page)

~~~
redis_mlc
> 21000 deaths is not "near zero"

I'm not sure what your contrived narrative is, but actually it is near zero,
far less than several other causes of death. (The annual mortality rate is
over 1,000 per 100,000, so 19 per 100,000 is a round-off error.)

"He noted that between January and April in 2018, more than 234,000 people in
the United States died of heart disease and nearly 199,000 died of cancer. So
far during the coronavirus pandemic, there have been about 16,700 Covid-19
deaths in the United States, according to the latest data from Johns Hopkins
University."

[https://www.cnn.com/2020/04/10/health/coronavirus-not-
leadin...](https://www.cnn.com/2020/04/10/health/coronavirus-not-leading-
cause-of-death-us-trnd/index.html)

Even auto deaths are higher at 37,461 in 2016:

"For 2016 specifically, National Highway Traffic Safety Administration (NHTSA)
data shows 37,461 people were killed in 34,436 motor vehicle crashes, an
average of 102 per day."

[https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in...](https://en.wikipedia.org/wiki/Motor_vehicle_fatality_rate_in_U.S._by_year)

There is nothing the US can do to get to zero deaths from corona, so a more
pragmatic public health policy is needed than "lock 300 million people down
for years."

~~~
mdemare
No, the annual death rate for the age group 18-45 is not 1000, it’s around
150. That is, even in the group of adults least affected by Covid-19, it would
be near the top of the list for causes of death. In the most affected group
(75+), the casualty rate is nearly 100 times higher.

It would be around the murder rate in Cincinnati (if all victims were 18-45
and the infection rate was equal to NYC)

I don’t have a narrative - I don’t pretend to know what the best course of
action is.

But I am pointing out some of the glaring factual errors repeatedly made by
people who are dismissive of the severity of this disease.

~~~
hedora
I suspect you are quoting case fatality rates instead of death rates.

In particular, the whole-population rate is <= 0.5%. (International agencies
and other governments say 0.5%, the CDC says (1-.3)*.4%).

That includes asymptomatic and undiagnosed people. Case fatality rates only
include diagnosed cases. Clearly, if you are diagnosed with the virus, you are
more likely to die from it than an asymptomatic person, or a person with minor
symptoms that doesn’t bother to call a doctor.

It is true that, at 100% infection rate, it would be the leading cause of
death this year. The thing is, it’s a one time hit to life expectancies, so
it’s not really comparable to the other risks.

That means it can be the number one cause of death, even though 99.5% of the
people that catch it will recover and die of something else.

~~~
mdemare
> I suspect you are quoting case fatality rates instead of death rates

No. There were 652 confirmed deaths and 129 probably deaths in NYC in the
18-44 age group. If there are 3 million people in that age group in NYC (my
estimate, look up if you want the exact number) that gives a confirmed death
rate of 21.7 per 100k and confirmed + probable death rate of 27 per 100k.
Close enough.

------
beezle
Of course, this assumes that the testing data is accurate and indications are
it may not be. Politico ran something today suggesting quite a few states had
inflated the number of tests done. Also not clear is whether they are unique
tests (ie, multiple tests of the same person only count once)

~~~
MR4D
I went to look up the accuracy for _antibody_ tests specifically (as opposed
to the other test which we've all heard bad things about generally), and I
found this [0].

Apparently the antibody tests suck wrt accuracy.

[0] - [https://www.cbsnews.com/news/cdc-warns-that-half-of-
coronavi...](https://www.cbsnews.com/news/cdc-warns-that-half-of-coronavirus-
antibody-test-results-are-wrong-2020-05-27/)

~~~
acqq
> Apparently the antibody tests suck wrt accuracy.

Here's what I have posted here exactly a month ago, referring to the article
from Guardian from April 4th:

\--

The " _false positives_ " are "especially significant with these antibody
tests, so _with the low numbers of positives it 's extremely important to
evaluate if the claimed values are more than noise artifacts of the tests
themselves._ It is also important to be aware of the scenarios for which the
use of the apparent test results is not reasonable.

Moreover, here's what happened in the UK a few weeks ago:

[https://www.theguardian.com/world/2020/apr/09/uk-
government-...](https://www.theguardian.com/world/2020/apr/09/uk-government-
urged-to-abandon-poor-finger-prick-antibody-tests-coronavirus)

"None of 3.5m home tests ordered have so far been accurate enough to detect
coronavirus immunity"

UK got 3.5 million(!) unusable antibody tests.

[https://www.bmj.com/content/369/bmj.m1449](https://www.bmj.com/content/369/bmj.m1449)

"John Newton, Public Health England’s director of health improvement, said:

"A number of companies were offering us these quick antibody tests, and we
were hoping that they’d be fit for purpose, but when they got to test, they
all worked but were just not good enough to rely on.

“The judgment was made [that] it’s worth taking the time to develop a better
antibody test before rolling it out, and that is what the current plan is.”

"Newton told the committee that the tests trialled so far had lacked
sufficient sensitivity to identify people who had been infected. “We set a
clear target for tests to achieve, and none of them frankly were close.”"

\--

Since then, Roche actually made an antibody test which according to them, in
laboratory conditions, doesn't have false positives. I haven't seen the
independently done confirmation, but personally, I wouldn't use anything else.

There are still a lot of bad antibody tests in circulation.

Also, the estimate that the death rate is close to 1% was known since... seems
like forever in this times: on Diamond Princess ship there were a lot of old
people and the death rate was under 2% so adjusting to the population
structure (where there are more younger people than on the ship) it was
obvious even then:

[https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_D...](https://en.wikipedia.org/wiki/2020_coronavirus_pandemic_on_Diamond_Princess)

But it was also obvious that it's something like 10 times more deadly than
flu.

What was also known is that once the health system is overwhelmed the death
rate would be much more than 1%, and that is also what was observed in Italy.
And that is the reason for having the goal of "flattening the curve": not
allowing to have more cases than the whole system could handle.

------
goalieca
Here’s the cdc estimates used for modelling.

[https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-
scena...](https://www.cdc.gov/coronavirus/2019-ncov/hcp/planning-
scenarios.html)

Their best guess scenario is 35% asymptomatic. Of the symptomatic the rate is
0.05% for those under 50. All ages is 0.4%.

~~~
nradov
It's important to note that the 0.4% number is the CDC's best estimate of
_symptomatic_ case fatality rate. The actual infection fatality rate appears
to be somewhat lower.

------
pdovy
I've seen a lot of people on social media tout a 0.5-1% death rate as if
that's inconsequentially low, which is baffling to me. 0.5% of the US
population is 1.6 million people. Even if you make a lot of optimistic
assumptions - a slow enough transmission rate to continue providing a normal
standard of medical care, herd immunity at ~60% infected, etc, the number of
deaths is still extremely high.

Unless this is revised _substantially_ downward as we get more data, there is
no clear return to normalcy without a vaccine.

~~~
SpicyLemonZest
It's not _inconsequentially_ low. However, n the individual level, it's about
the same risk of death as you face over a normal year. It's worth quite a bit
of effort and sacrifice to avoid multiplying that individual risk by the
entire population, but a lot of people talk like it's a megaplague they need
to avoid catching at all costs.

By all means, everyone should try and find ways to thrive inside, and wear a
mask when they go out. I see people propose that in-person social activity
should just be forbidden or strongly discouraged until a vaccine comes - that
would be a severe and harmful overreaction.

~~~
acqq
> But on the individual level, it's about the same risk of death as you face
> over a normal year.

It's surely not. Even the "normal" averages _include_ people who have big
problems. If you are an individual who is not in the group of people with big
problems, and if the virus can make you sick, your risk gets up significantly,
as soon as you risk being infected. Because, for example, you can know that
you personally aren't in the risk group of people tending to commit suicide.

The currently known estimate of "people who get the virus and have no
recognizable symptoms during all phases of infection" is just around 20%
across all the age groups. Knowing that younger than 45 aren't being only 20%
of population, it doesn't sound so trivial.

The same (that one can know that catching virus increases risk) is for some of
the people with big problems, even if they are young: it is known that some of
those (who have some big problems) are hit much stronger by the virus, e.g.
those with diabetes: without the virus they can safely expect to live for
decades more, with the virus, they can immediately expect much less. And no,
not only overweight people have diabetes.

And the above analysis is only for young people. But being old enough (and
that is even for those being above 45) and catching the virus increases the
risks of permanent health damage or death many times, according to all
statistics we have.

Finally, no age group can expect to have "no problems" as soon as the health
system collapses, and that is why the strict measures were introduced in most
of the world -- it is a reasonable goal to avoid that much.

~~~
SpicyLemonZest
Sorry, I may have been unclear. I'm not saying the risk adds up to zero
somehow; it's the risk you face over a normal year, _in addition to_ the
actual risk of living through 2020 which you'll still face. In other words, if
the virus spread to everyone in the US this year, we'd expect to see 2 normal
years worth of deaths this year.

The health system does need to be prevented from collapsing, but that can be
achieved with measures much less severe than "no socializing". Strict
lockdowns may have been necessary before, but they're not necessary now, which
is why they're being rolled back pretty much across the globe.

~~~
acqq
> In other words, if the virus spread to everyone in the US this year, we'd
> expect to see 2 normal years worth of deaths this year.

No again, as I've argued, you just can't use averages across the whole
countries to estimate individual increase of risk so simple as you suggest, as
your statement was

" _on the individual level, it 's about the same risk of death as you face
over a normal year_."

Everybody knows his own risk, and it's surely not "2 normal years" for most of
the people. I've given the examples for somebody who is young but not
suicidal, for somebody who is young, fit and with diabetes, for somebody who
is fit but older etc. What you argue is plainly wrong calculation:

According to your logic, if the average number of children per grown up person
in my country is 1.2 I should personally have 1.2 child. It doesn't work that
way. In reality, one person knows that he will never have children, another
that she will have 2 etc.

Edit: responding to the reply below this writing: "What I see people saying"
.. "That every single person in the country should live a life of isolation
for the next year to minimize the chances they get the coronavirus." \-- who
is claiming that and where actually? And even if you "see that" somewhere (not
on HN I'd guess) it doesn't change the fact that you claimed an "individual
risk" of "2 years" for practically everybody, which is, as I believed I've
proven up to now, obviously wrong.

~~~
SpicyLemonZest
I'm not presenting this as a one-size-fits-all prescription for estimating
individual risk. There are certainly some people who are more risk averse or
more likely to die than average, and they'll surely want to take more
precautions than the average Joe.

What I see people saying is that the average Joe, even the 35 year old peak of
his health Joe, is at extreme risk. That every single person in the country
should live a life of isolation for the next year to minimize the chances they
get the coronavirus. I don't think there's any plausible risk weighting where
that's true.

