Sunday, April 21, 2024

Just How Deadly is COVID-19?

Letter to the Editor


Globally, about 3.4% of reported COVID-19 cases have died,” according to the World Health Organization, March 3rd, 2020. To date in Canada about 3.6% of reported COVID-19 cases have died. In context, that denotes a case fatality rate about 36 times greater than the seasonal flu (.1% in Canada). Those numbers justify the drastic measures taken thus far and make the collective fear that permeates our communities understandable. However, these numbers are very misleading for a very simple reason.

To determine the percentage of people dying from a disease you need to know the total number of cases, not just reported cases. A conclusive statement about the deadliness of COVID-19 is not possible right now yet governments worldwide are taking steps with huge implications. This isn’t a criticism, because “flattening the curve” to reduce the load on our already overburdened medical systems made ample sense, especially in the early stages. But, for how long?

Early in April researchers from Stanford University conducted a serological study based on a broad cross section of the public in southern California. The tests looked for evidence of immune response (antibodies) in each person to determine the percentage of the population that were asymptomatic or had endured the virus without reporting. Conclusion: the number of cases was under-reported by a minimum factor of 28 times. In other words, the vast majority of infected people never sought medical care and were never tested. Although the test lacks peer review it was conducted under the watch of a highly respected physician-scientist with a lot of experience in clinical and meta-research.

If extrapolated to our counts, the 63 reported cases in Grey-Bruce would be 2,000 persons infected, Ontario’s number would swell to over 300,000, and nationwide cases would be over a million. Those high case counts sound terrible, but actually it would mean that we have achieved greater “herd” immunity and more importantly a corresponding downward push in the true mortality rate to .18% province wide, a fraction of the current 3.6%. That would be a case fatality rate less than one tenth of the often cited 1918 Spanish Flu (2.5%) and more in line with the 1968 Hong Kong Flu or 1957 Asian Flu.

Of the 622 deaths in Ontario thus far, 172 were aged 60-79, 417 were over 80 and an astounding 273 were within LTC facilities. What then is the threat to those under 60? It is clear that vaccines, treatment, and herd immunity are probably years away. In the shorter term a random cross-sectional serology test in Ontario could be invaluable in understanding the true mortality of this disease, planning future measures and maybe pivoting to focus almost entirely on the elderly and immunocompromised.

Steve Starr, Meaford

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