Estimating clinical severity of COVID-19 from the transmission dynamics in Wuhan, China

(COVID-19) on the Diamond Princess ship as 2.6% (95% confidence interval (CI): 0.89–6.7) and 1.3% (95% CI: 0.38–3.6), respectively. Comparing deaths on board with expected deaths based on naive CFR estimates from China, we estimated CFR and IFR in China to be 1.2% (95% CI: 0.3–2.7) and 0.6% (95% CI: 0.2–1.3), respectively." March 2020 - Symptomatic case fatality risk 1.4% https://www.nature.com/articles/s41591-020-0822-7 "Using public and published information, we estimate that the overall symptomatic case fatality risk (the probability of dying after developing symptoms) of COVID-19 in Wuhan was 1.4% (0.9–2.1%), which is substantially lower than both the corresponding crude or naïve confirmed case fatality risk"

correspondingly deflate the mortality rate? 2) Speculating about the mortality rate of Covid-19 based on several gigantic assumptions ("If our surmise of six million cases is accurate, that’s a mortality rate of 0.01%") seems borderline irresponsible. Numerous researchers have been modeling this virus and have generally arrived at numbers in the range of 0.5% to 1.6% [4][5][6][7][8][9]. The authors don't present any compelling reason why we should doubt those numbers. 3) Ultimately the mortality rate is not as important a number as the hospitalization rate. The authors would have you believe this virus is no worse than the flu, but this is not congruent with the number of reports coming out of places like Italy and New York saying they're about to run out of ICU beds, or China rushing to build temporary hospitals to house all of the patients that need critical care. What the mortality rate might be under ideal circumstances where every patient receives adequate medical care might be significantly different compared to a scenario where you've run out of ICU beds and have to start rationing ventilators. [1] https://www.mdpi.com/2077-0383/9/2/419/htm [2] https://www.medrxiv.org/content/10.1101/2020.01.23.20018549v... [3] https://www.mdpi.com/2077-0383/9/2/523/htm [4] https://www.imperial.ac.uk/media/imperial-college/medicine/s... [5] https://institutefordiseasemodeling.github.io/nCoV-public/an... [6] https://cmmid.github.io/topics/covid19/severity/diamond_crui... [7] https://www.medrxiv.org/content/10.1101/2020.03.04.20031104v... [8] https://www.medrxiv.org/content/10.1101/2020.03.09.20033357v... [9] https://www.nature.com/articles/s41591-020-0822-7

that tourists may have different frequencies of chronic diseases — a risk factor for worse outcomes with SARS-CoV-2 infection — than the general population. Adding these extra sources of uncertainty, reasonable estimates for the case fatality ratio in the general U.S. population vary from 0.05% to 1%.>> Mainly I think he wants more testing, but people are cherry picking his argument to try to downplay the risk. His key point from the overall piece is something like "we need more testing, including randomly sampled data. Let's not give up on testing while we ratchet up the countermeasures." Evidence: Second graph- <<At a time when everyone needs better information, from disease modelers and governments to people quarantined or just social distancing, we lack reliable evidence on how many people have been infected with SARS-CoV-2 or who continue to become infected. Better information is needed to guide decisions and actions of monumental significance and to monitor their impact.>> in the middle- <<The most valuable piece of information for answering those questions would be to know the current prevalence of the infection in a random sample of a population and to repeat this exercise at regular time intervals to estimate the incidence of new infections. Sadly, that’s information we don’t have.>> concluding graph- <<If we decide to jump off the cliff, we need some data to inform us about the rationale of such an action and the chances of landing somewhere safe.>> --- Coming from a different angle, the latest estimate from Wuhan is 1.4% (.9-2.1) https://www.nature.com/articles/s41591-020-0822-7?mod=articl...