COVID-19: China Numbers Seem Accurate; Ideas for Getting More Accurate Public Health Numbers in Your Locality

When COVID-19 hit China, it took off like a wildfire, with thousands dead. It looked like the Case Fatality Rate (CFR) was about 2%, which was alarming. But there were a lot of reasons to think this situation might not reproduce exactly in other countries:

  • China was caught by surprise; we’re prepared (sort of?)
  • China might have been underreporting their total cases — if so, the real CFR would end up being a lot lower
  • China has one of the highest rates of smoking in the world, which might make the population more vulnerable
  • China was being so weird and secretive about some of their data that the world really didn’t know what to think

Well, now that the virus is well-entrenched in Italy, S. Korea, and Iran, I’ve got good news and I’ve got bad news: the China numbers mostly hold up. The disease spread, the CFR, they all seem to mostly match China. The good part of it is that this gives us more data that we can use to prepare. The bad part is that that data is…double plus ungood.

I’ve been crunching the numbers on the Johns Hopkins Coronavirus Map . Here’s the Case Fatality Rate by Country, as of today:

Feb 29, ’20 Case Fatality Rate by Country Total # Cases
Singapore 0 102
Germany 0 79
Korea 0.005 3150
USA 0.015 68
Japan 0.02 241
Hong Kong 0.021 94
Italy 0.026 1128
France 0.027 73
Iran 0.072 593

As you can see, there’s quite a wide range, but a lot of CFR’s are hovering around 1-2.5%. The average CFR for all countries is 2%; if you remove Iran and its very high numbers, the average is 1.4%. However, bear in mind that any CFR will be preliminary and low for the time being. You cannot know the true CFR until the disease has run its course and you divide the TOTAL deaths by the TOTAL number of people who got the disease, including those fully recovered; in the meantime, the numbers are always changing.

Some thoughts on this:

  • The higher the sample size, the more useful the numbers are. So Korea and Italy are more useful than Germany.
  • However, once you get too high, it becomes clear that no government can keep up with testing, and the numbers will likely get distorted again.
  • Singapore’s government is a high functioning government; they have had zero deaths so far, and by all accounts their rate of infection increase has slowed.
  • Iran’s government is a low functioning government; they have the highest death rate so far, and by all accounts their infections are totally out of control.
  • I repeat; I’m very worried about Iran. If China’s numbers are a model, Iran at this rate will have at least 1,500 deaths by the end of March.

What begins as an epidemiological problem is rapidly becoming a dysfunctional government problem, as anyone with experience in epidemiology or governments — or anyone who’s ever watched a disaster movie — could have foreseen.

Which brings us to the US. We are about to see in real time whether we’re a mostly-first-world country that’s fallen on hard times, or whether we’re more like a second or third world country that’s still talking about its past glories. We have a lot of policies in place that were supposed to only screw the poor — no sick leave! Expensive healthcare! Deductibles that reset Right About Now! — but it turns out that a broken healthcare system affects rich people too, because infectious disease control IS healthcare.

On top of the clusterfuck of the usual American healthcare issues, we have a truth-averse malignant narcissist in charge who would rather fudge the truth than see the stock market go down (more).

What we’re seeing the last 48 hours or so has been the push-pull between the Trump administration and government officials on the ground. Trump has a news conference to say everything’s fine? Gavin Newsom immediately has a news conference to announce community transmission in California. More “everything’s fine” from the administration? More news conferences, more community transmission, this time from Oregon, Washington…

So, while normal folks are out there looking for answers, they’re finding out that they’ve accidentally walked out into the demilitarized zone with the truth on one side, and crazy Twitter trolls typing “the FLU is WORSE,” and everyone is shooting at each other, and those ‘answers’ you were looking for are becoming ever more elusive.

If you are looking for answers the next few days, the closest you’re going to get are public health briefings from big blue states like NY, CA and WA. Another thing to do is see if your local government keeps a public health website on the number of flu and pneumonia cases / deaths. A lot of COVID-19 cases are going to be mis-reported as flu and pneumonia to start out. Moreover, some public health rank-and-file folks are going to be afraid of retaliation from the Trump administration, so they’re not going to publicize these numbers, but they will put them there, hoping the public can find them.

For example, here’s the State of Idaho’s chart keeping track of “Influenza-like illness.”

As you can see, the rate is ticking up slightly for our current week (“week 8”), while not at all going into alarming territory yet. BUT, if you look at the chart for your state / city, and it starts going up into “weird” territory while the government says everything’s “fine,” then you’ll know it’s not necessarily “fine.” (That said, compare to the year 2017-2018 for an example of a really bad flu season for reference.)

Good luck figuring out what the hell is going on in your personal corner of the woods.

In the meantime, stock up on toilet paper.

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