It is to our national shame that Federal Public Health authorities are essentially playing with half a deck on this most serious infectious disease outbreak in more than a decade. Their retreat from compiling definitively all the available public health data and testing results is shocking and deeply troubling to any public health practitioner. In any normal Presidential environment heads would already have rolled at the highest administrative levels. Here of course, the problem is that most of the failure has been crammed top down in service of Trump.45’s ego and profound scientific illiteracy and ignorance.
So, the critical data transparency duty has fallen to private sources. God Bless the JHU Covid-19 Tracker and the New York Times database for their multiple daily updates from all 50 states (as well as the anemic Federal contributions). Else we would be even more kneecapped at tracking the wildfire that is this pandemic than we already are.
In any event, as of March 11, there are enough US reported cases and deaths by state to begin to make a few cautious suggestions about the state of affairs in our country. There are still the usual problems inherent with smallish numbers and the extremely rapid accumulation of cases every day, coupled with the unforgiveable damage lack of adequate testing capacity superimposes.
Still, the best we can do for now.
As of 6 PM based on the cases reported in the New York Times, there were 1,190 diagnosed infections in the entire country, and 37 deaths in five states: Washington (29), California (4), Florida (2), New Jersey (1), and South Dakota (1).
This New York Times US Corona Map is from 9 PM March 11, 2020
Here are the pertinent numbers, presented with state populations, and the critical case rate calculations for comparison sake.
Quick Analytic Take
There has been a ton of recent reporting about whether the Cocid-19 virus infection is or is not just like the flu. No surprise, the correct medical answer is no. As Dr. Fauci has been at multiple pains to repeat, over and over again, for the slow and dense (yes, I mean Trump.45, some congressmen, and talk show entertainers), so far in China the fatality rate is about 1% whereas for seasonal flu it is only 0.1 %. So Covid-19 is 10 times more lethal than seasonal flu. Let me repeat that 10 times. And of course, there is both a flu vaccine and pharmacologic treatments for infection, neither of which is available for Covid-19. In other words, more deadly and no specific treatment modalities. Trump’45’s rosy fantasy scenarios notwithstanding.
Dr. Fauci is very clear. We don’t know the full answer in the US. The infection is too new. His answer is an educated preliminary assessment based on the largest experience in the World to date from Chinese studies.
But we now have the beginnings of an American data set to look at.
Nationwide in the US, based on 1,190 diagnosed cases there have been 37 deaths. This is a % case fatality rate among infected patients of 3.11%. Not 1.4%, as in the Chinese study published in the New England Journal of Medicine.
As a minor point of interest, the published Chinese study included 1,099 patients. An interesting coincidence, relevant only because the US data set is the same order of magnitude as the Chinese data from which the 1.4% observation was drawn.
Now the US number will likely (but not certainly) fall as more tests become available to investigate less severely ill patients or as normal epidemiological surveillance testing is finally performed on a reasonable scale (up from nothing). But how much that fatality rate will drop is unknown. It would be foolish to project an answer with any confidence. What we can say is, here is the rate on March 11. Check back as more data hits the system.
We have a hint about the state by state variance in the reported case rates of infection per million population here. The US case rate has now increased to 3.56 per million from just 0.26 10 days ago. The initial number is undoubtedly artificially low, caused by the testing fiasco. What is more interesting is the 5-state range for variability now with a larger number of cases reported. California and Washington have the highest observed rates, not unexpected since the West Coast seems to have been the primary and earliest entry point for the Covid-19 virus invading our shores.
Sadly, Washington state probably was the epicenter of US infection, beginning as early as January 10. Their state-based case rate per million is 42.71. This rate is competitive with the worst of the European high hazard areas (France, Germany, and Spain) today except for Italy. Is it a simple harbinger of what is to come for America unless we change out ways?
A case rate of 40 nationwide would mean there are more than 13,000 acute cases on offer for us to discover in the relatively near future. And the Washington epidemic is growing, not slowing.
We can do one more set of state by state early comparisons. We can compare the 5 states in which deaths have occurred to see the range of actual rates in five different places.
The % case fatality rates in the five states run from 2.16% on the low end to 12.5% at the top. In Florida and Washington, both populous states with good medical care and public health infrastructure, the % case fatality rate as of March 11 is 8.7%. We can certainly hope this early observed rate declines with more data, larger case numbers, and better testing, but anything approaching an 8% fatality rate in a combined US population of 30 million at risk (10% of the entire country) is bad news.
And, just for the record it is 8 times higher than Dr. Fauci has described (though his opinion a priori is certainly more expert than mine). But I don’t have an opinion. I am only describing best current US results from reliable real-time sources at John Hopkins University and the New York Times databases.
If these numbers are anything close to accurate, in the early stages the Covid-19 virus in the US is 80 times more lethal than the normal seasonal flu.
Treat them the same at your sorrowful peril.
We can all hope the rates cool as the pandemic matures. Pandemic maturity is likely 3-6 months away, at a minimum. Don’t hold your breath.
In other words, Buckle Up. Or as Dr. Fauci said in perfectly straight forward and plainspoken English: It will certainly get worse before it gets better.
Is anybody in the rarified atmosphere at the White House listening?
