[The science on which this post is based is now very outdated.]

I don’t want to write this. It is inappropriate that I should be writing about COVID-19 at all. I am a nutrition scientist. A Ph.D. student, in fact. I am not an infectious disease expert.

But here I am. Trump does not value expertise. Not valuing expertise, he has not communicated clearly and frankly about the COVID19 pandemic and has prevented his best scientists from doing so. This was avoidable: Singapore was transparent, science-based, and honest with its public. The Trump administration has decided to take a different approach.

The magazines and newspapers have filled the information void, to disastrous consequence. These outlets are not equipped to relay information accurately. In the social media age, the mainstream media outlets have been forced to shift from a subscription-based model (which allows companies to focus on quality) to an engagement-based model (which forces companies to focus on generating engagement). Years of adapting to such a system has come at the expense of media companies’ ability to serve as impartial communicators of the facts.

The outcome for COVID19 is not good. Not being able to vet quality as they should be able to, mainstream media companies cannot serve as gatekeepers to protect the public from misinformation, even if they wanted to. The result is widespread confusion. Mainstream media could promote content from infectious disease experts and virologists. Instead they promote flashy pieces by celebrities and “opinion leaders”.

I write this post therefore to clear up some avoidable confusion. The confusion in this case is about the mortality rate from infection with COVID19.

My main points.

1. CFR is probably overestimated when it exceeds 1%; real CFR is probably well below 1%;
2. The discussion about CFR is academic and not of much practical importance.

Now, CFR is defined as the number of deaths divided by the number of infections

CFR = deaths / infections x 100

This gives us a percentage of people who die who are infected.

CFR relies on accurate counts of deaths and infections. Our count of deaths is probably somewhat accurate. Our count of infections is not. Studies show rate of undetected infections between 70-90%. This means that the CFR of many countries is in some cases an overestimate by as much as 10-fold.

For example, this would suggest that in Italy’s case, their CFR of 7-8% is actually closer to 0.7-0.8%. I think this is probably true. This is the story the data are telling us, without any exceptions of which I am aware.

Real CFR (as opposed to measured CFR) is therefore probably around 0.5-1% in most countries.

When CFR exceeds this figure, we can suggest the following relationship:

CFR ∝ infection rate / testing reach

More infections means more undetected cases. Lower testing reach means more undetected cases. These compound each other. Correspondingly, CFR shoots up. Hence the above equation.

High CFRs are the result of only testing the sickest patients, because there are not enough tests for everyone or because catastrophe has struck because of # of infections. This is supported by reports on the ground in Italy.

It is important to realize that the discussion about whether 500,000 or 1,000,000 or 2,000,000 die without action is academic. It would be a lot, and the medical, economic, and political systems would enter a crisis state greater than the one we are now confronting.

No matter what action we take, the pandemic will be catastrophic in America. This will begin to unfold vividly in the coming week in NYC.

COVID19 is catastrophic because of the rate at which it strikes and kills and hospitalizes and our inability to control spread once it has taken hold if we do not implement drastic measures.

The power of COVID19 is NOT dependent on percent of people who die of those who are infected but on its rapidity, penetration, ubiquity, and thereby, even with modest CFR: mass deaths and hospitalizations.

Neither reported CFRs nor the real CFRs are a measure of the damage that the pandemic will do. Even if CFR is 0.5%, we have no choice: we must respond with drastic measures. COVID19 is not causing pandemonium because it will kill 500,000 or 1,000,000 people. It is doing so because it is incredibly and visibly disruptive to human life.

Asia understands this. We in the West are just starting to understand it. Yet we are still arguing about it. Soon, we won’t be.

Good luck everyone.

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