Virus death toll will get worse even as out­break wanes


AS signs emerge that China’s coro­n­avirus out­break may be mod­er­at­ing, a mor­bid re­minder of the dis­ease’s toll is ex­pected to per­sist, or even rise, in the days to come.

While new cases re­ported in China ap­peared to de­cline af­ter a February 4, 2020, peak, the num­ber of dead has grown to around a hun­dred a day—dou­ble the daily count of just a few weeks ago.

But those deaths aren’t a sign the virus is get­ting more deadly, ac­cord­ing to ex­perts.

“Deaths are a lag­ging in­di­ca­tor,” said Marc Lip­sitch, an epi­demi­ol­o­gist at Har­vard Univer­sity, who is mod­el­ing the out­break. Once people are in­fected, “it takes around three weeks on av­er­age for some­one to die.”

On Thurs­day, the Hubei prov­ince where the out­break is cen­tered is­sued a re­vised count of cases and deaths, us­ing a new method­ol­ogy. The new method adds 13,332 new cases and 135 deaths to the to­tal in the prov­ince—in­fec­tions that were di­ag­nosed us­ing med­i­cal imag­ing but not a lab test.

Across China, more than 1,300 people have died from the virus and more than 59,000 have been in­fected, ac­cord­ing to au­thor­i­ties. Out­side ex­perts have said the num­ber of cases is likely far higher, and Hubei’s an­nounce­ment that it was count­ing thou­sands of new cases in its to­tal will likely add to that anal­y­sis.

As of Wednesday, there were 8,204 pa­tients clas­si­fied as se­vere cases, ac­cord­ing to num­bers re­leased by Chi­nese of­fi­cials. New con­firmed cases have fallen to about 2,000 a day, down from a peak more than 3,500 daily cases last week.

“If cases only plateaued a week ago, we might ex­pect num­bers of new deaths to con­tinue to rise for some time yet,” said Steven Ri­ley, pro­fes­sor of in­fec­tious dis­ease dy­nam­ics at Im­pe­rial Col­lege Lon­don’s MRC Cen­tre for Global In­fec­tious Dis­ease Anal­y­sis.

The chaotic na­ture of the out­break com­bined with limited ac­cess by in­ter­na­tional ex­perts to Hubei prov­ince, where it be­gan, has made it hard to know the full ex­tent of the epi­demic. Bloomberg and other

News out­lets have re­ported on a health-care sys­tem over­whelmed by the dis­ease, with some se­vere pa­tients turned away and sent home—mak­ing a fi­nal count of deaths far more dif­fi­cult.

“It may be by far that the vast ma­jor­ity of people are those who died at home,” said Michael Os­ter­holm, di­rec­tor of the Cen­ter for In­fec­tious Dis­ease Re­search and Policy at the Univer­sity of Min­nesota’s med­i­cal school. “We may never know how many people have died from this dis­ease in China. I don’t think we ever will.”

Health ex­perts have been work­ing to es­ti­mate the dead­li­ness of the dis­ease. A crude anal­y­sis done by di­vid­ing the num­ber of deaths by the num­ber of con­firmed cases yields a mor­tal­ity rate of about 2 per­cent. Other es­ti­mates that at­tempt to ac­count for un­di­ag­nosed, milder cases have put it closer to 1 per­cent.

“It’s drop­ping ev­ery day as the num­ber of tested pa­tients is going up,” Soumya Swami­nathan, chief sci­en­tist of the World Health Or­ga­ni­za­tion (WHO), said in an in­ter­view.

Mak­ing mat­ters more con­fus­ing, the crude mor­tal­ity rate mixes to­gether a wide va­ri­ety of dis­parate pop­u­la­tions.

“We are see­ing the tip of the ice­berg, and it is a very large ice­berg,” said Har­vard’s Lip­sitch.

Con­found­ing num­bers

THERE are people who were hos­pi­tal­ized for other con­di­tions in Wuhan and who then ac­quired the in­fec­tion from coro­n­avirus pa­tients in the same fa­cil­ity. The num­bers also in­clude se­vere cases in Hubei prov­ince and other parts of China who were di­ag­nosed early, pre­cisely be­cause of the grav­ity of their ill­ness. And there is a large swath of health­ier pa­tients with mild cases, who are more likely to re­cover but less likely to ever be di­ag­nosed.

“You are see­ing case fa­tal­ity rates in dif­fer­ent pop­u­la­tions be­ing glommed to­gether,” said David Fis­man, an in­fec­tious dis­ease doc­tor at the Univer­sity of Toronto. The coro­n­avirus death rate in vul­ner­a­ble pa­tients may not be rel­e­vant to healthy people who get the virus through every­day con­tact, he said.

While many people want to com­pare the out­break to SARS, a coro­n­avirus out­break from 2002 and 2003 that in­fected more than 8,000 people and killed al­most 800, a bet­ter com­par­i­son is sea­sonal in­fluenza, said An­thony Fauci, head of the NIH’s Na­tional In­sti­tute of Al­lergy and In­fec­tious Dis­eases.

Sea­sonal flu kills about 0.1 per­cent of those in­fected, while pan­demics in 1957 and 1968 had mor­tal­ity rates closer to 1 per­cent. The cat­a­strophic 1918 con­ta­gion, known as the Span­ish flu, had a 2-per­cent mor­tal­ity rate, sim­i­lar to what’s seen now in Chi­nese hos­pi­tals, Fauci said.

“It’s very dif­fer­ent from in­fluenza, but it would be act­ing like a re­ally bad in­fluenza sea­son,” he said.

The un­cer­tainly about how nasty the virus will turn out to be is a prob­lem for pub­lic health of­fi­cials try­ing to pre­pare for its po­ten­tial spread around the world.

The death rate “is a num­ber that we re­ally can’t nail down at the mo­ment,” said Ian Mackay, a vi­rol­o­gist at the Univer­sity of Queens­land in Aus­tralia. “It is hard be­cause we need that num­ber to know how much to pre­pare.”


WORK­ERS ar­range beds in a con­ven­tion cen­ter that has been con­verted into a tem­po­rary hos­pi­tal in Wuhan in cen­tral China’s Hubei Prov­ince, February 4, 2020.

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