Vital Facts About Covid-19
By James D. Agresti
March 17, 2020
NOTE: Just Facts has published a major update and expansion of the research below.
Given the spread of misinformation about Covid-19, Just Facts is providing a trove of rigorously documented facts about this disease and its impacts. These include some crucial facts that have been absent or misreported in much of the media’s coverage of this issue.
The U.S. Centers for Disease Control and Prevention emphasizes that “this is an emerging, rapidly evolving situation,” and as such, this article will be updated as new data becomes available.
On one hand, the facts show that:
- if the number of people with active Covid-19 infections is actually 10 times the number of people who have been diagnosed with it, the average American would have to come in contact with 386 people to be exposed to one person who has it.
- deaths from Covid-19 in the U.S. are now 0.5% of the lives lost each year from some typical causes of untimely death, including the flu, overdoses, and accidents.
- the death rate for people who contract Covid-19 is uncertain but probably closer to the seasonal flu than figures commonly reported by the press.
On the other hand, Covid-19 is highly transmissible, which means it could spread like wildfire without extraordinary measures to contain it. This would greatly increase its death toll.
However, such precautionary measures often have economic and other impacts that can cost lives, and overreacting can ultimately kill more people than are saved.
Reported and Active Cases
Per the U.S. Centers for Disease Control and Prevention, a total of 85,356 people in the United States have been diagnosed with Covid-19 as of 4:00 PM EST on March 26, 2020. The U.S. population is 329 million people, which means that one out of every 3,858 people has been diagnosed with Covid-19. The disease is not equally dispersed throughout the nation, so this figure is higher in some areas and lower in others.
Reported cases don’t include people who may be carrying the disease but have not yet been diagnosed. Because its incubation period is 2–14 days, the number of people who have been infected could substantially exceed the number who have been diagnosed.
Also, the vast majority of people who contract Covid-19 experience only mild or no symptoms, and some of them may never be diagnosed. This means that the count of reported cases further understates the actual number of people who have been infected. A February 2020 study in the Journal of the American Medical Association based on data from China found that 81% of reported Covid-19 cases are “mild.” The true portion of such cases is even higher than this, for as the paper explains, there are “inherent difficulties in identifying and counting mild and asymptomatic cases.”
A rare case in which asymptomatic cases can be counted is the Diamond Princess cruise ship, since all passengers were tested for Covid-19. Among those who tested positive, 51% didn’t have symptoms when they were tested. The number of these people who later developed symptoms is currently unavailable.
Inversely, many people who were once infected are recovering. The upshot of this is that the number of people who are actively infected is lower than the total of reported and undiagnosed cases.
All told, if the number of people with active Covid-19 infections is 10 times the number of people who have been diagnosed with it, the average American would have to come in contact with 386 people to be exposed to one person who has it.
A total of 1,246 U.S. residents have died from Covid-19 as of 4:00 PM on March 26, 2020. Among these deaths, roughly 41% have occurred in the city of New York and the state of Washington.
To put those figures in perspective:
- roughly 12,469 people in the U.S. died from the swine flu from April 12, 2009 to April 10, 2010. Unlike Covid-19, which mainly kills older people with preexisting health problems, 87% of people killed by the swine flu were under the age of 65.
- an average of 37,000 people in the U.S. have died from influenza (“the flu”) each year over the past nine years.
- about 67,000 people per year in the U.S. die from drug overdoses.
- around 170,000 people per year in the U.S. die from accidents.
In summary, deaths from Covid-19 are now 0.5% of the annual fatalities from some typical causes of untimely death, including the flu, overdoses, and accidents.
Initial media reports of a 2–3% mortality rate for Covid-19 are inflated, and the actual figure may be closer to that of the flu, which has averaged about 0.15% over the past nine years in the United States. A large degree of uncertainty surrounds this issue due to the same factor that prevents accurate counts of infections: unreported cases.
As explained by Dr. Brett Giroir—who has authored nearly 100 peer-reviewed scientific publications and serves as the Assistant Secretary for Health at the U.S. Department of Health and Human Services—the Covid-19 death rate is “lower than you heard probably in many reports” because the bulk of people who contract coronavirus don’t get seriously ill, and thus, many of them never get tested.
Giroir calls this a “denominator problem” because if you’re “not very ill, as most people are not, they do not get tested. They do not get counted in the denominator.” Giroir’s best estimate is that the mortality rate is probably “somewhere between 0.1% and 1%.” This “is likely more severe in its mortality rate than the typical flu” rate of 0.1% to 0.15%, “but it’s certainly within the range.”
Giroir’s estimate accords with a February 2020 commentary in the New England Journal of Medicine by renowned immunologist Anthony Fauci and others:
If one assumes that the number of asymptomatic or minimally symptomatic cases is several times as high as the number of reported cases, the case fatality rate may be considerably less than 1%. This suggests that the overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza (which has a case fatality rate of approximately 0.1%) or a pandemic influenza (similar to those in 1957 and 1968) rather than a disease similar to SARS or MERS, which have had case fatality rates of 9 to 10% and 36%, respectively.
A prime example of how journalists misreport on this issue is a March 12th article in Business Insider by Andy Kiersz. In this piece, he compares the “death rates” of Covid-19 from the South Korean CDC to that of the flu from the United States CDC. Based on these numbers, he reports that “South Korea—which has reported some of the lowest coronavirus death rates of any country—still has a COVID-19 death rate more than eight times higher than that of the flu.”
What Kiersz and his editors fail to understand is that the denominator for the Korean rate is the number of “confirmed cases,” while the denominator for the U.S. rate is based on a “mathematical model.” The CDC clarifies how the model works by citing a study on swine flu, which multiplies “43,677 laboratory-confirmed cases” of the disease by 41 to 131 times to calculate the denominator for the death rate. In the authors’ words, they do this because confirmed cases are:
likely a substantial underestimate of the true number. Correcting for under-ascertainment using a multiplier model, we estimate that 1.8 million–5.7 million cases occurred, including 9,000–21,000 hospitalizations.
Put simply, Covid-19 death rates that are based upon reported or confirmed infections grossly undercount the number of people with the disease. This, in turn, makes the death rate seem substantially higher than reality.
Another important factor in weighing the risks posed by Covid-19 is its transmissibility, or how contagious it is. In this respect, Covid-19 appears to be much more dangerous than the seasonal flu, but once again, there is some ambiguity.
Scientists measure the contagiousness of diseases with a basic reproduction number, which is the average number of people who tend to catch a disease from each person who has it. This measure is an innate characteristic of the disease because it doesn’t account for actions that people take to prevent it. A February 2020 paper published in the Journal of Travel Medicine explains that any disease with a basic reproduction number above 1.0 is likely to multiply over time.
The same paper evaluates 12 studies of the basic reproduction number of Covid-19 in various nations and finds that they “ranged from 1.4 to 6.49,” with an average of 3.28 and a median of 2.79. Based on their analysis of these studies, the authors conclude that the basic reproduction number of Covid-19 will likely prove to be “around 2–3” after “more data are accumulated.”
In contrast, a 2014 paper in the journal BMC Infectious Diseases analyzes 24 studies of the seasonal flu and finds that the median result for the basic reproduction number is 1.28. The authors stress that the seemingly small difference between 1.28 and higher figures like 1.80 “represent the difference between epidemics that are controllable and cause moderate illness and those causing a significant number of illnesses and requiring intensive mitigation strategies to control.”
In other words, if the transmissibility of Covid-19 is as high as currently estimated, the aggressive measures that some governments, organizations, and individuals have taken to limit large gatherings and travel from areas with outbreaks will save many more lives than doing the same for common diseases like the flu.
There are, however, mortal dangers in overreacting because measures to limit the spread of Covid-19 often have economic impacts that can cost lives. As detailed in the textbook Macroeconomics for Today, countries with low economic growth “are less able to satisfy basic needs for food, shelter, clothing, education, and health.” These hazards can manifest quickly and over extended periods of time.
If certain industries adopted the social distancing extremes that many people have embraced, this would shut down food production and distribution, health care, utilities, and other life-sustaining services. Even under far more moderate scenarios where people who are not in these industries shun work, all of those necessities and many more aspects of modern life depend on the general strength of the economy. Thus, overreacting can ultimately kill more people than are saved.
The same applies to people who are flooding supermarkets to stockpile food, toilet paper, and other supplies. In doing so, they have often stood in close proximity to each other and touched the same items, which opens avenues to spread the disease. Panic buying also creates shortages that deprive typical consumers of provisions.
Likewise, panic can fuel suicides, which number 47,000 per year in the United States. That’s about 38 times the current death toll of Covid-19.
The implications of overreacting to Covid-19 or any other potential hazard are aptly summarized in a teaching guide published by the American Society for Microbiology. This book explains why “the factors driving your concept of risk—emotion or fact—may or may not seem particularly important to you, yet they are” because “there are risks in misperceiving risks.”
During a March 14th press conference, U.S. Surgeon General Jerome Adams asserted that “this situation will last longer, and more people will be hurt” if “we are complacent, selfish, uninformed,” and if “we spread fear, distrust, and misinformation.” Conversely, he said that “we will overcome this situation” if we “pitch in” and “share the facts.”
The essential facts above confirm the wisdom of his words.
I would really like to know the ages and any preexisting conditions of those who have died.
Nice summary. Matches the facts I’ve found elsewhere, in one handy article.
The discussion of numbers and undetected cases was particularly useful.
Wouldn’t undetected cases be a factor in all the comparative figures listed? The article states that Covid death rates are lower than similar flu’s. That means the denominator of those other epidemics is known and therefore death rates are known as well. Surely there were a large number of unreported Swine Flu cases which in turn means a lower death rate in those situations as well.
Thank you so much for bringing some clarity and objectivity to this Corona Virus issue. The symptoms due appear to be much more like a severe cold, where the Influenza virus infections can sometimes take multiple months to completely recover from, especially if you are older. I agree completely with you that the Fear and Panic from misinformation or overstatement of the facts is not helping anyone. It does appear that ease of transmission may be the only real issue. Why hasn’t anyone reported the statistics from the CDC on the 2017-18 Flu Season where 54 million people were symptomatic, 250,000 people were hospitalized and 61,099 people died from it. What has happened to true investigative journalism where all sides are presented like you attempted to do in this article from Just Facts. When a person has fear and scarcity in their mind they are more like to get sick. When someone has appreciation and gratitude in their heart and mind they are more likely to fight off an illness. In addition, connecting with others and having a sense of community does wonders for one’s well being and health. This is what we need to be promoting. Let me know if there are opportunities for me to help out in getting accurate information out to the public. with Thanks and Gratitude, Joe Albers, Denver CO
Great analysis compared to what the current media outlets put out, political BS.
Thanks so much for this information. I am 73 years old and my husband is 75, so we are frightened with all the news we are seeing on TV. I will be sharing this site, so perhaps others will read and gain some comfort as well.
Excellent summary, and as a physician dealing with the systemic impacts of the excessive fear and misinformation on the subject, I agree with the perspectives presented in it completely. Thank you for the excellent work you do in providing sober, balanced and factual analysis of complex and controversial subjects.
It seems to me the number that should matter the most is the hospitalization rate, since the real danger is a medical system too overwhelmed to give proper care and thus driving up the mortality rate. This, of course, has been the horrible experience in Italy. But I’m having a heck of a time finding numbers for hospitalizations. A Wednesday weekly morbidity and mortality report from the CDC indicated 508 hospitalizations at the then-current count, which represented an 11+% hospitalization rate per confirmed cases. That accords with the low-end of a number of estimates, but is twice that of others.
Knowing that number matters hugely. A March report showed that there are some 560,000 acute care beds in the U.S., obviously dispersed in varying densities according to urban populations across the country, and some 200,000 ventilators available.
So to me those are the numbers we should be watching. But I’m having a heck of a time finding anyone reporting them.
There is so much the media has done to totally disrupt our lives and this is where the panic level was raised to pandemonium. The media never reports on the other diseases and life events that cut our lives short, but when there is nothing to blame the president for, currently, they have skillfully aimed their questions and opinions at his feet once again. The China virus was covered up and misrepresented far sooner than released and the crimes that should be reported and uncovered, will probably never see the light of day, because those who are truly to blame for the panic have far more to gain from the sensationalism than finding the truth and REPORTING IT!
I love “Just the Facts” and go to this site often for sound information. This article does a good job of presenting information about the Covid-19 virus and compares it to other flu virus outbreaks. I spent yesterday reading various scientific websites to try to understand why governments around the world would shut down their economies in order to avoid the spread of Covid – 19. I think understanding that is very important before you try to compare this to other viruses. I didn’t see that kind of information on this website and was very disappointed because I know a lot of people come to this website for perspective. Covid 19 is very different than a flu virus. The biggest difference is this virus has the ability to mutate and mutate quickly. It’s first mutation happened in Wuhan China in November 2019 when it mutated for the first time and attacked a human. That was something Covid 19 wasn’t able to do prior to November 2019. The virus then mutated giving it the ability to pass from one human to the next around that same timeframe. It has since mutated again creating two strains of the virus. Because this particular virus is never been transmitted from human to human no human beings have a natural immunity to it. That is why it is so contagious, it also limits for a long time on services up to three days on metal surfaces. In five months time this virus went from a exotic food market in Wuhan China to all around the world and is breaking the backs of healthcare systems. Our threat in the United States is that at the rate people are contracting the virus we will not have enough ventilators or hospital ICU rooms to care for those people that are vulnerable. That message needs to be said loud and clear to everyone.
Thank you for your kind words.
Much remains to be seen about the mutations of Covid-19, but the early indications are that it will mutate materially less than the flu, not more. Covid-19 belongs to a genus of viruses called “coronavirus,” which includes the common cold. This genus tends to mutate rapidly, but Covid-19 does not appear to share that trait.
As explained in a March 17th paper in a molecular biology journal that quotes Michael Farzan, co‐chair of the department of immunology and microbiology at Scripps Research:
Likewise, a February 19th editorial in the British Medical Journal about Covid-19 reports that the “genome data available so far show no unexpected mutation rate or signs of adaptation, so viral factors are unlikely to be contributing to the differences observed between China and the rest of the world.”
Put simply, Covid-19 does not seem to mutate as much as the flu, and thus, it will not take lives regardless of acquired immunity and vaccines. If this proves true in the long run, then the lifetime risk of death from Covid-19 will be considerably lower than common causes of untimely death.
Have you seen any figures for the hospitalization rate for Covid-19? Also the average hospital stay duration for Covid-19? Thanks
I saw this website that tracks this by state. It looks like the hospitalization rate is about 14% compared to positive tests. I would think this number would start to go down as the catch up on the backlog of tests.
What investigations have been done into the true origin of Covid 19. How reliable are the assumptions that it began in the wet markets vs the CCP Lab outside of Wuhan?
Reading this from the U.K. Really good to read some sound facts on here. The reporting in the UK media is totally out of control with no facts about underlying health conditions or illness. It’s all got a bit out of control.