In the news today: the world passed 1 million cases of Coronavirus. A daily Covid-19 update from Taj Pharmaceuticals Limited Coronavirus Latest Breaking News, Coronavirus Treatments, Coronavirus Clinical Trials, and Special Reports on COVID-19.
It’s a great headline, but what does it actually mean?
The number represents the ‘recorded cases.’ A recorded case is someone who tested positive for the virus. So it is someone who was ill, was tested, and tested positive. Anyone who was ill, or was infected but asymptomatic, and was not tested is not included in this number.
The number of people tested and the circumstances in which they are tested varies enourmously. In some countries, people are only tested if they are sick and go to hospital. At that point, if they show symptoms, they are tested. So that number, for example in the UK, represents an equation something like this:
Number of people sick enough to go to hospital + number of available tests = how many people are tested, of which x% have Coronavirus
This number really only tells you how many sick people in hospital, who could be tested, had the virus. This is then extrapolated by most of the media as how many people have Coronavirus, or how many ‘recorded’ cases there are. The latter is more accurate, but still a relatively unuseful number.
Some countries are only testing sick people in hospital. Others are testing randomly across the population. Some countries lack testing kits, and others lack the public infrastructure to test people. Think of the difference between, say, America, where there is a huge shortage of testing kits relative to a large population, a crowded slum in India with no infrastructure or tests, and a small country like Iceland, which is conducting large-scale testing across the population.
The lack of consistency means that the 1 million number globally does not represent the situation at all. It’s a good round number for a news headline, but of little more value.
The reasearch in Iceland has suggested that as many as 50% of people who get Covid-19 don’t display symptoms, so (apart from in Iceland) they would rarely be tested. In the UK, only 163,000 people have been tested, and they were all sick in hospital. In most countries, people who do not get too ill do not get tested. Around 10 of my friends and 3 of my neighbours have told me they’ve had it, and none were tested. That alone implies a lot of people have it who are not showing up in the numbers.
Of the 1 million people who have tested positive for Covid-19, this number represents primarily the number of available test kits, within social infrastructures that can deploy them, and which have mainly been aimed at people who are likely to have the virus. This suggests there must be millions more people who have had it mildly, or with no symptoms, or in countries with very few test kits, or countries with limited infrastructure. That scale would correspond with how infectious Covid-19 is.
The second number that is misleading is the number of deaths.
A death from Covid-19 does not mean a healthy person contracted the virus and then died as a result. We hear a lot, ‘had underlying health problems,’ and the statistics show that a very large proportion of people who have died from the virus were already ill with something else. In some cases that existing illness made them vulnerable, and they died as a result of catching the virus, but in many cases these people were already dying. As Prof. Ferguson, the expert at Imperial College London, mentioned in an interview, sadly most of these people would have died soon from their underlying illness. What has made the statistic startling is that they are all dying at once due to Covid-19.
If a country only tests people who are sick enough to go to hospital, and then of those records who died and had the virus, the death rate will be the proportion of people who were hospitalised, and tested, and then died. That is not the same as the number of people who died as a proportion of the total number of people to have been infected, which is currently unknown.
In many cases, depending on which country a person dies in, if they have Covid-19 in their blood, the death will be recorded as Covid-19 even if that person was already dying of something else. That leads to a misleading sense that Coronavirus is killing lots of people. Prof Ferguson reckons actually 2/3 of these people would have died anyway.
So in real terms, maybe fewer than 1/3 of the deaths recorded as being caused by Covid-19 are actually ‘new’ deaths that otherwise would not have happened around now.
Of course, as each country records deaths differently, this number is as confusing as the recorded cases number. Futhermore, in many countries people may be dying of this unnoticed, if there is not the public infrastructure to investigate, test, and record their death.
The other interesting aspect of this is that people with underlying respiratory conditions are more vulnerable to Covid-19. These are people who would normally be at high risk from polution, especially over the summer. The air around the world is now cleaner than it has been for years, thanks to Coronavirus stopping modernity in its tracks. So, many people who may have died from polution will not now die (this year), though many of those same people may end up dying from Coronavirus instead, which is a cruel irony.
Equally, there are far fewer cars on the roads, which will presumably reduce the annual death rate from motor accidents, which was around 1.3m people in 2016. Industry is all but shut down, reducing deaths from workplace accidents, which could be as high as 2.3m people per year, or 6000 per day.
Whilst the death rate from Covid-19 is a misleading number, especially as a percentage, the rise in total deaths over this period will give a better indication of the impact the virus had on mortality, taking into account new deaths because of the increased demand on healthcare, and reduced deaths due to the reduction in polution, traffic, and industrial activity.
Along with the numbers, the bias in the reporting is also confusing.
The news is full of horror stories about young or healthy people dying from Covid-19, or just of people saying how terrible it was for them to fall ill from the virus. Whilst each of these stories is a genuine human tragedy, and deserves to be told, there is a bias in the way we are reading the pandemic. These stories are written because they are the outliers, and they are shocking. As we’ve learned over recent years about the way algorithms have manipulated how we perceive reality, people click on shocking headlines, not on mundane ones, and the media responds by writing shocking stories.
For every story of a young, healthy person who suffered or died from Covid-19, there must be many thousands of boring stories of people who got a bit ill, spent a few days in bed, then got better again. But as that is the most normal scenario, nobody writes about it. There are no headlines outlining the millions of people who have it so mildly they aren’t even tested, or about the hundreds of thousands, or probably millions of people who have survived Covid-19.
I am not saying it’s not bad. An illness that can sweep across the human race unhindered is terrifying, even if the death rate (as a percentage of infections) may turn out to be quite low, and for most people it is just a bit annoying. People will die, and many more who were dying anyway will now die alone, and that will rightly secure this period in history as one of sadness and fear.
The greatest fear, and the actual reason we’re all isolated in our homes, is that the small percentage who get seriously ill will overwhelm our healthcare systems, as is happening. That then also means healthcare is not available to other people suffering from the usual range of medical problems. To avoid that, our governments have shut down everything. The knock-on economic crisis will also lead to more deaths, whether it is in the West, with people becoming homeless, desperate, and slipping through the net, or in developing nations, where people will be cramped together in slums and will catch other diseases as a result, or just starve.
That will lead to a whole other death rate that is neither being measured nor reported. Some early attempts in Italy have looked at the overall death rate compared with previous years and seen a net rise in deaths. Globally that number will only give a true picture once the virus has finished its journey around the globe, taking in Africa and India, Syria, and the huge populations of refugees and migrants adrift around the world.
What we haven’t seen yet is this tsnumani break over the slums and refugee camps, the places where there are no tests, no ventilators, no hospitals, and possibly nobody to record the statistics. So the true horror of what a novel virus can do has yet really to be seen. In countries with infrastructure it has caused a huge amount of inconvenience, a painful human cost, and a potentially devastating economic cost. In countries with large populations of malnuourished, uneducated people with no access to healthcare it may become truely horrific.
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