The grim toll from Novel Coronavirus (COVID-19)

Most people with COVID-19 recover. For those who do not, the time from development of symptoms to death has been between 6 and 41 days, with the most common being 14 days. As of 12 April 2020, approximately 113,000 deaths had been attributed to COVID-19. In China, as of 5 February about 80% of deaths were in those over 60, and 75% had pre-existing health conditions including cardiovascular diseases and diabetes. Official tallies of deaths from the COVID-19 pandemic generally refer to dead people who tested positive for COVID-19 according to official protocols. The number of true fatalities from COVID-19 may be much higher, as it may not include people who die without testing — e.g. at home or in nursing homes. Partial data from Italy found that the number of excess deaths during the pandemic exceeded the official COVID-19 death tally by a factor of 4–5x. A spokesperson for the U.S. Centers for Disease Control and Prevention (CDC) acknowledged “We know that [the stated death toll] is an underestimation”, a statement corroborated by anecdotal reports of undercounting in the U.S. There are indications of undercounting of deaths in Brazil, China, Iran, North Korea, Russia, the UK, and the U.S. Such underestimation often occurs in pandemics, such as the 2009 H1N1 swine flu epidemic.

The first confirmed death was in Wuhan on 9 January 2020. The first death outside mainland China occurred on 1 February in the Philippines, and the first death outside Asia was in France on 14 February. By 28 February, outside mainland China, more than a dozen deaths each were recorded in Iran, South Korea, and Italy. By 13 March, more than forty countries and territories had reported deaths, on every continent except Antarctica. Several measures are commonly used to quantify mortality. These numbers vary by region and over time, and are influenced by the volume of testing, healthcare system quality, treatment options, time since initial outbreak, and population characteristics such as age, sex, and overall health. The death-to-case ratio reflects the number of deaths divided by the number of diagnosed cases within a given time interval. Based on Johns Hopkins University statistics, the global death-to-case ratio is 6.2% (113,296/1,833,685) as of 12 April 2020. The number varies by region. In China, estimates for the death-to-case ratio decreased from 17.3% (for those with symptom onset 1–10 January 2020) to 0.7% (for those with symptom onset after 1 February 2020).

Other measures include the case fatality rate (CFR), which reflects the percent of diagnosed people who die from a disease, and the infection fatality rate (IFR), which reflects the percent of infected (diagnosed and undiagnosed) who die from a disease. These statistics are not timebound and follow a specific population from infection through case resolution. A number of academics have attempted to calculate these numbers for specific populations. The University of Oxford’s Centre for Evidence-Based Medicine estimates that the infection fatality rate for the pandemic as a whole is between 0.1% and 0.39%. The upper estimate of this range is consistent the first random testing in Germany, and a study analysing the impact of testing on CFR estimates.

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