What Is the Actual Case Fatality Rate (CFR) for Covid-19?
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The disease Covid-19—caused by the novel coronavirus—clearly can be deadly, especially for seniors and those who are immune-compromised or metabolically unwell. But how dangerous is it, precisely? Epidemiologists measure something called a Case Fatality Rate (CFR), which tracks the number of deaths caused by a disease per the number of “cases” of that disease. It seems like it should be straightforward to calculate this number, but many things prevent clarity. For instance:
What exactly constitutes a “case”? Do we only count those who test positive according to an official Covid-19 test? Do we also count people who show symptoms but don’t get tested? (After all, they are infected, too.) Do we count people who are infected but asymptomatic? And, if so, how do we locate this cohort and measure it with any precision?
How many people die from Covid-19? There’s a difference between dying from this disease and dying with it. Many serious Covid-19 cases present with other comorbidities, such as heart disease and diabetes. Can we tell that the coronavirus infection was responsible for all deaths or just some fraction of them? On the other hand, the official statistics will leave out people who die at home from Covid-19. Also, some sick people won’t die right away but will die months later from unresolved complications, such as lung injuries.
What kind of care will people get? When medical care systems are functioning, seriously sick patients should be able to get ventilators, antivirals, and other treatments to manage secondary infections, like bacterial pneumonia. This extra care should bring down the CFR. But when systems get overwhelmed, the CFR should go up because medical care will be worse.
The weeks and months immediately after a pandemic can lead to a kind of “fog of war”. Even the experts don’t know how to model Covid-19, and so we see CFRs ranging from the horrifying 10%, based out of initial data out of Italy, to 0.1%, as relatively benign as a standard flu season. Only time and data will give us clarity.
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