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Worldometers closed case rate

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 nikoid 19 Mar 2020

I note the closed case death rate is trending upwards, according to Worldometers and is currently at 10%. This seems at odds with the predicted death rates widely quoted so far of 1-3%. Will the closed rate death rate trend downwards again as the epidemic progresses and if so how and why? I did think herd immunity would bring this (closed case rate) down, but that can't be the explanation as the closed case rate only captures individuals who have actually contracted the disease. Or can it?

Can't get my head round this at the moment.

In reply to nikoid:

Probably quite a lot of cases not diagnosed because of testing being inadequate.  Also Italy seems to have been clobbered early - I suspect over time the rate there will reduce.

 MeMeMe 19 Mar 2020
In reply to nikoid:

I wonder if the the time to resolve a closed-death is different from the time to resolve a closed-recovered?

So if most deaths happen after a week but you can't tick off someone as recovered until a month then there'll be a 3 week lag between the figures.

 jkarran 19 Mar 2020
In reply to nikoid:

Assuming no significant mutation since there is no talk of it It'll be one of two things, probably both: Increasingly as the virus gets ahead of the response and speculative testing it's only serious medical cases being opened, those are the ones most likely to have bad outcomes. Also if cases closed by deaths close faster than those closed by recovery then you would expect to see this as the open cases grow rapidly.

jk

 nikoid 19 Mar 2020
In reply to MG:

> Probably quite a lot of cases not diagnosed because of testing being inadequate.  Also Italy seems to have been clobbered early - I suspect over time the rate there will reduce.

I was thinking along these lines but the undiagnosed cases (as I see it) have no bearing on the closed case rate. That's why the closed rate case seems to be a more accurate way of looking at death rates. Still scratching my head though.....

 Jack B 19 Mar 2020
In reply to nikoid:

> I was thinking along these lines but the undiagnosed cases (as I see it) have no bearing on the closed case rate. That's why the closed rate case seems to be a more accurate way of looking at death rates. Still scratching my head though.....

This would be true if the under-testing was still random. As is, severe cases will be getting identified because they turn up at hospital, where mild cases don't get diagnosed. The outcomes for the hospital cases are worse than the non-hospital cases. That drags the average down. Or to put it another way, pretty much all the deaths are getting counted, and a lot of recoveries could be getting missed.

I think it's probably a combination of that and, as MeMeMe says, the different recovery times.  While the number of cases is growing quickly (probably still exponentially) the statistics will be dominated by recent cases just because there are more of them. And the fatalities get resolved quicker than the recoveries, so drag the numbers down. As the infection rate peaks and starts to drop off again, we'll see the number of old cases exceed the number of new cases, and the mortality rate should come back down (if nothing else has a bigger effect).

 MeMeMe 19 Mar 2020
In reply to nikoid:

> I was thinking along these lines but the undiagnosed cases (as I see it) have no bearing on the closed case rate.

They likely do surely. 

It's likely that the closed-death number is pretty accurate because anyone dying with Corona Virus symptoms will have been tested (or at the extreme tested after death) but the closed-recovered number is likely to be a huge underestimate because the lack of testing means that unless you are critically ill you'll likely not be tested (although this varies wildly between different countries).

The rate you are looking at is the number of deaths of critically ill people not the number of deaths of all cases (because the number of 'mild' undiagnosed cases is likely to be high).

At least that's my take on it, I'm not an expert!

 vancian 19 Mar 2020

In the UK we are only testing hospital admissions, serious cases

The apparent death rate will be far higher as a result, probably the actual rate too as mass testing would be helpful. I hear in areas with wide testing it's 1.5% ish. (15x worse than flu, in bad years that causes 25000 deaths in the UK).

Assuming you don't run out of intensive care beds - the death rate for over 70s rockets at that point obviously

 neilh 19 Mar 2020
In reply to vancian:

This has been addressed by CSO and CMO in the briefing this moring. Until they get more kits and develop tests to show that people have had it and recovered then in a nutshell the correct % is all open to debate.

 wintertree 19 Mar 2020
In reply to Jack B:

> This would be true if the under-testing was still random

Spot on.  The randomness or otherwise of the sampling method is the key point many don’t consider when interpreting them and generalising to the population.

 DancingOnRock 19 Mar 2020
In reply to nikoid:

That’s 10% of the 20% being tested or admitted to hospital which works out at 1-2%  of cases. 
 

10% of 20 people is 2.

1% of 100 people is 1. 

Post edited at 13:55
 nikoid 19 Mar 2020
In reply to DancingOnRock:

> That’s 10% of the 20% being tested or admitted to hospital which works out at 1-2%  of cases. 

> 10% of 20 people is 2.

> 1% of 100 people is 1. 

Where does your 20% figure come from?

 DancingOnRock 19 Mar 2020
In reply to nikoid:

20% of cases require hospitalisation. That’s why we are in trouble. If 1% just fell over and died it would be no problem. The problem is the 19% jamming up the system and probably requiring years of aftercare. 
 

*obviously that sounds quite callous but isn’t intended to be. 

 RomTheBear 19 Mar 2020
In reply to DancingOnRock:

Unless the government knows something we don’t we are heading for big big problems very soon.

People are not following confinement advice. At this stage in the upward curve Italy had already enforced strict lockdowns. Sure not the same geographical distribution but still.

Post edited at 14:58
 nikoid 19 Mar 2020
In reply to DancingOnRock:

Ok thanks, but I think that is the unmitigated figure, ie without social distancing, self isolating etc.

 stp 19 Mar 2020
In reply to nikoid:

I did see something about this. I think the fact that some people who have the disease will die but are not dead yet will put the rate up. But then there will be many who have the disease, perhaps with mild symptoms, that are never tested and this will bring the rate down. The guy being interviewed reckoned the death rate would likely be 1% to 2%.

10% is really scary. I'm guessing few countries will have the resources the Chinese had, particularly as they went down the containment route and most countries aren't bothering/failing with that. We now have to treat the whole country so we can't use resources from other cities as they're gonna be needed everywhere.

 BnB 19 Mar 2020
In reply to nikoid:

1.4% in the only study to have reached statistical maturity: Wuhan.

https://www.nature.com/articles/s41591-020-0822-7

 DancingOnRock 19 Mar 2020
In reply to RomTheBear:

Italy had direct flights to Wuhan and Chinese nationals had been travelling backwards and forwards to the leather factories for months. Nearly 100,000 of them. Even well into the Wuhan lockdown and many returning after the Chinese New Year. Italy’s rate of infection won’t model ours. 

 damowilk 19 Mar 2020
In reply to nikoid:

This is a good article about the epidemiology and statistics of COVID, some way down it talks about the different methods of calculating mortality, and the difference between open and closed cases:

https://medium.com/@tomaspueyo/coronavirus-act-today-or-people-will-die-f4d3d9cd99ca

 RomTheBear 19 Mar 2020
In reply to DancingOnRock:

> Italy had direct flights to Wuhan and Chinese nationals had been travelling backwards and forwards to the leather factories for months. Nearly 100,000 of them. Even well into the Wuhan lockdown and many returning after the Chinese New Year. Italy’s rate of infection won’t model ours. 

Maybe. But it does so far.

 elsewhere 19 Mar 2020
In reply to RomTheBear:

> Maybe. But it does so far.

Yes. Imported cases are no longer significant once it is growing by community transmission within Italy.

In reply to RomTheBear:

> Unless the government knows something we don’t we are heading for big big problems very soon.

> People are not following confinement advice. At this stage in the upward curve Italy had already enforced strict lockdowns. Sure not the same geographical distribution but still.

I'm rather disturbed by the amount of people I know who are ignoring the advice re social distancing and more disturbing ignoring the bit about locking down the entire household if someone is showing symptoms. 

 neilh 20 Mar 2020
In reply to Dax H:

That unfortunately changes after it has hit. Mate of mine who lives in Hungary was telling me that he was in a queue at a DIY shop when somebody coughed. He was nearly lynched by the rest of the queue. 


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