COVID-19 crisis: Have we overestimated the threat?

News of COVID-19 deaths in various parts of the world is adding to the prevailing panic and paranoia. The virus is a dreadful enemy and by all accounts most countries were unprepared to deal with it.

But as we come to terms with it and learn to deal with the virus, curiously several scientists have begun pointing out that estimates of COVID-19 deaths in countries such as the USA and Italy are possible ‘overestimates’.

Nina Schwalbe, Principal Visiting Fellow at the United Nations University’s International Institute for Global Health, is among those who have voiced such concerns. Writing on the website of the World Economic Forum on April 4, she argued that while calculating fatality percentage or rate, the denominator in the form of number of infections is underestimated, hence the fatality rate appears to be much higher than what it actually is.

Due to lack of adequate tests—including in the USA—in many places only hospital patients are now counted as COVID-19 infection cases. This leaves out a large number of other infections. What is more, Schwalbe writes, even when we are testing, depending on the type of test used, we may only be counting people who are actively infected, not those who had it earlier and are currently immune.

Schwalbe concludes, “By not counting the people who don’t need hospital care, we are massively over projecting the per cent of infected people who die of COVID-19. It is a dangerous message that is causing fear—all driven by a false denominator.”

Schwalbe’s contention is that the fear, anxiety and mental health problems caused by overestimates of fatality rate could have been avoided.

Another reason why the fatality rate is getting exaggerated is that the number of deaths related to COVID-19 are being overestimated. While the denominator is underestimated, the numerator is overestimated in several official estimates.

Dr. Jason Oke of Oxford University has also argued that the mere presence of this virus in a dead patient’s body is not evidence enough that this was the cause of death or the main cause of death.

Dr Oke and Dr. Carl Heneghan say, “Dying with the disease ( association) is not the same as dying from the disease ( causation).” (CEBM Research Evidence Service).

Failure to make this distinction may be responsible for a lot of confusion and overestimates, as is also evident from the writings and video recordings of scientists like Dr. Sucharit Bhakdi of Germany (Head of the Institute for Medical Microbiology and Hygiene) and Dr. John Loannidis of the USA (Professor of Medicine and Professor of Epidemiology and Population Health at Stanford University School for Medicine).

An article written by Dr. Loannidis appears to have drawn a lot of attention internationally. In the article titled ‘A fiasco in the Making’, he not just questioned prevailing overestimates of fatality rate but also highlighted certainfacts that were well-known in scientific circles but which did not find adequate space in popular and media debates on the issue.

He pointed out that ‘mild’ coronaviruses affected millions of people every year and accounted for 3% to 11% of those hospitalised in the USA with lower respiratory infections each winter. These ‘mild’ coronavirus infections, he pointed out, would have caused several thousand deaths every year worldwide, though the vast majority of them would not have been documented with precise testing.

In the United States, he writes, this winter season saw 1,073, 976 (over one million) tests for influenza of which 222,552 (20.7 %) tested positive. The estimated number of influenza-like illnesses was between 36,000,000 and 51,000,000, with estimates of deaths ranging between 22000 and 55000. He emphasises the very wide range in this estimate, a difference of 2.5 times, a difference of 33000.

Further he points out that in some people who die from viral respiratory pathogens, more than one virus is found upon autopsy and bacteria are often superimposed. A positive test for coronavirus does not mean necessarily that this virus is always primarily responsible for a patient’s demise, he suggests.

All these scientists believe that excessively harsh measures triggered by panic are avoidable. These voices should also be heard by policy makers in various countries.

(The writer is Convenor of ‘Save the Earth Now Campaign’ and author of Planet in Peril and Protecting Mother EarthFor Children)