Communicating the Risk of Death from Novel Coronavirus Disease (COVID-19)

Abstract

To understand the severity of infection for a given disease, it is common epidemiological practice to estimate the case fatality risk, defined as the risk of death among cases. However, there are three technical obstacles that should be addressed to appropriately measure this risk. First, division of the cumulative number of deaths by that of cases tends to underestimate the actual risk because deaths that will occur have not yet observed, and so the delay in time from illness onset to death must be addressed. Second, the observed dataset of reported cases represents only a proportion of all infected individuals and there can be a substantial number of asymptomatic and mildly infected individuals who are never diagnosed. Third, ascertainment bias and risk of death among all those infected would be smaller when estimated using shorter virus detection windows and less sensitive diagnostic laboratory tests. In the ongoing COVID-19 epidemic, health authorities must cope with the uncertainty in the risk of death from COVID-19, and high-risk individuals should be identified using approaches that can address the abovementioned three problems. Although COVID-19 involves mostly mild infections among the majority of the general population, the risk of death among young adults is higher than that of seasonal influenza, and elderly with underlying comorbidities require additional care.

Robust Estimation of Infection Fatality Rates during the Early Phase of a Pandemic

“…From a stochastic point of view, such modelling is prone to an exponential propagation of imputation error, which can principally be controlled for and reported with these models 12 . However, as in the present case such error propagation will finally arrive at conclusions via modelling, that are indeed based on assuming merely all or nothing 4 and thus indeed would need to be communicated with uttermost caution to the public and foremost health politicians 5 .…”

“…There is one last question, which I will not discuss here. Provided that there was a defined place with more than 364.000 people, and provided at that place everybody knew what COVID-19 is, will not miss a single death, will take care of people coughing, and provided that there was enough testing capacity at hand: Could it be that my formula (5) to correct for selecting more morbid persons into a test pool, will also correct for all other sorts of selection bias, therefore delivering an ultra-precise early estimate for mortality?…”

“…Case Fatality Rates (CFR) can be helpful to critically control and reflect the outcome of robust modelling to estimate the global burden by mortality 1 . During the phase of an outbreak CFRs are preliminary and should be communicated and used with caution 5 . Even in the case of the well-known and frequently studied seasonal Influenza A, it is a matter of debate on how to estimate a CFR during the phase of the pandemic, which could be calculated by the total number of "deaths" divided by the number of "cases".…”

Nomogram Prediction of Severe Risk in Patients With COVID-19 Pneumonia: A Retrospective Study

“…Previous studies have reported several clinical characteristics in severe cases and patents with adverse outcomes following COVID-19 infection. Older age, comorbidities such as hypertension, respiratory disease, diabetes, cancer, cardiovascular disease, high LDH level, and lymphocytopenia have all been associated with an increased risk of mortality (4,9,(16)(17)(18). Obesity and smoking have been reported to correlate with increased risks in other studies (4,17).…”

Exploring the Relevance of Senotherapeutics for the Current SARS-CoV-2 Emergency and Similar Future Global Health Threats

“…The global outbreak of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003 and the more recent coronavirus 2 (SARS-CoV-2) have made it clear that older people, especially those with comorbidities, die more easily from these infections than younger people [1][2][3]. The global spread of the novel coronavirus disease (COVID- 19), and the emerging evidence of a sustained human-to-human transmission, suggest that we are dealing with a historic challenge to our capacity to protect the health of our elderly community.…”