now I've just read a couple of papers
that basically are quite disconcerting
so I'm going to bring them to you now
and I'm going to put the links below in
the description so you can analyze them
for yourself now the first one is from
the Journal of the American Medical
Association and it's published on the
17th of Mars so this is data that's
taken up to round about that time the
17th of March now this is a corona virus
disease covered 19 in Italy so this is
data from Italy because we've been
looking at the Italian data with some
consternation now for some time and this
is a bit of a breakdown on that data now
these were the number of cases here the
people that actually became infected so
men were outnumbering women and the
difference there is statistically
significant so there may be something
going on here been the ratio between
male and female and the likelihood of
contracting this condition some data now
are showing that men probably get
infected
more frequently than women now age of
the people that were infected with the
condition now is a pretty crude
breakdown naught to 18 years 19 to 50
years 51 to 70 years and over seventy
but these were the figures now these
again these are people that got infected
that got the disease so of all those
that were infected 1.2 percent were
between the ages of 0 and 18 years of
all those that got infected 24 percent
were between the ages of 19 and 50 years
so good to see the young people aren't
getting the condition so much they're in
children aren't getting it so much
having said that there is data that
shows that young people do get this
disease it's just less common from this
data and and from the Chinese data as
well so 51 to 70 years of age comprised
37.3% of the people that contracted the
condition and those over the age of 70
37 percent so this seems to be showing
that roughly over the age of about 50
your chances of getting the disease
don't go up tremendously the number of
cases in that age group indicate that
now this isn't about the complications
because well as we'll see the
complications is greater with increasing
age so they were the people that
actually got it now of the people that
got it how severe was the condition and
this is the breakdown of that so
asymptomatic without symptoms 6.7% of
people that got the infection that were
diagnosed with the infection didn't get
any symptoms so that's that's good but
it's bad because of these these people
of course could be super spreaders and
go around spreading it to many other
people because they don't know they've
got it unspecified that means sort of
vague symptoms they just didn't feel
very well for a while of 10.6% few
symptoms 6.7% mild symptoms 46.1% and
altogether if we take these no symptoms
on specified few symptoms and mild
symptoms that gives us a disappointingly
low number of 70 percent so mild disease
or even milder than mild if you like but
mild all or these categories here 70%
now that this is incredibly
disappointing we had hope this was over
80% but that's not what the Italian data
has shown in the Italian situation now
this doesn't mean say this is going to
be universal in your country but this is
this is the data from Italy now severe
cases now frustratingly the paper
doesn't define severe and critical but
critical is normally taken that these
people need intensive care unit support
in order to survive and this means that
these patients feel pretty poorly for a
period
and may need a degree of medical
intervention although that isn't
specified unfortunately in this paper so
we're not quite sure the precise
meanings of severe and critical from
this paper but if we take the number
they're critical these are the 5% you're
only going to survive with significant
very significant medical input now in
Italy many people got that support in
poorer countries of the world people
aren't going to get that support
so in poorer areas where there's no
medical support maybe some of those who
were severe might have potential
complications that could lead to death
and the critical ones could potentially
well probably all die without without
intensive support so the potential here
for the case fatality rate in poorer
parts of the world is actually
disturbing to think about now moving on
to the case fatality rates now you
probably remember that the case fatality
rate or the case fatality ratio is
essentially the percentage of people
that die compared to the total number
that get infected so if the case
fatality rate is 1% that means that 1%
of people that get the infection died
from the infection and this is the
Italian data up to the time this paper
was submitted so nought to 9 no deaths
therefore zero percent case fatality
ratio so that's that's good to see 10 to
19 again no deaths therefore zero
percent case fatality ratio 20 to 29 no
deaths therefore zero percent case
fatality ratio now 30 to 39 there was
four deaths in the total sample and that
equated to a death rate of naught point
3 percent of the people that got the
affection 4249 there was 10 people 10
deaths and that represented naught point
4 percent of people in the age group
that got the infection so the people
that were 40 to 49 in Italy point 4 of
them died in other words for in a
thousand cases died 50 to 59 year old
age group 1 percent died 60 to 69 year
old age group 3.5% died 70 to 79 12.5
percent so of 100 people that got the
covered 19 infection who were aged 70 to
79 12.5 of them died 12.5 percent and
then 80 to 89 we see it goes up even
more and eighty to ninety eight going
off to twenty two point seven percent
and the total number of deaths in this
sample up to the submission of this
paper was that and that gives a very
high overall 7.2 percent death rate so
total number of deaths recorded up to
the submission of the paper 7.2 percent
death right now we have looked at
similar data from China before so it's
interesting to compare these two so in
China likewise there was naught percent
in that age group and naught percent not
no no in that in 10 to 19 in China there
was no point 2 percent of death very
sorry so in China the death rate in the
nine 10 to 19 year old age group was
higher than in Italy now the 20 to 29
again in China it was nought point two
so again higher in China than in Italy
in that in that age group 30 to 39 in
China that was naught point two so quite
similar so in Italy 3 nought point 3
percent died in that age group and in
China it was nought point two percent
died in that age group now 40 to 49 the
figures were exactly the same so in
China naught point four percent four and
a thousand of those aged 40 to 49 that
got the infection died the same as the
Italian figure now the 50 to 59 was 1.3
in China
so again reasonably similar there the 60
to 69 in China was three point six so
again really quite really quite similar
figures in Italy and China the 70 to 79
in China was 8 percent so more people in
the 70 to 79 age group who got the
infection in Italy died compared to
those in China that was the number in
the sample in Italy that died
representing 12.5% of the total number
that got the infection now the 80 to 89
in China was 14.8 so we see the death
rate in Italy in this older age group
was higher and that that was all that
all the data that we had from from China
China actually just gave data for over
overrate as it didn't break it down so
basically we're seeing that the Italian
data fairly strongly agrees with the
Chinese day to that risk of death the
case fatality ratio in people who get
this infection increases with increasing
age that's consistent between the
Italian and the Chinese data but it does
show that in China some people between
the age of 10 and 19 died whereas in
Italy they didn't likewise for the 20 to
29 a few died in China nought point two
percent and
but this does show that there is cases
in younger people as well so it's not
saying younger people don't get this
disease well we know they get it but
it's not saying that they don't die of
this disease they just die much less
frequently than older people so that's
some quite interesting data from Italy
now the second paper that's concerned me
this evening is from The Lancet 12th of
March prestigious British Medical
Journal and this is real estimates of
mortality following covered 19:00
infection so again it's about case
fatality rates now this research letter
in The Lancet said that they assumed an
incubation period of up to 14 days which
is about right we know there can be very
very occasional cases that are longer
than 18 days but not 14 days but not
many so incubation period is typically
five or six days but can be up to a
maximum of 14 normally not more now the
median time from onset of symptoms to
intensive care admission has been around
10 days and this is from World Health
Organisation data on all the cases of
the deflected data for so it's showing
that people tend to deteriorate if
they're going to deteriorate in the
second week after the onset of symptoms
World Health Organization data again the
time interval between symptom onset and
death is typically two to eight weeks so
symptom onset to intensive care
admission 10 days symptom onset to death
two weeks and upwards now of course the
things about the death rates is in an
epidemic the death rates are people that
have had the infection as we've seen for
two or more weeks so the death rates
today compared to the number of Kay
is 14 days ago will give us a more
accurate picture so what we want to know
is how many people die per a number of
people that are infected or a number of
people that have symptoms in this case
and because the death is delayed then
it's more accurate to look at the cases
14 days ago and that's what these
authors did so they took the death rate
on any given day and then they compared
that to the number of cases 14 days ago
because of course if the number of cases
are increasing all the time then there's
going to be more cases on today which is
going to give you an artificially low
death rate so that's what they did it's
quite clever really so they took the
number of cases on any one day the
number of deaths on any one day and
compare that to the number of cases 14
days ago and this is based on w-h-o data
cumulative numbers of deaths up to March
the first 2020 so the World Health
Organization have collected as much data
as the count from China and all the
countries and this is what they came up
with now this is what concern me when
these authors took the death rate the
case fatality rate or the case fatality
ratio for the people that died on one
day compared to the number of cases 14
days ago so these are the people that
have the disease 14 days ago that have
gone on to die 14 days later they found
the overall case fatality rate was
between 5.5 and 5.9 estimating it to be
5.7 percent now this is way way higher
than my chief medical officer is saying
but this is a logical way to analyze
these data because you're taking the
deaths now for people that had the
disease 14 days ago and we know that the
death is delayed by 14 days so it makes
perfect sense and the overall case
fatality ratio is 5.7 percent
so that is alarmingly high let's hope
there's something wrong here but if
there is I don't quite see what it is at
the moment but do read the papers for
yourself estimates will be increased of
a longer delay between onset of illness
and death is considered so in other
words if this was three or four weeks
more people will go on to die so that
could potentially have been higher
because not everyone would die after two
weeks some people will die after three
weeks or four weeks or five weeks so the
number of deaths were going increasing
and these authors in The Lancet conclude
these findings show that the current
figures might underestimate the
potential threat of covered 19 in
symptomatic patients in other words this
this research paper is indicating the
death rate may be higher than was
previously thought with the probability
of death increasing with increasing age
but not unheard of in younger adults