Thursday, April 30, 2020

Bill Gates and Pandemic I

Bill Gates has been front and centre during the current pandemic.  Media outlets, Ellen DegeneresStephen Colbert and many others have been lining up to hear Dr. Gates MD pontificate on the COVID-19 pandemic and, in particular, the development of a vaccine as a "cure for the sweaty masses".  One Gates-related item caught my eye; GatesNotes, Bill Gates personal blog.  Let's look at what he had to say about the current pandemic.

Here is a screen capture showing the key posting:

Here is his introduction noting that bolds throughout are mine:

"The coronavirus pandemic pits all of humanity against the virus. The damage to health, wealth, and well-being has already been enormous. This is like a world war, except in this case, we’re all on the same side. Everyone can work together to learn about the disease and develop tools to fight it. I see global innovation as the key to limiting the damage. This includes innovations in testing, treatments, vaccines, and policies to limit the spread while minimizing the damage to economies and well-being. 

This memo shares my view of the situation and how we can accelerate these innovations.  The situation changes every day, there is a lot of information available—much of it contradictory—and it can be hard to make sense of all the proposals and ideas you may hear about. It can also sound like we have all the scientific advances needed to re-open the economy, but in fact we do not. Although some of what’s below gets fairly technical, I hope it helps people make sense of what is happening, understand the innovations we still need, and make informed decisions about dealing with the pandemic."

Gates then goes on to explain how important it was to reduce the R0 (R naught) or reproduction rate of the SARS-CoV-2 virus in order to prevent exponential growth in the number of infected persons.  The solution was the current civil-rights crushing, government imposed lockdown of society in what can only be described as one of the world's largest social experiments.

He then proceeds to outline the economic costs of the current pandemic:

"The economic cost that has been paid to reduce the infection rate is unprecedented. The drop in employment is faster than anything we have ever experienced. Entire sectors of the economy are shut down. It is important to realize that this is not just the result of government policies restricting activities. When people hear that an infectious disease is spreading widely, they change their behavior. There was never a choice to have the strong economy of 2019 in 2020.

Most people would have chosen not to go to work or restaurants or take trips, to avoid getting infected or infecting older people in their household. The government requirements made sure that enough people changed their behavior to get the reproduction rate below 1.0, which is necessary to then have the opportunity to resume some activities."

This is pretty easy to say when you are ensconced in your 66,000 square foot waterfront home, counting your massive financial holdings:

Het then goes on to discuss the role of the Gates Foundation in the pandemic and in the control of infectious diseases as a whole:

"In normal times, the Gates Foundation puts more than half of its resources into reducing deaths from infectious diseases....

Now that the epidemic has hit, we are applying our expertise to finding the best ideas in each area and making sure they move ahead at full speed. There are many efforts going on. More than 100 groups are doing work on treatments and another 100 on vaccines. We are funding a subset of these but tracking all of them closely. It is key to look at each project to see not only its chance of working but also the odds that it can be scaled up to help the entire world.

One urgent activity is to raise money for developing new tools. I think of this as the billions we need to spend so we can save trillions. Every additional month that it takes to get the vaccine is a month when the economy cannot return to normal. However, it isn’t clear how countries will come together to coordinate the funding. Some could go directly to the private sector but demand that their citizens get priority. There is a lot of discussion among governments, the World Health Organization, the private sector, and our foundation about how to organize these efforts."

Rather than even mentioning the concept of herd immunity, Gates outlines potential treatments, all involving the efforts of "Big Pharma", most particularly the development of a vaccine:

"Short of a miracle treatment, which we can't count on, the only way to return the world to where it was before COVID-19 showed up is a highly effective vaccine that prevents the disease…

Researchers can save time by compressing the clinical safety/efficacy phases while conducting animal tests and building manufacturing capacity in parallel. Even so, no one knows in advance which vaccine approach will work, so a number of them need to be funded so they can advance at full speed. Many of the vaccine approaches will fail because they won’t generate a strong enough immune response to provide protection. Scientists will get a sense of this within three months of testing a given vaccine in humans by looking at the antibody generation. Of particular interest is whether the vaccine will protect older people, whose immune systems don’t respond as well to vaccines.

The issue of safety is obviously very important. Regulators are very stringent about safety, to avoid side effects and also to protect the reputation of vaccines broadly, since if one has significant problems, people will become more hesitant to take any vaccines. Regulators worldwide will have to work together to decide how large the safety database needs to be to approve a COVID-19 vaccine…

An RNA vaccine is significantly different from a conventional vaccine. A flu shot, for example, contains bits of the flu virus that your body’s immune system learns to attack. This is what gives you immunity. With an RNA vaccine, rather than injecting fragments of the virus, you give the body the genetic code needed to produce lots of copies of these fragments. When the immune system sees the viral fragments, it learns how to attack them. An RNA vaccine essentially turns your body into its own vaccine manufacturing unit

A big challenge for vaccine trials is that the time required for the trials depends on finding trial locations where the rate of infection is fairly high. While you are setting up the trial site and getting regulatory approval, the infection rate in that location could go down. And trials have to involve a surprisingly large number of people. For example, suppose the expected rate of infection is 1 percent per year and you want to run a trial where you would expect 50 people to be infected without the vaccine. To get a result in six months the trial would need 10,000 people in it.

The goal is to pick the one or two best vaccine constructs and vaccinate the entire world—that’s 7 billion doses if it is a single-dose vaccine, and 14 billion if it is a two-dose vaccine. The world will be in a rush to get them, so the scale of the manufacturing will be unprecedented and will probably have to involve multiple companies…"

I believe that's enough of Bill Gates' musings for this posting.  Let's close with this summary which has a very interesting and perhaps prophetical comment, noting that he completely ignores the 1957 and 1968 influenza pandemics:

"Melinda and I grew up learning that World War II was the defining moment of our parents’ generation. In a similar way, the COVID-19 pandemic—the first modern pandemic—will define this era. No one who lives through Pandemic I will ever forget it. And it is impossible to overstate the pain that people are feeling now and will continue to feel for years to come...

At the same time, we are impressed with how the world is coming together to fight this fight. Every day, we talk to scientists at universities and small companies, CEOs of pharmaceutical companies, or heads of government to make sure that the new tools I’ve discussed become available as soon as possible. And there are so many heroes to admire right now, including the health workers on the front line. When the world eventually declares Pandemic I over, we will have all of them to thank for it."

Thank goodness that the Gates family foundation is there to ensure our healthy futures as the human race anticipates Pandemic II, Pandemic III, Pandemic IV etcetera ad nauseam.  One might be almost be forgiven for thinking that Bill Gates is looking forward to his indispensable advice as a world-leading epidemiologist and vaccinologist when future pandemics lay waste to humanity.

Wednesday, April 29, 2020

COVID-19 - Out-of-Pocket Expenses for Hospitalizations

Thanks to an analysis by the Peterson Center on Health Care at the Kaiser Family Foundation, Americans can get a sense of the potential costs of coronavirus treatment for people with employer health insurance coverage.  While private insurers have agreed to waive copayments and deductibles for COVID-19 tests, America's Health Insurance Plans (AHIP) has made it clear that out-of-pocket costs for hospitalizations would not be waived, meaning that people who have plans with high copayment costs could find themselves with high expenses.  Here's what AHIP has to say:

Now, let's look at the analysis by the Peterson Center.  The analysis opens by noting that the total average cost of treatment (combination of employer plan and employee's out-of-pocket expenses) for pneumonia with major complications and accompanying co-morbidities was $20,292 in 2018 with a range from $11,533 to $24,178 (25th and 75th percentiles).  Here is a graphic showing the total average cost of treatment depending on the level of complexity:

In the case of China, the average length of hospital stay for a patient diagnosed with coronavirus was 11 to 12 days with around 2.3 percent of Chinese COVID-19 hospitalized patients receiving mechanical ventilation support.  In the case of the United States, when ventilator support is required for pneumonia, the average length of hospital stay increases substantially as follows:

1.) Pneumonia with or without major complications or comorbidities - 3.1 days

2.) Respiratory system diagnosis with ventilator support for less than 96 hours - 5.8 days

3.) Respiratory system diagnosis with ventilator support for more than 96 hours - 22.6 days

Obviously, the total cost of treatment rises substantially when mechanical ventilation is required.  Here are the average costs of hospital stays where ventilation is needed (2018 data):

1.) Pneumonia with or without major complications or comorbidities - $12,692

2.) Respiratory system diagnosis with ventilator support for less than 96 hours - $34,223

3.) Respiratory system diagnosis with ventilator support for more than 96 hours - $88,114

Out-of pocket expenses can be significant for patients with employer coverage.  Here is a graphic showing average out-of pocket spending for inpatient admission for pneumonia among enrolees in large employer plans by degree of complexity (2018 data):

The analysis notes that there are three reasons why out-of-pocket expenditures could be higher during this outbreak:

1.) many patients will have higher deductibles, particularly those with private coverage through small businesses and in the individual market.  The Peterson analysis is based on claims from large, more often generous private plans.

2.) The COVID-19 pandemic is occurring early in the calendar year meaning that many people have not yet accrued much health spending to fulfill their deductible.

3.) The Peterson analysis does not include balance billing where an out-of-network provided sends an additional bill directly to the patient for an amount not covered by the health plan.

Let's put these numbers into perspective.  According to Magnify Money (data from the Federal Reserve and Federal Deposit Insurance Corp.), a median American household has $12,330 in total savings in bank accounts and retirement savings accounts.  At the bottom end, 29 percent of households have less than $1,000 in savings.  The analysis by Peterson suggests that hospitalization as a result of a COVID-19 infection could result in severe financial difficulty for a very significant portion of American households, particularly since many of these households likely find themselves without their regular income thanks to the shuttering of the United States economy.  It is no wonder that a survey by the Kaiser Family Foundation found that 36 percent of Americans were worried about being able to afford testing or treatment related to the COVID-19 pandemic.

Monday, April 27, 2020

Redefining COVID-19 Deaths the World Health Organization Way

While the number of new deaths apparently associated with COVID-19 seems to be skyrocketing in some jurisdictions, there is a single reason that could be pushing the death total higher.

Here is a recently released set of guidelines for classification (coding) of COVID-19 as a cause of death from the World Health Organization:

Here is the key page which defines the definition for deaths due to COVID-19:

Note this:

"A death due to COVID-19 may not be attributed to another disease (e.g. cancer) and should be counted independently of preexisting conditions that are suspected of triggering a severe course of COVID-19."

Here is how an International Form of Medical Certificate of Cause of Death is to be filled out where COVID-19 is listed as the "underlying cause of death" but comorbidities (i.e. pre-existing conditions including cancer, heart disease etcetera) are present:

Note that in the fourth case, the decedent had HIV for five years but yet, it is only considered to be a contributor to the death but COVID-19 is considered to be the underlying cause of death.

Here are examples of deaths not counted as having COVID-19 as an underlying cause:

As shown on this page, death coding of COVID-19 can be used in cases where there is no laboratory confirmation of the presence of the novel coronavirus, it merely has to be "probable" or "suspected":

Let's take a quick look at what Dr. John Lee had to say about the issue of recording deaths in The Spectator:

"If someone dies of a respiratory infection in the UK, the specific cause of the infection is not usually recorded, unless the illness is a rare ‘notifiable disease’. So the vast majority of respiratory deaths in the UK are recorded as bronchopneumonia, pneumonia, old age or a similar designation. We don’t really test for flu, or other seasonal infections. If the patient has, say, cancer, motor neurone disease or another serious disease, this will be recorded as the cause of death, even if the final illness was a respiratory infection. This means UK certifications normally under-record deaths due to respiratory infections.

Now look at what has happened since the emergence of Covid-19. The list of notifiable diseases has been updated. This list — as well as containing smallpox (which has been extinct for many years) and conditions such as anthrax, brucellosis, plague and rabies (which most UK doctors will never see in their entire careers) — has now been amended to include Covid-19. But not flu. That means every positive test for Covid-19 must be notified, in a way that it just would not be for flu or most other infections.

In the current climate, anyone with a positive test for Covid-19 will certainly be known to clinical staff looking after them: if any of these patients dies, staff will have to record the Covid-19 designation on the death certificate — contrary to usual practice for most infections of this kind. There is a big difference between Covid-19 causing death, and Covid-19 being found in someone who died of other causes. Making Covid-19 notifiable might give the appearance of it causing increasing numbers of deaths, whether this is true or not. It might appear far more of a killer than flu, simply because of the way deaths are recorded."

While all of this may seem rather academic to many of you, we must keep in mind that the number of reported deaths due to COVID-19 is being used by governments around the world to justify their "lockdown" procedures and imposition of "states of emergency", all of which reduce our civil freedoms.  With the WHO clearly demonstrating that it is willing to stretch the definition of a COVID-19-related death and the strong association of COVID-19 deaths and pre-existing conditions (Italy - 97.9 percent), we can be assured of one thing - don't believe everything you read when it comes to the number of COVID-19 deaths being reported.

Thursday, April 23, 2020

Social Distancing - The Difference That Three Feet Makes

Many of us are being subjected to social distancing rules, something that most people had not heard of until the appearance of the most recent novel coronavirus, 2019 edition.  

In my jurisdiction, we are being told that we must maintain a 2 metre or 6 foot distance from everyone, whether they are exhibiting symptoms like coughing or sneezing that may indicate that they are positive for COVID-19 or not.

With that in mind, let's look at how various governments around the world are managing the social distancing aspect of the coronavirus pandemic.  Here is what is on the Canadian government's Health Canada COVID-19 website:

Here is what is on the United States Center for Disease Control and Prevention (CDC) website:

In both of these cases, the Canadian and American governments are recommending a 2 metre or 6 foot distance between everyone.

In contrast, here is what we find on the European Centre for Disease Prevention website:

Here is what we find on the Australian Government's Department of Health website:

Lastly, since the World Health Organization is largely responsible for driving the measures that nations have used to slow the spread of COVID-19, here is what the world's leading health body has to say about social distancing:

Here is a WHO video with the same information:

Note, that in this case, the World Health Organization does not recommend social distancing for all people, just for those who have a fever or who are coughing or sneezing and then only a distance of 3 feet.

Let's close with a couple of thoughts.  Where I live, grocery stores have recently implemented very strict social distancing measures including putting tape on the floor to ensure that customers are more than 6 feet apart when waiting to check out, putting arrows on the aisle floors to ensure that people only go one direction and remain more than 6 feet apart and only letting a small number of people into the store to ensure that they remain more than 6 feet apart.  This 6 foot/2 metre rule is the main reason why restaurants, bars and retailers in Canada and many other jurisdictions have been forced to close and why police are now issuing tickets when two people with different addresses are siting in the same vehicle.  I can certainly understand erring on the side of caution but when the World Health Organization is only recommending 3 feet/1 metres for social distancing from people showing potential symptoms of COVID-19, why is it that governments have taken it upon themselves to make a bad situation even worse by making us keep at least 6 feet away from everyone, positive for the virus or not?  On a personal note, after seeing people's reactions when I get what they deem as "too close for comfort" in our "6 foot social distancing world", perhaps governments are just ramping up the fear and discomfort level to justify whatever comes next.  By then, many of us will be begging for freedom.

Who would have ever thought that 3 feet could make such a difference?  If it's scientifically sound consistency that you are looking for in the COVID-19 narrative, you will have to keep on looking.

Wednesday, April 22, 2020

Tracking COVID-19's First Appearance in the United States

On April 21, 2020, Santa Clara County Public Health released this interesting information:

The fact that an individual who died at home on February 6, 2020 tested positive for the SARS-CoV-2 virus is a rather fascinating turn of events given that, until this point, it was believed that the first American death from coronavirus was announced by Public Health - Seattle and King County on February 29, 2020 as shown here:

As well, while testing was not widely available in the United States at the time, according to the CDC, there were only 11 cases of COVID-19 reported in all of the United States on February 6, 2020.  The first American positive COVID-19 infection was reported to the CDC on January 22, 2020 as shown here:

According to the Santa Clara County Public Health press release, there were two individuals in California who died prior to the "first COVID-19-related death" in the State of Washington, the aforementioned death on February 6th and another death on February 17th.  Both individuals in California had no travel history to China or anywhere else that would have exposed them to the virus.  This means that there was likely community spread happening in California during mid-January 2020 since the time required between contact with the virus and infection is between two and three weeks, suggesting that the virus was more widely prevalent in the United States long before experts had originally concluded.  In case you've forgotten, the World Health Organization declared COVID-19 a "Public Health Emergency" on January 30, 2020 and a "pandemic" on March 19, 2020.  The first case of "pneumonia of an unknown cause" was declared by China on December 31, 2019.  

The probable appearance of the SARS-CoV-2 virus in the United States just two to three weeks later is a rather interesting development and suggests that the virus was present in America not substantially later than it made its appearance in China.  Further research is required to determine whether other deaths in the United States prior to the beginning of February 2020 are also test positive for the SARS-CoV-2 virus. 

COVID Terrorism

A memorandum dated March 24, 2020 from Deputy Attorney General Jeffrey Rosen to all heads of law enforcement components, heads of litigating divisions and United States Attorneys looks at actions that the Department of Justice could take in response to criminal activity related to the COVID-19 pandemic.  One aspect of this memorandum may surprise you.

Here is the letter in its entirety:

As you can see, there certainly is a need to protect the American public from various criminal schemes ranging from malicious hoaxes, threats targeting individuals, conspiracies to rig bids and fix prices for medical goods needed during the COVID-19 pandemic as well as the accumulation of excessively high levels of inventory of medical supplies.  All of that said, there is one part of the memo that is concerning:

Since it is mentioned in the memorandum, let's look at 18 U.S. Code Section 178:

"(1) the term “biological agent” means any microorganism (including, but not limited to, bacteria, viruses, fungi, rickettsiae or protozoa), or infectious substance, or any naturally occurring, bioengineered or synthesized component of any such microorganism or infectious substance, capable of causing—

(A) death, disease, or other biological malfunction in a human, an animal, a plant, or another living organism;

(B) deterioration of food, water, equipment, supplies, or material of any kind; or

(C) deleterious alteration of the environment;"

It is under this law that the Deputy Attorney General claims that COVID-19 meets the statutory definition of a "biological agent" which means that the "purposeful exposure and infection of others with COVID-19" could be legally construed as an act of terrorism since the use of a biological agent falls under America's terrorism-related statutes as shown here:

"Whoever knowingly develops, produces, stockpiles, transfers, acquires, retains, or possesses any biological agent, toxin, or delivery system for use as a weapon, or knowingly assists a foreign state or any organization to do so, or attempts, threatens, or conspires to do the same, shall be fined under this title or imprisoned for life or any term of years, or both. There is extraterritorial Federal jurisdiction over an offense under this section committed by or against a national of the United States.

For purposes of this section, the term “for use as a weapon” includes the development, production, transfer, acquisition, retention, or possession of any biological agent, toxin, or delivery system for other than prophylactic, protective, bona fide research, or other peaceful purposes."

Neither the laws nor the Deputy Attorney General's memorandum specify exactly what is involved in the "intentional spread" of the coronavirus.  At this point, Americans who protest en masse against government COVID-based restrictions, those who do not maintain a six foot distance from others or those who ignore other government-mandated restrictions including social isolation and self-quarantining could technically be seen to be involved in the intentional spread of the COVID-19 virus, finding themselves charged with an act of terrorism.

My how America has changed in two months.

Tuesday, April 21, 2020

The COVID-19 Mortality Risk vs. Death by Automobile

Updated May 4, 2020

With the comments made by readers in mind, I wanted to add one thought to this posting.  The author of the study, Dr. John Ioannidis, is simply trying to help us put the actual risk of dying of COVID-19 into a context that is more understandable to all of us.  With governments heavily falling back on the use of fear to keep all of us in line, the more that knowledge that we have, the better we can understand the narrative and the actual impact of the SARS-CoV-2 virus on society.

A study by John P. A. Ioannidis at Stanford Prevention Research Center et al entitled "Population-level COVID-19 mortality risk for non-elderly individuals overall and for non-elderly individuals without underlying diseases in pandemic epicenters" examines the relative risk of dying from COVID-19 in people under the age of 65 and compares this risk to the risk of death in older individuals as well as providing estimates of the absolute risk of COVID-19 death for the entire population.

The authors used data from countries (Belgium, Germany, Netherlands, Portugal, Spain, Sweden and Switzerland) and United States states (Louisiana, Michigan and Washington) or major cities (New York City) with at least 250 COVID-19 deaths effective on April 4, 2020.  The death records had to include age which allowed the authors to calculate the number of deaths in people under the age of 65 with no underlying predisposing conditions.  The study then compared the death risk as an equivalent to the death risk associated with driving a motor vehicle.  For motor vehicle death statistics, the authors used data provided by the Insurance Institute for Highway Safety in the United States and data provided by the International Transport Forum Road Safety Annual Report for 2018 for European nations.

Let's look at their findings.  The authors found the following:

1.) individuals under the age of 65 account for between 5 percent and 9 percent of all COVID-19 deaths in the eight European epicentres and approached 30 percent in three of the American hotspots.  

2.) People 65 years and younger had a 34- to 73-fold lower risk of dying from COVID-19 than those 65 years of age and older in Europe and a 13- to 15-fold lower risk of dying from COVID-19 than those 65 years of age and older in New York City, Louisiana and Michigan.

3.) The absolute risk of dying from COVID-19 for people 65 years of age and younger ranged from. 1.7 per million in Germany to 79 per million people in New York City. The absolute risk of dying from COVID-19 for people 80 years of age and older ranged from 1 in 6,000 in Germany to 1 in 420 in Spain.

Here is the absolute risk of dying of COVID-19 for people 65 years of age and younger for all nations/states/cities in the study (in deaths per million people):

Belgium - 11
Germany - 1.7
Italy - 30
Louisiana - 30
Michigan - 18
Netherlands - 6.1
New York City - 79
Portugal - 2.5
Spain - 24
Sweden - 3.3
Switzerland - 5.3
Washington - 4.6

Almost all deaths that took place within the under 65 years of age group occurred between the ages of 40 years and 65 years.

Now let's look at the risk of dying from COVID-19 compared to the risk of dying while driving a motor vehicle.  To calculate the death risk, the authors calculated the following:

"We then divided the estimated miles travelled that correspond to the same death risk by the number of days that have passed since the first COVID-19 death was recorded in each location and until April 4, 2020. The result transforms the average risk of COVID-19 death during the period where COVID-19 deaths occur into an equivalent of miles travelled by car per day."

Here is the absolute risk of dying of COVID-19 for people 65 years of age and younger for all nations/states/cities in the study as miles travelled per day equivalent:

Belgium - 37
Germany - 9
Italy - 48
Louisiana - 88
Michigan - 105
Netherlands - 27
New York City - 415
Portugal - 11
Spain - 57
Sweden - 25
Switzerland - 34
Washington - 11

As you can see, the risk of dying from COVID-19 for a person under the age of 65 is equivalent to the risk of driving a distance of between 9 and 415 miles by car per day during the COVID-19 fatality season.  Most of the COVID-19 hotbeds are on the lower end of this range where the risk of death is roughly the same as the risk of dying from an automobile accident on a daily commute.

Here's the authors' conclusion:

"People less than 65 years old have very small risks of COVID-19 death even in the hotbeds of the pandemic and deaths for people less than 65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic....

Aggressive measures such as lockdowns have been implemented in many countries. This is a fully justified “better safe than sorry” approach in the absence of good data. However, long-term lockdowns may have major adverse consequences for health (suicides, worsening mental health, cardiovascular disease, loss of health insurance from unemployment, etc.) and society at large. It is even argued that lockdowns may be even harmful as a response to COVID-19 itself, if they broaden either asymptomatic or mildly symptomatic and thus do not come to medical attention." (my bolds)

The Actual Prevalence of COVID-19 Infections and Its Impact on the Fatality Rate

A recently released study out of Stanford University tested residents of California's Santa Clara County, looking at how widely people had been infected by the novel coronavirus using seroprevalence data which measures the level of antibodies in the blood of participants.  The paper entitled "COVID-19 Antibody Seroprevalence in Santa Clara County, California" has not yet been peer-reviewed but provides some much needed balance to the COVID-19 pandemic narrative being touted by governments and their bought-and-paid-for "experts".

To accurately estimate or project fatality rates of epidemics or pandemics, it is important to properly estimate the total number of infections.  To date, there have been three biasing processes that have prevented the health care community from accurately estimating the total number of infections:

1.) PCR testing which measures only the presence of the live virus and cannot determine which individuals have been infected and cleared the virus from their system, in the process, creating antibodies.

2.) the majority of cases tested early in the epidemic have been acutely ill and highly symptomatic while individuals that are either asymptomatic or mildly symptomatic have not been tested.

3.) PCR testing rates have been highly variable across contexts and over time leading to a "noisy" database.

The first two cases of COVID-19 appeared in Santa Clara County on January 31, 2020 and February 1, 2020 in returning travellers and the third case was identified on February 27, 2020.  In the following month, nearly 1000 new cases were identified, suggest community transmission as well as the scaling up of testing for the virus.  At the time of the study, Santa Clara County had a total of 1,094 confirmed cases.  

The authors tested the prevalence of antibodies to the SARS-CoV-2 virus using the Premier Biotech serology test, drawing from a sampling of 3300 volunteers (children and adults) who were recruited using Facebook advertising.    Advertising was aimed to ensure that there was balanced representation across the county using zip code data.  The prevalence of antibodies to the novel coronavirus are as follows:

Unadjusted prevalence - 1.5 percent

Population adjusted prevalence - 2.81 percent (balanced gender and race)

After adjusting for population and test performance characteristics, the authors found that between 2.49 percent and 4.16 percent (range between 1.8 percent and 5.7 percent) tested positive for antibodies to SARS-CoV-2 in Santa Clara County.  This is not out of line of studies showing that at least 10 percent of the population of Robbio, Italy was seropositive and 14 percent of the population of Gangelt Germany was seropositive.  The most important implication of these findings is quoted here:

"The most important implication of these findings is that the number of infections is much greater than the reported number of cases. Our data imply that, by April 1 (three days prior to the end of our survey) between 48,000 and 81,000 people had been infected in Santa Clara County. The reported number of confirmed positive cases in the county on April 1 was 956, 50-85-fold lower than the number of infections predicted by this study.  The infection to case ratio, also referred to as an under-ascertainment rate, of at least 50, is meaningfully higher than current estimates…This is likely a function of reliance on PCR for case identification which misses convalescent cases, early spread in the absence of systematic testing and asymptomatic or lightly symptomatic infections that go undetected." (my bold)

Now, let's see how the authors used this data to estimate the infection fatality rate.  As of April 10, 2020, a total of 50 people had died of COVID-19 in Santa Clara County.  If one uses the study's number of infections ranging from 48,000 to 81,000 and projects deaths to April 22 (3 weeks from time of infection to death), there should be roughly 100 deaths by that date.  This results in an infection fatality rate ranging from 0.12 percent to 0.2 percent, a rate that is not substantially different than normal seasonal influenza.  If antibodies take more than 3 days to appear, if the time taken from case identification to death is less than 3 weeks or if the epidemic wave has peaked and there are fewer deaths per day as time passes, then the infection fatality rate is lower than noted above.  It is the number of fatalities that concerned politicians the most since it is likely that most of these cases would have required the use of intensive care units and ventilators, both of which are in short supply given the cuts to health care spending by the same politicians who feign concern.

If you are interested in further information on this study, please listen to this very informative interview with Dr. Jay Battacharya, one of the authors of the study who is both a physician and an economist:

Here is another fascinating interview with Dr. John Ioannidis, a co-author of the paper who also discusses the study:

This study by Stanford University strongly suggests that the current COVID-19 infection rate is far higher than the headline number of infections would suggest.  With a much higher level of infections and the fact that the fatality rate is calculated as shown here:

          Fatality Rate  =    Number of Deaths
                                    Number of Infections the number of infections rises, the fatality rate of an infection drops.  In the case of the Stanford study, their initial calculations suggest that the fatality rate of COVID-19 may be no worse than seasonal influenza.


A recent news item from the University of Southern California notes a similar infection trend:

Here's a quote:

"Based on the results of the first round of testing, the research team estimates that approximately 4.1% of the county’s adult population has an antibody to the virus. Adjusting this estimate for the statistical margin of error implies about 2.8% to 5.6% of the county’s adult population has an antibody to the virus — which translates to approximately 221,000 to 442,000 adults in the county who have been infected. That estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county at the time of the study in early April. The number of COVID-related deaths in the county has now surpassed 600." (my bold)