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COVID-19
WHERE TO FROM HERE

cough or forceful speech, because the transmission is spread through dividuals. I suspect the CFR is even lower due to the fact there are
consequential droplets. From the chart on the previous page listing people infected, pre-symptomatic, who have not been tested. I would
possible mask materials, we see that a surgical mask is 89% effective estimate that the CFR is closer to .2% to .5% given that the unknown
against COVID-19 particles. Masks made from other materials are prevalence of COVID-19 is probably at least 10 to 20 times greater
less effective, but better than not wearing a mask. If you touch the than we know. The CDC has new scenarios that suggest it is closer
mask after touching a surface that has the virus, none of the mask to .26%. The flu is about .1%, and about 50% of the population gets
materials may be as effective as you think. a vaccination for the flu. Context is important!
On March 13th, the NY Times reported that up to 2.2 million
deaths could occur from the U.S. pandemic. This prediction of 2.2 LESSONs LEARNED:
million deaths was based upon the Imperial College of London 1. The lesson here is that when calculating CFR, do not base it on
COVID-19 Response Team. It is amazing how computer models, incidence rates, base it on prevalence rates; that will take some
interpretations and actual progress of the pandemic changed the time to estimate as testing becomes more widespread. Currently,
outlook and strategy for dealing with the pandemic in just 30 days! for every 100 people that get tested, about 11% test positive.
Think of a disease pandemic as a puzzle. If I had a 1,000-piece This may suggest why the prevalence could be at least ten times
jigsaw puzzle and gave 20 people around the room ten different more than the stated number of cases.
pieces each, and then asked everyone to tell me what the picture is
based upon their ten pieces, they would all get it wrong. This pan- Another reason the COVID-19 infected rate of citizens (i.e., the
demic is like a jigsaw puzzle, everyone has a few pieces here and prevalence rate) may be higher than advertised has to do with the
there, and no one has a full picture. It is the responsibility of those calculation of excess deaths. Why do we calculate “excess deaths,”
managing the response to such diseases to interpret data and ground and what is the implication of such? The mortality rate of “ob-
them in science. That is not an easy job! served” over “expected” deaths tells us the relative risk of death of
a particular disease. A rate of over 1.00 is considered "excessive"
LESSONs LEARNED: deaths for a specific illness. It is important to understand whether
1. The lesson here is to be measured in comments when empirical or not deaths are the result of a specific disease, such as COVID-
data is insufficient to come to proper, exact conclusions. Policy- 19, vs. merely a catalyst of a death that would have occurred anyway.
makers, as well as the public, rely on these conclusions; therefore, The CDC calculates two sets of excessive deaths for this pandemic.
extreme caution is necessary when there is not enough data to One measurement of deaths is due to COVID-19, and then they
come to exact conclusions. compare it to all-causes of deaths when COVID-19 is not the cause,

The CDC now reports (as of the end of the second
week in June) total deaths as 115,729. This number
may not be exactly accurate for a variety of reasons.
According to the CDC, the definition of a COVID-
19 death “may not be confirmed”, or it “may be pre-
sumed”. Therefore, it is quite possible there are H1N1
flu deaths comingled into the COVID-19 deaths.
“COVID-19 deaths are identified using a new ICD–
10 code. When COVID-19 is reported as a cause of
death — or when it is listed as a “probable” or “pre-
sumed” cause — the death is coded as U07.1. This can
include cases with or without laboratory confirmation.”
The Case Fatality Rate (CFR) drops with widespread
testing. Let me explain. As of the first week in June,
the CDC reported that 20,384,850 people were tested
for COVID-19, and the number of individuals in-
fected (i.e., tested positive) was 2,296,561 with 112,078
deaths. That suggests a CFR of 4.8% of infected in-
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