Why insufficient SARS-CoV-2 testing and media misinformation is creating a socio-economic nightmare in the United States and worldwide.
The coronavirus, SARS-CoV-2, or COVID-19 pandemic has brought heightened awareness and media attention unlike any other in the history of mankind. Few people would argue that the virus is highly contagious and has caused many deaths worldwide. What is unprecedented is how the unknown qualities of this virus have paralyzed societies with lock downs of of national populations to varying degrees worldwide. This is the first pandemic that, due to governmental polices to contain it, is also creating an economic disaster that rivals and threatens to surpass all financial crises in the 20th and 21st centuries. Along with economic turmoil comes the accompanying social strife of crime, social unrest, poverty, broken families, higher suicide rates, and tremendous strain on government entitlement programs. One of the big problems with this pandemic is how data is presented to the public, how the media portrays the virus, and how policy makers have responded. While this virus has caused tragic deaths and and has threatened to overload healthcare systems worldwide, it is important to keep this particular virus in perspective with other respiratory infections. A virus we are all familiar with, influenza or the common flu, causes between 9 and 45 million cases, 140,000 to 810,000 hospitalizations, and 12,000 to 61,000 deaths annually in the United States according the the Centers for Disease Control. If you are hospitalized with the flu in the United States, you have about an 8 percent chance of not surviving, yet people rarely alter their behaviors to avoid the flu, and the economy is not generally affected other than the burden of people calling in sick from work. People do not have the same level of fear from influenza because vaccines of varying levels of effectiveness are available, and because the mortality rate has been deemed tolerable by society whether we consciously admit it or not Death by the flu is just as tragic to those affected as a COVID-19 death is, but does not warrant widespread coverage by the media.
What we are seeing through all kinds of media COVID-19 exposure, is a virus that is correctly perceived as highly contagious, but at the same time the mortality or death rate is portrayed as orders of magnitude higher than the flu. A highly contagious disease that kills 1–3% of the people it infects is to be rightly feared and avoided. A younger healthier person could indeed go to visit their parents or grandparents or health-compromised individual and inadvertently spread a contagion that poses a serious risk. As a society we do not want to present undue risk to our most vulnerable citizens. The huge problem we face is the unrelenting pressure from the media to see this virus as highly contagious, with a high mortality rate, hence a “fear factor” that comes with this perception. Selective reporting contributes to this fear when we learn of a celebrity or a younger seemingly healthy person who has passed away due to COVID-19. The media has a vested interest in keeping our attention, because ratings are directly correlated to interest in the topic at hand. Coronavirus stories have gripped us like no other story this decade because of the direct and severe effect it is having on society as a whole. The huge problem with the reporting is the numbers come from inadequate testing.
When a person is tested positive for coronavirus, this is then reported as a confirmed case. What we see in the news is active or confirmed cases, not positive-tested cases, and it is very important to make this distinction. Deaths as a percentage of active or confirmed cases is very different from deaths as a percentage of positive tested cases, because there is a huge bias in testing due to the inadequate capacity of testing worldwide. Right now, most testing is biased towards those that have moderate to severe symptoms, or known exposure to someone else who has had COVID-19. The United States has the third largest population in the world and the economic means to ramp up testing faster and more efficiently than any other country, so we are seeing a huge increase in positive-tested cases, but those cases are rising at a relatively linear rate that is limited by testing capacity due to the 330 million people that potentially may need to be tested eventually. At the time of this writing, confirmed cases were rising at a rate of about 30,700 +/- 6,000 for the last 11 days, (which was selected because it is assumed that widespread testing has been firmly established nationwide as of April 1st, 2020). Because we see active cases rising at a steep yet linear rate limited by testing capacity, it could actually reflect a virus that is much more pervasive, yet has a much, much lower mortality rate. In contrast, if we had an exponentially-growing viral infection that was increasing at a rate of 30 percent infected cases each day, with 100 percent detection, one “patient zero” could contribute to over one half million cases if spread unchecked over six weeks (see graph below).
I live in Washington State, which holds the dubious honor of the first detected case on January 21st, 2020. Ten days later flights were banned from China, but the virus may have been taking hold for several weeks in the U.S., especially on the West Coast and larger cities like New York. A little over a month later, the first case of ‘community spread’, meaning we have no idea where it came from, was detected in California…the cat was out of the bag. It is unclear how many COVID-19 infections were spread before and over this time frame because there was no way to get tested, but it was likely much more widespread than originally thought.
The amount of time coronavirus has been a secret agent of disease in the United States, allowing it to spread undetected, disguised in the overlapping symptoms of influenza, and the timing that it arrived on the scene, smack dab in the middle of flu season make this a severely confounding factor that prevents statistically representative rates of infection from being gathered. Other factors include the reality that people can contract COVID-19 and not exhibit symptoms. This asymptomatic spread makes it virually impossible to control without testing on a massive and rapid scale, and up to half the people that have it may not know it. Some people may not want to get testing to avoid social stigma and just ‘ride it out’. What is so important is to get a feel for how many people actually have or have had COVID-19, not just who has tested positive.
One country that is doing an admirable job of testing is Iceland, that small island country of 349, 765 in the North Atlantic. Roughly 10% of the population has been tested for COVID-19, using both random and biased testing. As of April 13th, Iceland had reported 1,711 positive tested cases and nine deaths. This would give a running mortality rate of 0.5%, much lower than countries with less complete testing. What is more remarkable is that this testing has allowed scientists to estimate the as yet undetected rate of COVID-19 infection, which may be 88–94%! If only 10 percent of the actual cases have been tested, the running mortality rate drops to 0.05%, a much more palatable number. So how do these numbers hold up? With the horrors the media relays to us that we watch on a daily basis in New York city and the surrounding region, no one can absorb the images we see on the internet, TV and related media, and not feel sympathetic, but does a 0.05% death rate hold water in the United States? New York state is leading the nation for good reason in testing, but still has only tested 2.1% of their population, a 5-fold lower effort than Iceland per capita. On April 13th New York state has reported 195,031 positive-tested cases with 10,056 deaths, sobering numbers to be sure. Other scientists are studying the cases of influenza-like illness (ILI) that do not actually have the flu, and have been able to unpack the likely coronavirus cases from this number. They believe that only 0.1 to 1 percent of the true number of cases in the U.S. have actually been tested positive! When we take a step back and look at the entire country, 576,695 people have tested positive with 23,068 deaths. If 57,669,500 is the real number of people that have or have had the virus, then the actual mortality rate would be 0.04%. That number may actually be lower if less than 1 percent of the population is positive.
Clearly the coronavirus is a serious infection that has caused significant deaths around the world, especially in Italy, Spain, and the United States among others. COVID-19 has the ability to spread despite the best efforts at containment due to asymptomatic transmission, with large confounding numbers of mild and flu-like symptom carriers muddying the waters of accurate testing. But does the virus warrant the fear sown by the media, and economic devastation wrought by government policies? Probably not. If the mortality rate is 0.05 percent, it would be 50 times less deadly than the Spanish Flu of 1918. Some areas with dense populations may need to take extra precautions due to how contagious the virus appears to be. Nursing homes, extended care facilities and hospitals may need to follow rigous containment protocols. Common sense measures like washing your hands make sense for everyone. Certainly elderly and vulnerable people may want to consider isolation until the worst has passed and the majority of the population has stopped spreading COVID-19. Is SARS-CoV-2 really a deadly killer of 1.5–3 percent of it’s victims that warrants worldwide fear and lockdown, or a ubiquitous virus that kills far fewer people that it infects more on par with a nasty strain of influenza? Due to hysterical press coverage and draconian governmental measures, it appears to be the former, but we will likely find out when we pull the curtain back with better, more complete and statistically significant testing, that this has been one of the biggest self-inflicted economic and social disasters we will see in our lifetimes.