Covid-19: Are distorted statistics fuelling unnecessary panic?
CAPE TOWN - All South African are in the same Covid-19 boat and in our family’s case, my 84-year-old father and my wife, who is an anaesthesiologist working at Groote Schuur Hospital are probably at the greatest risk.
Certainly, the health challenges which we will face in the months to come will be mirrored to a greater or lesser extent by households throughout our country although any economic deprivation we might suffer will be irrelevant when compared with those less fortunate.
A week ago, our president faced the proverbial damned if he did and a damned if he didn’t choice.
He could order a lockdown in the hope of containing the virus to more manageable levels knowing that massive collateral damage would be inflicted upon the economy and that the vast majority of our citizens whose living conditions are already dire would worsen even further or he could gamble and keep SA open for business with the massive downside being that if he was wrong, then the potential for massive numbers of deaths in SA loomed large.
After careful consideration, President Cyril Ramaphosa took no chances in making a decision premised upon the scientific research that Covid-19 poses profound health risks for the aged and those with existing co-morbidity which is present in large numbers of our population.
In recent weeks, mainstream and social media have bombarded the world with frightening mortality statistics which have fuelled fear and panic equally amongst the educated and the illiterate. The effect of this has been for rational thinking to plumb depths best illustrated by the stockpiling of toilet paper by people who should know better.
For those of us with private medical care and telephonic access to personal general practitioners, it is easier to be more sanguine about our individual outcomes knowing that healthcare, in the event that becomes necessary, is more readily available. However, for the vast majority of the population, they are but a number in an already stressed public healthcare system.
I know that in the case of the blue-collar workers who work with me, their fear is that not only will they contract Covid-19 (we will all contract it at some stage), but that they might likely die from it because they have no access to health facilities.
Speaking to other employers of blue-collar workers, it appears that this sentiment is widespread.
While I must be emphasise that the risk of Covid-19 should not be downplayed, I do believe that it is incumbent upon us and our government to examine the veracity of the statistics to ensure that the numbers do not fuel unnecessary panic and fear and that we allow the space to consider things more rationally.
A closer look at the statistics
At the time of writing there were a reported 670 000 worldwide cases of Covid-19 with 32 000 deaths representing a frightening mortality rate of 4.7 deaths per hundred infected.
Italy, with a reported 92 000 cases and 10 000 deaths, has an even more alarming death rate of 10.87 deaths per hundred.
Whilst the tragic evidence of 32 000 bodies represents unimpeachable evidence in terms of actual numbers of dead, it is the unreasonably small denominator of 670 000 confirmed Covid-19 cases, which appears to have resulted in a materially overstated mortality rate driving worldwide fear.
To date, no-one has provided an estimate for the figure of people actually infected by Covid-19 since November 2019. Those who have been asymptomatic or who have shrugged the virus off as normal flu have gone unreported and it is this combined number which should be used as the denominator to determine mortality rates.
Scientists have confirmed that Covid-19 is far more infectious than seasonal flu and if one understands how many people contract flu in a normal season then it is far easier to arrive at a more realistic denominator for Covid-19 in order to determine a more accurate mortality rate.
Conventional and historical flu figures and seasonal flu mortality rates:
The World Health Organisation (WHO) estimates that between 5percent and 15percent of the world’s population of 7. 6 billion contracts seasonal flu resulting in 250 000 to 500 000 deaths each year. A 10 percent infection seasonal flu infection rate equates to 760 million people and a mid-point of World Health Organisation (WHO) annual death estimates of 375 000 deaths means that the world’s mortality rate of those infected with seasonal flu is 0.049 per hundred (375 000 / 760 million) which is a tiny fraction of the alarming reported Covid-19 death rate of 4.7 per hundred.
European Union figures report that in a bad flu season, 50 million Europeans will contract flu with 71 000 deaths in a year resulting in a mortality rate of 0.142 per hundred.
So, is the current denominator being used to calculate the Covid-19 mortality rate accurate?
As explained above, the size of the denominator will determine the mortality rate and the key question is whether the denominator of 677 000 confirmed Covid-19 cases is reasonable.
If the historical WHO normal seasonal flu figures estimate that 760 million people worldwide get seasonal flu per annum and given the contagious nature of Covid-19 which was first identified in November 2019, then is a realistic denominator for the total number of people infected worldwide not in the tens of or even hundreds of millions by now?
Taking the world reported 32 000 Covid-19 deaths (at the time of writing) and dividing by a conservative unreported 30 million worldwide infections (both symptomatic and asymptomatic) results in a mortality rate of 0.106 per hundred which is far closer to the estimated WHO mortality figure of 0.049 and the EU figure of 0.142 per hundred for seasonal flu than the current 4.7 per hundred reported for Covid-19.
But what of the outlier mortality rates for Italy?
Just as one must question that the worldwide denominator currently being used to calculate the mortality rate, one must also interrogate Italy’s outlier mortality rate with respect to the numerator used to calculate its Covid-19 death rate.
Professor Walter Ricciardi, the adviser to Italy’s minister of health, has explained that Italy’s death rate appears high because of the manner in which its doctors have recorded record fatalities and is on record as saying:
“On re-evaluation by the National Institute of Health, only 12 percent of death certificates have shown a direct causality from coronavirus, while 88 percent of patients who have died have at least one pre-morbidity – many had two or three.”
In essence, what Ricciardi is saying is that although Italian doctors have recorded 10 000 deaths (at the date of writing) due to Covid-19, the accurate figure should be nearer to 1 200 deaths or 12percent with a direct causal link to the virus.
Thus, the numerator changes materially and when divided by a realistic denominator as explained above, then the statistics look very different.
Germany has a reported mortality rate for Covid-19 of 0.9 per hundred which is hopelessly at odds with the Italian mortality rate of 10.87 per hundred where the terrible media
visuals have become a significant and understandable source of worldwide fear and panic.
Surely, we owe it to ourselves to question the veracity of Italian statistics?
At this time, our focus and that of our leaders, apart from Covid-19, should be on developing the substantial interventions necessary to ameliorate the financial and emotional plight of our less fortunate citizens.
The economic deprivation happening before our eyes in huge swathes of our country is a state of emergency in its own right and the middle class must stop speaking a good game about “social distancing” in our well-equipped and comfortable uncapped bandwidth homes and become proactive.
While every effort must be made to continue to educate with the preventative measures necessary to contain the spread of the virus, it is also vital that our citizens’ real and imagined fears be assuaged by a measured consideration and then fair reportage of the statistics.
The old adage of lies, damned lies and statistics should be foremost in our leaders’ minds and it is hoped practical questions will be asked and information properly interrogated before charting the most appropriate course for South Africa in the coming weeks which will, in all probability, be the most crucial period in our history.
Simon Mantell is employed at a food factory and writes in his personal capacity.