Stanford experts say COVID-19 death estimates may be too high

BY ELAINE GOODMAN
Daily Post Correspondent

Although some have estimated that COVID-19 could kill millions of people, those projections — which are shaping government responses such as shelter-at-home orders — might be too high by orders of magnitude, according to two Stanford researchers.

The World Health Organization and others have estimated that 2% to 4% of people with confirmed cases of COVID-19 will die, figures that could be used to project that 2 million to 4 million people in the U.S. would die if 100 million Americans get the respiratory disease, Dr. Eran Bendavid and Dr. Jay Bhattacharya said in an opinion column in the Wall Street Journal on March 24.

But Bendavid and Bhattacharya called those figures “deeply flawed.” The way to find the true death rate would be to look at fatalities as a percentage of people who have been infected with the new coronavirus — not just those who are tested and become confirmed cases, they said.

And if the number of people infected with the virus is much larger than the number of confirmed cases, projections of fatalities would drop substantially, Bendavid and Bhattacharya said. That could mean COVID-19 would kill 20,000 people rather than 2 million, they added.

“If it’s true that the novel coronavirus would kill millions without shelter-in-place orders and quarantines, then the extraordinary measures being carried out in cities and states around the country are surely justified,” they wrote. “But there’s little evidence to confirm that premise — and projections of the death toll could plausibly be orders of magnitude too high.”

Bendavid is an associate professor of medicine at Stanford and a core faculty member in the Center for Health Policy. Bhattacharya is a professor of medicine and director of the Program on Medical Outcomes.

In addition to running in the WSJ, which has a paywall, excerpts of their column are posted on the website of Stanford’s Freeman Spogli Institute for International Studies, which doesn’t charge.

In an email responding to questions from the Daily Post, Bhattacharya said he isn’t claiming that the widespread shelter-at-home orders are unnecessary.

But more information is needed to determine what types of protective measures are needed, he said. That includes how many people have been infected with the virus, how widely it is spreading, and how many people are becoming seriously ill or dying from it.

Bendavid and Bhattacharya are organizing a study in California to collect some of that information. They are planning to use blood tests to see how many people have been infected with the new coronavirus.

The blood test looks for antibodies that the body has made in response to an infection with the virus. The test determines whether someone has been infected, regardless of how ill they’ve become from it or if they’ve since recovered. This type of research is known as a seroprevalence study or a serosurvey.

In contrast, tests that involve nasal swabs from a patient look for the virus’ genetic material, a sign of current infection.

Bhattacharya said the antibody tests are just now becoming available in the U.S. He said the researchers hope to start testing in Santa Clara and Los Angeles counties this week.

“The facts to date are consistent with a wide range of uncertainty regarding the fatality rate from COVID-19,” Bendavid said in an email. “We desperately need a population-representative estimate of the seroprevalence of the disease so we can reduce that uncertainty and make better policy on the basis of our improved knowledge.”

Bendavid’s message was an auto-reply that said “we are struggling to keep up with inquiries.” The researchers have raised some money for their study but are looking for additional funding, he said.

In a report this month, the World Health Organization said the COVID-19 death rate is between 3% and 4% of reported cases. WHO acknowledged that the death rate as a percentage of infections, rather than reported cases, would be lower.

WHO last month called for prioritizing COVID-19 research including seroprevalence studies, such as the one the Stanford researchers are planning. The studies have reportedly begun in other countries, including China.

Bendavid and Bhattacharya cited a few examples where data is available regarding the coronavirus infection rate. When people were evacuated from Wuhan, China, in late January, 2,433 of the evacuees were tested on arrival, quarantined, and tested again 14 days later. Of those, 0.9% tested positive for the coronavirus, the researchers said.

Applying the 0.9% positive rate to the population of the Wuhan area produces an estimate of 20 million people infected with the virus — and a death rate that’s at least 10-fold lower than figures based on number of reported cases, they said.

“If we’re right about the limited scale of the epidemic, then measures focused on older populations and hospitals are sensible,” Bendavid and Bhattacharya wrote.

Other researchers are analyzing the expected spread of COVID-19. At the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine, researchers are projecting deaths from the respiratory disease to hit a peak of 2,341 per day in the U.S. on April 14. They project that total COVID-19 deaths in the U.S. will plateau over the summer, reaching 81,114 by Aug. 4.

The projections “assume the continuation of strong social distancing measures and other protective measures,” they said.

In San Mateo County, the Health Department is tracking COVID-19 data, but it’s still unclear what the trajectory of the disease will be, County Manager Mike Callagy said in a conference call with local elected officials on Friday. San Carlos City Councilman Mark Olbert provided a recap of the conference call on his website.

The county is discussing extending its emergency regulations beyond the current April 7 end date, Olbert said.