Demonstrating how a virus with a 99%+ survival rate can still result in a deadly pandemic

Cianos

Hi all,

I'm seeking to demonstrate how despite a very low Infection fatality rate, Covid can still result in a deadly pandemic and am hoping to get a bit of help particularly around the numbers.

It's in response to a view that given the virus has a 99%+ survivability rate, there is no deadly pandemic and therefore any restrictions are disproportionate.

Ireland has had 583,000 confirmed cases, with 5,707 deaths, which is a 0.9% Case Fatality Rate (CFR).The number I'm aware of to base the median Infection fatality rate (IFR) on is 0.23% (per studies by John Ioannidisa). If all the above is correct, our mortality numbers would suggest total number of cases (confirmed + unconfirmed) is around 4x the number of confirmed cases.

Covid can't be considered a 'deadly' virus on an average case by case basis, but given its transmissibility its impact needs to be considered across millions of people, and across society as a whole. As such, the conclusion on whether it should be considered a deadly pandemic needs to be gauged on all factors, not just its survivability per the individual, particularly its impact on health services.

I'm trying to find a reliable set of numbers on hospitalisation rates (both pre and post vaccination), not necessarily for Ireland.

My view is that there are 3 primary factors;

1. Mortality rate of the virus
2. Transmissibility
3. Hospitalisation rate

The virus can still have a very low mortality rate, but if transmissibility or hospitalisation rate are very high, then it becomes something that will have a disproportionate impact on society.

Any thoughts/tips would be great, thanks.

MontgomeryClift

Why not just compare 2020 and 2021 mortality numbers to previous years?

Danno

You see, back in the 1800s we had fever hospitals... we didn't learn from history and here we are.

afatbollix

Because our health systems are shite.

Because of Covid they are canceling everything like most surgeries due to ICUs being full where people would be taken to after surgery and whatnot.

Because of this, our politicians are creating lockdowns to keep our health systems in check.

If we had 10 times the hospitals we would be able to get on like normal, UK has been able to have 8 months of normality due to having a small bit better health care system as they haven't been as much overrun. (They have still been overrun and have huge waiting lists)

I hope that the one thing we learn from this is to properly fund our health care systems otherwise to even get over the waiting lists its going to take a decade.

Cianos

https://www.boards.ie/discussion/comment/118270340#Comment_118270340

Because extreme preventative measures have been undertaken, therefore any excess mortality (if there has been any significant level) really doesn't paint a full picture of what a worst case scenario might have been if zero preventative measures were taken.

Danno

https://www.boards.ie/discussion/comment/118270420#Comment_118270420

I agree with what you said until the last point...

We're the 6th highest funders of healthcare per head of population in the OECD.

We do fund our healthcare. But it's like a wealthy uncle leaving a sizable will to his alcoholic niece/nephew - it gets p155ed up against a wall.

lenny palmer

https://www.boards.ie/discussion/comment/118270449#Comment_118270449

This is it. For whatever reason the money spent every year in the hse does not seem to get the work done. There are only ff and fg to blame. They've been in charge for 100 years. If we had a proper health care system there would be less need for all these restrictions, we would have the capacity to look after covid patients and the people who need other medical care.

swampy353

Might be useful to compare the death rates for covid v common causes of death e.g. cardiac disease or cancer. Based on the cso

https://www.cso.ie/en/releasesandpublications/fr/fr-ucd2020/analysisofunderlyingcauseofdeathdataincludingcovid-19januarytooctober2020/

Saying 32% of deaths were cancer

26% Cardio Vascular

10% Respiratory

6.5% Covid

You're 5 times more like to die from Covid then you are to have a fatal accident

In terms of hospitalisation, check out this pre print study https://www.medrxiv.org/content/10.1101/2021.08.27.21262356v1

Having skimmed and read the conclusion, its saying that unvaccinated are 17 times more likely to be hospitalised then the vaccinated.

I find why I am talking to people about death rates etc, if you take it out of the abstract 1% and convert it to something thats easier to understand e.g. if Ireland has a population of 4.9million people, with 1% death rate, that equates to 49k people dead

At this point, if someone has decided that covid is not a thing, then I really dont know what you can say to move their mindset. A lot of these people wont accept evidence from "reliable sources" as they have been so brainwashed with misinformation from tinfoil hat wearing crack pots. Unfortunately a mindset shift only comes when they are directly affected by it.

Cianos

https://www.boards.ie/discussion/comment/118270517#Comment_118270517

Thank you. What I'm hoping to get is something like number of hospitalisations per 1000 confirmed cases amongst vaccinated, and number of hospitalisations per 1000 cases amongst unvaccinated.

I agree it's best to illustrate through applicable numbers instead of abstract %s etc.

Thanks again

Russman

I don’t think it’s necessarily about the survival rate Op. I think that while it’s far from the most virulent or most deadly virus out there, it’s just virulent enough and just deadly enough to be right in the sweet spot for causing mayhem in health care systems. For whatever reason it seems to put a big enough percentage of people in hospital (still a fairly low percentage overall) and give enough people a bad time of it that there’s not a system in the world with enough capacity to operate with covid running wild through a population. Our capacity is very poor but way better systems than ours are struggling. If it was any deadlier you’d have more buy-in to the necessary measures and if it was significantly less harmful we probably wouldn’t need them. You almost couldn’t come up with a better virus to do what it’s doing and no country will ever plan their ICU capacity based on the contingency of a pandemic occurring. Purely an opinion of course.

Wibbs

https://www.boards.ie/discussion/comment/118270517#Comment_118270517

I find why I am talking to people about death rates etc, if you take it out of the abstract 1% and convert it to something thats easier to understand e.g. if Ireland has a population of 4.9million people, with 1% death rate, that equates to 49k people dead

It doesn't. The fatality rates are hugely biased towards the elderly and chronically unwell. 90% of all deaths in Ireland from covid 19 were in the over 65's, 40% were over 85. There aren't nearly five million over 65's in Ireland. According to the oul wiki there are 675149 Irish people aged over 65. If we apply your abstract 1% that would mean 6751 deaths in that age group. Add in the 10% under that age and throw another thousand odd on top(and that's pumping the figures). Really shítty death numbers, which would be a terrible tragedy and massive strain on our country and health service, but not within an asses roar of nigh on 50,000 dead. That's a wild exaggeration.

swampy353

https://www.boards.ie/discussion/comment/118273496#Comment_118273496

What the OP was looking for was a set of stats that could be used to demo the effects of covid. When I used the 49k number, it was a deliberate simplification of the 1% mortality rate on the population of the country. The 1% mortality rate is based on a whole population rate, obviously there is a higher risk of mortality for the elderly population then "youth".

Also the 49k is assuming that every single person in the country gets covid. This is purely a hypothetical to put death rates into a more understandable metric.

While what you say may be correct, if someone is not able to grasp the basics of covid and its effects, they are not going to be able to grasp the intricacies of variable mortality rates within different cohorts of the population

magicbastarder

we know that 90%+ of the adult population are vaccinated and that roughly 50% of ICU cases are unvaccinated patients. now, i don't know the actual inflow and outflow per day in ICU - but if 60 cases in ICU are the unvaxxed, and they're 10% of the population, it stands to reason that if it weren't for the vaccine, the number in ICU would be 600, not 120. so being vaxxed reduces your chances of ending up in ICU by about a factor of 10. i think it's actually greater.

anyway, were we to scale mortality by roughly the same amount as we'd scale ICU - i.e. a factor of roughly 5, based on no vaccines available, we'd be seeing roughly 30-50 deaths per day for the last few weeks (it's been hovering between 6 and 11 per day rolling average). and that's after covid made its way through the nursing homes and care centres.

that compares with 85 deaths per day in the state (all causes) in 2019. (source: https://www.cso.ie/en/releasesandpublications/ep/p-vsys/vitalstatisticsyearlysummary2020/ )

FintanMcluskey

https://www.boards.ie/discussion/comment/118275234#Comment_118275234

While what you say may be correct, if someone is not able to grasp the basics of covid and its effects, they are not going to be able to grasp the intricacies of variable mortality rates within different cohorts of the population,

Will ya go away out of that

Maybe its because someone can actually grasp the intricacies of variable mortality rates within different cohorts of the population, they can also grasp the basics of covid and its effects.

Wibbs

https://www.boards.ie/discussion/comment/118275234#Comment_118275234

With respect, that's a word salad that means feck all. The parroted recieved jargon terms like cohort and mortality rates don't make it any better than the fear mongering number crunching it is(As an aside; I do so wish for the day when "cohort" goes back to some obscure classics type referring to Roman legions). We had enough of that stuff early on in the campaign when we knew so much less than we do now and panic was obviously an understandable response. While what I say may, or indeed may not be correct- it's rarely enough the former - it's a damned sight more correct than pulling figures like 50k dead out of my fundament like you have.

It's not just that "obviously there is a higher risk of mortality for the elderly population then[sic] "youth"", the gulf is absolutely bloody enormous. There are around 1.6 million people under the age of 25 in Ireland, the number of tragic deaths from this pox in that age group? Seven. In percentage terms 0.0004%. A six month camel ride away from even close to 1%. With another two months on top. And maybe a boat trip.

Let's ramp it up to all the under 65's. They make up approx 4.2 million of Irish people. Number of deaths? 535. And that obviously includes a load of middle aged 40 plus types with dodgy tickers, beer guts and diabetes. Even then the percentage of deaths in that wide demographic? 0.01% What's that? Ten times lower than 1%? AKA feckin tiny. And much of those figures were reached before we had vaccines in play.

Now obviously those numbers do not reflect the confirmed infected and recovered, or dead, and it doesn't reflect the overwhelming effect everybody being infected would have on our society and the health services, but we'd have to really rev up the overall population death rates from this pox to get within an asses roar of 1% or 50,000 Irish dead. That's more than a deliberate simplification, it's a wild exaggeration bordering, nay stepping over the border of nonsense.

Geuze

https://www.boards.ie/discussion/comment/118270420#Comment_118270420

Given the age profile of our population, we overspend on healthcare.

swampy353

https://www.boards.ie/discussion/comment/118275465#Comment_118275465

There is no respect there and to pretend that there is, is just disingenuous.

I apologise that using the correct terminology offends you so deeply. While all of these terms may have an obscure etymology, global events push new words (or old back) into daily use, but I'll make sure to not to use cohort or mortality rate lest it offends you. BTW nice use of the uber modern word "nay" .

Again OP was looking for a simplified way of showing how low mor*****y rates can still lead to high death rates, pretty much the opposite to your post

Wibbs

https://www.boards.ie/discussion/comment/118275857#Comment_118275857

No low mortality rates lead to low death rates, that's what mortality rates are. Even if we went to the full 1% of the Irish population dying, it would be roughly double the existing annual death numbers(IIRC around 40k people die from various causes each year?). Horrific to be sure, but not exactly armageddon.

Now the knock on effect is a different matter. You can have low mortality and a very high impact on wider society in things like overstressed healthcare, economic downturns and psycological impacts across a society. That I would 100% agree with.

We can see this with covid 19. On the raw stats it's the single least deadly pandemic in history and left the young almost entirely alone, yet it has caused and continues to cause massive disruption to our modern societies.

https://www.boards.ie/discussion/2058221241/demonstrating-how-a-virus-with-a-99-survival-rate-can-still-result-in-a-deadly-pandemic

Interesting how a virus with an IFR of 0.23% has already resulted in deaths of 0.24% or more of the total population of 20 countries, up to a highest of 0.59%, a country with a younger population than Ireland

Wibbs

Comparing it the annual flu rates which run around half a milllion deaths per year, with covid so far accounting for five million deaths(over 18 months) it looks to be approx five to ten times more deadly. To pull a figure out of my arse, I'd reckon when it's all done and dusted and numbers are counted it'll come out around 0.6 as a percentage figure, heavily weighted towards the over 60's where it'll be over 1%.

PintOfView

https://www.boards.ie/discussion/comment/118273496#Comment_118273496

It doesn't. The fatality rates are hugely biased towards the elderly and chronically unwell. 90% of all deaths in Ireland from covid 19 were in the over 65's, 40% were over 85. There aren't nearly five million over 65's in Ireland. According to the oul wiki there are 675149 Irish people aged over 65. If we apply your abstract 1% that would mean 6751 deaths in that age group. Add in the 10% under that age and throw another thousand odd on top(and that's pumping the figures). Really shítty death numbers, which would be a terrible tragedy and massive strain on our country and health service, but not within an asses roar of nigh on 50,000 dead. That's a wild exaggeration.

Aren't you making a fairly basic error there? The 1% (if that's what it is) is calculated based on everyone in the population getting Covid, resulting in 1% of the population dying. It's fairly clear that the death rate will not be uniform over the different age groups, where we would expect very small numbers of under 40's dying, but with significant percentages of over 70's and over 80's dying (Fig 4 on this page seems to suggest a 5% death rate for over 70s, and a 15% death rate for over 80s)

So the 49k deaths would be expected to be mostly in the upper age groups, and in those with underlying conditions. In addition, comparing those number to the yearly deaths is also a bit iffy. The 30k people approx that die in Ireland each year have mostly arrived at the end of life of their bodies. If we had 49k Covid deaths there would be an overlap with the annual 30k, but I would guess there would also be a significant percentage of the 49k would would be departing this life many years before their natural time (you must know many people who are living for many years with conditions that put them more at risk from Covid!).

https://www.boards.ie/discussion/comment/118275912#Comment_118275912

0.6% in a vaccinated population. Closer to 0.1% in a fully vaccinated population

Wibbs

https://www.boards.ie/discussion/comment/118276025#Comment_118276025

Aren't you making a fairly basic error there? The 1% (if that's what it is) is calculated based on everyone in the population getting Covid, resulting in 1% of the population dying. It's fairly clear that the death rate will not be uniform over the different age groups, where we would expect very small numbers of under 40's dying, but with significant percentages of over 70's and over 80's dying (Fig 4 on this page seems to suggest a 5% death rate for over 70s, and a 15% death rate for over 80s)

That's the point I was making in response to the other poster.

So the 49k deaths would be expected to be mostly in the upper age groups, and in those with underlying conditions. In addition, comparing those number to the yearly deaths is also a bit iffy. The 30k people approx that die in Ireland each year have mostly arrived at the end of life of their bodies. If we had 49k Covid deaths there would be an overlap with the annual 30k, but I would guess there would also be a significant percentage of the 49k would would be departing this life many years before their natural time (you must know many people who are living for many years with conditions that put them more at risk from Covid!).

Let's switch it around and ask how many people in their late 80's would you know? Because they make up 40% of all deaths from covid 19 in Ireland. That's not so far off half. And it's five years older than the mean longevity number for Ireland as a whole before this pox hit. 90% of all deaths from covid 19 were in the over 60's, even then heavily weighted towards the over 70s and the median age of death from covid 19 is 82 years of age, mean is 80 years of age, pretty bloody close to the overall mean age of longevity that's 80 years of age. Now that's just the bald figures which mask the individual tragedies of all who died from this Woo flu and of course the younger peoplewho died from it, or those left in bad health from it, never mind the much wider societal cost which we'll paying for some time yet on a few fronts. However the number of those departing this life before their time from covid is a small one.

I wonder has anyone the overal death rates from before and during this pandemic and the differences involved. I'd be willing to bet the jump isn't that high.

notAMember

99% survival rate is ok on an individual level, but for a population it isn't great. 1% of the population dying from a single cause is a big deal.

https://www.boards.ie/discussion/comment/118270420#Comment_118270420

"If we had 10 times the hospitals" is thrown out here flippantly, like it's achievable.

Staff, equipment and facilities don't just fall out of the sky. It takes almost a decade of experience to become a competent doctor. Add another 5 for specialties. 5 years for nurses. Hospitals are complex buildings, and the equipment takes commissioning and maintenance. You intend to train all these people up, for every one we have now train another 9, buy heaps of complex equipment, and have them sit idle awaiting a pandemic. What would the tax rate to be to pay for this hospital driven economy?

Lumen

https://www.boards.ie/discussion/comment/118275912#Comment_118275912

Funnily enough 0.6% CFR was exactly as predicted by the Chinese with OG covid early last year. Working as designed! 😁

joe40

Are there any figures on the total confirmed cases in Ireland as a percentage of the overall population.

Obviously this won't take into account asymtomatic cases or instances where peole were ill but did not get tested but how many confirmed cases have there been so far.

I haven't had covid yet as far as I'm aware, am I in the minority at this stage?

On the point about a 1% mortality rate, if that was uniform across the population it would be an absolute disaster. Imagine your local secondary school with 1000 pupils and then imagine 10 dying from a pandemic. It would be unthinkable.

I'm not for one minute downplaying the devastating affect of this virus but we are nowhere near 1% fatality rate.

PintOfView

https://www.boards.ie/discussion/comment/118276234#Comment_118276234

Let's switch it around and ask how many people in their late 80's would you know? Because they make up 40% of all deaths from covid 19 in Ireland. That's not so far off half. And it's five years older than the mean longevity number for Ireland as a whole before this pox hit. 90% of all deaths from covid 19 were in the over 60's, even then heavily weighted towards the over 70s and the median age of death from covid 19 is 82 years of age, mean is 80 years of age, pretty bloody close to the overall mean age of longevity that's 80 years of age. Now that's just the bald figures which mask the individual tragedies of all who died from this Woo flu and of course the younger peoplewho died from it, or those left in bad health from it, never mind the much wider societal cost which we'll paying for some time yet on a few fronts. However the number of those departing this life before their time from covid is a small one.

I wonder has anyone the overal death rates from before and during this pandemic and the differences involved. I'd be willing to bet the jump isn't that high.

I think as a country we've been successful in minimising deaths due to Covid, and I agree that many of those that did die were likely frail due to old age or due to having other medical conditions. However I don't think that's the full story. It seems to me that there were also many deaths where the person could have lived on for many years but for Covid. Consider that the life expectancy of someone who is 80 in Ireland is 9.2 years!!! So if half the people who are dying from Covid are 80, or younger, then it's likely a proportion of those are being robbed of several years of life due to Covid.

As regards excess deaths in Ireland this past couple of years, it's not been high as far as I can see, and seems mostly to be March/April 2020 and Jan/Feb 2021 (and is much lower than, for eg., the USA). This page puts it between 692 - 1,857 excess deaths in 2020 (depending on how it's measured), and between 1,193 - 1,619 in the first 3 months of 2021. I imagine that mortality will be much reduced this winter due to vaccinations, but some people will still require hospitalisation to survive.

Of the three factors the OP identified the hospitalisation rate seems to me to be the main thing we have to worry about, and counteract. If the hospitalisation rate gets too high it will overwhelm the hospitals, and delay and displace other medical procedures that can carry negative consequences for those affected.

Like the OP, I would be interested in the hospitalisation numbers, plus their vaccination status. If the unvaccinated are not a significant proportion of hospitalisations due to Covid then there wouldn't be as much of an imperative to push them to get vaccinated against their fears. However if the unvaccinated (10%) are making up more than 50% of the hospitalisations then there may be a case to try to persuade some of that 10% to get vaccinated (though I'm not keen on the idea of compulsory vaccination)

Cianos

Thanks for the responses all. Far be it from me to determine the direction the thread should go in, I suppose what I was originally aiming for is to look at how there can still be a considerable impact from a low mortality/high transmissibility virus.

As Russman writes;

"while it’s far from the most virulent or most deadly virus out there, it’s just virulent enough and just deadly enough to be right in the sweet spot for causing mayhem in health care systems. For whatever reason it seems to put a big enough percentage of people in hospital (still a fairly low percentage overall) and give enough people a bad time of it that there’s not a system in the world with enough capacity to operate with covid running wild through a population."

This is the main thing for me really. The "99% survivability!!!" line massively simplifies things because the matter is far more complex than an individual's likelihood of living or dying from it. To put it another way, theoretically you could have a virus with a 100% survivability rate that could also have a detrimental impact on society.

rahmalec

https://www.boards.ie/discussion/comment/118276401#Comment_118276401

Well, a few places like Bulgaria and Russia are already pushing past a 0.7% death rate when looking at excess deaths.

https://www.economist.com/graphic-detail/coronavirus-excess-deaths-tracker

Wibbs

https://www.boards.ie/discussion/comment/118278671#Comment_118278671

theoretically you could have a virus with a 100% survivability rate that could also have a detrimental impact on society.

True enough. Bubonic plague(not a virus but..) if caught early is very curable with antibiotics, however it requires a hospital bed and resources, so even if you had only 4000 people exposed in Ireland it would be mayhem, even if they all survived. The dead are - and this sounds awful - pretty "cheap" and are out of the picture, the walking wounded take up far more resources in the moment.

Geuze

https://www.boards.ie/discussion/comment/118276401#Comment_118276401

559,705

https://www.cso.ie/en/releasesandpublications/br/b-cdc/covid-19deathsandcasesseries37/

Table 1.