Arnold Solof, MD
ABC news today relayed a statement from WHO (The World Health Organization) “Globally, about 3.4% of reported COVID-19 cases have died,” WHO Director-General Dr. Tedros Adhanom Ghebreyesus said at a press conference in Geneva on Tuesday. “By comparison, seasonal flu generally kills far fewer than 1% of those infected.”
The problem with this statement is the denominator which is “reported COVID-19 cases”.
We already know that the majority of even reported cases are mild illness and that the infection can, in some cases, be completely asymptomatic. Until we test general population samples regardless of the presence of any symptoms we will not know how prevalent the virus is in our communities and what the true lethality rate is.
Let me illustrate some points by comparing COVID-19 with other infectious diseases that have been well studied.
When the CDC reports about epidemics like Influenza in their publication MMWR (Morbidity & Mortality Weekly Report) they describe the clinical presentation in terms of percentages of cases with listed symptoms. So, for example, a Flu outbreak study might reveal 80% of cases with fever, 70 % with cough, 75 % with runny nose, 25% with abdominal pain, 60% with body aches, 15 % with diarrhea, 25% with vomiting, etc. Note that most cases will not have every possible symptom and that each case might have a different combination of symptoms, even though they are infected with exactly the same virus. The percentages often vary in different subgroups, so, for example, children with Flu get gastrointestinal symptoms more often than adults and that an individual case might present clinically more like gastroenteritis than Flu.
So, considering the above, we have yet to fully define the clinical spectrum of COVID-19 because we are only recognizing the patterns we have already identified. If COVID-19 were also to cause a greater gastrointestinal pattern in children compared to adults, and a COVID-19 infected child with predominently gastrointestinal symptoms presented to a physician for a diagnosis, it would not be identified.
Consider the case of meningococcal infections. Meningococcus is known & feared for causing extremely serious and potentially fatal infections of septicemia and meningitis. However, outbreaks of meningococcal disease often consist of 1 to a few cases. Meanwhile, in some of those outbreaks, more than 10% of some populations (eg. college students) could be carrying the bacteria silently with no symptoms, spreading it around the community. Only the few unlucky individuals who get the severe forms of the disease are recognized as having it.
So I anxiously await studies/surveys of samples of the general population so we can get a much more complete and numerically accurate picture of COVID-19 and what we are dealing with. My suspicion is that the lethality of the virus is much lower than what is currently being reported. The above studies will provide the answers.
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