What’s the risk of death from coronavirus? A summary from Nature

A new article in Nature has gathered statistics from several studies to come up with an estimate of the overall death rate from coronavirus (click on screenshot below to read it, pdf here). If you’re paywalled, a judicious request might work. I’ll put the latest estimates at the bottom, as you’ll need to read the preliminary information since these figures come with many caveats.

As the article notes, when you’re estimating fatality rates, the gold standard is called the “infection fatality rate” (IFR), which is the proportion of all infected people, including those who are asymptomatic or haven’t been tested, who will die from the disease at issue.  You can imagine the difficulty of estimating this. While we can get an accurate handle on the fatality rate among those known to have the disease, that’s only a part of the statistic, and may either under- or over-estimate the IFR.  Further, if you have antibodies against the virus, you may have recovered from an infection without knowing you’ve had it. Yet that data must also be incorporated into the IFR, and antibody testing is not the same thing as testing for the virus. (How many of you have been antibody tested?) One study from Germany showed that 15.5% of the people in a town that had an outbreak had coronavirus antibodies—five times the proportion of people known to have had coronavirus at the time. Not doing antibody testing would have drastically overestimated the IFR.

Another complication is that some countries don’t test postmortem, and, importantly, the fatality rate in different groups (age, ethnicity, class and wealth, comorbidities, access to healthcare) haven’t been compiled thoroughly. Of course, if you’re infected or in a group that doesn’t have the average IFR, you’ll won’t care that much about the overall rate—you’ll want to know your own chance of dying.

Why do we need these data? As Nature notes:

Getting the number right is important because it helps governments and individuals to determine appropriate responses. “Calculate too low an IFR, and a community could underreact, and be underprepared. Too high, and the overreaction could be at best expensive, and at worst [could] also add harms from the overuse of interventions like lockdowns,” says Hilda Bastian, who studies evidence-based medicine, and is a PhD candidate at Bond University in the Gold Coast, Australia.

The article outlines other complications, but there’s no need to go into them here. I’ll just add that Nature presents the rate of six studies from five countries, and there isn’t much variance among them, with the first study, using data taken from a cruise ship in which everyone was tested, gives the only estimate of the true IFR. But the sample (3,711 people) was small.

So here are the data at hand, and realize that there are problems with all of the studies. But it is interesting that they tend to converge on a value of 0.5% to 1%. (Of course, if you’re old like me, or have other medical issues, this will be an underestimate):

Some scientists impute the small scatter to “luck” (whatever they mean by that) or coincidence, and virtually none of the data have been published in peer-reviewed manuscripts.  Finally, of course, we need to know the death rate for different groups, which will help in figuring out individual treatment, though for epidemiological purposes the IFR is necessary—if it’s from a random sample of people. (Nature cites one study from Switzerland estimating an overall IFR of 0.6%, but a tenfold higher rate of 5.6% for people 65 or older.

The lesson: so far across several populations, one’s chance of dying should they contract the disease is about 0.5% to 1%. But your mileage may vary (I have a lot of mileage and my figure would be higher), and it’s early days for these statistics.

61 thoughts on “What’s the risk of death from coronavirus? A summary from Nature

  1. I would like to see stats compiled for lasting damage from the disease. It’s important to know this as well as perhaps it’s more of a risk than death.

      1. Yes and adults (and perhaps children) who develop permanent lung conditions for scarring on the lungs.

      2. I’ve been reading about that, too, Nicolaas. Children who end up in cardiac arrest due to COVID-19 is extremely sad to consider. I have 3 kids and a 103 year old grandmother, as well as parents who are in the late 70s to think of. I will be staying home and continuing strict quarantining for as long as I possibly can.

    1. Agreed. There seems to be quite a few possible lasting effects, from lungs to kidneys. That scares me more than the chance of dying.

    2. Although there is a small statistical risk, the consequences appear to be extremely unpleasant, no matter how you look at it. Still much is unknown about consequences. I’ll be hoping for an early vaccine.

    3. There are even more complications that have turned up and have lasting damage. I’ve heard there can even be cognitive and psychological damage but I haven’t yet looked into it. They keep discovering new complications. They don’t even know if and when more complications will appear, perhaps years down the line, especially when children contracted the disease and appear to have survived it unscathed.

      The Broadway actor Nick Cordero, who is 41 years old, contracted COVID-19 in March, had a leg amputated, suffered septic shock and mini-strokes; was/is? From Wikipedia: “His wife, Amanda Kloots, reported that he was in critical condition, on a ventilator, and being treated with dialysis and extracorporeal membrane oxygenation (ECMO)”

      People Magazine reported one day ago that he could “move his jaw.” This is June 25. The poor guy. This is tragic.

      1. Forget the “was/is?” I thought I’d deleted the entire sentence. Obviously not.

      2. For some reason, perhaps cognitive slippage, I omitted the second “n” from my handle.

        1. Jesus H. Christ! said the atheist. I admit to having a couple of tokes of dynamite cannabis and thought I should use two “n”s or is it “ns”? The double “n” is in “Jenny.” Have mercy, Mister Percy! Hope it is the cannabis and not incipient dementia. Though some think I’ve gone down that primrose path to oblivion long ago.

        2. Maybe you had COVID, recovered, and this is what has happened to you. 😉

          It is pretty bad though and I am really tired of hearing the deniers.

    1. Yes, when it has been reported that the risk for a 75 year old is 10,000 times that for a 15 year old, the overall IFR for a population is not very informative. You need at least age-specific data, and if possible also data on other risk factors, before you can calculate the effect of the pandemic on a particular population.

  2. The news this morning indicated that over 54,000 deaths in the U.S. are from nursing homes, facilities that house and care for the elderly. That was said to be about 40% of total deaths in this country. We know why this is really bad news and shows how incompetent our govt. has been. These facilities are more than most others, the responsibility of our government. Our federal govt. has done very little to nothing to put resources into the area where the most people are dying.

    It is possible to have prevented most of this because we have samples of individual places that have avoided the desease by shutting them down from outside visitors, isolating anyone that gets it, testing and testing both customers and employees. Shutting down common eating facilities and feeding individually in the rooms. Wearing proper gear and on and on. The facility where my mother in law lives, now at the age of 101 has had no infections.

    1. Canada, mostly in Ontario and Quebec, had a high infection and death rate in long term care facilities, mostly privately run. The military came in to assist when staff abandoned them and it was only at this point that the public learned the high level of neglect because the military are required to report such things up the chain of command. A report was submitted and now inquiries are being launched. It is absolutely appalling what this report revealed.

    2. We’re lucky. My Sweetheart is in our local nursing home. Thank goodness the energetic young fellow (not even 30 yet) who runs the place shut things up tight back in February. So far none of the residents have gotten the virus. One employee who works in the basement and has no contact with residents did test positive and quarantined him/herself for two weeks. And an agency nurse was there for two days and tested positive. (How the nurse got in I do not know, because everyone who comes in the building is checked for symptoms. Maybe the nurse was asyptomatic…) But since everyone was wearing masks and face shields and gloves, nobody got sick.

      Now they’re gearing up to test everyone. This will be the third time for my Sweetie. Twice he had a slight fever and a cough, so they tested him and put him in quarantine until the test results (negative) came back.

      This is very stressful. We talk on the phone and I come and peek through the window. But I willingly cooperate with the guy in charge. There won’t be any visitors for a long time. Criteria have to be met. But that’s okay with me! I want my Sweetie and all the other people there to be safe!

      1. Sounds like good management at that place. One thing they are doing where my mother-in-law lives is allowing an outdoor meeting with a patient and 2 visitors. You have to book ahead then arrive with masks on, get temp checked and you go to this outside place where they positioned 3 chairs for visits. You cannot move the chairs and the visits are one hour. Better than nothing.

  3. Simple solution. Stop measuring corona virus deaths and the rate drops to zero. Why can you people not appreciate our glorious leader’s brilliance?

    1. If we don’t check whether people are actually dead the overall death rate is zero too 😉

        1. Maybe Trump can lower the mortality totals by claiming victims are merely pining for the fjords.

          1. What would be the analogue of having claws nailed to the perching bar? I suppose that’s a bit too gross to contemplate.

          1. I don’t believe I received any coronavirus stimulus payment. Could that be because I am not dead? At least I don’t think I am.

            1. You can be sure you’re not dead. If you were, you would have been paid.

              …That’s some catch, that catch-22.

    2. The real reason tRump ignores the deaths is, he lacks empathy. He’s exhibiting traits of the psychopath. The emotional aspects of personality that are missing means he wants to move on with life, meaning – opening the economy and promoting his reelection. We’ve got his number.

  4. I firmly believe that the biggest toll will be from long term morbidity. The virus binds at so many sites in the body and activates so many cytokine and chemokine pathways that long term inflammation and fibrosis may pose the biggest challenges. Lost lung capacity, decreased renal function, fertility issues all on the table at this point.

    1. Even all over body inflammation. I am starting to wonder if my issues today (high inflammation – doctors always look for an autoimmune disease that isn’t there, chronic migraines, all over body pain and fatigue, foot pain no one seems to completely cure) is a result of two severe flus I had in the early 2000s. After that I seemed to just go downhill and never recovered.

      1. As a kid and teenager I had latent asthma which would sometimes appear after a lot of physical activity. But I never needed medication like albuterol or steroids. Then in 1996 (or around there) I caught a really bad flu (it was called Russian flu at the time) which manifested in my lungs. It lasted almost a month, and it was the first time I was prescribed albuterol. Within a couple years after recovery, I was pretty much considered an asthmatic and now have been on steroids/albuterol for 20 years.

        There’s something to your theory.

        1. Yeah…I certainly don’t have the CRS of a person who is getting an implant but there is some sort of inflammatory response that goes out of control. My doctors always think I for sure have an autoimmune disease….it’s to the point that I now quote “House” and say, “it’s not Lupus”. They never get the reference and go on to explain that perhaps I have diabetes. I go along with them and then when I get the results that say everything is normal I try not to make a face or say “I told you so”. I think a lot of migraines, fibromyalgia (which they always try to tell me I have), and Chronic Fatigue System are some sort of autoimmune/neurological shit storm no one has figured out yet. I think in my case having the bad flus and working where I was being harassed caused it….the final nail in the coffin was when I got c-diff and went to work every day with it. I was so very sick. After that incident I had daily intractable migraines for 2 years (also while working and commuting). Good grief…I was in my 30s and if that happened now I’d keel over and die immediately or at least go into a coma.

          1. Damn Diana, that is some serious suffering. I couldn’t imagine going through what you’ve gone through. I must say, you’re one tough woman, but I sincerely hope you find a doctor (like the rheumatologist) who can successfully diagnose and treat you.

    2. These pro-inflammatory pathways are often the reason why many therapies for cancer fail as well. The work I do professionally is to try to understand – and ameliorate- post transplant cytokine release syndrome (sometimes called “cytokine storms”) that cause many promising responses to cancer therapy to fail, particularly in the new, spectacularly successful adoptive T cell therapies.

      CRS is particularly bad in the long term if, like our poor dear Diana, it becomes chronic. In the COVID-19 cases, like in cancer therapies, acute CRS and its effects are usually resolvable – if they don’t kill you first…and there’s the rub. But even if one survives though, if bad enough, CRS can do permanent damage, particularly to the heart and kidneys.

      1. I went to an orthopaedic surgeon about my feet and he was the first doctor to say that he sees screwed up feet all the time and although my feet have their issues I need to go to a rheumatologist and see about getting on something like humera to stop inflammation. He didn’t even know that all my blood tests show high inflammation and now I even have high platelets no one seems to understand. I usually just get a shrug from doctors who want me to just go away. This has been a 20 year battle. My new neurologist might be able to help too. Still waiting on the referral to a rheumatologist.

        1. I am sorry to hear that Diana and I wish you the best health. Also, I didn’t mean to suggest a diagnosis of CRS, only that elevated cytokine levels have serious health consequences, as you are experiencing. If it’s any consolation, thromobocytosis (high platelet count), while possibly related to serious problems, is also not uncommon as we age. The creeping decrepitude of aging is, I find, the hardest thing to deal with.

          Do see a board-certified rheumatologist for a proper diagnosis.

          1. Yeah the playlets count is elevated but not through the roof. The good news is I clot easily now where I used to bleed for ages. I usually end up diagnosing myself as I find doctors tend to throw their hands up when it isn’t immediately obvious. Something more known, like cancer (which I had 5 years ago) is much better handled.

          1. I was thinking that the COVID situation has really accelerated research into the immune response and inflammation and hopefully, there will be other uses from whatever comes out of it that will allow other diseases and conditions to be treated effectively.

            1. The future of research in the US seems promising, provided we have a new administration in Washington. Canada does pretty well under any circumstance.

        1. Thanks also from me, Diana. I have a nephew, specialist not in epidemiology, heavy responsibilities at one of the hospitals down there in London On., and medical prof at that Western University. I talk to his family, but haven’t to him since Xmas, so this is particularly interesting to know about.

  5. As intimated, our actual individual risk is very different than the estimates made here. These estimates are not worth much in a practical sense, but they do help understand the epidemic. This shows, for example, that in terms of public health policy, this pandemic has a mortality rate that is about ten times the rate of the seasonal flu. But our individual risk is something else entirely and we are absolutely terrible at understanding it, even if we have good data. We think nothing of jumping in our cars every day -probably the most dangerous habits we have-, even to cover short distances, but are terrified of sharks even if we only dip out feet in the ocean once a year.

    1. Exactly. I imagine the risk for a 70 year old is at least 100 times the risk of 7 year. Old people need to protected while youngish people need more freedom.

      It’s a tough balancing act.

  6. What I’m interested in knowing are my chances, or someone I know’s chances, of surviving after coming down with Covid-19 symptoms. On that issue, the consensus seems to be there exists about a 5% fatality rate (from the raw numbers of deaths over cases), but in my case, being above 70, the actual probability must be on the order of 25%. Of course, I may have caught the virus, recovered, and never knew it.
    The variable inclusion of data from antibody tests are now making interpretation of survival chances much more difficult. Different antibody tests from different manufactures seem to give uneven numbers of false negatives and false positives, and I suspect there is variation in how borderline readings are scored by individual technicians. Some of the early tests had very high error rates.
    There is also the question of whether some false positives are due to cross reactions with antibodies produced by diseases other than Covid-19. For example, along the Amazon valley of Brazil, antibody testing in local populations are giving positive rates that vary regionally from 12.5% (Manaus) to 19.6% (upper Rio Negro). These values seem suspiciously high. If false positives are common in particular regions, this could lead to disastrous policies based on supposed “herd immunity”.
    In Portuguese, the link is:

    1. This is a significant point.

      False positive (type 1) and false negative (type II) errors can have surprising consequences. For some time (in the 1990s – early 200s), for example, many disputed the value of mammography for detecting breast cancer because of the consequences of these errors. For example, the prevalence of breast cancer is about 0.8% (the number of people with breast cancer, diagnosed or not, is about 8 in every 1000).

      The standard mammography at the time had a 7% type I error rate (IOW 93% of people with breast cancer were correctly diagnosed, meaning 7% were false positives) and a type II error rate of 10%. This means 90% of the people who tested negative did not have cancer. Of course that means 10% of people who tested false actually had breast cancer.

      Doing the math, this means that the mammography test accurately predicts breast cancer only 11% of the time. Things have improved dramatically since then (better tests, better error rates).

      1. There is also a big debate about over-treatment of breast cancer. If the person has even a small chance of recurrence the treatment may not vary much from someone with a much larger chance. With DNA testing, these predictions are pretty accurate. In my case, I chose to discontinue hormone therapy because they side effects were quality of life altering to the extent that I would sleep all day and therefore would need to stop working and really stop living for the 5 year period. I tried it for 1.5 years and decided the 1% advantage I was getting over not doing it was worth the risk (I’m sure I’ll kick myself if I get a recurrence, which could have happened anyway). When I told my oncologist my decision, she admitted the they often do over treat women and that’s because there is an advantage to doing the treatment so if you can tolerate it, it makes sense to do so.

      2. correction; “the number of people with undiagnosed breast cancer is about 8 in every 1000″.

  7. This is not about the post-hoc political effect, which seems to me should be simply the total number who died in a particular country or other region, during a particular time period, but would not have died if the corona virus had not reared its ugly head.

    And really that should be per million population, and modulo the level of wealth in the country. US looks very bad, though when the talking heads on cable news sound confident US has the worst in the world, they almost always are not looking at per population, and generally seem almost as bad as the general public w.r.t. simple statistical questions.

    That total number at the top includes people with heart problems etc. who didn’t it get `fixed’ because of full hospitals, fear of hospitals, ..

    The best way to estimate that first number is deaths statistically in excess of expected deaths. And then adjust for the second by knocking off a percentage, maybe 5%. But that percentage must be hard to guess with much confidence. Also the number of deaths from that virus you now have does not account for the fine points related to the proximate condition, maybe heart attack, directly causing death, but the virus had weakened the heart.

    However, then to estimate the actual number of infections must be much harder. I’ve never read anything that made me feel confident they could be sure to get even within 20% on that.

    How much use is the deaths/infections ratio then if it could easily be that inaccurate? Anyway, experts have struggled with this with other pandemics and with less deadly flus. Likely they have extra good ideas beyond the above, though the article seems not to give any examples.

    1. Re penultimate paragraph, from NYTimes:
      “Dr. Robert Redfield, director of the Centers for Disease Control and Prevention, said on Thursday that the number of people in the United States who have been infected with the coronavirus is actually about 10 times higher than the 2.3 million cases that have been reported.”

  8. FYI, the Coronavirus Task Force is holding their first public briefing in 2 months this morning (Friday). Trump is not expected to appear. Supposedly they’re going to talk about pool testing where many samples are mixed together and one test applied to them. If the test is positive, then each sample is tested separately.

  9. Diana: You are brave. You are strong. You are amazing.

    Affects/After-affects of Covid-19: Given the notion that so little seems to be known about genetic input, prior illnesses individuals have had and their after-affects, I’m surprised we think we’ve learned as much as we have about Covid-19. I was born with Asthma and almost died with it as a youngster. I outgrew Asthma, but was a chronic target ever after for colds and flus. I have “junk” in my lungs. I tend to wheeze and cough more than others, even without Colds, Flus or Covid. I may be stuck at home for years while trying to be safe and protect my family. Wah!!

    1. Thanks Rowena. I don’t feel that way. And because you can’t always tell something is wrong with me, I think people think I’m exaggerating. I know it can be much worse. I’m happy for what I got.

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