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Saturday, March 7, 2020


The accumulating evidence suggests a death rate of 1% or less for COVID-19, but some studies being done quickly show death rates of 30-40% for persons over 80, especially those with compromised immune systems.  I live in a Continuing Care Retirement Community.  Most of the 700 residents are over 80 or near to it.  And many of those here have compromised immune systems for one reason or another.  If the virus were to enter the community, the consequences could be catastrophic.


Jerry Brown said...

Yes it sure is scary. I hope you stay well. At least we are not stuck on a cruise ship somewhere.

David said...

You are right. That is what happened at the Life Care facility in Kirkland, WA. Thirteen residents have died from COVID-19, and eleven more, who died in February, will be tested post-mortem. Seventy employees from the facility currently show symptoms of the disease, and Life Care has had to rely on emergency help from the CDC and medical personnel from the U.S. Department of Health and Human Services.

Another facility, Ida Culver House in the Ravenna neighborhood of Seattle, has had one resident test positive for the virus. My mother-in-law lives in a memory-care facility on nearby Mercer Island, and we are concerned, to say the least.

Yesterday I went into Seattle to go to the University of Washington library and to see a friend. What a strange experience that was. The commuter train was desolate, and the campus was nearly cleared out. The University has cancelled in-person classes at least until spring break, as has Seattle University and Seattle Pacific University. The Northshore School District, north of Seattle, is closed for two weeks.

In the hip Capitol Hill neighborhood, however, the young were out and about. I suppose that makes sense. They are not as vulnerable as people who are elderly or immune-compromised. I do wonder where all this is going, though.

RobertD said...

Dear Professor Wolff

I am not sure what studies you have seen, but my understanding is that the CRF for patients aged 80+ is 10-15%, which is certainly bad, but still not as bad as 30-40%.

Hopefully though the US government will take the epidemic seriously soon, and impose the unfortunately drastic measures necessary to avoid millions of deaths across the US (2% of 80% of 300 million = 4.8 million)

Dean said...

Seems to me we can't rely too confidently on the data just yet. Per note 1 below, for instance, JAMA reported a ~15% CFR for 80+ year-olds (in China), but that figure didn't factor for immune system condition. I've seen a few stories like note 2 below that caution against exaggeration of the numbers when we can't be certain about incidence.

One would think that a facility like the one in Kirkland would already have been well-prepared to protect against any communication of viruses among its residential population, but early onset of this one caught folks unawares (not to mention the CDC's muddling and ambivalence--see Brian Leiter's recent post, note 3 below). Not so much with each passing day. My mom is in an assisted living facility. I would guess it experiences less turnover of residents than the WA facility, which provides long- and short-term care, including inpatient and outpatient programs. Still, there are lots of visitors to her site, and it's in a region of the country, the Bay Area, where I imagine travel is per capita higher than in others. Consequently, the visitors -- families, medical professionals, etc. -- could be a particularly robust avenue for introduction of the virus. And yet as visitors, we are well aware of the risks we might pose to the residents pre- or post-COVID-19, and we behave accordingly: frequent hand washing and sanitizing, face masks, etc. Thus, perhaps the risk of introduction of any virus is generally lower in this type of facility than in other vulnerable communities.




David Palmeter said...

There's a Swiss study that puts the death rate for those 80 and older at 36%:

Jennifer said...

Dear Professor Wolff,

Because you have so much to offer the world, and because you mentioned in one of your lectures that you walk every morning for a few miles (when discussing counting and rule recognition), and because I reckon you eat well because you're rational, I imagine you will be in the 60+% in your age group who remains unaffected.

Death stalks us all--old and young.

Be well. Live!


Michael Hobart said...

RPW et al.,

My librarian wife put me on to the following blog article on cryptic transmission of Covid-19. For a bit of science on the coronavirus' vector, it is excellent:

If I read the piece correctly, the "seeding" event in the Seattle area was ~January 15, some 7 plus weeks ago. The first case in Snohomish County, just north of Seattle, was from a traveler who had recently returned from Wuhan, China. That virus was labeled USA/WA1/2020. Since then it has mutated to USA/WA2/2020, three mutations later from the original WA1 in Wuhan China. (Each genetic mutation takes a couple of weeks or so). Given this trajectory, some ~600 infections are anticipated in the Seattle area, developing in the next couple of weeks.

Wuhan, China, was put on a large-scale lockdown, effectively controlling the spread in the immediate area (a bit of closing the barn door after the horse fled). Cases in Wuhan are dropping dramatically. Conclusions? (1) This is a controllable epidemic. BUT (2) we are at a critical juncture now as regards the spread in our region (the Seattle area in particular -- I live just 90 miles north). The next two or three weeks are quite significant, at least in this neck of the woods. This would seem to put a premium on exercising control over behaviors now. First among the non-pharmaceutical recommendations listed in the article was "practicing social distancing, such as limiting attendance at events with large groups of people." To than end, several colleges and universities in this area are being closed to classroom, face-to-face instruction, including the University of Washington (main campus). So too with numerous K-12 schools.

The author of the piece, Trevor Bedford, is a colleague of a statistician friend of mine who works at the Fred Hutch research center, a highly respected analytics group. Trevor's piece was the basis of a NY Times article about the probable trajectory of Covid-19.

Michael Llenos said...

Dr. Wolff,
I used to think hypothetically if there ever was a great disaster or even a zombo apocalypse (possible not probable) that humans would do a great job against it. Now with all the hoarding and price gouging and paranoia, I have a pessimistic feeling about it all. I guess the WW2 generation always inspired me with optimism. I am not so optimistic now.

David Auerbach said...

@Hobart You beat me to it. That Bedford piece is useful. There was also a piece in NYTimes by Gorman about a British mathematician who works on the mathematics of contagion that has some useful observations.
Wash your hands.

Anonymous said...

Please allow me to draw your attention to a summary paragraph from a WHO report on China (linked by Professor Leiter):
"COVID-19 is spreading with astonishing speed; COVID-19 outbreaks in any setting have very serious consequences; and there is now strong evidence that non-pharmaceutical interventions can reduce and even interrupt transmission. Concerningly, global and national preparedness planning is often ambivalent about such interventions. However, to reduce COVID-19 illness and death, near-term readiness planning must embrace the large-scale implementation of high-quality, non-pharmaceutical public health measures."

I was especially struck by the term "non-pharmeceutical".

As you know, a former lobbyist for pharmaceutical companies (Alex Acosta, HHS) was involved with the government's response. Whatever his actual powers today, the following words are, I think, chilling: " “We can’t control that price because we need the private sector to invest..”

Might there be some who prefer a "pharmaceutical" intervention to a non-pharmaceutical public health measure?

Unknown said...

As someone living in Japan, a place for hard as you pretty know, the advice regularly reported to the public is just to wash your hands and gargle, plus a mask helps.
If these are really appropriate countermeasures in not so sure but wanted to share regardless.