March 2nd 2020

By Mark Sumner

Daily Kos

For the first time in over a week, the total number of active COVID-19 cases around the world has slipped below 50,000, as China continues to report more recovering cases than new cases. And on Monday, the number of new cases in South Korea fell sharply after several days of explosive growth. Unfortunately, that’s the end of the good news on COVID-19.

Leading off the less-than-good news: Iran. On Monday, Iran’s deputy health minister gave a briefing on the incidence of coronavirus in his country, a briefing in which he appeared to be shaking, sweating, and a long way from healthy. On Tuesday, he admitted that he is sick with COVID-19. So are a lot of other people, and not just in Iran—which has become the second epicenter fueling what’s harder and harder not to call a pandemic.

Officially on Tuesday morning, Iran had 95 cases of COVID-19, 15 of which had already resulted in death. Unofficially, but much more factually, that is bullshit. At this point it is clear that the number of cases in Iran is in the thousands. At least six other countries can now trace their first case of 2019 novel coronavirus to people who traveled not to China, but to Iran. And as the government in Iran continues to trickle out news of handfuls of cases, people on the ground in Qom call the situation there “desperate,” with local healthcare facilities overrun and the central government in Tehran refusing to provide assistance. 

Considering the recent instability in Iran, there’s little doubt that the government has been downplaying the outbreak over concerns that it will lead to a collapse of the power structure. At this point, that collapse appears inevitable. What’s more than unfortunate is that Iran’s government seems determined to bring down millions of people as it heads for the door. Forget whatever Soleimani was supposed to be doing in Iraq, or any weapons that Iran has provided to forces in Yemen, or its efforts to restart its stalled nuclear program. Its handling of COVID-19 represents a much greater threat to world health, to the world economy, to global stability than anything else it’s done.

Iran did report that three cases inside that country had recovered. Which might be considered a good sign, and at least broke its streak of resolving every single case through death. But since the average time to recovery is 14-17 days, and Iran only announced its first case less than a week ago … even that seems problematic, at best.

The only thing that could potentially be worse is that Donald Trump seems determined to follow the same plan as Iran. Speaking from India, Trump repeated his claims that the coronavirus is completely under control in the United States and that we’re down to “probably about 10 cases.” The actual number of confirmed active cases in the United States at that moment was 46. That’s not thousands, but it’s also very much not “about 10.” Trump’s insistence on minimizing the threat posed by COVID—including a number of tweets about how it’s all fine, nothing to see here—increase the threat.

So does a whole parade of right-wing hand-waving that includes not just Republican Rep. Tom Cotton claiming that COVID-19 was cooked up in a Chinese bio lab, but also Tucker Carlson using the whole issue to declare that “diversity is not strength” as he blames the disease on Chinese dietary habits. The idea that the disease is the product of a bio lab was repeated by Steve Bannon, which did at least generate one good moment in which the virologist Bannon had invited on his show called his ideas “crackpot” and “a load of crap.” Still, every Fox News host seems to be using this moment to promote The Wall, or warn against how the next “caravan” is bringing disease. Which should surprise no one, as there were already plenty of claims, including by Trump, that immigrants represented a threat to bring Ebola into the country.

The peak of all this may be right where you’d expect, with Rush Limbaugh, who has declared that the whole COVID-19 epidemic is a conspiracy against … Donald Trump. Because, hell, we’re only talking a few million deaths! It’s not a big deal! “The stock market’s down like 900 points right now,” said Limbaugh. “And I think - the survival rate of this is 98%!”

Limbaugh has been among those pushing hard on the line that coronavirus is “like a cold” or that “the flu is worse.” This is definitely not true. An unchecked epidemic of COVID-19 in the United States would lead to somewhere between 450,000 and several million deaths. Even that lowest number is many, many times worse than the worst flu season. It is comparable to the 1918 flu.

Just like the government in Iran, Donald Trump is right to fear this—because a government that fails to stave off such a disaster, especially after actively engaging in covering up the threat, will not stand. Okay, let’s see charts.

The total number of active cases may be barely below 50,000, but it seems like another good sign that, assuming the numbers coming out of China are correct, the situation there is being brought slowly under control. We are not seeing the hundreds of thousands of daily cases that some experts warned about by this point in the outbreak. We’re not even seeing thousands. 

And yes, someone will surely comment, as they do every day, that we don’t know if the numbers provided by the Chinese government are accurate. After all, it, like Iran, has refused to allow in teams from the WHO and CDC. All I can say is … these are the numbers we have.

The number in South Korea, where active cases threaten to top 1,000 in the next day, is certainly far from good. But the overnight increase (144 cases) was well below what it has been over the past two days. Reports from the South Korean government indicate that more than 50% of cases continue to be directly connected to one of two sources (a hospital where an early carrier sought treatment, and that single oddball church). They suggest that it’s now chased down the immediate connections to these sources and is bringing the tertiary cases under control. Another day should give an indication of whether that is true, but even a brief respite from the daily doubling that has been going on is a very good thing.

In Italy, officials are indicating that they feel the situation is under control and that new cases are connected with known sources or found in what are being called “red areas” inside the military-led quarantine. Italian officials are also saying things that generate concern, such as the head of the ministry for civil protection worrying about “the cancellations of foreign tourists” and stating that "we are a safe country." Finding the right tone between Panic! Everyone run for the hills! and Nothing to see here, go about your business is difficult. And when all the people involved in delivering the message are worried about how every statement affects their ability to hang on to a job, it’s even more problematic. But this is probably not the right time to plan a vacation.

As mentioned above, Iran is the one place where we can be dead certain that the numbers are in no way reflective of the true scope. On Monday, multiple countries around the Middle East boosted their number of known cases, including countries such as Iraq and Afghanistan that are definitely not equipped to deal with an epidemic. The universal source of these infections was Iran.

Despite this already running a bit long today, I’m going to do something I promised to do yesterday—take a second look at Case Fatality Rate (CFR) and how we can be increasingly sure the rate for COVID-19 is somewhere near 3.5%.

This chart compares Outcome Mortality (deaths/deaths + recovered) to Case Fatality Rate (deaths/total cases). After some chaos in early days, OM has been marching steadily downward, while CFR trends slowly upward. The reason: It takes some time after people are infected with COVID-19 before they die. It takes even longer for them to recover. When all the books are closed, CFR will tell the definitive story. When that happens, the OM and CFR lines will touch. But can we get ahead of history and predict where that will happen? Maybe.

Comparing the current number of deaths to the total number of cases at the moment produces 3.37% for a value that’s been slowly growing. But what if we compare the value of deaths to the number of cases that had been diagnosed three days ago? That gives 3.55%, and that value is also trending up. However, if we compare the number of deaths to the number of cases seven day ago, we get a value of 3.7% … and that value has been fluctuating up and down for several days. That value likely represents something close to the true value. Or as close to it as we can get at this moment.

Resources

World Health Organization 2019 Coronavirus information site.

World Health Organization 2019 Coronavirus Dashboard.

2019-nCoV Global Cases from Johns Hopkins.

BNO News 2019 Novel Coronavirus tracking site.

Worldometer / Wuhan Coronavirus Outbreak.

CDC Coronavirus-2019 (COVID-19) information site.

Posted with permission