Sunday, September 13, 2020

The Covid Conundrum: Rising Positive Test Numbers, Declining Mortality Rates

After peaking in April, at about 5500 per day, reported Covid infections in Britain fell to around 150 a day in July before rising sharply to a total this month of around 3500 per day. However, reported Covid deaths, which also peaked in April at a rate of more than 1000 per day, have fallen continuously amounting now to only about 15 a day. Thus the mortality rate for Covid19 appears to have dropped from around 18% in the spring to only 0.4% now, an almost 50-fold reduction. Why? That is the Covid Conundrum.

Possible explanations include:

1. Viral evolution to a less deadly form.

Evidence? None.

2. More testing.

Evidence? We can assume that the UK government has been cranking up Covid testing programs throughout the epidemic, so this explanation is credible. If, as appears to have been the case, initial testing was largely confined to Covid cases, i.e., people so ill with Covid-like symptoms that they came to medical attention, then early test results would have yielded a vast under-estimate of the population-wide Covid infection rate, assuming, as is now generally accepted, that many Covid infections do not cause serious illness and are often asymptomatic.

3. Better Covid treatment.

Evidence? There are many reports of positive effects of various drugs including the cheap and plentiful hydroxychloroquine, as touted by President Trump, and of the protective effects of Vitamin D and zinc supplements. Meantime, the early reliance on ventilators in the treatment of severe cases seems to have been largely abandoned as ineffective.

4. As a result of increased public awareness of individual risk factor a change in the distribution of Covid infections among population groups differing in risk of Covid mortality by virtue of age or pre-existent conditions.

Evidence? While quantitative data are scarce if they exist, at all, such behavioral changes have surely occurred as knowledge of the risk factors for serious Covid illness have become known. Older people and those with pre-disposing health conditions will have become more careful to limit their risk of infection, whereas most young people will have become more care-free concerning the virus.

Of these four factors, the last, spontaneous behavioral adaptation may be important, but there can be little doubt that changes in Covid testing methods and the expansion of testing programs mean that test data from different periods during the epidemic are not comparable. Moreover, the reliability of many test methods, especially those used early in the epidemic, is questionable. Whether the virus has mutated to a more benign form is possible but unknown.

Pretty certainly, therefore, the decline in Covid mortality in most Northern hemisphere countries indicates the achievement of a rising degree of population immunity combined with the well-established seasonality in Corona virus susceptibility, whereas the rise in reported infections is a consequence of increased testing and an increase in the proportion of the population who are either asymptomatic Covid carriers or those who have recoveved from Covid infection but still carry the virus. The Covid conundrum is thus simply an artifact of Covid testing.

Related:
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