When was the First Case of COVID-19 in the United States?

SARS-CoV-2 was not around last winter. COVID-19 truly is a novel infection.

Why do some folks continue to believe that COVID-19 has been around for a while and that it isn’t as novel a virus as the rest of us know it really is?

Jay Gordon thinks that he might have been seeing a lot of kids with COVID-19 in January, well before the first confirmed cases in the state.
Jay Gordon thinks that he might have been seeing a lot of kids with COVID-19 in January, well before the first confirmed cases in the state.

The usual suspects…

When was the First Case of COVID-19 in the United States?

While some are wondering if they were seeing COVID-19 in January, some think they were seeing in even earlier.

#COVidiots are spreading the idea that COVID-19 has been in the United States since December.
#COVidiots are spreading the idea that COVID-19 has been in the United States since December.

Were the first cases of COVID-19 here in December?

“Yeah, me too. I’ve been telling almost every patient I see that, well, you know it’s flu season, but it doesn’t seem like you have the flu, it seems like you have a really bad cough. And everyone I’m seeing, it’s like their coughs are worse this winter. And their coughs are lasting for 3 or 4 weeks, instead of 1 or 2 weeks. And something went around this winter that was not the flu. Flu went around too, but there was a really terrible cold going around and you’re right, it is really possible in hindsight that coronavirus has been here this whole time.”

Bob Sears

What do you think of when you hear Bob Sears talk about seeing kids with a “really bad cough” that lingers for a month?

Since he wrote a book pushing a non-standard, parent-selected, delayed protection vaccine schedule, my first thought is pertussis too…

That isn't the COVID-19 type of coronavirus they are talking about in the cold and flu reports from December!

This has been a fairly bad flu season though, and as early as December, there were high rates of flu in many parts of the United States.

That isn’t the COVID-19 type of coronavirus they are talking about in the cold and flu reports from December!

And since it was cold AND flu season, there were already high rates of other cold viruses, including RSV, adenovirus, rhinovirus, enterovirus, and non-COVID-19 types of coronavirus.

Still, that doesn’t prove that the SARS-CoV-2 virus that causes COVID-19 wasn’t around in December or earlier.

So what evidence do we have?

Well, we have the evidence that the first strains of SARS-CoV-2 emerged in Wuhan, China in November.

“From very early on, it was clear that the nCoV genomes lacked the expected genetic diversity that would occur with repeated zoonotic events from a diverse animal reservoir. The simplest parsimonious explanation for this observation was that there was a single zoonotic spillover event into the human population in Wuhan between mid-Nov and mid-Dec and sustained human-to-human transmission from this point.”

Trevor Bedford on Early warnings of novel coronavirus from genomic epidemiology and the global open scientific response
The first case of 2019 Novel Coronavirus was detected in Washington in January.

And we know that the first cases in the United States were seen in Washington in mid January.

Genomic epidemiological analysis traced the first case in Washington to a traveler from China in mid January.
Genomic epidemiological analysis traced the first case in Washington to a traveler from China in mid January.

Wait, how do “we” know that?

“The field of genomic epidemiology focuses on using the genetic sequences of pathogens to understand patterns of transmission and spread. Viruses mutate very quickly and accumulate changes during the process of transmission from one infected individual to another. The novel coronavirus which is responsible for the emerging COVID-19 pandemic mutates at an average of about two mutations per month.”

Trevor Bedford on Cryptic transmission of novel coronavirus revealed by genomic epidemiology

We know that because experts can examine the small mutations in the SARS-CoV-2 virus when it emerges in an area.

“We know that Wuhan went from an index case in ~Nov-Dec 2019 to several thousand cases by mid-Jan 2020, thus going from initial seeding event to widespread local transmission in the span of ~9-10 weeks. We now believe that the Seattle area seeding event was ~Jan 15 and we’re now ~7 weeks later.”

Trevor Bedford on Cryptic transmission of novel coronavirus revealed by genomic epidemiology

That has helped them track where and when the SARS-CoV-2 virus pops up in each part of the country.

The SARS-CoV-2 virus in each area is different enough that they can trace where it came from, but no, the differences aren't large enough to affect immunity.
The SARS-CoV-2 virus in each area is different enough that they can trace where it came from, but no, the differences aren’t large enough to affect immunity.

No we don’t have a time machine to test folks in November or December or even earlier, except to test those who submitted specimens in flu studies (which will be done as folks get caught up with testing new samples), but by examining the mutations in the virus, they can tell how long the virus has been spreading in each area.

And that has allowed them to create fairly detailed timelines of SARS-CoV-2 outbreaks in the United States.

Do any of these timelines show COVID-19 cases in the United States in December or early January?

Nope.

Is there any good reason you should be listening to the folks pushing misinformation about COVID-19?

Of course not!

Not surprisingly, these are the same folks who are well known to push misinformation about vaccines.

But why do they want you to think that SARS-CoV-2 has been around for awhile?

It’s propaganda to make you think that getting COVID-19 isn’t that serious.

Don’t believe them.

More on the First Case of COVID-19 in the United States

About Those Rapid COVID-19 Tests

A company is selling rapid COVID-19 tests that promise quick results in 10 minutes. The only problem? They are not approved by the FDA…

While everyone has been talking about tests for SARS-CoV-2 infections, it is mostly the PCR tests from nasopharyngeal swabs that take a few days to get results.

The PCR tests that nobody can really get their hands on…

About Those Rapid COVID-19 Tests

Now, in addition to more and more of those tests becoming available every day, many folks are excited about rapid tests.

How rapid?

“The Food and Drug Administration has approved the first rapid point-of-care COVID-19 test, that can deliver results in less than an hour.”

FDA Approves First Rapid COVID-19 Test

The new COVID-19 test, from Cepheid, provides results, also from a nasal swab, in about 45 minutes.

Most importantly, like strep and flu tests, this new COVID-19 rapid test doesn’t have to be sent anywhere. That doesn’t mean that your pediatrician will be able to see you and run a rapid COVID-19 test anytime soon though.

“The test has been designed to operate on any of Cepheid’s more than 23,000 automated GeneXpert Systems worldwide, with a detection time of approximately 45 minutes.”

Cepheid Receives Emergency Use Authorization from FDA for Rapid SARS-CoV-2 Test

It needs the specialized, and expensive, GeneXpert System to run.

Who has these systems?

Mostly hospital labs.

And that’s great news!

Even if the test could be run in your pediatrician’s office, a lack of personal protective equipment would still limit how much testing they could do.

On the other hand, a fast test that could be run in big hospitals will help them set up centralized, mobile testing centers.

Unfortunately, in addition to the very real rapid COVID-19 test from Cepheid, we are seeing many other rapid tests pop up that are not FDA approved!

COVID-19 test results in 10 minutes? From a blood sample?
COVID-19 test results in 10 minutes? From a blood sample?

Among the tests that you should be especially wary of are those that say they give quick results from a blood sample – a serology test.

“Initial work to develop a serology test for SARS-CoV-2 is underway at CDC. In order to develop the test, CDC needs blood samples from people who had COVID-19 at least 21 days after their symptoms first started. Researchers are currently working to develop the basic parameters for the test, which will be refined as more samples become available. Once the test is developed, CDC will need additional samples to evaluate whether the test works as intended.”

Serology Test for COVID-19

Unfortunately, these types of serology tests which look at antibody levels are not yet available – at least they aren’t available in the United States.

Several companies have begun the application process with the FDA under the COVID-19 Emergency Use Authorization (EUA) though.

We will have to see if they really work and how long it takes for them to get approved.

What else isn’t available yet? There are no FDA approved home COVID-19 test kits, even though many companies and some physicians are selling them…

More on Rapid COVID-19 Tests

Telemedicine for Parents and Pediatric Providers

Ideally, we would continue to see kids in our office when they are sick, but until the COVID-19 pandemic is over, telemedicine is a great alternative to help us keep all of our kids healthy and recognize when they are truly sick, perhaps even needing immediate medical attention.

Many parents and pediatric providers are getting a crash course in telemedicine because of the COVID-19 pandemic.

Although using virtual visits when kids are sick certainly isn’t a new idea, many things have gotten in the way of making online visits to pediatric offices more popular. Chief among them is the simple fact that most people prefer an in-person, in-office visit.

Telemedicine for Parents and Pediatric Providers

Unfortunately, with the risk of spreading the SARS-CoV-2 virus, even when kids don’t have symptoms, in-office visits aren’t always possible and certainly aren’t always safe anymore.

That doesn’t mean that your pediatric provider is going to close, as other non-essential businesses are doing.

Newborns, infants, children, and teens still need to be seen for essential preventative care and when they are sick.

Be flexible. Consider modifying your clinical schedule and physical space to minimize risk. Increase capacity to deliver telehealth when possible.”

Sally Goza, MD, FAAP President, American Academy of Pediatrics

Still, we are going to have to change how we provide that care until the COVID-19 pandemic is over.

Remember, while it is true that kids aren’t thought to be at risk for severe COVID-19 symptoms, they likely can still get and spread the spreading SARS-CoV-2 virus.

That’s why most pediatric providers are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead moving to phone/virtual consultations.

And with community spread in more and more areas, many are switching to telemedicine visits for any non-essential visit. Is your child due for an ADHD recheck? Do you need to discuss test results or need your pediatrician to look at a rash? Is your child constipated? With the risk of COVID-19, these are all ideal reasons to ask for a telemedicine appointment instead of visiting the office.

“Aetna announced it will offer zero co-pay telemedicine visits nationally for any reason for the next 90 days for all commercial plans. Humana, Blue Cross Blue Shield of Massachusetts, Horizon Blue Cross Blue Shield of New Jersey, and others have announced similar expansions of telehealth coverage.”

Opportunities To Expand Telehealth Use Amid The Coronavirus Pandemic

Before COVID-19, the simple fact that most insurance companies didn’t pay for telemedicine visits got in the way of there becoming more popular. That’s changed now, as have some laws and regulations (especially HIPAA restrictions) that had previously made it harder to do telemedicine.

Making the Most of Your Telemedicine Visit With Your Pediatric Provider

While some parents likely are excited about doing telemedicine visits, since they can be more convenient than visiting the office, many others probably still have doubts.

However you feel about it, since it is likely that your child might need a telemedicine visit before this is all over, let’s look at how we can all make the most of it.

To start, if possible, make the telemedicine visit with your usual pediatric provider or someone else in their office. Sign their telehealth consent form and review other polices and procedures before your online appointment.

It can also help if, just before the visit, you:

  • weigh your child
  • check your child’s temperature
  • check your child’s heart rate or pulse
  • check your child’s respiratory rate (count the breaths per minute)
  • write down all of the medicines your child has been taking
  • write down all of your child’s symptoms, including how long they have had them and if they are getting better or worse
  • write down how your child’s symptoms are affecting their eating, sleeping, and other activities, for example, are they drinking fluids, playful, consolable, or are they just crying all of the time?
  • write down any questions you have, as you might forget them during the telemedicine visit!
  • make sure you have a flashlight handy in case your provider wants to take a look at your child’s throat. Maybe even practice having them open wide before the visit.

And most importantly, understand how you are going to connect to your pediatric provider for the online visit! Are you using Facetime, Skype, or a website like doxy.me, etc?

Telemedicine Do’s and Don’ts

Are you and your child (yes, you want your child to be with you during the telemedicine visit!) ready for your first telemedicine visit with your pediatric provider?

Do have everything ready at home and be prepared for when your pediatric provider “shows up” to the visit.

It is also a good idea that you:

  • don’t use medical terminology, like lethargic (is your child really hard to wake up?), dehydrated (just mention the last time your child urinated, etc.), or say that your child is having trouble breathing (is your child breathing fast and hard or having trouble catching their breath?) – instead, just describe what your child is doing and how they are acting, which, since it is a telemedicine visit, your provider will actually get to see for themselves!
  • don’t say that you can’t control your child’s fever, if what you really mean is that it goes back up after their fever reducer wears off, and remember that fever is typically just a symptom, like a cough or runny nose, and not a sign of how sick your child is
  • don’t ask for or expect a prescription, especially for an antibiotic, just because you had an online visit with your provider. Studies have found high rates of antibiotic prescribing during telemedicine visits, especially for kids with respiratory infections, and that hopefully won’t continue as telehealth becomes more popular.
  • avoid sitting in a dark or noisy room, as that will make it harder for your provider to see and hear you

And at the end of the visit, make sure you understand your child’s diagnosis, recommendations for treatment, and most importantly, don’t forget to ask when you should expect that your child should begin to get better and the signs to look for that might indicate that they are getting worse.

“We recognize we are all practicing pediatrics in circumstances we have never encountered before in our careers.”

Sally Goza, MD, FAAP President, American Academy of Pediatrics

Are there limits to telemedicine?

Sure.

We can’t sew up a cut that needs stitches, for example, but you know what? If your child falls and cuts themselves, we can do a telemedicine visit to let you know if they do need stitches, maybe saving you a visit to the office or the ER.

Ideally, we would continue to see kids in our office when they are sick, but until the COVID-19 pandemic is over, telemedicine is a great alternative to help us keep all of our kids healthy and recognize when they are truly sick, perhaps even needing immediate medical attention.

More on Telemedicine for Parents and Pediatricians

When to Call Your Pediatrician – COVID-19 Edition

As pediatricians encourage kids with cold symptoms to stay home, it becomes important for parents to know when to call their pediatrician.

Parents should always feel that they can call their pediatrician when their kids are sick, but that call might not get you a quick visit now that we are concerned about COVID-19.

Why not?

Folks realize that this doesn't actually include a test for COVID-19, right? They are just going to tell you that you have the symptoms of COVID-19 after you tell them your symptoms. As we all start using telemedicine visits more and more in the next few weeks and months, you are still best off scheduling a video visit with your own health care provider.
Folks realize that this doesn’t actually include a test for COVID-19, right? They are just going to tell you that you have the symptoms of COVID-19 after you tell them your symptoms. As we all start using telemedicine visits more and more in the next few weeks and months, you are still best off scheduling a video visit with your own health care provider.

Although we don’t think that kids typically develop serious COVID-19 symptoms, they probably do still get sick and can be contagious to others.

That makes it important to keep them home if they have any symptoms of COVID-19, which unfortunately, can mimic most of the other viral infections that kids get.

When to Call Your Pediatrician – COVID-19 Edition

As more and more pediatricians limit who they will be seeing in their offices, it becomes even more important that parents learn to recognize when their kids have mild symptoms that can safely be treated at home and when they might have urgent problems that need medical attention.

Many pediatricians are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead providing phone/virtual consultations.
Many pediatricians are encouraging patients with fever and respiratory symptoms (URI, cough, runny nose, difficulty breathing) to stay home and are instead providing phone/virtual consultations.

Fortunately, while many parents have gotten used to running to their pediatrician as soon as their kids have a fever, sore throat, diarrhea, or cough, most of these symptoms are caused by viral infections that go away without treatment.

And parents should understand that their pediatricians are still available! Most of us likely won’t be able to see everyone as quickly and easily as we usually do, but the kids who get triaged to stay at home without being seen will almost certainly be those who don’t need to be seen.

Recognizing the signs of a more serious infection will also help you trust your pediatrician’s judgment on home care so that you don’t rush to an urgent care, where they might not be triaging kids with COVID-19 symptoms and are seeing everyone who comes in.

So how do you know if your child has a mild viral infection or if it is something more serious?

Ultimately, you might need to call your pediatrician, but it might help to know that:

  • fever itself is not a disease and how high a temperature gets doesn’t tell you how sick your child is. Unless you have an infant under 2 months old with a rectal temperature at or above 100.4°F (38°C) – which is always a medical emergency – your otherwise healthy (no chronic medical problems) older child with a fever doesn’t necessarily need treatment or a visit to the doctor, as long as they are drinking and aren’t irritable and aren’t having trouble breathing etc.
  • a sore throat with a runny nose and cough is typically caused by a virus and not strep throat. On the other hand, if your child has the sudden onset of a sore throat and fever, with red and swollen tonsils (tonsillitis), possibly with white patches (exudate) and small, red spots (petechiae) on the roof of their mouth, and tender, swollen lymph glands in their neck, then they might have strep and should have a strep test.
  • the flu, although it can be a life-threatening disease, especially in those who are high risk, typically goes away on its own after 5 to 7 days of fever, runny nose, and cough. Unless they are at high risk for flu complications, kids don’t necessarily need a flu test or Tamiflu, so don’t necessarily need to visit their pediatrician when you think they have the flu.
  • a runny nose, even if it is green or yellow, doesn’t mean that your child has a sinus infection and needs antibiotics, unless the symptoms are lingering for ten or more days or the child has severe symptoms
  • ear pain doesn’t mean that your child has an ear infection and even when your child does, a 2-3 day watching period before starting antibiotics is becoming the standard of care because the great majority of ear infections go away on their own
  • a cough, even if has been lingering for a week or two, doesn’t mean that your child needs antibiotics, as most kids with coughs simply have bronchitis, which will eventually go away
  • diarrhea can be a sign of a food intolerance or an infection, typically a stomach virus. Either way, you can likely treat your child at home, unless your child has high fever and bloody diarrhea or is dehydrated.
  • vomiting, especially when it is accompanied by diarrhea, is also often associated with gastrointestinal infections, and can respond to proper rehydration techniques

Of course, if your child has a chronic disease, like diabetes, asthma, or cystic fibrosis, etc., then even mild symptoms might put them at high risk for serious disease and you shouldn’t hesitate to call your pediatrician any time they get sick.

What are some other “red flag” type things parents should look for? In general, you should seek quick medical attention if your child has viral symptoms and:

  • is truly lethargic, which means that they are hard to wake up and not that they are just sitting on the couch watching Netflix instead of running around the house
  • has vomiting or diarrhea that has led to dehydration – dry mouth, few tears, only urinating a few times a day, etc
  • has vomiting with severe stomach pain
  • is breathing fast and hard, which could be a sign of pneumonia
  • has a fever and a purplish rash
  • is not at all playful or consolable
  • is not eating or drinking anything

On the other hand, even if your child has a fever, runny nose, cough, and sore throat, if they are also sometimes playful and drinking, then you likely have less reason to need an immediate visit to the doctor.

What if it’s COVID-19?

Again, most kids are not at big risk to get severe COVID-19 symptoms, so the main reason to see your pediatrician about COVID-19 would be to get tested to help know if you need to quarantine your child. Unfortunately, as most people are aware, testing is still very limited. Your pediatrician likely does not have the ability to test kids yet.

What about well checks and vaccines and other visits to your pediatrician?For that info, you will have to call your pediatrician.

And see if they are set up to do telemedicine yet.

More on Calling Your Pediatrician – COVID-19 Edition

Mixed Messages About COVID-19

Don’t let mixed messages about COVID-19 leave you confused or get in your way of preparing your family for this new pandemic.

Do you feel like you are getting mixed messages about COVID-19?

Don’t stockpile things, but be prepared.

Don’t wear a mask, but avoid other people so you don’t get sick.

It’s just like a bad flu, but states are declaring states of emergency and countries are restricting travel.

Mixed Messages About COVID-19

Are you confused yet?

Are you wondering why we continue to see new cases?

Have you forgotten that we were warned that SARS-CoV-2 would likely become a pandemic?

“With the inexorable spread of 2019-nCoV, we are again upset about the way officials and reporters are talking about containment. We think it is crucial to try to prepare the public for the very high likelihood that containment WILL FAIL, if what we mean by “containment” is that we might be able to stop a pandemic.”

Risk Communication about Containment – 2019 Novel Coronavirus

Shouldn’t we have been able to stop it if we had warning?

Although ideally we would have contained SARS-CoV-2 before we started to see community spread, the more realistic goal has been slowing down its spread.

Containment measures can help to flatten the curve in a pandemic, buying everyone some more time to get ready.

Slowing down its spread will help prevent everyone from getting sick all at once so that doctors and hospitals don’t get overwhelmed.

Wait, is everyone going to get sick?

That’s probably another thing about COVID-19 that has you confused.

And the answer is almost certainly no.

There likely won’t be constant exponential growth and like many other respiratory diseases, this one will hopefully end at some point.

We shouldn’t expect exponential growth of COVID-19, which means that everyone isn’t going to get it over the next few months.

It is also very important to understand that most of the people who do get sick will have a mild illness.

So if we can’t stop it and most cases are mild, then why are we declaring emergencies, closing schools, and canceling some large community events?

“That this disease has caused severe illness, including illness resulting in death is concerning, especially since it has also shown sustained person-to-person spread in several places.”

Coronavirus Disease 2019 (COVID-19) Situation Summary

It is because we are still learning about this new virus and we already know that it can cause severe, even life-threatening disease, in some people.

Why are we trying to slow down the COVID-19 pandemic?

So what should you do?

“Call your doctor: If you think you have been exposed to COVID-19 and develop a fever and symptoms of respiratory illness, such as cough or difficulty breathing, call your healthcare provider immediately.”

Prevent the spread of COVID-19 if you are sick

Be prepared.

There is a lot of good information out there from the CDC, WHO, and your local and state health department to help you get prepared for COVID-19.

Most importantly, be smart and do all of the common sense things that we always talk about that can help keep you from getting sick, like washing your hands and not touching your eyes, nose, or mouth, etc.

And if you are in a high risk group, or have frequent contact with someone in a high risk group, you should likely be a little extra careful to help reduce your chances of getting COVID-19. That’s when you might take the extra steps of avoiding crowds and limiting contact with others, etc.

“Stay home: People who are mildly ill with COVID-19 are able to isolate at home during their illness. You should restrict activities outside your home, except for getting medical care.”

Prevent the spread of COVID-19 if you are sick

What’s next?

As testing becomes more widely available in the coming days and weeks, you can almost certainly expect to hear about more and more cases in more and more parts of the United States.

Don’t be surprised.

Be prepared.

More on Mixed Messages About COVID-19

Kids and COVID-19

Kids might not be at big risk from COVID-19, but that doesn’t mean that they are immune from stress and anxiety from hearing about it all of the time.

One good piece of news that is easy to pick out from all of the doom and gloom about COVID-19 is that kids don’t really seem to be at extra risk from this new disease.

That’s good news, as kids are often in high risk groups and at extra risk for other infectious diseases, like flu, measles, and RSV.

Kids and COVID-19

So why aren’t kids affected by COVID-19?

“There have been very few reports of the clinical outcomes for children with COVID-19 to date. Limited reports from China suggest that children with confirmed COVID-19 may present with mild symptoms and though severe complications (acute respiratory distress syndrome, septic shock) have been reported, they appear to be uncommon.”

Children and COVID-19

Well, we actually don’t know that kids aren’t affected at all.

Right now, it just seems like they don’t get severe disease.

“Though the evidence to date suggests this virus doesn’t inflict severe disease on children, there’s reason to think kids may be helping to amplify transmission. It’s a role they play to devastating effect during flu season, becoming ill and passing flu viruses on to their parents, grandparents, teachers, and caregivers.”

A critical question in getting a handle on coronavirus: What role do kids play in spreading it?

They could just be getting very mild disease or infection without symptoms.

While that’s certainly reassuring, we can’t ignore the possibility that kids could get and spread the SARS-CoV-2 virus to others in high risk groups, including older people and people with severe chronic health conditions.

“If parents seem overly worried, children’s anxiety may rise. Parents should reassure children that health and school officials are working hard to ensure that people throughout the country stay healthy. However, children also need factual, age appropriate information about the potential seriousness of disease risk and concrete instruction about how to avoid infections and spread of disease.”

Talking to Children About COVID-19 (Coronavirus): A Parent Resource

And we shouldn’t forget that there is one thing that children aren’t immune to right now – anxiety from hearing about COVID-19 all of the time!

More on Kids and COVID-19

What is the COVID-19 Mortality Rate?

Do we know how deadly COVID-19 really is?

Knowing the COVID-19 mortality rate would help folks get a better understanding of just how concerned they should be about this new disease that is quickly spreading around the world.

New modeling from the CDC puts the COVID-19 case fatality rate at 0.1 to 1%.

Unfortunately, the widely different numbers we are hearing might contribute to some of the confusion people already have about the SARS-CoV-2 virus.

What is the COVID-19 Mortality Rate?

In general, the mortality rate for a disease is “the measure of the frequency of occurrence of death in a defined population during a specified interval.”

Defined population?

That’s not how many people have the disease. That’s literally how many people there are in the place you are talking about.

Instead of mortality rate, right now, what we really want to be talking about is the case fatality rate.

“The case-fatality rate is the proportion of persons with a particular condition (cases) who die from that condition. It is a measure of the severity of the condition.”

Mortality Frequency Measures

Still, differences in defining the “population” or cases has lead to differences in reports of case fatality rates from the CDC and WHO.

“There is now a total of 90,893 reported cases of COVID-19 globally, and 3110 deaths.”

WHO Director-General’s opening remarks at the media briefing on COVID-19 – 3 March 2020

The WHO reports a case fatality rate of 3.4% for COVID-19, which they get by simply dividing the 3,110 deaths by the 90,893 reported cases.

“This crude CFR is high: for comparison, the CFR for seasonal influenza is 0.1%. However, as I will show below, this number is not a one-size-fits all, and is influenced by many factors. Please do not look at 3.4% as an indicator of your risk of dying from COVID-19!”

SARS-CoV-2 coronavirus case fatality ratio

The CDC, on the other hand, is using a method that factors in the idea that there are likely many more mild cases that haven’t been officially reported. That gets them a much lower case fatality rate rate of 0.1 to 1%.

Only more testing will get us a more accurate case fatality rate for COVID-19.
Only more testing will get us a more accurate case fatality rate for COVID-19.

Then there is the large study on COVID-19 case fatality rates that did include suspected and asymptomatic cases, Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China. They found an overall case-fatality rate (CFR) of 2.3%.

“Epidemiologists think and quibble in terms of numerators and denominators—which patients were included when fractional estimates were calculated, which weren’t, were those decisions valid—and the results change a lot as a result.”

COVID-19 Isn’t As Deadly As We Think

What do these numbers mean to you?

They might be easier to understand if you compare the case fatality rate of COVID-19 to some other diseases.

DiseaseCase Fatality Rate
Rabies99.9%
H5N1 bird flu60%
Ebola50%
MERS34%
H7N9 bird flu25%
SARS15%
Yellow fever15%
Tetanus13%
Diphtheria5-10%
1918 flu pandemic1-3%
COVID-19*0.1-3%
2009 flu pandemic0.1%
Seasonal flu0.1%
Measles0.1%
A high case fatality rate doesn’t tell the whole story. It is also important to understand how likely it is for a disease to spread and get a lot of people sick. And a reminder that many vaccine preventable diseases are quite deadly!

Fortunately, COVID-19 is near the bottom of the list, and as we get more and more data, it seems like the official case fatality rate will continue to drop.

Still, since it is spreading at pandemic levels, that means a lot of people will get sick and could die, especially those in high risk groups.

Older people and people with severe chronic health conditions are likely at higher risk COVID-19 infections.
Older people and people with severe chronic health conditions are likely at higher risk for COVID-19 infections.

*How many? It’s too early to tell, as we really don’t know what the real COVID-19 case fatality rate is yet.

“Practice everyday preventive behaviors! Stay home when sick. Cover coughs and sneezes. Frequently wash hands with soap and water. Clean frequently touched surfaces.”

Preventing COVID-19 Spread in Communities

That makes it important to take steps to try and slow down the spread of SARS-CoV-2, especially to people who are at high risk.

More on the COVID-19 Fatality Rate