Coronavirus testing, data, and fatality rate with Dr. Kirk Parsley.
- Current coronavirus data are biased toward the very sick, so the case fatality rate may be inaccurately high.
- The risk from coronavirus death may not be much more than the risk from seasonal influenza.
- A science-based approach to policy is preferable to a fear-based approach.
Is coronavirus risk as high as the media and government are making it out to be? I recently met with Dr. Kirk Parsley, to discuss coronavirus data, and what conclusions we can make. He thinks the data suggest we don’t need to be as concerned as we have been.
He also outlines a very thought provoking hypothesis, which is that there might be an upper limit in terms of how many people are susceptible to death from any kind of sickness in a population at any given time.
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In This Episode
Dr. Kirk Parsely’s Background … 00:05:29
How Do We Move Forward with COVID-19? … 00:07:25
Case Fatality Rate & Data Bias … 00:11:20
COVID Politics & Choosing A Direction … 00:15:57
Information & Fear … 00:18:59
Mask Effectiveness … 00:25:22
COVID Death Data & Test Data Challenges … 00:30:21
Relative Risk: COVID vs. Flu … 00:40:17
Herd Immunity … 00:49:12
Vaccine … 1:00:35
Coronavirus Testing … 1:04:08
How Do We Move Forward with COVID-19?
I’m sure we’re all in agreement that we needed to flatten the coronavirus curve so as not to overwhelm hospital capacity. But what does the long-term road from here look like? Are we going to try to mitigate until we have a viable treatment or coronavirus vaccine, or are we going to go fully in the other direction? What is the best path to take?
Dr. Parsley acknowledged that even though we really don’t know yet, “At the end of the day, regardless of what anybody’s calculations are, we’re going to have to expose most of the population to this. There’s really no way around that.”
“So I think the way ahead that makes the most sense is we need to protect the vulnerable and susceptible, which isn’t as severe as a lot of people think it is…at some point, we need to rise above that and we need to…put our toe in the deep end of the pool and…ease in there.”
Case Fatality Rate & Data Bias
One of the biggest challenges we face in making decisions about coronavirus is the lack of clear data. One of the least clear data points is the true case fatality rate (CFR). We don’t really know how many people are dying from COVID-19 compared to those who died with COVID-19, and we don’t know the true number of coronavirus infections. Dr. Parsley said, “If we’re only looking at people who are very, very sick going to the hospital and being tested, that’s a biased sample…So it throws off the math.”
And who is and isn’t getting tested is also influencing the data. “Anybody who is a positive case got tested for a reason. There’s a selection bias to that. And that selection bias could be that they were really sick. It could be that they were healthcare workers, it could be that maybe they were in a particularly vulnerable population, like in a retirement home…”
Dr. Parsley says that the challenge is, “If you test everybody in America, that data becomes useless because you’ve never tested everybody in America for anything else.”
What we really need to know is the case fatality rate, but until we have larger data sets and more widespread coronavirus testing, the data aren’t going to truly reflect the risk. So how else can we consider risk?
Relative Risk: COVID-19 vs. Flu
Dr. Parsley suggested there are a lot of possible risks in life, so how do we assess whether COVID-19 is risky enough to warrant what we’re doing? “I think one of the things…is giving people relative risk data. How does this compare to XYZ?”
“The question is, is it dangerous enough to do what we’re doing? I think the answer to that is pretty clearly no.”
Dr. Parsley has been comparing seasonal flu data with coronavirus data, and thinks that the number of deaths will be within the statistical average for a bad flu year when all is said and done. ‘If we’re going to compare it to other influenza-like illnesses, in 2017-18, we had a really bad flu season and we had 61,000 deaths.”
He commented on his perception of the risk of cases and deaths if you’re fairly young and healthy: “I think that the data is very suggestive that this is not going to be some astronomically different death toll than what we’ve seen before.”
He also suggested that there might be an upper limit as to how many people die, because there are only so many susceptible people in the population who might die from a virus, like influenza virus or coronavirus, during any year.
He encouraged us to study the sources of data ourselves:
COVID-19 Politics & Choosing a Direction
Dr. Parsley: “I just think [the media] have done a bad job of presenting people with information that doesn’t lead to fear and excess risk. How you communicate risk is very important. I think we can all get behind a direction and go in that direction rather than what it feels like is happening: no one wants to be culpable for people dying or people losing their jobs. So they’re trying to kind of tow the middle line. And I’m not sure if that’s the best approach.”
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There’s a lot of debate about face masks and whether they are an effective method for coronavirus infection prevention.
Dr. Parsley shared a little metaphor about viral size: “If you enlarge the virus to the size of a marble, the smallest hole you could see on your mask would be 83 feet in diameter.” He cited a research study that was done in Korea, comparing viral transmission with no mask, a surgical mask, and an N-95 mask. Interestingly, there was no difference whether you had a mask on or not.
But Dr. Parsley admitted that a mask is “definitely better than nothing if you’re trying to reduce the absolute distance any person could spread [infection].” He added, “I just think that if we’re going to set policies, there needs to be scientifically based logic behind them.”
Dr. Parsley said that scientists seem optimistic about finding a coronavirus vaccine, but that we don’t really know if we’ll truly be able to develop one. But he also gave the caveat that “we really can’t just sit around and wait for that to happen. And even if it came out in two to three weeks, you still have to inoculate everybody.”
Dr. Parsley thinks the biggest benefit of coronavirus testing is to use it to do research to understand the patterns of getting infected with the virus, so we can learn more about how to effectively slow or stop the spread of the virus. “But the biggest benefit overall is that with more testing, we’ll have a better idea of how many people have it.”
The Bottom Line
According to Dr. Parsley, the threat of coronavirus may be overestimated, and we need to find ways to be clear about the relative risks of being infected. Accurate use of data will be one of our biggest assets.
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