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Determining COVID-19’s lethality muddied by politics

Click to play video 'Why we don’t know the true death rate for COVID-19' Why we don’t know the true death rate for COVID-19
WATCH ABOVE: Why we don't know the true death rate for COVID-19

COVID-19’s lethality was always going to be a question for epidemiologists. But six months after the deadly coronavirus first gained international attention, politics has muddied the answer.

The two main agencies tracking the virus, the Centers for Disease Control and the World Health Organization, have access to the same raw data, yet disagree on the interpretation for determining the IFR, or infection fatality rate. To calculate IFR, scientists consider not only known infections, but also computer modelling to estimate undiagnosed and asymptomatic cases.

“We won’t know the true fatality of this disease until it is all said and done,” says University of Ottawa epidemiologist Dr. Raywat Deonandan.

In January, the WHO predicted COVID-19’s IFR would be 3.4 per cent, meaning three or four people out of every 100 infected would die. By comparison, the Spanish flu, which resulted in an estimated 50 million dead, had an IFR of two per cent.

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But with months of updated COVID-19 statistics to consider, the CDC and WHO have released new estimates, with the CDC putting COVID-19’s IFR at .65 per cent, much lower than the WHO’s prediction of one per cent.

“(One per cent) doesn’t sound like a big number,” says Deonandan. “That’s a big number. So a pretty bad case of the flu would give us an IFR about .1 per cent, so .5 per cent is five times bigger than that. And when you scale this up to the population levels, we’re looking at hundreds of thousands of people dead, as we know now. So this is a deadly disease.”

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But those aren’t the only numbers being used to fill the COVID-19 narrative, much to the dismay of the top infectious disease expert in the U.S. Dr. Anthony Fauci appeared exasperated when asked by reporters about the factually incorrect White House claim that the U.S. death rate was inflated because the U.S. tested more than other countries.

The U.S. (155,000 tests per million) has tested fewer people per million than Russia (178,000), the U.K. (205,000) and Israel (166,000), among others, according to the website Worldometer. Canada has tested 97,000 per million.

Click to play video 'Coronavirus: Parts of the U.S. approaching more grim milestones as COVID-19 numbers climb' Coronavirus: Parts of the U.S. approaching more grim milestones as COVID-19 numbers climb
Coronavirus: Parts of the U.S. approaching more grim milestones as COVID-19 numbers climb

“It’s a false narrative to get caught up in lower death rates,” says Fauci.

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Another metric used is the case fatality rate (CFR), which is the proportion of people who die from a disease compared to the total number of people diagnosed. But epidemiologists say the CFR can be misleading if a country either tests too much or too little. The quality of health care is also a factor.

And then there’s deaths per million, a metric that relies entirely on how diligent a specific country is in reporting deaths. Based on numbers compiled by Worldometer, Belgium is far and away the worst country for COVID-19 deaths with 846 per million, followed by the U.K. (669) and Spain (608). The U.S. (435) and Canada (235) are further down the list.

But it’s the comparison with India that shows how flawed “deaths per million” truly is. While India has the third most cases in the world, it has only reported 21 deaths per million.

Read more: Mexico’s president dismissive of wearing mask as coronavirus cases climb

“I think the comparisons across countries can be problematic in the sense that nobody wants to be the worst-performing country,” says epidemiologist Ashleigh Tuite. “And so there is potentially a desire to not necessarily count things very well and not be the country who has the most deaths.”

India’s death registration system has been overwhelmed with the pandemic. Only those who previously tested positive for COVID-19 are included in the death toll. By contrast, authorities in Belgium have been criticized for being far too liberal in how they count the number of people who die as a result of the virus, leading to the country’s tourism minister to publicly worry that they were scaring off future tourists.

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“But then (Belgium) became a news story,” says Tuite, “because why did they have such high fatality in their population? And so there’s certainly a bit of a disincentive to count and count well. And so I think transparency, particularly during a pandemic, is incredibly important. But there are absolutely disincentives to being transparent because you can be held up for criticism.”

There have been over 15.5 million COVID-19 cases reported in the world so far with over 630,000 deaths, both of which continue to rise.

Click to play video 'Coronavirus: Parts of the U.S. approaching more grim milestones as COVID-19 numbers climb' Coronavirus: Parts of the U.S. approaching more grim milestones as COVID-19 numbers climb
Coronavirus: Parts of the U.S. approaching more grim milestones as COVID-19 numbers climb