#15,199
As we discussed last week in When Studies Collide (COVID-19 Edition), we continue to see a lot of incomplete, and frequently conflicting, information coming out about the spread of our novel coronavirus.
Some of this is to be expected, because our existing surveillance systems aren't designed to track a novel pandemic in real time. There are also some countries who are either unable, or unwilling, to share reliable information.
So we have to take all numbers - official or otherwise - with a hefty grain of salt.The two million `official' cases reported worldwide is likely off by a factor of 10 or more, while the number of deaths is also badly undercounted. Just as with seasonal influenza (see Why Flu Fatality Numbers Are So Hard To Determine), it is unrealistic to expect an accurate count of cases, and/or deaths, from COVID-19.
But slowly, we are beginning to see more realistic numbers starting to emerge on the attack rate, and mortality, of COVID-19.This week New York State began reporting `probable' deaths from COVID-19, along side lab confirmed deaths, after NYC reported a 400% increase in sudden cardiac arrest deaths since late March (see NBC affiliate Massive Spike in NYC ‘Cardiac Arrest’ Deaths Seen as Sign of COVID-19 Undercounting).
We've seen similar reports from other states, and from other countries, where thousands of `at home' or nursing home deaths have gone uncounted.Recent studies have shown a high degree of neurological manifestations and cardiovascular problems with COVID-19 infection, likely resulting in increased strokes and heart attacks, so it is probable that COVID-19 related deaths will continue to be undercounted.
All of which brings us to two reports from the Netherlands' National Institute for Public Health - RIVM, the first of which looks at the undercounting of deaths from COVID-19.
A second report, this time from the media, describes comments made by RIVM director Jaap van Dissel today during a technical briefing in the House of Representatives. As of today, the Netherlands (pop 17 million) has reported just over 28,000 cases and 3,143 deaths from COVID-19. Mortality from the new Coronavirus
Publication date 04/10/2020 | 13:44
The actual number of people dying in the Netherlands from the consequences of the new coronavirus is higher than the reported numbers published daily by the RIVM National Institute for Public Health and the Environment . The picture that the figures give about the distribution of mortality by, for example, age, gender and region, does agree. This is evident from an analysis of the RIVM and CBS Central Bureau of Statistics , based on monitoring mortality in the Netherlands. This makes it particularly clear how important it is that people continue to adhere to the measures.
Normally, there are between 2,694 and 3,002 deaths per week this time of year. The most recent mortality rates in the Netherlands show that a total of 4,718 people died in the week of March 26 to April 1, 2020. That means that an estimated 1,716 to 2,024 more people died than expected this week. This number is approximately two times higher than the deaths reported to RIVM National Institute for Public Health and the Environment by COVID-19 in the same week.
Not all people who die in the Netherlands have been tested for COVID-19. The actual number of people dying in the Netherlands from the consequences of the new coronavirus is higher. By looking at the total number of deaths per week as reported to the CBS Central Bureau of Statistics - so regardless of the cause of death - creates a more complete picture of the situation in the Netherlands.
Age, gender and region
Mortality was greatly increased in the age groups 54-64 years, 65-74 years and 75 years and older. Nearly two-thirds of the deceased COVID-19 patients reported to RIVM are men. The fact that more men die is also reflected in the total mortality figures.
Mortality was strongly increased in certain regions. This concerns the regions of Zeeland / North Brabant / Limburg, Overijssel / Flevoland / Gelderland and Utrecht / North Holland / South Holland. Statistics from Statistics Netherlands also show that mortality is increasing in, for example, North Holland, South Holland and Gelderland.
Registration of causes of death
A significant part of the excess mortality is expected to be related to COVID-19. It is not yet clear which part that is. This can only be deduced later from the cause of death registrations.
RIVM: About 3 percent of Dutch people have antibodies against coronavirus
April 16, 2020 10:05 AMLast update: 7 minutes ago
About 3 percent of the Dutch have developed an antibody against the coronavirus. According to a yet to be published study among blood donors, RIVM boss Jaap van Dissel reports Thursday during a hearing in the House of Representatives.
This is an investigation by Sanquin Blood Supply. The organization looked at the proportion of Dutch plasma and blood donors that have developed antibodies against the virus.
From a number of people tested, the researchers know from previous sampling that they were not yet infected with the coronavirus. It is still being determined whether the persons all have a memory of the infection. The organization started the investigation at the end of March .(SNIP)
Individuals who have recovered from the coronavirus have "some degree of immunity," said the RIVM chief. He repeated his previous suspicion that not everyone who has had the virus is immune.
(Continue . . . )
This data is preliminary, has yet to be published, and we don't have specifics regarding the number of blood samples tested, or the sensitivity and specificity of the antibody tests used. At best this is a snapshot in time, from a single location in Northern Europe, which may or may not reflect the bigger picture.
While the probative value of these reports is limited, if we can get enough `snapshots' of data from other locations, we can start to generate a more complete picture of how COVID-19 is spreading through populations around the globe.
This data is preliminary, has yet to be published, and we don't have specifics regarding the number of blood samples tested, or the sensitivity and specificity of the antibody tests used. At best this is a snapshot in time, from a single location in Northern Europe, which may or may not reflect the bigger picture.
With those caveats in mind, the RIVM Director indicated that the level of antibodies detected varied widely by age groups, with 18-20 year old's showing the highest antibody levels (n=3.6%), while antibody levels taken from older donors declined with age.If these numbers end up being reasonably representative of the Netherlands as a whole, then 97% of the population have yet to be infected, which puts any prospects of `herd immunity' a long way off. It would also suggest that `official' surveillance is only capturing about 1 in 18 infections.
While the probative value of these reports is limited, if we can get enough `snapshots' of data from other locations, we can start to generate a more complete picture of how COVID-19 is spreading through populations around the globe.
