Submitted by Taps Coogan on the 4th of January 2020 to The Sounding Line.

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As of February 3rd, 2020, 20,428 cases of the Wuhan Coronavirus have been officially confirmed in mainland China. Another 210 cases have been confirmed outside of mainland China. The number of newly confirmed cases continues to rise everyday, although the daily growth rate has slowed from a peak of 63.5% on January 27th to 18.6% per day as of today.

One of the odd aspects of this outbreak is the discrepancy between the infection and fatality rates seen outside of mainland China and the rates seen within mainland China. One study, which looked at the percent of people leaving China who were found to be infected in other countries, concluded that there were perhaps 100,000 people in mainland China who were already infected. Furthermore, the fatality rate inside China remains above 2% while the fatality rate outside China is ‘just’ 0.9% (two out of 210 cases).

These discrepancies have led to widespread suspicions that the Chinese authorities are intentionally under-reporting the infection rate and possibly also the fatality rate. While this is entirely possible (we have been routine critics of Chinese government statistics and policies), all reporting suggests that Chinese medical authorities simply don’t have sufficient test kits to test everyone that presents with flu/pneumonia like symptoms.

To put the problem in perspective, approximately 80,000 Americans died of the seasonal flu (or complications arising from the flu) during the 2017/2018 winter season. An estimated 45 million Americans were infected. The current flu season is on pace to be even worse. China, which has 4.3 times as many people as the US, may have nearly 350,000 deaths and roughly 190 million seasonal flu cases this year. It is safe to assume that every single one of those people will worry that they have the Coronavirus. How many will want to be tested? 50 million? 100 million? 190 million?

In such a situation, Chinese healthcare providers must prioritize the limited supply of Coronavirus test kits for those who appear to be the most sick, not those with mild symptoms and not those who have already died. Widespread reports about Chinese authorities failing to test suspected cases and fatalities are probably less nefarious than they are being portrayed as. It’s likely a result of triage.

The bad news is that official statistics are likely telling a very incomplete story about the scale of the outbreak within China. The good news, if it can be called that, is that the true fatality rate may be meaningfully lower than 2%. If China is indeed testing the sickest people first, the current 2% fatality rate represents the fatality rate among the sickest cases, not the overall population of infected individuals.

Outside of China, where there is a more manageable number of cases to test, the fatality rate is currently 0.9%. That number is based on a very small sample size of two deaths out of 210 infections. Both of those fatalities reportedly involved significant pre-existing conditions. Time will tell whether the fatality rate outside of China rises or falls.

As a point of comparison, the fatality rate of the seasonal flu is roughly 0.01%, though in recent years it may have been higher than 0.1%. The fatality rate of Swine flu is reportedly 0.02%, though it may also be higher. The fatality rate of the Spanish flu, perhaps the deadliest pandemic in human history, was somewhere between 10% and 20%. The fatality rate of SARS and MERS were 10% and 34% respectively. The true fatality rate of this new Coronavirus is yet to be determined with any meaningful confidence. However, the discrepancies in statistics inside and outside China may mean that the rate is meaningfully less than the currently reported 2%.

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