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Your boss, the head of the WHO, put out a mortality rate number yesterday
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that had us all gasping frankly.
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3.4% mortality.
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I would say that number is way under 1%.
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Unlike Italy where the mortality rate is around 10%, the rate in the US
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is closer to 1.5%.
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In China, there's different numbers.
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So why are Covid-19 fatality rates so varied?
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Well, firstly, there's not just one rate.
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There's one that helps you understand an outbreak.
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And then there's two more, which will tell you the risk of dying.
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Let's take a look at how they work.
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During the outbreak of a new disease, you likely only know that some people have
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been infected and some of those people have sadly died.
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If 10 people have been infected and one infection has ended in fatality,
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is tempting to conclude that this illness has a fatality rate of 1 in 10 or 10%.
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But that's not accurate.
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The problem is that there's a time lag between when someone gets infected and
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when they either recover or succumb to the illness.
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To get a more accurate number, you should only count those cases
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that have resolved.
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In this example, five infections have resolved so by excluding unresolved cases,
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as we should, our fatality rate has risen to 20%.
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This is a useful number.
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It's the case fatality rate.
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It's the number that you've probably been hearing the most.
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This number helps to guide our response.
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We can separate big populations into smaller groups
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and discover which are most vulnerable.
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And we can also see how effective different treatments are.
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Definitely helpful things to know.
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So is this number the risk of dying too?
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No.
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Remember, there are two other fatality rates for that,
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But we can't get to them just yet.
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Why?
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Well especially early on in an outbreak we're still missing lots of information.
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We definitely haven't counted all infected people.
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We're missing those that have not been tested.
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Perhaps, because of a shortage of tests.
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We're missing those that didn't seek medical attention
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and we're missing asymptomatic cases.
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If we found lots of these cases, it would bring our fatality rate down.
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But early on, we just can't be sure about how big these groups are.
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Counting fatalities seems simpler.
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But it's not.
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If a person with another serious condition gets infected and then dies,
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is that a fatality from the infection or from the condition?
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Or both?
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Fatalities can be undercounted too.
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In some places, Covid-19 fatality counts have initially only included those
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within the Health System,
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with delays in counting fatalities in people's homes and care homes.
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So when the count eventually catches up the fatality rate will rise.
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So over time, as we fill in the gaps in our knowledge,
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our case fatality rate will get closer to the number we probably want to know:
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the risk of dying.
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but our case fatality rate will never get us completely there.
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Why?
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Because by definition we're only counting known cases.
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We could be missing loads of hidden infections.
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These guys.
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To try to fill in these gaps and tell us our risk of dying we can turn to our last two rates.
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There's the Infection Fatality Rate.
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It tells us the risk of dying if you get infected.
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This is achieved by randomly testing a group of people.
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This then picks up every case,
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giving us a truer representation of the number of infections.
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And subsequently, what share ended with a fatality.
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Then there's the Crude Mortality Rate.
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That tells us the risk of dying relative to the whole population.
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Or put another way, what portion of the population has died from this disease.
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But because we don't know how many people will end up being infected.
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We won't know this figure until the disease has run its course.
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So, we have three types of fatality rate:
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two that give us a risk of dying for those infected and whole populations.
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And a third that, though dealing with partial information, is incredibly useful
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for understanding of disease and understanding which treatments are most effective.
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Knowing what these numbers are for and what information they're based on
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means that we can use them more effectively.