What does distribution of deaths by age tell us about total infections in the US?

2,665 Views | 15 Replies | Last: 5 yr ago by BusterAg
BusterAg
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AG
Check out this distribution of confirmed deaths from the CDC.

All ages - 1,889
Under 1 year - 0
14 years - 1
514 years - 0
1524 years - 0
2534 years - 14
3544 years - 50
4554 years - 113
5564 years - 218
6574 years - 439
7584 years - 526
85 years and over - 528

So, these total numbers are understated by perhaps a factor of five, but the distribution by age should be roughly the same.

In the US, if you don't require hospitalization, you are not going to get tested. Well, about half of America is under 35 years old, and death rates for this demographic approach zero. There are zero reasons why a young person would get infected with this virus at a lower rate than an older person. But, since they are not at risk of dying, none of them are getting tested and turning into a confirmed case.

This means, at worst, our published death rates are overstated by a factor of two. But I think its overstated by a whole lot more than that. If we can miss reporting infections on almost every single person under 25, what does that say about our reporting on people between 35 and 55? Infections in that demographic has to be vastly under reported as well.

If you have a strong immune system, and it doesn't spiral out of control for whatever reason, you are fighting this thing off. There is no other reasonable explanation for the low death rates in under 25. We are MASSIVELY under counting total infections.

What does this do to the prediction models? I'm a little out of my element on this topic, but if your r0 of infections is actually double your assumption, aren't you are missing significantly under-reported exponential growth in total infections? What if it's off by a factor of 3 or 4? My wonder is if this is what all the virology experts realized over the last week or two, and this contributed to the massive revisions downward.
Gump 02
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AG
Under 1 year - 0
14 years - 1
514 years - 0
1524 years - 0
2534 years - 14
3544 years - 50
4554 years - 113
5564 years - 218
6574 years - 439
7584 years - 526

Wow, people in the US are OLD!
Rubble
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AG
How old is that data? There are over 10k deaths now...
Kool
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Antibody testing will be the only thing that gives us a real picture here. Example: my employee's sister is sick with fever, cough, malaise, body aches. She's mid-20s. She is self isolating, with family members bringing her food. She's single and in school, which she's doing online. Perfect situation to hunker down and isolate. My employee asked if she could bring her in to get tested. I offered to do it, but told her there really wasn't much reason to do so. She is doing everything right, and isn't sick enough to need hospitalization. She won't get counted in statistics, but she has the virus and will survive. If the result of a test will not change your management, there really isn't much of a reason to order the test. This, along with poor testing technique and poor test kits, is part of why we see such low positive test rates, especially with some of the early tests. Just my opinion.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
jpistolero02
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My experience was similar to the above post. Had a number of the symptoms and since I was doing a video chat with my doctor, he just told me to stay put as a positive test wouldn't change anything for me. My wife actually had to go in to the clinic and they tested her on the spot and she was positive. I do believe the numbers are way under reported. Luckily, we both had mild cases and didn't require anything other than water and Tylenol from time to time.
BusterAg
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AG
LantanaAg said:

How old is that data? There are over 10k deaths now...
It's based on death certificates, so it is trickling in. It's not that the data is old, it just takes a while to report it.

That said, every piece of data I have seen supports the fact that people below 25 do not get the disease even if infected, and people 25 to 35 are usually OK as well.

The difference is DRAMATIC.

More links:

https://www.vox.com/2020/3/23/21190033/coronavirus-covid-19-deaths-by-age

https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/ (here is just death rates of confirmed cases by age. Confirmed cases by age is, as discussed very low for kids).

https://www.ncbi.nlm.nih.gov/pubmed/32214079 In China, exactly one death by a person under 18 through March 16.

https://www.statista.com/chart/21173/hospitalization-icu-admission-and-fatality-rates-for-reported-coronavirus-cases/ On March 19, no young hospitalizations so far.

https://www.cdc.gov/mmwr/volumes/69/wr/pdfs/mm6912e2-H.pdf In this paper, CDC lumps 20 - 44 year olds together, which make the data worse. Kind of sneaky, IMO.

The point I am making here is that, by ignoring the fact that a large demographic group is not being counted, we are likely under counting the entire population of infections. I think that the media's practice of grouping 20 year olds with 44 year olds is unhelpful. No other age demographic has that large of a band.
Kool
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AG
Good for you, and for your doctor.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
BusterAg
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AG
Kool said:

Antibody testing will be the only thing that gives us a real picture here. Example: my employee's sister is sick with fever, cough, malaise, body aches. She's mid-20s. She is self isolating, with family members bringing her food. She's single and in school, which she's doing online. Perfect situation to hunker down and isolate. My employee asked if she could bring her in to get tested. I offered to do it, but told her there really wasn't much reason to do so. She is doing everything right, and isn't sick enough to need hospitalization. She won't get counted in statistics, but she has the virus and will survive. If the result of a test will not change your management, there really isn't much of a reason to order the test. This, along with poor testing technique and poor test kits, is part of why we see such low positive test rates, especially with some of the early tests. Just my opinion.
Thanks Kool, good post.

The bolded part here is true for the individual. But, from a national policy perspective, the implications here need to be seriously considered.
Kool
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AG
I agree. However, a better test is needed. And a nasopharyngeal, nasal, or oral swab is going to have a lot of false negatives. And it won't tell us how many people are asymptomatic carriers, how many have convalesced, etc. That is why I'm hopeful about the antibody testing.

As a bit of an aside, I was listening to the radio this am and there was discussion about having an MLB game played in an empty stadium with electronic home plate pitch calls (no umpire). All players would need to be tested prior to being allowed to play in the game. If it is an antibody test, this would be a really interesting look into the prevalence of current and prior exposure in a very healthy population.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. See full Medical Disclaimer.
Chetos
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AG
Good theory for estimating unreported. Assuming that they are impacted worse and thus more likely reported, Use the older age brackets as the likely infection rate proxy by extrapolating for remaining population . You'll need up to date infection numbers and census numbers by age bracket . The problem with this is you probably don't have infection numbers by age. You'd still have to make a fatality rate assumption for the older brackets
zachsccr
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AG
My question is, would the number of elderly patients be more likely to be more underestimated? I know testing now might be more uniform, but 2-3 weeks ago a 70yr old with COPD and CHF might not have triggered a test but a 40 yr old with fewer to no co-morbidities coming in would have raised more COVID flags? I know there's no great answer, just wondering if we may have missed proportionally more elderly patients earlier vs young patients.
Sid Farkas
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AG
OP might want to click edit and hit the hyphen key a few times
Zobel
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AG
Check out figure 2 of this paper.

https://www.nature.com/articles/s41591-020-0822-7.pdf
Whitetail
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AG

All ages - 1,889
Under 1 year - 0
1-4 years - 1
5-14 years - 0
15-24 years - 0
25-34 years - 14
35-44 years - 50
45-54 years - 113
55-64 years - 218
65-74 years - 439
75-84 years - 526
85 years and over - 528

Missing a dash guys.
Keegan99
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AG
If those under 25 are difficult to infect, this would also explain how on an aircraft carrier with a crew of 6,000+ there were only about 160 positives.

(And the Navy tested 3,000+, so they didn't miss asymptomatic or paucisymptomatic positives.)
Zobel
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AG
They might have. It's not clear whether or not the PCR test works the same for asymptomatic carriers. In fact if I recall I saw a study out of China that followed up with close contacts of known cases and checked for antibodies, and found that the other test missed people. I'd be super curious what an antibody test of the TR would show...
BusterAg
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AG
k2aggie07 said:

Check out figure 2 of this paper.

https://www.nature.com/articles/s41591-020-0822-7.pdf



This was an interesting read. I like the idea of using cruise ship data as a way to consider Inputs. But the paper focused on cases that showed significant symptoms. The paper even admitted that finding data about infected people with low to no symptoms is tough, even though those people might be carrier's.

If this virus is spreading by people that are not getting too sick, we are going to see herd immunity impacts very soon.
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