- A lack of adequate testing means many of those who have been infected with the coronavirus will not appear in official statistics.
- This suggests that many estimates for its mortality rate are much too high.
- We need to build better systems for sharing and reporting data.
Public health epidemiology is the science of counting to prevent disease and promote health. We count the number of new cases of a particular disease; this is the incidence. Then we count how much a disease has spread in a population; this is the prevalence.
When it comes to COVID-19, counting is a challenge. Despite all the news articles and reports, we know very little about the incidence or prevalence of this new disease. And as is always the case: ignorance breeds fear. In my hometown of New York City and elsewhere one fear is on just about everyone’s mind: death rates here appear to be considerably higher than rates reported elsewhere.
Or are they? Using patient data from China, public health officials initially estimated that 80% of COVID-19 cases are either asymptomatic or have mild disease. Given that hospital beds, health workers, and test kits are in short supply, only highly symptomatic people are advised to go to the hospital. Because of lack of adequate testing, including in the United States, in many places only hospital patients are now counted as cases. The people who do not feel seriously ill stay home, recover quietly, and are never counted. This matters because they do not appear in any of the official statistics.
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