US CoVid-19 Data/ Analysis/ Response

Benjamin Craig – May 2nd

 Objective
• To analyze data from a host of sources to determine the current
health, economic, and societal impact to the on-going CoVid-19
pandemic and the US response to the crisis.
• To put CoVid-19 in context to other causes of death and risk.
• To try and estimate the cost-benefit to the shutdown for various
assumptions.
• To make a societal and legal case for re-opening as quickly as possible.
 Topics to Discuss
• Cumulative Death Statistics by Below Certain Ages
• Herd Immunity Estimates
• Serological Studies and Implications to Population Death Rate
• CoVid-19 Population Death Rate Compared to Leading Causes of Death
• Mortality Rate Estimates by Age
• Comparisons to 2017-2018 Flu Season (Worst of the 2010s)
• Quality Adjusted Life Years Analysis Across Various Outcomes
• Hidden Costs of the Shutdown on Health and Well-being (Coming Soon)
• Hidden Costs of Shutdown on the Economy (Coming Soon)
• Legal Impacts of Shutdowns and the “New Normal” (Coming Soon)
 CoVid-19 Cumulative Deaths by Age
100.00%
(***Needs Update***)
90.00% ***May 2nd Update:
80.00% These cumulative
70.00% percentages should still be
Chance of Death

60.00% valid assuming the age vs

50.00% mortality characteristics
40.00% are not changing over
30.00% time***
20.00%

10.00%

0.00%
4 14 24 34 44 54 64 74 84 If you are below THIS age
110
Series1 0.01% 0.02% 0.12% 0.92% 2.96% 8.43% 21.54% 43.76% 71.51%
Then THIS is your
100.00%
Age Under
chance of death (If
• CoVid19 has current killed about 49,000 Americans out of 328,000,000 total population. This is tested positive – April
0.015% of Americans. [Update May 2nd: 65605 total deaths → 0.02% Overall Population Death 21st)
Rate]
• Above shows the percentage of these deaths under certain ages. As one can see, death below
age 40 is EXCEEDINGLY RARE! [Source: https://data.cdc.gov/NCHS/Provisional-COVID-19-
Death-Counts-by-Sex-Age-and-S/9bhg-hcku ].
 Herd Immunity Concept
• Here is a link to a wonderful John Hopkins Explanation of herd immunity:
https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-
covid19.html
• Note that they claim that the death rate is 10x the common flu. The next slide
tries to show that this is a gross over-estimate based on initial serological studies.
• Herd Immunity is natural and, in the end, what will end up stopping this virus
before we have a vaccine. The vaccine will take AT LEAST 18 months to develop
and deploy. Herd immunity is typically achieved when the following equation is
satisfied
𝑅0 − 1
%𝐼𝑛𝑓𝑒𝑐𝑡𝑒𝑑 > [Source: https://academic.oup.com/cid/article/52/7/911/299077]
𝑅0

• For CoVid-19, it is cited that the R0 is about 5.7 (95%CI: 3.8 – 8.9) (Source:
https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article).
• This means a herd immunity % range of 55% to 89% based on the above
equation.
 CoVid-19 Population Death Rates and
Serology
• Original Estimates of death rate was 2-4%. This was based on #death/#cases calculation.
This is a MAJOR OVER-ESTIMATE of the real death rate.
• Below shows several Serological studies that have been conducted. All-in-all, the real
population death rate is somewhere between 0.08% and 0.76% (Discounting the
Diamond Cruise ship data, see note below).
• It is then expected that anywhere between 210,000 and 2,000,000 will die in the US by
the time herd immunity is reached. This assumes that we DO NOT protect our elderly
and at-risk groups until treatments/ vaccines are developed. This is the worse case range.
• Considering current estimates of prevalence, we are looking at an estimated 613,000
total deaths (564,000 more deaths) before we reach herd immunity if no effective
treatments or vaccines are found.
Number Population Prevalance Population Death
Study Deaths in Total Real Cases Estimated
Cite of Cases Rate Rate Rate
Source Link Populat Affected
Number in
ion Region
Region Low Ave High Low Ave High Low Ave High
Santa Clara CA 1 https://www.medrxiv.org/content/10.1101/2020.04.14.20062463v1.full.pdf 3300 1946 88 2.49% 3.33% 4.16% 78152.6104 62465.728 46778.8462 0.11% 0.15% 0.19%
NYC 2 https://www.medpagetoday.com/infectiousdisease/covid19/85965 210 139,385 10,657 10.00% 1393850 0.76%
Germany 3 500 0.37%
https://www.land.nrw/sites/default/files/asset/document/zwischenergebnis_covid19_case_study_gangelt_0.pdf
Los Angeles 4 https://news.usc.edu/168987/antibody-testing-results-covid-19-infections-los-angeles-county/ 7994 663 2.80% 4.20% 5.60% 832700 628310 423920 0.08% 0.12% 0.16%
Princess Diamond Cruise* 5 https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.12.2000256 3711 301 8.11% 0.38% 1.99% 3.60%

*Diamond Cruise ship data is suspect due to mean age of 58. As one can see from previous slide, this HEAVILY skews case death rate and thus population death rate
 CoVid-19 Death Rate Compared to Other
Causes
• Below shows Covid-19 Population death rate compared to other causes (2017
data, source: https://www.iii.org/fact-statistic/facts-statistics-mortality-risk)
• CoVid-19 was the 8th most common cause of death in the US as of April 30th)
Population Death Rate – CoVid-19 vs 2020 Flu
• Below shows the population death rates for CoVid-19 and 2020 Influenza (YtD) on a log scale
(Source: https://www.cdc.gov/flu/about/burden/2017-2018.htm and
https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku)
• One can immediately see that as age increases, the mortality ratio increases. This is due to a few
factors including CoVid-19 being novel, 2020 being a below average flu year, and CoVid-19 being
overall deadlier.
Population Death Rates

Age CoVid-19 Influenza Ratio

2.5 0.0002% 0.0002% 1.10

9.5 0.0001% 0.0001% 1.00

19.5 0.0004% 0.0001% 3.80

29.5 0.0013% 0.0003% 4.60

39.5 0.0034% 0.0005% 6.77

49.5 0.0088% 0.0012% 7.13

59.5 0.0237% 0.0025% 9.33

69.5 0.0564% 0.0042% 13.58

79.5 0.1459% 0.0085% 17.27

89.5 0.4024% 0.0185% 21.80

 Mortality (Among all Causes of Death)
• Below shows chances of CoVid-19 or Pneumonia death amongst all causes of death year to date 2020. If you
have died in 2020 before April 30th, this is the chance the death was from CoVid-19 or Pneumonia by age.
This graph was made by taking #CoVid-19/#Total YtD and #Pneumonia/#Total YtD
• Source: https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku

Overall Chance of Death out of All Possible Causes (April 30th 2020)
12.0%

10.0%
Chance of Death

8.0%

6.0%

4.0%

2.0%

0.0%
0 10 20 30 40 50 60 70 80 90
Age [Years]

Chance of CoVid Being Cause of Death (Out of All Possible Causes) Chance of Pneumonia Being Cause of Death (Out of All Possible Causes)
 Mortality (Absolute - if Infected)
• Below shows the absolute chances of death from CoVid-19 and Pneumonia combined as a function of age assuming two different
population infection death rates (0.08% as a low-end from LA County study and 0.76% from NYC study, See Serology slide).
• Note that the CDC tallies the following causes of death: All causes, CoVid-19, Pneumonia, and Pneumonia with CoVid-19. This
graph corrects for double counting by adding CoVid-19 and Pneumonia deaths and subtracting Pneumonia with CoVid-19.
• Source: https://data.cdc.gov/NCHS/Provisional-COVID-19-Death-Counts-by-Sex-Age-and-S/9bhg-hcku
 Comparisons to 2017-2018 Seasonal Flu
• Below Shows the overall death rate if infected by age during the 2017-2018 flu season. Overall death rate was 0.136% with
61,000 total deaths in America (Source: https://www.cdc.gov/flu/about/burden/2017-2018.htm).
• Also below is a overlay of the cumulative chance of death by age for CoVid-19 and the 2017-2018 Flu season. Note that
the age distribution of each are quite corelated. This suggests that the two viruses are affecting each age group similarly.
• According to this data and the serological data, CoVid-19 seems to be currently half as deadly to 5.6 times more deadly
than the worse flu of the 2010s (Source: https://www.cdc.gov/flu/about/burden/past-seasons.html). This ratio is expected
increase as we ride down the tail of wave one of CoVid-19.

Chance of Influenza Death 2017-2018 Season Cumulative Death Rate with Posistive Diagnosis
100.00%
0.900%
90.00%
0.800%
Overall Death Rate (If Infected)

80.00%
0.700%
70.00%

Chance of Death
0.600%
60.00%
0.500%
50.00%
0.400%
40.00%
0.300% 30.00%
0.200% 20.00%
0.100% 10.00%
0.000% 0.00%
0 10 20 30 40 50 60 70 80 0 20 40 60 80 100 120
Age [Years] Age Under
 Assigning Real Value to Life
• Value of life statistics are common-place for policy makers (Source:
https://en.wikipedia.org/wiki/Quality-adjusted_life_year)
• The QALY (Quality Adjusted Life Year) is the measure of the weighted year of a
person
• Aggregated across a group of people, it can be used to assign monetary value to
life years gained by a certain policy. This leads to a $/QALY which describes how
much one tear of a person’s life is worth, adjusting for quality of life.
• The US uses a range of $33,000/QALY to $200,000/QALY. Note that kidney patient
care decisions are considered effective only when it’s less than than
$121,00/QALY (Source:
https://www.forbes.com/sites/theapothecary/2020/03/27/how-economists-
calculate-the-costs-and-benefits-of-covid-19-lockdowns/#23e20fe16f63)
• One can use this type of analysis to vet the effectiveness of the US CoVid-19
response as will be shown.
 Cost of CoVid-19 Death Reduction (Low End)
• Below Shows a simple determination of the $/QALY assuming 2.7 Trillion spend (as of
April 30th), an incredibly high-end estimate of 2.14 million lives saved, and a very
generous 20 years average life years gained per death avoided.
• This works out to and figure of about $68,000/QALY which is considered effective.
• However, this is far from the reality of CoVid-19 as will be shown.
Source
$/QALY STDR Low $ 33,000.00 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.5.1366
$/QALY STDR High $ 200,000.00 https://www.forbes.com/sites/theapothecary/2020/03/27/how-economists-calculate-the-costs-and-benefits-of-covid-19-lockdowns/#23e20fe16f63
Money Spent $ 2,700,000,000,000.00 High Estimate (As of April 30th)
Total Deaths (April 30) 62,444.00 CDC
Expected Death (No Q) Low 74,000.00 IMHE Models - Wave 1
Expected Death (No Q) Median 620,000.00 Original Estimates (0.37%)
Expected Death (No Q) High 2,200,000.00 Original Imperial - High
Lives Saved (Low) 11,556
Lives Saved (Median) 546,000
Lives Save (High) 2,137,556
Life Ex USA 78.54 https://www.cdc.gov/nchs/fastats/life-expectancy.htm
Average Age of Death 75.6 https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html And Analysis of CDC Data
Average Years gained 20
Quality of life at average age of death 0.9 Estimate
QALY Low 208,008.00
QALY Median 9,828,000.00
QALY High 39,600,000.00
$/QALY Low $ 68,181.82
$/ QALY Median $ 274,725.27
$/QALY High $ 12,980,269.99
 Cost of CoVid-19 Death Reduction (Middle)
• We change the end spend to 5 Trillion (assuming we can start re-opening soon and
recover quickly to mitigate future down-stream economic losses)
• We also assume 546,000 lives saved with an average of 8 life years per person saved (still
generous but more realistic).
• We now see that the $/QALY is about $1,270,000, which is a highly inefficient policy.
Source
$/QALY STDR Low $ 33,000.00 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.5.1366
$/QALY STDR High $ 200,000.00 https://www.forbes.com/sites/theapothecary/2020/03/27/how-economists-calculate-the-costs-and-benefits-of-covid-19-lockdowns/#23e20fe16f63
Money Spent $ 5,000,000,000,000.00 High Estimate (As of April 30th)
Total Deaths (April 30) 62,444.00 CDC
Expected Death (No Q) Low 74,000.00 IMHE Models - Wave 1
Expected Death (No Q) Median 620,000.00 Original Estimates (0.37%)
Expected Death (No Q) High 2,200,000.00 Original Imperial - High
Lives Saved (Low) 11,556
Lives Saved (Median) 546,000
Lives Save (High) 2,137,556
Life Ex USA 78.54 https://www.cdc.gov/nchs/fastats/life-expectancy.htm
Average Age of Death 75.6 https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html And Analysis of CDC Data
Average Years gained 8
Quality of life at average age of death 0.9 Estimate
QALY Low 83,203.20
QALY Median 3,931,200.00
QALY High 15,840,000.00
$/QALY Low $ 315,656.57
$/ QALY Median $ 1,271,876.27
$/QALY High $ 60,093,842.54
 Cost of CoVid-19 Death Reduction (High End)
• Last we look at the most realistic numbers for this pandemic.
• We take the full brunt of the actual 7.2 Trillion dollars spent, take the IMHE models of 74,000 total cases by August (10,000 saved
as of April 30th), and we take the arithmetic average age of CoVid-19 patient death and compare it to US life-expectancy.
• The average age at time of CoVid-19 Death was 75.6 and life expectancy in the US is 78.54. This works out to about 2.94 life years
per person saved.
• In this case we can see that the $/QALY is about $229,000,000 which is an absurdly low efficiency policy.
Source
$/QALY STDR Low $ 33,000.00 https://www.healthaffairs.org/doi/full/10.1377/hlthaff.28.5.1366
$/QALY STDR High $ 200,000.00 https://www.forbes.com/sites/theapothecary/2020/03/27/how-economists-calculate-the-costs-and-benefits-of-covid-19-lockdowns/#23e20fe16f63
Money Spent $ 7,000,000,000,000.00 High Estimate (As of April 30th)
Total Deaths (April 30) 62,444.00 CDC
Expected Death (No Q) Low 74,000.00 IMHE Models - Wave 1
Expected Death (No Q) Median 620,000.00 Original Estimates (0.37%)
Expected Death (No Q) High 2,200,000.00 Original Imperial - High
Lives Saved (Low) 11,556
Lives Saved (Median) 546,000
Lives Save (High) 2,137,556
Life Ex USA 78.54 https://www.cdc.gov/nchs/fastats/life-expectancy.htm
Average Age of Death 75.6 https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173---,00.html And Analysis of CDC Data
Average Years gained 2.94
Quality of life at average age of death 0.9 Estimate
QALY Low 30,577.18
QALY Median 1,444,716.00
QALY High 5,821,200.00
$/QALY Low $ 1,202,501.20
$/ QALY Median $ 4,845,242.94
$/QALY High $ 228,928,923.98
 Conclusions of Cost of COVid-19 Response
• We have spent realistically over 7 Trillion dollars to date just flattening
the curve. This doesn’t even guarantee the lives the models predict
will be lost and we have no idea how many lives have been saved thus
far (adding maybe 0.2 QALY to each death postponed)
• If we continue this shut-down, we can expect to spend Trillions of
additional dollars per month to stabilize the economy and provide for
American citizens.
• Even if this was possible, it would push the $/QALY to such an
unprecedented level that no-one with sound rationale could defend it
as a continuing policy.