Graphic detail Measuring covid-19 The Economist April 11th 2020 69

Footprints of the → In the past month “flu-like illnesses” besides the flu itself have surged

Non-flu influenza-like illnesses

invisible enemy % of visits to sampled primary health-care providers, by week 15

2019-20
New Jersey
10

Why a study showing that covid-19 is 5

everywhere in America is good news
Median 2010-19*
O ne of the few things known for sure
about covid-19 is that it has spread fast-
er than official data imply. Most countries
Aug 2019 Sep Oct Nov Dec Jan 2020 Feb Mar
0

have tested sparingly, focusing on the sick.

Oklahoma
Just 0.1% of Americans and 0.2% of Italians 10
have been tested and come up positive. In
contrast, a study of the entire population of 5
the Italian town of Vò found a rate of 3%.
The lack of testing has set off a hunt for
0
proxies for covid-19 infection, from smart-
thermometer readings to Google searches Aug 2019 Sep Oct Nov Dec Jan 2020 Feb Mar
for “I can’t smell”. A new paper by Justin Sil-
verman and Alex Washburne uses data on
influenza-like illness (ili) to show that → Estimates of patients with flu-like symptoms closely track covid-19 counts
sars-cov-2 is now widespread in America.
Every week, 2,600 American clinicians Increase† in estimated non-flu influenza-like New confirmed covid-19 cases
report the share of their patients who have illnesses v new confirmed covid-19 cases per 100,000 people, log scale
United States, March 22nd-28th 2020 1,000
ili—a fever of at least 37.8°C (100°F) and a
cough or sore throat, without a known
Population
non-flu reason. Unsurprisingly, ili is often New York
30m
caused by flu. But many other ailments also 1m
produce ili, such as common colds, strep New Jersey 100
throat and, now, covid-19. The authors as- Louisiana
sume that the share of these providers’ pa- Washington
Michigan
tients with ili who do have the flu matches
Georgia
the rate of flu tests that are positive in the Indiana
Maryland 10
same state and week. This lets them esti-
Oklahoma
mate how many people have ili seriously West Virginia
Kentucky
enough to call a doctor, but do not have the Texas California
flu—and how many more people have had
non-flu ili in 2020 than in prior years. 1
They find that non-flu ili has surged. Its 10 100 1,000 10,000
rise has the same geographic pattern as co-
Increase in estimated non-flu influenza-like illnesses, per 100,000 people, log scale
vid-19 cases: modest in states with few pos-
itive tests, like Kentucky, and steep in ones
with big outbreaks, such as New Jersey. In
→ If covid-19 has spread faster than commonly thought, it must be less deadly
total, estimated non-flu ili from March 8th
to 28th exceeded a historical baseline by United States, covid-19 cases and deaths under different
23m cases—200 times the number of posi- modelling scenarios, assuming no social distancing
tive covid-19 tests in that period. This may Millions 25
overstate the spread of covid-19, since non- New daily cases 20
flu ili has other causes. It could also be too 15
low, because people with asymptomatic or Scenario 1: Scenario 2: 10
mild covid-19 would not report non-flu ili. Faster-growing Slower-growing
5
This sounds alarming, but should be re- and less deadly and more deadly
assuring. Covid-19 takes 20-25 days to kill 0
victims. The paper reckons that 7m Ameri- Jan Feb Mar Apr May Jun
cans were infected from March 8th to 14th,
and official data show 7,000 deaths three New daily deaths Thousands 200
weeks later. The resulting fatality rate is
Both scenarios match the 150
0.1%, similar to that of flu. That is amazing- deaths officially attributed
ly low, just a tenth of some other estimates. to covid-19 in early April, 100
Perhaps it is just wrong, possibly because then diverge
50
the death toll has been under-reported. April 5th
1,212
Perhaps, though, New York’s hospitals are 0
overflowing because the virus is so conta- Jan Feb Mar Apr May Jun
gious that it has crammed the equivalent of Sources: “Using ILI surveillance to estimate state-specific case *Modelled median, based on data from 2010-19
a year’s worth of flu cases into one week. 7 detection rates”, by J. Silverman & A. Washburne; Johns Hopkins CSSE †Difference between rate in 2020 and modelled median