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 In Wuhan, the epicenter of the disease, one person has died for
every 23 infections reported. That number drops to one on 50
nationally, and outside mainland China, one death has been recorded
per 114 confirmed cases.
Experts say the discrepancy is mainly due to under-reporting of
milder virus cases in Wuhan and other parts of Hubei province that
are grappling with shortages in testing equipment and beds.
"In an outbreak your really have to interpret fatality rates with a
very skeptical eye, because often it's only the very severe cases
that are coming to people's attention," said Amesh Adalja, an expert
in pandemic preparedness at the Johns Hopkins Center for Health
Security in Baltimore.
"It's very hard to say those numbers represent anything like the
true burden of infection" said Adalja, who estimates current
fatality rates are likely below 1%.
As of Tuesday, 24,551 cases have been confirmed globally. A 1%
fatality rate would put total cases at over 49,000, based on the
current death toll of 492.
Gauden Galea, the World Health Organisation (WHO) representative for
China, told Reuters on Sunday that a "crude calculation" done by
dividing total cases by deaths put the rate at 2% and said the rate
was generally falling.
"Trying to really demystify those fatality numbers by including
mildly symptomatic cases will help people to better understand the
risk," said Adalja.
CLUSTER OF DEATHS
In Wuhan, some patients with milder symptoms have been turned away
from hospitals in recent weeks because of the strain on resources,
several people in the city told Reuters. Others have opted to
self-isolate.
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Wuhan resident Meiping Wang said she and her sister both believe
they have mild cases of the virus after their mother tested
positive, but have not been tested.
"There is no use going to the hospital because there is no
treatment," Wang, 31, said in a telephone interview.
Under-reporting mild cases - which increases fatality rates - could
have a negative social and economic impact as global health
authorities race to contain the disease.
"It's good to remember that when H1N1 influenza came out in 2009,
estimates of case fatality were 10 percent," said David Fisman, an
epidemiologist at the University of Toronto, who was working in
public health at the time. "That turned out to be incredibly wrong."
"As the denominator is growing in terms of case numbers, and case
fatality goes down and down... you start to realize it's
everywhere," he said.
The global response to the coronavirus epidemic has been swift and
fierce. Several countries have implemented partial or full travel
bans on Chinese travelers.
"There are many actions going on all over the world that really are
premised on the idea that this is a very severe illness," said Johns
Hopkins' Adalja.
WHO chief Tedros Adhanom Ghebreyesus said on Monday that the bans
were an unnecessary interruption to travel and trade.
(Reporting by Cate Cadell; Editing by Raju Gopalakrishnan)
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