Wednesday, March 4, 2020

Difference between mortality and case fatality rate

In light of loose use of the term "mortality" with respect to the COVID-19 epidemic, it is important to remember that there is a dramatic difference between mortality and case fatality rates. What I've noticed is that many are referring to a 2-3% "mortality" rate for COVID when what they mean is 2-3% case fatality rate.

Here's why the difference matters...

Mortality Rate = Deaths / Population at Risk Often the denominator for mortality rate is the entire population at the beginning of some time period (usually a year), but sometimes we mean a specific sub-population (for example, Infant Mortality Rate = Infant Deaths / Live Births).

Case Fatality Rate = Deaths / Population with the Condition The case fatality rate is a special subset of mortality rates in that the rate is calculated only based on those with the condition.

Because not everyone gets every condition, Case Fatality Rates are higher--sometimes dramatically so--compared with overall Mortality Rates.

Example:

The Case Fatality Rate for measles is approximately 15%. This means that of those people who get measles, approximately 15 percent die. But we have widespread vaccination, so most people do not get measles. From 2016-2019 there were 0 measles deaths among the United States population of nearly 330 million. Thus, while the Case Fatality Rate remains high, the observed measles Mortality Rate for 2016-2019 in the United States was 0.

In other words: the risk of death is still high for those who contract measles, but the number of cases has been low due to preventative measures (like vaccines).

For COVID-19:
(Based on March 1, 2020 data from WHO)

Mortality Rate = unknown
(was 3,000 deaths / 7,000,000,000 population as of March 1, 2020 but is still rising
Note: The year-end mortality rate will be much higher because the disease is still spreading, but the current number is well below 0.001%)

Case Fatality Rate = 3,000 / 87,137 = 3.4%
Note: This estimate may be too high because not every country has implemented widespread testing, so the number-of-cases denominator may be somewhat low. Best estimates to date of COVID-19 Case Fatality Rate are between 2%-3.4%.

So when you see someone refer to 2-3.4% for the COVID-19 "mortality rate," that does not mean the virus will exterminate 3 percent of the global population. It does mean, however, that we should take the risk seriously.

We can slow the spread through social distancing, good hygiene, and (eventual) vaccine development.


Tuesday, December 31, 2019

Book roundup 2019

A friend recently noted that she read more than 100 books in 2019, which sort of dampened my pride at reading 30 (15 non-fiction). Neither one of us counts flipping glossy cookbooks nor "early reader" chapter books read with the pint-sized members of our respective families. (My friend does count audiobooks, though, so maybe our eyes-on-words reading tallies aren't quite as disparate as it might seem?)

Anyway, since it's year-end, it's a good time for reflection. In addition to rethinking my stance on audiobooks, I'm going to share some reflections on what I read this year.

Some of the best non-fiction books I read in 2019 (regardless of original publication date):

Invisible Women
by Caroline Criado Perez

Thick
by Tressie McMillan Cottom

Heart: A History
by Sandeep Jauhar

The Library Book
by Susan Orlean


Tenth Island
by Diana Marcum