COVID-19: interesting data from Korea and from the Diamond Princess

One of the first countries to deal with the epidemic was South Korea. Unlike China, South Korea is a fairly transparent society and data published by the Korean CDC (Center for Disease Control) can be more or less taken at face value.

A progress report is published every day on their website: here is today’s edition.

The most interesting part of the report is Table 5, which I am reproducing as a screenshot below:

Table 5 from the Korean CDC report, March 18, 2020

Let’s have a good look at this. Preliminary remark: Korea started a massive testing (according to Table 1 in the same report, nearly 300,000 people have been tested, at a current rate of 10,000 a day) and tracking program early, leveraging all available tech data — privacy concerns be darned.

Observation 1: overall mortality is 1 (one) percent. Still one percent too much, to be sure. But considerably lower than what has been reported from some other places — I suspect because of undertesting.

Observation 2: mortality in the 0-29 age bracket is nil — not one death out of 2,867 patients.

Observation 3: in the 30-49 age bracket, just two (2) deaths out of 2,044 patients, or about 0.1%. Only above 50 does mortality start rising, over 60 in a worrisome fashion. (Not coincidentally, so do comorbidities/pre-existing conditions. I would love to see the statistics broken down between otherwise healthy people and those with chronic cardiovascular/pulmonary/immunity/diabetes problems, or cancer patients. Hypertension is apparently another major risk factor.)

Observation 4: Note the interesting “gender gap”. Men (1.39%) have nearly twice the mortality of women (0.75%). I asked friends on Facebook familiar with South Korea, and they told me over half of men smoke, compared to fewer than five percent of women.

Now what can we expect for older people who are otherwise healthy? Chinese data (caveat lector) suggest overall mortality for patients without comorbidities may be about one-third the overall statistic. https://www.worldometers.info/coronavirus/coronavirus-age-sex-demographics/

And then there is the uncertainty factor of how many people are asymptomatic virus carriers. This is impossible to ascertain without a much more massive testing program (and this isn’t a test you can quickly do with a strip!), but I have seen estimates from 5-7 carriers for each overt disease case.

But the Diamond Princess cruise ship offers an interesting insight. It had nearly 4,000 people on board—many of them in risk groups. (Somebody who used to perform aboard cruise ships quipped that passengers are mostly “the newlywed and the nearly dead” ;)) You’d expect these packed together on a ship in quarantine to be all infecting each others. And yet… 4,061 passengers and crew were examined, on board what effectively became an unintentional virus incubator. Only 712 contracted the virus (about 17.5%), of which 334 asymptomatic (8.2% of the total), leaving 378 (9.3% of the total) ill. Only 7 people died (1.85% of those ill, or 0.17% of all passengers and crew examined), all of them age 70 or older. (Remember, the passenger population is skewed toward the elderly.)

One might treat Diamond Princess stats as an upper limit (since spreading in even dense urban areas will never be as efficient as on a cruise ship) and South Korea as what can be achieved with agile and efficient tracking and containment measures.

Meanwhile, a frantic search for both vaccines and drugs continues. One track that may yield results earliest is the repurposing of existing drugs following off-label testing, since safety and “therapeutic interval” testing have already been done for their original approval. I have mentioned a promising remdesivir trial and I see increasing reports that chloroquine (which has been used for decades as an antimalarial) may interferewith the virus lifecycle. (See e.g., https://www.ncbi.nlm.nih.gov/pubmed/32171740)

Be well, stay healthy, be prepared, and remember:

[L]et me assert my firm belief that the only thing we have to fear is fear itself — nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.

FDR, inaugural address (1933)

UPDATE: via Behind The Black,

(1) an article in SCIENCE about South Korea and how it got a “wake-up call” in 2015 when a businessman brought back MERS from the Middle East

(2) a lengthy analysis of the Diamond Princess data
(3) are there 6 asymptomatic or “too mild to notice” cases for each clinical case?

(4) https://www.statnews.com/2020/03/16/lower-coronavirus-death-rate-estimates/

UPDATE 2: computational biochemistry pioneer Michael Levitt (2013 Nobel Prize in Chemistry shared with Arieh Warshel and Martin Karplus) sounds an optimistic note based on what he knows. His comments start off with Israel (he divides his time between Weizmann and Stanford) but then go on to the rest of the world.

22 thoughts on “COVID-19: interesting data from Korea and from the Diamond Princess

    • It may have to do with the Shinuiju (sp?) cult that was the center of their outbreak. I saw some Korean coverage of one of their services and it seemed like almost all middle-aged and older women.

    • I don’t know of Korean first and second generation culture is the same as RoK, but the guys in that culture were a lot less likely to do physical contact.

      Backstory: my husband had to play peacemaker with one of his volunteer groups, because there was a recent merging of Korean immigrant, a group of immigrants that’s very physically demonstrative, and the average American not-shaking-hands-is-an-issue group. He boiled down the conflict to the Korean grandfather types trying to be polite…so they kept a polite distance, had their arms neatly folded, didn’t get grabby, etc.

      Which both of the other groups interpreted as being stand-off-ish or even flatly hostile.

      That would go a LONG ways towards preventing transmission to men.

  1. In contrast, there’s an article in Foreign Policy that urges us – all Americans – to prepare for lockdown. Get to where you want to be for the foreseeable future. Sigh…

  2. From actual cruise ship employees from the ’90s who were lounge lizarding at our hotel in Cozumel: The newlywed, overfed, and nearly dead.

    Regardless, cruises are profound except maybe the Caribbean versions.

  3. Yes, but you have left out a significant number factors which would adjust your estimates. Ordinary flu season kills about o.1%.

    So, what adjustments have you left out? First, the South Koreans also used the Zithro-hydrochloroquine as antivirals, reportedly with good success. Hence these numbers? (How frequently? I haven’t seen the numbers, admittedly.) More importantly, this roughly 1% more death comes not as flu but as bad pneumonia. And instead of getting spread over 5 months, it comes as a tsunami wave to us in 5 weeks. Thus, it means it is like a 20 fold impact on skilled, labor intensive resources to manage patients with ARDS or Acute Respiratory distress Syndrome which is very labor intensive, if lives are to be saved. Already in the the UK, nearly half of such patients wind up dead.

    Finally, the chief complication that will make the US death rate higher than South Korea’s is that obesity is large in the US (a much much more widespread than in South Korea or anywhere in East Asia), and in NYC, this category vulnerable to death by the new virus is the single biggest.

    Finally, the nations with the means and closest to China have deeply prepared for this type of emergency pandemic. In the US, we have barely prepared. Thus, are you saying that a sudden rate of death amounting to 1.5% is acceptable to you? Do you know that the total possible loss is greater than the loss of all lives from all US wars combined? And that cannot alarm you?

    • You seem to be lacking in reading comprehension.

      From the above post:

      Observation 1: overall mortality is 1 (one) percent. Still one percent too much, to be sure. But considerably lower than what has been reported from some other places — I suspect because of undertesting.

      (Emphasis added)

      Where did you get the idea that he’s saying 1.5 percent fatality rates are increases? Or are you willfully misrepresenting him?

    • Um, did you just compare one number of deaths per population (the .01% flu deaths) to another number of deaths per confirmed cases (1%)? And then for some unexplained reason increase that second number by 50%? And then play the “Have you no shame?!” card?

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