Limited coronavirus testing in the US has meant its death rate appears alarmingly high — but it will likely drop
The US has the world's highest death rate for the new coronavirus at 5.4%, compared to a global average of 3.4%. That's likely because the CDC has focused on testing the most severe cases. New testing standards and more widely available test kits could pick up more mild cases in the US and lower the death rate. For the latest case total, death toll, and travel information, see Business Insider's live updates here. Visit Business Insider's homepage for more stories.
The US has the world's highest death rate for the new coronavirus: Based on the ratio of confirmed deaths to reported cases, 5.4% of patients have died. That's far higher than the global rate of 3.4% that World Health Organization reported on Tuesday — and even higher than mainland China's 3.7%. Only the Philippines has a higher coronavirus death rate than the US, and that's because it has only had three cases. One of them, a man from Wuhan, China, became the first known fatality outside China in early February. It's highly unlikely that the coronavirus is more deadly in the US; rather, the number is a product of limited testing in the country. Because widespread testing wasn't possible in the US immediately after the first cases were reported, the CDC held stringent standards for who qualified for a test. Until Wednesday, the agency only tested people who had recent exposure to a confirmed patient, had travelled to a country with an outbreak, or required hospitalization. So the US still probably has not tested or diagnosed many patients with mild cases. "There's another whole cohort that is either asymptomatic or minimally symptomatic," Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in a February 6 briefing. "We're going to see a diminution in the overall death rate." As of Thursday, the US' national coronavirus case count was 221. That total includes results from state-level coronavirus testing, implemented more widely. The CDC had only confirmed 99 cases across the country as of Thursday at noon. If you calculate the death rate based on only those federally verified cases, it jumps to roughly 10%. 'Other countries are testing much more broadly than we are'
Because flawed tests and limited funding initially meant testing capacity in the US was restricted, the CDC has tested about 1,526 people in the US. Alex Azar, the US secretary of health and human services, told ABC on Sunday that 3,600 Americans had been tested in total. South Korea, by contrast, has implemented free coronavirus-testing drive-thrus and tested more than 136,000 people. The country's death rate is currently just 0.5% — 35 deaths out of a total of 6,088 reported infections. (It is constantly evolving, however, as patients' illnesses progress and as more people are diagnosed.) "Other countries are testing much more broadly than we are," William Schaffner, an infectious-disease specialist at the Vanderbilt University School of Medicine, previously told Business Insider. "We are trotting along while they're racing along."
To be sure, the US has a much lower case count overall than either South Korea or China, so any death significantly impacts the country's fatality rate. But again, the low case count is likely due to how few people have been tested. "I'm in coronavirus briefings with groups of experts as well as members of Congress and the military," Matthew McCarthy, a hospitalist at Weill Cornell Medicine in New York City, tweeted on Sunday. "These meetings are contentious, but there's one thing we agree upon: Coronavirus has been circulating in the United States for weeks. We didn't detect it because we weren't testing properly." The CDC changed its testing standards this week The new CDC's new testing standards are much more open-ended, saying that "clinicians should use their judgment" to determine if patients should be tested for the new coronavirus. US officials also said they are working to distribute more tests. Azar told ABC on Sunday that "we now have 75,000 tests available." "The estimates we're getting from industry right now — by the end of this week, close to a million tests will be able to be performed," Dr. Stephen Hahn, commissioner of the Food and Drug Administration, said at a White House press briefing on Monday. On Thursday, however, senators briefed on the matter said that timeline was unlikely, according to Bloomberg. Some experts say the US government should have taken steps to ramp up testing weeks ago.
"It is well within the realm of possibility that there are 100,000 people infected with this right now in the United States," Yale professor Howard Forman, a radiologist and expert in healthcare management, told Business Insider. "Healthcare providers may be being exposed, other patients may be being exposed, and until you can give confidence to people about those answers, we are in a crisis here." Aria Bendix, Aylin Woodward, and Jessica Snouwaert contributed reporting.
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More than 1.3 million people have recovered from the coronavirus — and are likely now immune. But painful symptoms may last far longer than people realize.
More than 1.3 million people worldwide have recovered from the coronavirus. Recovered COVID-19 patients may have...More than 1.3 million people worldwide have recovered from the coronavirus. Recovered COVID-19 patients may have a residual cough or fatigue for weeks after major symptoms disappear. Though long-term effects remain unclear, patients who develop severe pneumonia could come away with scarred lungs and reduced lung function. Recovery likely means immunity, at least for a period of time, so people who were once infected could go back to work with low risk of reinfection. Visit Business Insider's homepage for more stories. Most people who get the coronavirus recover. More than 1.3 million such cases have been documented worldwide. "Eventually, if all goes well, your immune system will completely destroy all of the virus in your system," Tom Duszynski, director of epidemiology education at Indiana University–Purdue University Indianapolis, wrote in The Conversation. "A person who was infected with and survived a virus with no long-term health effects or disabilities has 'recovered.'" Still, many uncertainties remain: It's not yet clear how many people have recovered, how the illness will affect them in the long run, or how long they'll be immune. The process can take much more time and pain than people realize. Here's what the research so far reveals about people who have recovered from COVID-19. Recovery by the numbers Although more than 1.3 million people who had the coronavirus have recovered worldwide, according to Worldometer, the true number is probably far higher. Data on recoveries is less precise than case counts and death tolls, and many counties, states, territories, and regions don't report how many of their residents have recovered. "Recovered cases outside China are country-level estimates based on local media reports and may be substantially lower than the true number," Douglas Donovan, a spokesman for Johns Hopkins University, which previously tracked global recoveries in its COVID-19 database, told CNN. Plus, due to limited testing availability in some countries (including the US), the most severe cases were initially prioritized for official diagnoses. People who had mild symptoms, or none at all, have been less likely to get tested — if they even seek testing in the first place. That means that many mild infections are not included in the count of total cases or recoveries. That can skew experts' understanding of the disease and how they predict its trajectory. "Knowing the real number of infected people in the population would be very useful to have better models of when disease will peak and decline, and also when we can begin to return people to work," Dr. Bala Hota, a professor of infectious diseases and Associate Chief Medical Officer at Chicago's Rush University Medical Center, told CNN. What recovery is like Recovery doesn't necessarily mean feeling all better. Hota told CNN that many patients still have a mild cough and feel tired even once they're considered recovered and are no longer contagious. It can take a long time to fully get back to normal. "It takes anything up to six weeks to recover from this disease," Dr. Mike Ryan, executive director of the World Health Organization's Health Emergencies Program, said in March. "People who suffer very severe illness can take months to recover from the illness." The process is different for patients who were put on a ventilator. "What we're seeing in patients who end up on ventilators is that they often stay on them for several weeks," Dr. J. Randall Curtis, a professor at the University of Washington Harborview Medical Center, told US News & World Report. "And then, coming off the ventilator, they're often going to be in the ICU for several days, and then back [in a regular hospital unit] for a few days to a week or so to regain their strength." People who were put on a ventilator can walk away with long-term physical and psychological damage. If they develop acute respiratory distress syndrome (ARDS), that can scar their lung tissue. Lasting effects Dr. Shu-Yuan Xiao, a pathology professor at the University of Chicago School of Medicine, told ABC News that most people with mild cases of COVID-19 should recover "with no lasting effect." The future is murkier for patients who develop severe illness, though. Hong Kong's Hospital Authority reported in March that within a group of 12 recovered patients, "two to three" showed decreased lung capacity in follow-up visits with doctors. Those few patients gasped for air when they walked, according to the South China Morning Post. Scans of nine patients' lungs revealed signs of organ damage. But because the coronavirus was first identified in December, there hasn't been much time to research recovered patients and publish the findings. "This is a little bit of an understudied group," Hota said. Experts do have a sense of the effects that severe pneumonia can have on the body, though. If a patient develops acute respiratory distress syndrome (ARDS), that can scar their lung tissue. "It's the same general thing that you have with any type of phenomena that's severe enough to land you in the ICU," Dr. Amesh Adalja, an infectious-disease expert at the Johns Hopkins Center for Health Security, told ABC News. Adalja and Xiao both said that some severely ill patients may never recover full lung function. Antibodies and immunity People who have been infected develop antibodies that can probably fight off the coronavirus if they encounter it again. A pre-print study published Tuesday reported the results of 1,300 antibody tests from people who had confirmed and suspected cases of COVID-19 in and around New York City. The findings showed that 99.8% of people who got a positive diagnostic test later got positive results for antibodies. The research countered fears that not all patients walk away with antibodies. One Chinese study, which has also not yet been peer-reviewed, tested 175 recovered COVID-19 patients and found that 10 of them had not developed any detectable coronavirus antibodies. Antibody tests can sometimes return false negatives as well as false positives. But proponents of antibody testing say that it's imperative in the fight against the outbreak, since immune people could return to work safely. "Ultimately, this might help us figure out who can get the country back to normal," Florian Krammer, a professor in vaccinology at Mount Sinai's Icahn School of Medicine, told Reuters. "People who are immune could be the first people to go back to normal life and start everything up again." Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said in an interview on "The Daily Show" that he was "willing to bet anything that people who recover are really protected against reinfection." "What we don't know yet is how long that immunity will last, the quality of that immunity, and whether all individuals will generate a long-lasting high immune response," Frances Lund, chair of the microbiology department at the University of Alabama at Birmingham, previously told Business Insider. Fauci also said on April 8 that because the virus doesn't seem to be mutating much, people who recover will likely be immune should the US see a second wave of spread in the fall. "If we get infected in February and March and recover, next September, October, that person who's infected — I believe — is going to be protected," he said. Although China, South Korea, and Japan have all reported rare instances in which people who recovered from the coronavirus later tested positive, those cases were probably the result of false positives, experts say. When you can leave self-quarantine If you're sick and wondering how to know when you've recovered, CDC guidelines depend on whether or not you were tested. If you weren't tested and probably won't be, you should stay isolated until you meet three criteria: You've have had no fever for at least 72 hours (without fever-reducing medication), your other symptoms (such as shortness of breath or coughing) have improved, and at least ten days have passed since the onset of symptoms. If you have gotten or will receive a diagnostic test, you need to test negative twice, 24 hours apart, before leaving isolation. Those tests must be done after you no longer have a fever (without fever-reducing medicine) and after other symptoms have improved. Once you have met these criteria, you can leave your home for essential outings, in accordance with your city, county, and state rules. You should still minimize contact with others, though, as well as disinfect all surfaces, clothes, and objects you've touched. Scientists still aren't sure when a person with the virus stops being contagious to others, but a team of German researchers found that coronavirus patients "shed" high amounts of virus early on in their infection. (The research is not peer-reviewed yet, however.) In mild cases, the amount of the virus the gets shed decreased significantly after day five. Patients with mild cases were not infectious eight days after they first started experiencing symptoms. The serious cases were not infectious after day 10 or 11. Holly Secon contributed reporting.Join the conversation about this story » NOW WATCH: How to help hospitals and healthcare workers fighting the coronavirus
South Korea reported that 51 coronavirus patients' infections went away then 'reactivated' But it's unlikely the virus has a dormancy period.
The South Korean CDC reported that 51 patients recovered from the coronavirus, tested negative, then positive...The South Korean CDC reported that 51 patients recovered from the coronavirus, tested negative, then positive again within a relatively short time. Jeong Eun-kyeong, the agency's director-general, said that virus may have "reactivated" in the patients after going dormant. However, experts say that's unlikely. Only certain types of viruses, such as HIV and herpes, go through periods of latency periods and reactivation. It's more likely that the virus hadn't fully been cleared from a patient's system. Visit Business Insider's homepage for more stories. South Korea reported this week that 51 patients who had recovered from the coronavirus and tested negative later tested positive again. Jeong Eun-kyeong, director-general of the Korea Centers for Disease Control and Prevention, said in a briefing on Monday that the virus may have "reactivated" in those patients after going dormant. He said tests were conducted within a "relatively short time" after the patients were cleared, so it's unlikely they got reinfected. "While we are putting more weight on reactivation as the possible cause, we are conducting a comprehensive study on this," Jeong said. "There have been many cases when a patient during treatment will test negative one day and positive another." Most experts think it's unlikely that the virus reactivates after a "dormancy" period. Only a few types of viruses do that — it's sometimes called going latent — as part of their life cycles inside a cell. HIV and herpes are two examples. It's more likely that the people in South Korea still had fragments of the coronavirus in their bodies after they recovered. Such fragments don't mean the patients are still infectious or sick, but they can still show up in a nucleic acid test, Dr. Keiji Fukuda, director of Hong Kong University's School of Public Health, told the Los Angeles Times last month. "The test may be positive, but the infection is not there," Fukuda said. Reactivation versus reinfection Over 315,000 people worldwide have recovered from the coronavirus (likely more, given that many mild and asymptomatic cases are not reported in official counts). Generally, once your body has antibodies to fight off a particular disease, you can't get it again. Dr. Anthony Fauci discussed coronavirus immunity during livestreamed conversation with Journal of the American Medical Association editor Howard Bauchner on Wednesday. Fauci said it's unlikely that people can get the coronavirus more than once — at least within a short time period. "If a person gets infected with coronavirus A, and then gets reinfected with a coronavirus, it may be coronavirus B," Fauci said. "But right now, we don't think that this is mutating to the point of being very different." With viruses that mutate — such as the common cold or seasonal flu — antibodies people build up against one strain aren't effective against others. Plus, some types of antibodies weaken over time. Viruses that cause persistent infections, meanwhile, can have latency periods and reactivate as part of their life cycles. After an initial infection, these viruses stay inside of host cells, neither replicating nor shedding until they're reactivated. Chickenpox, for example, usually occurs in children but can reactivate in adults as shingles. But in general, this is not common for viruses. Latent viral infections also differ from chronic viral infections, such as hepatitis C. The outbreak in South Korea The Korean CDC is conducting an epidemiological probe into the patients who retested positive. "There have been many cases when a patient during treatment will test negative one day and positive another," Jeong said. In South Korea, patients are declared recovered after two negative nucleic acid tests 24 hours apart. However, false negatives and false positives are possible . South Korea had one of the earliest large-scale outbreaks of COVID-19 outside of China. But it peaked at the end of February, thanks in part to the country's wide-scale testing and digital contact tracing. It has only seen roughly 200 deaths and 10,400 cases in total, with a relatively small number of new infections per day over the last month. Join the conversation about this story » NOW WATCH: What could be the fastest way to end the coronavirus crisis?
At least 5 US health workers have gotten the coronavirus, and hundreds more are in quarantine. Hospitals may face staffing shortages as cases surge.
At least five US health workers have tested positive for the coronavirus, hundreds are in quarantine...At least five US health workers have tested positive for the coronavirus, hundreds are in quarantine after exposure, and dozens are waiting on test results. Healthcare workers are especially vulnerable to the coronavirus because they're exposed to more viral particles. Healthcare leaders say the US healthcare system is not ready for a widespread coronavirus outbreak. Delays in testing, mask shortages, and staffing issues could all hinder the country's response. Visit Business Insider's homepage for more stories. As the coronavirus spreads in the US, healthcare workers are on the front lines. At least five have contracted the virus, and hundreds of others have been exposed and sent home to self-quarantine over the last month. "It's high anxiety," Sal Rosselli, president of the National Union of Healthcare Workers, told Business Insider. "There's a lack of confidence that the industry is prepared to adequately provide a safe environment for patients that have the virus and for patients that don't have the virus, and provide safe working conditions for the people caring for them." As coronavirus case numbers swell, asking health workers to stay home for two weeks after they're exposed could leave hospitals short-staffed. "Already, hospitals and nursing homes are often not staffed appropriately," Rosselli said. "If a lot of health care workers contract the virus and have to stay home, obviously at the same time, more patients are being admitted to hospitals. It's potentially a huge critical situation." On Saturday, the CDC updated its recommendations to encourage healthcare providers who have been exposed to the coronavirus but aren't experiencing symptoms to continue coming in to work. They should check their temperature daily and wear face masks, the CDC said. Healthcare workers have a high risk of getting coronavirus The coronavirus has infected at least 111,000 people and killed 3,300. Nearly three-quarters of all cases have been in China. The US has over 600 cases; of these, 26 patients have died. Healthcare workers are particularly vulnerable to infectious diseases like the coronavirus for a handful of reasons. First, medical staff members are exposed to more viral particles than the general public. Second, they face potential shortages of protective supplies and tests as the tide of patients rises. Third, a combination of stress and long hours could make their immune systems more vulnerable than normal. In China, nearly 3,400 healthcare workers have contracted the virus. At least 13 have died. The US could see 4.8 million coronavirus hospitalizations Dr. James Lawler, a professor at the University of Nebraska Medical Center, offered estimates of how much the virus might spread in the US in a February webinar hosted by the American Hospital Association. His projections suggest the US could see 96 million cases of coronavirus, 4.8 million hospitalizations, and 480,000 deaths. Hospitals should prepare for an impact on the system 10 times that of a severe flu season, the presentation said. The CDC has lagged behind in testing and confirming suspected cases — as of Sunday, about 1,700 people had been tested. This also puts healthcare workers at risk of exposure, since limited testing raises the likelihood that patients go undiagnosed and spread the virus in medical settings. In Solano County, California, a patient with coronavirus went undiagnosed for four days each at two different hospitals last month because she didn't meet the CDC's coronavirus testing requirements. Over 200 employees between the two hospitals were exposed and have had to self-quarantine for weeks. Three have tested positive for coronavirus. "Healthcare providers may be being exposed, other patients may be being exposed, and until you can give confidence to people about those answers, we are in a crisis here," Yale professor Howard Forman, a radiologist and expert in healthcare management, told Business Insider. US hospitals are asking patients who suspect they might have the coronavirus to call ahead. That way, health workers can ensure they're taken to an isolation room, and that all of the health workers involved wear personal protective gear. But that's not what always happens, Rosselli said. "There's all kinds of workers that have direct contact with patients," said Rosselli. "There's a much larger number of housekeepers, dietary workers, technicians, radiologists, x-ray technicians, clerical workers." "It goes way beyond nurses and physicians," he added. Many healthcare workers at the Life Care Center were exposed At the Life Care Center in Kirkland, Washington, 13 residents and one visitor have died. Officials said 70 staff members out of 180 had symptoms resembling coronavirus as of Saturday. In addition, 26 firefighters and three police officers who had contact with facility residents are also under quarantine. Kirkland Patch reported that 12 of those responders are experiencing flu-like symptoms. Tim Killian, a spokesman for the center, said the state had provided enough test kits for all of the residents, but it was not clear whether there were also enough kits to test all staff members. In addition, 20 staff members at the Valley Medical Center in Renton, Washington, are being tested for coronavirus after exposure to a patient there. One has already tested positive and is in isolation. Eleven are awaiting results under quarantine. Given the risk of staff shortages at hospitals like this, the CDC updated its recommendations for healthcare workers and facilities over the weekend, removing a requirement that asymptomatic workers who'd been exposed to a coronavirus patient stay home. Asymptomatic transmission of the coronavirus has been recorded before, however. A study last month found that 20-year-old woman from Wuhan, China, transmitted the coronavirus to five family members without ever showing symptoms. 'I did this assuming that if something happened to me, of course I too would be cared for' After potential exposure to a coronavirus patient in a northern California Kaiser facility, an anonymous quarantined nurse released an open letter about her situation through the California Nurses Association. "As a nurse, I'm very concerned that not enough is being done to stop the spread of the coronavirus. I know because I am currently sick and in quarantine after caring for a patient who tested positive," she wrote. "I'm awaiting 'permission' from the federal government to allow for my testing, even after my physician and county health professional ordered it. I volunteered to be on the care team for this patient, who we knew was positive. I did this because I had all the recommended protective gear and training from my employer. I did this assuming that if something happened to me, of course I too would be cared for." Many health workers are concerned about getting paid during self-quarantine, Rosselli added. Some hospitals haven't released guidelines yet around whether quarantines count as sick time, paid time off, or unpaid time. "It's not unusual for healthcare workers to live from week-to-week because they're working class people generally, especially in nursing homes where the wages and benefits are inferior," he added. "If employers don't commit to paying folks if they have symptoms or if they contract the virus, we're concerned that people will hide the symptoms because they live from week-to-week and can't afford to take work off without pay." Lydia Ramsey and Jessica Snouwaert contributed reporting. Have you been personally affected by the coronavirus epidemic? Are you a healthcare worker on the front lines of this disease? Have you or someone you know been tested or diagnosed? We want to hear your story. Please email email@example.com. SEE ALSO: People are racing to buy face masks amid the coronavirus outbreak, but they probably won't protect you from illness Join the conversation about this story » NOW WATCH: Pathologists debunk 13 myths about the coronavirus, including why masks won't help