Canada Might Have 100,000 More COVID-19 Cases Than Figures Show

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Yoni Freedhoff: A report on the estimated number of undetected, SARS-CoV2-infected and contagious individuals could have an impact on people’s behavior regarding physical remoteness and staying at home.

Yoni Freedhoff is an Associate Professor of Family Medicine at the University of Ottawa.

You cannot fight an enemy that you cannot see. You’ve probably heard someone make this statement with reference to the need to step up testing for COVID-19. And While this is undoubtedly true for those who develop our response to this nightmare, it is also true that in the absence of accelerated testing, our public health officials and the media, with one far too rare exception, do have failed to convey to the public the true scope of the number of people infected with SARS-CoV2.

And so, my question – watching the coast-to-coast failure of most cities and provinces to shut things down effectively, and of people ignoring Canada’s continuous and overly polite calls to stay home voluntarily – is: blame for some Canadians’ more laissez-faire attitude toward staying at home because some believe the enemy has only infected according to our official government COVID-19 website Statistics from April 5 – 15,496 people with only “16 probable cases”?

Let’s talk for a moment about these probable and proven cases, as well as some rudimentary mathematics. According to our government’s April 5 figures, Canada has suffered 280 deaths from COVID-19. Even assuming a conservative fatality rate (CFR) of 1% (a very recent estimate published in Lancet suggests an overall overall CFR of 1.38% after adjustment for censorship, demography and under-determination), these 280 deaths would reflect 28,000 probable cases. (For much more robust mathematical modeling, please visit this calculator from the Center For Mathematical Modeling of Infectious Diseases).

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We also need to remember that deaths are a lagging indicator, which means it takes about three weeks on average between the time of infection and the time of death, so these 28,000 people were contagious three years ago weeks. Now, if we want to consider the number of probable cases today, we have to estimate how many people these 28,000 contagious people have infected in the past three weeks. Again, taking a conservative value of 1.6 infected person per infected person per week (to reflect the impact of recommendations for fragmented physical distancing and voluntary actions), two weeks ago, probable cases would have been 44,800, 71,680 a week ago, and 114,688 today. subtracting the 15,496 reported confirmed cases leaves us with 99,176 cases more likely than those reported on our government website. 16

Now, I realize that this is not really what the government graph reports; these 16 probable cases are their definition of the probable cases linked to the tests. But shouldn’t there be a column of probable cases reflecting an estimate of the number of individuals not detected, not tested, infected with SARS-CoV2 and contagious? If there was such an estimate, its regular report could have an impact on the behavior of the public with regard to respecting calls to the physical distance and keeping at home. Such reports could also help contextualize the mathematics of exponential growth, whose breathtaking and terrifying nature is clearly more astounding and impactful as the numbers go up.

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Another number that is not shared with Canadians is the use of our hospitals’ intensive care beds nationally and, for the most part, locally. As with deaths, this provides a late indicator of the burden of disease, but would also provide Canadians with concrete action as to how close we are already to our outdated health care system, which matters to anyone who is unfortunate enough to demand treatment and care in a hospital setting, and not just for those who develop severe COVID- 19. Right now, at least here in Ontario, latest report on critical care services released in Ontario shows we are already at 65.1% of capacity and these numbers are increasing of course.

It would not be difficult to communicate this data, nor is it a big demand. Instead of tweets, headlines and statements from public health officials and journalists touting the number of new cases and the total number of cases each day, they should qualify them, each time, stating that these figures are the number of new “known” cases, and Ideally, also provide an explicit warning highlighting the number of suspected cases that we simply haven’t tested, at least until our tests become significantly more robust. This, combined with regularly updated information about what’s going on in our intensive care units, could simply help keep more people at home, which, according to calculations from infectious epidemics, will save literal lives.

Obviously, this is not the time for platitudes, sugar coating or darkening. The time has come for absolute transparency – we must resist the urge to call it “radical transparency”. The provision of information that will make the difference between life and death should never be described as radical. There is nothing radical about it. This is an explicit obligation.



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