Public Health Lessons Learned From Biases in Coronavirus Mortality Overestimation | Disaster Medicine and Public Health Preparedness | Cambridge Core

In a comparative analysis with WHO and CDC documents, the coronavirus mortality rate of 2-3% that was adjusted to 1% in Congressional testimony is consistent with the coronavirus CFR of 1.8-3.4% (median, 2.6%) reported by the CDC. 13 Furthermore, the WHO reported that the CFR of the H1N1 influenza virus (1918) is also 2-3%, 14 similar to the unadjusted 2-3% CFR of the coronavirus reported in Congressional testimony, with no meaningful difference in mortality. As previously mentioned, the WHO also reported that 0.1% is the IFR of seasonal influenza, 5 not the CFR of seasonal influenza as reported in the NEJM editorial.

Of relevance, nationwide mitigation measures, such as lockdowns, social distancing, and shelter-in-place orders, were not implemented during the 2017-2018 influenza with 45 million US illnesses reported by the CDC. 57 Neither were mitigation measures implemented during the 2009 influenza, with reported estimates adjusted for underreported hospitalizations of approximately 60.8 million US cases, ranging between 43.3 million to 89.3 million cases. 58

Last, severe mitigating measures during the COVID-19 pandemic caused considerable global social and economic disruption. 71 Enforced lockdowns increased domestic violence, closed businesses and schools, laid off workers, restricted travel, affected capital markets, threatened the security of low-income families, and saddled governments with massive debt. Between February and April 2020, US unemployment rose from 3.5%, the lowest in 50 years, to 14.7%. 72 A recession in the United States was also officially declared in June 2020 by the National Bureau of Economic Research, ending 128 months of historic economic expansion. Of relevance, economic downturns are associated with higher suicide rates compared with times of prosperity, and increased suicide risk may be associated with economic stress as a consequence of severe mitigation measures during a pandemic. 73 Relapses and newly diagnosed cases of alcohol use disorder were also predicted to increase due to social isolation, and harmful drinking in China increased 2-fold following the COVID-19 outbreak. 74

Public Health Lessons Learned From Biases in Coronavirus Mortality Overestimation | Disaster Medicine and Public Health Preparedness | Cambridge Core