Thanks to the work of three Stanford University professors and recently FDA-approved antibody tests, we will we soon finally know the real size of the denominator of all those infected by COVID-19 — and that could be the game changer we need.
The denominator is the total number of people who have been exposed to the virus, many of whom never knew they even had it. The numerator, tragically, is the total number of people who have died from the disease. Divide the numerator into the denominator and we get the death or case fatality rate.
As the founder of several airlines in four countries, my companies and our industry have been particularly hard hit by the spread of COVID-19. Since the outbreak, I have spent all my days and a lot of my nights trying to find a solution to save as many as possible of the 40,000 jobs I am responsible for and do what I can to help avoid an economic catastrophe in the making.
My search for a solution has led me to three amazing and dedicated professors and scientists from Stanford University School of Medicine with impeccable credentials. I have come to know them personally. Drs. John Ioannidis, Jay Bhattacharya and Eran Bendavid, using their epidemiology models and other evidences from China, Italy, Iceland and the US, have questioned from the beginning the true number of those who have been infected by COVID-19. Everyone agrees that the number of confirmed cases reported is not a correct value for the total number of infected. But by how much? Recent research is telling us that up to 50% of those infected are asymptomatic, and of the remaining 50%, 80% have mild symptoms and are unlikely to have been tested. This creates a confirmation bias because we are only testing those with the most severe symptoms. Drs. Ioannidis, Bhattacharya and Bendavid believe that the actual number of cases is very likely off by an order of magnitude of 10, or maybe even many times more.
Why is this so important for all of us searching for a ray of hope amid the dire predictions? As of today, the US is approaching 400,000 confirmed cases of the COVID-19 virus and, tragically, more than 10,000 deaths. What if the Stanford doctors are right and the actual number of those infected is actually 3 million, 10 million or more? It would be a game changer in our fight against the virus. If it could be proven that 20 or 30% of New Yorkers were actually infected instead of less than 1%, it would tell us that the peak is closer than we think, and most important, the case fatality rate would be a tiny fraction of the percentage based on deaths as a fraction of confirmed cases.
Most important of all, this information would provide governors, mayors and public health officials valuable new data in determining the number of ICU beds that may be required. As of yesterday, New York had 4,000 patients in ICU beds. With less than 1% of population with confirmed cases, Governor Cuomo rightly believes he could need 30,000 ICU beds at the peak of the epidemic. That number would change significantly if the actual number of those actually infected — most of whom are healthy and highly unlikely if not certainly not to be infected again because of their resulting antibodies — were 10 to 30 times higher than those that have tested positive.
Fortunately, there has emerged a surprisingly simple way to know the actual number of those infected. Last week, the FDA approved Cellix’s rapid response antibody detection test. Those tests detected COVID-19 antibodies in 93.86% of those who have tested positive for the virus. Cellix is only one of scores of companies, universities and hospitals developing and seeking FDA approval for their antibody test. The science of finding antibodies after a patient has been infected is not new. The scientists that I have spoken to say because COVID-19 is a new virus, it makes it easier to detect.
While the FDA advises that caution should be taken in relying on these tests for individual use, they are more than sufficient for determining the correct denominator from a population sample. These tests are inexpensive, only require a prick of the finger to get a blood sample, and can be produced by the hundreds of thousands very quickly.
Last week, Drs. Bhattacharya and Bendavid began a study in Santa Clara County in California using antibody tests. They assembled a team that collected 2,500 blood samples over 2 days. Once they have the results of these samples, they will compare those who test positive for the antibodies with the number of confirmed cases to give them scientific information to better predict the actual denominator. Drs. Bhattacharya and Bendavid would like to roll out this test to many cities across the nation very quickly. A relatively small representative sample of the population would give us a very accurate number of the true denominator and death rate. In New York, some 10,000 tests could be administered and the results known in a matter of days.
Once we know the true denominator, predictions of those likely to die might end up being revised from the hundreds of thousands to the tens of thousands.
Once we have this information, more effective measures could be taken to protect the most at-risk so we make certain COVID-19 patients do not overwhelm our health care system, and tens of millions of Americans could return to work and we could resume the lives we once cherished.
Because of my consultations with the Stanford doctors and scores of other experts, I believe there is a plan that would allow us to exit this crisis in a safe manner, saving more lives, and sooner than we think. I will post my thoughts on an exit plan later this week to help stimulate discussion, and perhaps give us the hope we so desperately need.
David Neeleman is the founder of JetBlue Airways, Azul Brazilian Airlines, co-founder of Westjet Canada and a major shareholder of Tap Air Portugal.