During the Coronavirus Task Force press briefing on Monday, task force coordinator Dr. Deborah Birx was asked about the potentially significant early findings of a study by the Los Angeles County Department of Public Health on the infection rate in L.A., which found that the fatality rate is “much lower” than experts previously thought — or as one reporter pointed out, that the fatality rate is “more in line with the 2017-2018 flu than what we’ve seen in some other areas of the world.”
Dr. Birx responded by saying the task force is extremely interested in studies like the one being conducted in Los Angeles because they still have no definitive data on the number of asymptomatic cases, which is crucial to understanding the infectious rate and the mortality rate. While she said the team is looking at the potentially significant findings of the study — which its lead researcher said could require authorities to “recalibrate disease prediction models and rethink public health strategies” — Birx also cautioned that testing is not always “100% accurate.”
In a press release Monday, the L.A. County Department of Public Health announced that the early results of its highly anticipated joint study with the University of Southern California on COVID-19 infections rates in the county suggest that “infections from the new coronavirus are far more widespread — and the fatality rate much lower — in L.A. County than previously thought.”
“Based on results of the first round of testing, the research team estimates that approximately 4.1% of the county’s adult population has antibody to the virus,” the press release states. “Adjusting this estimate for statistical margin of error implies about 2.8% to 5.6% of the county’s adult population has antibody to the virus — which translates to approximately 221,000 to 442,000 adults in the county who have had the infection. That estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county by the time of the study in early April. The number of COVID-related deaths in the county has now surpassed 600.”
If the study’s early estimates are correct, the fatality rate in the county could range from around 0.14% to 0.28% — far lower than the 4.5% found by looking at only the current confirmed cases in the county (13,817 cases, 617 deaths) or the 3.7% by looking at confirmed cases and deaths in the state (28,964 cases, 1,072 deaths). The fatality rate of the flu is around 0.1%.
“We haven’t known the true extent of COVID-19 infections in our community because we have only tested people with symptoms, and the availability of tests has been limited,” said USC Public Policy Professor Neeraj Sood, the study’s lead researcher. “The estimates also suggest that we might have to recalibrate disease prediction models and rethink public health strategies.”
During the press briefing Monday, a reporter asked Dr. Birx about the study, noting that the researchers believe as many as 442,000 people in L.A. County may have already been infected, and said that the study suggests two things: that you may have “a lot more people out there who could be spreading the virus,” but that the mortality rate is “more in line with the 2017-2018 flu than what we’ve seen in some other areas of the world.”
Birx responded by saying that they are “looking at all those studies very carefully,” but suggested that they are handling them with caution because many tests give false results. “These tests are not 100% sensitive or specific,” Birx emphasized. That said, the idea that more people have carried and are carrying the virus who are asymptomatic than confirmed cases indicate, she said, is something they are very interested in as they still have no hard data on it yet.
Watch her full response below (video via the White House, relevant exchange begins at around the 48:20 mark):
LIVE: Press Briefing with Coronavirus Task Force https://t.co/4Wx0XDkiAK
— The White House (@WhiteHouse) April 20, 2020
Below is the full text of the L.A. County Department of Public Health’s press release on the early results of the study:
USC-LA County Study: Early Results of Antibody Testing Suggest Number of COVID-19 Infections Far Exceeds Number of Confirmed Cases in Los Angeles County
Los Angeles (April 20, 2020) – USC and the Los Angeles County Department of Public Health (Public Health) today released preliminary results from a collaborative scientific study that suggests infections from the new coronavirus are far more widespread – and the fatality rate much lower – in L.A. County than previously thought.
The results are from the first round of an ongoing study by USC researchers and Public Health officials. They will be conducting antibody testing over time on a series of representative samples of adults to determine the scope and spread of the pandemic across the county.
Based on results of the first round of testing, the research team estimates that approximately 4.1% of the county’s adult population has antibody to the virus. Adjusting this estimate for statistical margin of error implies about 2.8% to 5.6% of the county’s adult population has antibody to the virus- which translates to approximately 221,000 to 442,000 adults in the county who have had the infection. That estimate is 28 to 55 times higher than the 7,994 confirmed cases of COVID-19 reported to the county by the time of the study in early April. The number of COVID-related deaths in the county has now surpassed 600.
“We haven’t known the true extent of COVID-19 infections in our community because we have only tested people with symptoms, and the availability of tests has been limited,” said lead investigator Neeraj Sood, a USC professor of public policy at USC Price School for Public Policy and senior fellow at USC Schaeffer Center for Health Policy and Economics. “The estimates also suggest that we might have to recalibrate disease prediction models and rethink public health strategies.”
The results have important implications for public health efforts to control the local epidemic.
“These results indicate that many persons may have been unknowingly infected and at risk of transmitting the virus to others,” said Dr. Barbara Ferrer, director of the L.A. County Department of Public Health. “These findings underscore the importance of expanded polymerase chain reaction (PCR) testing to diagnose those with infection so they can be isolated and quarantined, while also maintaining the broad social distancing interventions.”
The antibody test is helpful for identifying past infection, but a PCR test is required to diagnose current infection.
“Though the results indicate a lower risk of death among those with infection than was previously thought, the number of COVID-related deaths each day continues to mount, highlighting the need for continued vigorous prevention and control efforts,” said Dr. Paul Simon, chief science officer at L.A. County Department of Public Health and co-lead on the study.
The study’s results have not yet been peer reviewed by other scientists. The researchers plan to test new groups of participants every few weeks in coming months to gauge the pandemic’s trajectory in the region.
About the study With help from medical students from the Keck School of Medicine of USC, USC researchers and Public Health officials conducted drive-through antibody testing April 10th and 11th at six sites. Participants were recruited via a proprietary database that is representative of the county population. The database is maintained by LRW Group, a market research firm.
The researchers used a rapid antibody test for the study. The FDA allows such tests for public health surveillance to gain greater clarity on actual infection rates. The test’s accuracy was further assessed at a lab at Stanford University, using blood samples that were positive and negative for COVID-19.
In addition to Sood and Simon, other authors and institutions contributing to the study include Peggy Ebner of the Keck School; Daniel Eichner of the Sports Medicine Research & Testing Laboratory; Jeffrey Reynolds of LRW Group; Eran Bendavid and Jay Bhattacharya of Stanford University School of Medicine.
The study was supported with funding from USC Schwarzenegger Institute, USC Lusk Center, USC President’s Office, Jedel Foundation, LRW Group, Soap Box Sample, and several individual donors.
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