Tristan Hotham

Unfortunately co-morbidities and age are heavily related to fatality. Using Chinese CCDC/ WHO data released on Feb. 17 based on 72,314 confirmed, suspected, and asymptomatic cases as of Feb. 11, alongside a study of 1099 patients clinical outcomes, it is clear that we must act now to protect the vulnerable. We are only as strong as the weakest link in the chain.

As the graph below shows, co-morbidities are clearly associated with poor clinical outcomes. Nevertheless a large amount of the data was missing, meaning there is a large potential for error.

Of co-morbid conditions, it appears that cancer, hypertension, cardiovascular and diabetes offer the worst prognosis. However, this data is not connected with age, so is not totally reliable.

In terms of cases vs. fatalities you can see the over representation of older age groups who are more likely to have co-morbid conditions. There are also a few unlucky younger people under 30 who also die. Unfortunately anyone is at risk, however thankfully children appear to be escaping the worst instances of the disease.

This age trend of disease is important to consider in relation to China’s demographics and situation. Wuhan/Hubei where most of these cases are from features a younger population than Italy for example, and has some of the best healthcare facilities available in the world. The lower average CFR rate seen here (2.2% – see the original report) is reflective of this younger population, the Chinese states restrictive measures and access to quality healthcare including huge numbers of ICU beds.

It is inevitable that the makeup of the cases/fatalities will alter depending on nation. Nations different healthcare systems, age demographics and health will influence the CFR for different groups. We must do all we can to help poorer nations with older demographics.

The graph below shows total cases vs. fatalities. Younger people do have a far greater chance of surviving, but are just as likely to catch the virus. Washing hands, shutting down events and maintaining social distance are clearly key to protecting the vulnerable. It is vital we keep healthcare staff (that are thankfully younger on average that those who require serious medical interventions) healthy in order to look after those who need care. The use of younger volunteers would be particularly beneficial.

Men are more likely to die. Using the CFR gathered from the data, but adding a proportional 30% fatality rate for men gives a clearer appreciation of the male CFR.

Age	CFR Male + Female	CFR Male
0 to 9	0	0
10 to 19	0.2	0.26
20 to 29	0.2	0.26
30 to 39	0.2	0.26
40 to 49	0.4	0.52
50 to 59	1.3	1.69
60 to 69	3.6	4.68
70 to 79	8	10.4
80+	14.8	19.24

The overall death rate above was calculated at 2.2% for the cohort, however we have seen the CFR rate increase worldwide to 3.4%. As such the numbers above are not stable but can increase or decrease. For example in South Korea, where they test a lot of cases, the current CFR is 0.6%, while in Italy the CFR is closer to 5%.

Using a different study based upon 1099 cases inside Hubei province, we can see a breakdown of case outcome by age, including severity of disease. Data does not divide between ICU or death. The data shows that severity of disease does also reflect age and co-morbidities. However, many younger people will unfortunately also get the severe version of the disease. This will generally require oxygen treatment which is difficult to provide to large numbers of people. We must make sure that there are enough oxygen supplies for those who get a more severe version of the disease. Currently it is thought that 80% get a mild version, 15% a severe version and 5% a critical version. However, as is shown below, this ratio is dependent on age. Many of those aged over 65 will require oxygen or ventilation.

The data again reflects the relationship between age and co-morbidities. However, a quite high number of younger people will also catch the more serious forms of the virus including up to 10% of 0-14 / 15-49 year olds. However, it is important to note that these are cases that presented themselves to hospitals and thus are more likely cases with more serious symptoms. Given that South Korea, who are currently testing the most, have a lower CFR the young and the strong must do their upmost to protect the weak and the vulnerable. The situation is continuously evolving and thus it is vital we all personally act, work from home, avoid crowds, help those in need and most importantly please wash your hands.