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23 March 2020 - 5 minute read

The academic papers and articles found in the following links are, in Winton’s view, among the most informative on the epidemiology of the coronavirus.

Why Novel Coronavirus Fatality is Likely Overestimated, The BMJ, March 4

“As with other epidemics, the final Case Fatality Risk (CFR) for COVID-19 will likely be significantly lower than both the currently reported rates, and those announced in the coming weeks. Accurate CFRs are only possible after the rates of asymptomatic infection and mild otherwise unreported cases are determined.”

Why What Does Not Kill Us Makes Us Panic, Project Syndicate, March 12

An article on the importance of spreading risk literacy by Gerd Gigerenzer, Director of the Harding Center for Risk Literacy at the Max Planck Institute for Human Development in Berlin, and who, says Steven Pinker, is “the cognitive psychologist who has worked to enhance statistical reasoning, and is the main scientific critic of Kahneman & Tversky's ‘heuristics & biases’”.

We Shouldn’t Worry When a Virus Mutates During Disease Outbreaks, Nature, February 18

“Ill-informed discussions of mutations thrive during virus outbreaks, including the ongoing spread of SARS-CoV-2. In reality, mutations are a natural part of the virus life cycle and rarely impact outbreaks dramatically.”

Zika Virus, Like all Other Viruses, is Mutating, Virology Blog, 14 April 2016

“Let’s stop blaming viral mutation rates for altered patterns of virus spread and pathogenesis. More likely determinants include susceptibility of human populations, immune status, vector availability, and globalization, to name just a few.”

How Much ‘Normal’ Risk Does Covid Represent?, Medium, March 21

What is the normal risk of dying in the UK? David Spiegelhalter, Chair of the Winton Centre for Risk and Evidence Communication at Cambridge University, argues that “if COVID deaths can be kept in the order of say 20,000 by stringent suppression measures, as is now being suggested, there may end up being a minimal impact on overall mortality for 2020”.

Investigating the Impact of Asymptomatic Carriers on COVID-19 Transmission, medRxiv, March 18

This preprint, which has not yet been peer-reviewed, “provides an updated mathematical model taking into account current knowledge of asymptomatic carriers. This new model revises earlier estimates of the basic reproduction number of SARS-nCov-2 (also known as the R0, pronounced “R-naught”), finding that number may be as high as 26.5”.

The Coronavirus Looks Less Deadly than First Reported, but it’s Definitely Not ‘Just a Flu’, UNIVERSAL-SCI, March 20

Professor in evolutionary biology Mike Lee and computational evolutionary biologist Sebastian Duchene point out that flu’s fatality rate is typically less than 0.1%. Compared to a fatality rate of probably at least 1% for the coranavirus, the latter is “much deadlier than seasonal flu, particularly for older people, and there is no vaccine”.

Genomic Analysis of COVID-19 Spread, Nextstrain, weekly situation reports

“Here, we analyzed 723 publicly shared COVID-19 genomes. By comparing these viral genomes to each other, we can characterize how COVID-19 is moving around the world.”

Estimating Clinical Severity of COVID-19 from the Transmission Dynamics in Wuhan, China, Nature Medicine, March 19

"We estimate that the overall symptomatic case fatality risk (the probability of dying after developing symptoms) of COVID-19 in Wuhan was 1.4% (0.9–2.1%), which is substantially lower than both the corresponding crude or naïve confirmed case fatality risk (2,169/48,557 = 4.5%) and the approximator of deaths/deaths + recoveries (2,169/2,169 + 17,572 = 11%) as of 29 February 2020."


Review of Ferguson et al “Impact of non-pharmaceutical interventions..."
, New England Complex Systems Institute, March 17

A review of the Imperial College London research that criticises several aspects of the underlying model’s assumptions, albeit in emotive terms, at times.

A Fiasco in the Making? As the Coronavirus Pandemic Takes Hold, We are Making Decisions Without Reliable Data, STAT, March 19

A contrarian take on the worldwide response to COVID19 by John Ioannidis at Stanford University, a leading authority on selection bias, who argues we may be overreacting.


A Serological Assay to Detect SARS-CoV-2 Seroconversion in Humans
, medRxiv, March 17

"With this assay we can figure out who was infected and who wasn't… [to] determine the true infection rate and infection fatality rate. We can use the assay to screen for people who seroconverted and are now immune… and they can donate their serum and it can maybe [be] used to treat patients." Twitter thread from co-author.


The Positive Impact of Lockdown in Wuhan on Containing the COVID-19 Outbreak in China
, Journal of Travel Medicine, March 17

"Our findings indicate a significant increase in doubling time from 2 days…to 4 days…, after imposing lockdown. A further increase is detected after changing diagnostic and testing methodology to 19.3."


Temporal Dynamics in Viral Shedding and Transmissibility of COVID-19
, medRxiv, March 17

Finds that infectiousness appears to peak on or before symptom onset, making contact and tracing isolation alone potentially insufficient.


Epidemiological Characteristics of 2143 Pediatric Patients With 2019 Coronavirus Disease in China
, Pediatrics, March 16

Findings include that clinical manifestations of 2019-nCoV infection, while less severe than in adults, were present for young children, particularly infants.


Potential Biases in Estimating Absolute and Relative Case-Fatality Risks during Outbreaks
, PLOS Neglected Tropical Diseases, July 2015

Neil Ferguson and co-authors on potential sources of bias in estimating case fatality risk and the effectiveness of interventions during epidemics.

Severe Acute Respiratory Syndrome Coronavirus as an Agent of Emerging and Reemerging Infection, Clinical Microbiology Reviews, October 2007

This paper reviews "the biology of the SARS virus in relation to the epidemiology, clinical presentation, pathogenesis, laboratory diagnosis, animal models or hosts, and options for treatment, immunization, and infection control."