GIDEON blog

Try it Free Latest Updates Video Tutorials
Subscribe , j

Estimating the True Case-Fatality Rate of COVID-19

For several months, we have been inundated by reports summarizing incidence and mortality data for COVID-19, on both the national and global level. In a previous ProMED post I cautioned that “reported cases” cannot be equated with “total cases” without inclusion of individuals with asymptomatic of sub-clinical infection that do not seek medical care. [1] If a large segment of the population is found to be seropositive, we might conclude that the true case-fatality ratio of COVID-19 is lower than official data might suggest. A seroprevalence study reported this week seems to provide solid evidence that this is the case. [2]

A national survey of individuals identified IgG antibody toward SARS-CoV-2 in 5.0% of the general population of Spain. At the stated specificity of 100% and sensitivity of 98%, the true seropositivity may be estimated at 5.15%. Although factors which determine seroprevalence rates in Spain need not apply to other countries, the following chart extrapolates the potential impact of a 5.15% population seroprevalence on case-fatality data from high-incidence countries in the European Region, United States and China. [3]

The impact of future SARS-CoV-2 seroprevalence surveys will largely depend in the quality of the test itself, the duration of immunity and protective role of the antibody, possible emergence of newer strains of coronavirus, and other factors. In any event, additional seroprevalence data will play a key role in planning our response to this pandemic going forward.

COVID-19 Reported vs. Estimated cases

Country Reported cases % of population Reported Deaths CFR (%)* Estimated cases** Estimated CFR (%)***
Belgium 55,280 0.48% 9,052 16.4 596,548 1.52
China 82,947 0.0058% 4,634 5.6 74,125,174 0.0063
France 179,569 0.28% 28,108 15.7 3,360,686 1.14
Germany 176,651 0.21% 8,049 4.6 4,313,197 0.19
Israel 16,617 0.19% 272 1.6 444,866 0.061
Italy 225,435 0.37% 31,908 14.1 3,114,329 1.02
Spain 277,719 0.59% 27,650 10 2,407,759 1.14
U.K. 243,695 0.35% 34,636 14.3 3,493,878 0.99
U.S.A 1,527,664 0.46% 90,978 6 17,034,349 0.53

* CFR = deaths / cases X 100
** True number of cases based on population seroprevalence of 5.15%
*** Adjusted CFR = deaths / estimated true cases X 100

References

  1. ProMED – What’s the denominator 20200228.7035438
  2. ProMED – Spain: seroprevalence study 20200516.7342334
  3. https://www.worldometers.info/coronavirus/ (status as of May 17)

Can Cell Phones Carry COVID-19?

spray disinfecting phone from germs and viruses

It’s long been known that cell phones can carry a multitude of germs, bacteria, and different forms of fungi. With the arrival of the COVID-19 virus, it begs the question if it too can live on the surface of a phone and subsequently be transmitted to another person. 

A compilation of studies from across 24 countries over the past 13 years indicates that it is a very likely possibility. 

Although COVID-19 was not included in any of these original studies, the rapid rate at which it has spread throughout the world, and the increased and ever-growing physical attachment that people have to their cell phones, leads researchers to believe that phones could in fact harbor the virus. 

Our co-founder, Dr. Stephen Berger, who is double board-certified in infectious disease and microbiology, recently commented on this topic for an article in HealthDay

“Cellular phones are ideal vehicles for the virus of COVID-19,” he agreed. “They are repeatedly exposed to material exhaled from our mouth and nose and spend literally hours in our rather filthy hands. Viruses of this type are known to survive on plastics and stainless steel for two to three hours; on aluminum for two to eight hours, on cardboard and paper for up to 24 hours, and ceramic or glass for up to five days.”

While many experts suggest wiping down your phone frequently with a disinfectant and abstaining from sharing your phone with others, Dr. Berger says that it is our hands and not the phones that merit the extra attention when it comes to disinfecting. 

“Whenever these and other objects in our daily life are examined in the laboratory, a veritable ‘zoo’ of bacteria, parasites, fungi, and viruses are discovered. But the common denominator for all of these is the human hand that touches them, and then goes to our mouth or nose.”

Keeping your phone clean may help limit exposure to the virus, but even more helpful is to keep your hands clean with frequent washing and then away from your face as much as possible. 

You can read the entire article here

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates about our new interface!

Why Some Countries Have Fared Better in Fighting COVID-19

World map with an outbreak marker indicating COVID-19

There are more than 1.2 million confirmed cases of COVID-19 in the United States right now with nearly 80,000 related deaths on record. This number is greater than a quarter of the total deaths suffered worldwide. 

What has America gotten wrong in its response to the deadly virus, and what have other countries done right?  

New Zealand, South Africa, and Vietnam—even sharing a border with China where the virus originated —all have experienced relatively few cases and minimal deaths from COVID-19. 

Our co-founder and infectious disease expert, Dr. Stephen Berger shared his thoughts for a recent article in Healthline as to why these countries might be faring better than others.

“All three countries have a coordinated, nationwide, centrally planned response as well as travel restrictions, both domestic and international,” said Dr. Berger.  

Elements of each country’s response that likely have contributed to their success in keeping the virus at bay include:

  • Speed: rapid response to the situation in closing borders immediately, implementing full lockdowns, and requiring that masks be worn right away
  • Aggressive enforcement: all three countries have been stern in enforcing these regulations with government assistance and even military intervention 
  • Testing: meticulous attention devoted to testing and then contact tracing as to following where someone infected has traveled  

Additionally, South Africa and Vietnam have been able to draw on their past experiences with such deadly diseases such as HIV infection, Tuberculosis, and SARS.

Experts agree that early and swift action is key to a country’s success in fighting any deadly virus. “Trying to play catch-up is always more difficult than heading things off early on,” says Dr. Berger.

You can read the entire article here

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates about our new interface!

Antibody vs antigen testing

Coronavirus testing. Hand holding a tube with 'coronavirus' written on it.

Our co-founder and infectious disease expert, Dr. Stephen Berger, recently explained the differences between diagnostic, antibody, and antigen testing for the virus in Business Insider

  • Diagnostic test: conducted via a nasal or throat swab; best suited for someone with severe symptoms; results may take several days or even weeks to become available. 
  • Antibody test: taken via a blood sample; confirms if you had a previous infection of the virus, but may not detect if it is still in your system as it generally takes 14 days following symptoms for antibodies to appear; does not determine if you will get the virus again; can help track where the virus has spread and monitor fatality rates if conducted over a widespread area. 
  • Antigen test: quickly registers antigens to the virus (or certain molecules that help evoke an immune response to something foreign in the body, such as a virus); results are ready in a shorter time; may potentially become a more efficient and affordable option for testing in the future.

“The presence of COVID-19 and many other viruses in patient specimens can be confirmed using these antigen tests, usually within minutes to hours,” Dr. Berger told Business Insider. 

Although these antigen tests are not yet currently on the market, they are in development right now. The speed at which they can detect the virus, as well as the possibility of at-home antigen test kits, making them an attractive option as we continue to face COVID-19. 

You can read the entire article here

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates about our new interface!

Is it Safe to Go Back to the Gym? Dr. Berger talks to Shape.com

Illustration of two females exercising in a gym

Many states are relaxing their stay-at-home guidelines, which includes opening up fitness facilities to the public again.  Most must operate under a limited capacity, enhanced cleaning and sanitation practices, and use signs and floor markers to ensure social distancing. But the big question is whether it’s safe to go back? Experts warn social distancing may not be so easy at a gym.

“A gym is just another venue in which disease can be passed from person to person, and the risk of contracting COVID-19 might increase there, where group sports and games require close personal contact,” our co-founder and infectious disease specialist, Dr. Stephen Berger explained to Shape.com

“The fact that you might be young and healthy won’t affect your chance of becoming infected; it will really only increase your chances of surviving an infection without severe or fatal consequences.”

Similarly, if you’re in a region where local officials are mandating or strongly urging residents to wear face masks or other facial coverings in public, the gym is not exempt from those guidelines, notes Dr. Berger.

You can read the entire article here.

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates about our new interface!

COVID-19 and Fame

Ask anybody on the planet, “What do Tom Hanks, Boris Johnson, and Prince Charles have in common?” and they will instantly shout – “Corona.”

Ask these same people, “Who were the three Prime Ministers that died of Coronavirus last month?” Few will respond, “Well…there was Nur Hassan Husein from Somalia, Mahmoud Jabril from Libya and Joachim Yhombi-Opango from Congo – who died (respectively) in London, Cairo, and Paris.”

As of May 4, no fewer than eleven movie stars had contracted COVID-19, nine with fatal results. Other victims include retired Commanders of the Turkish and Polish Armies, a well-known rapper, and a mafia hitman. Almost half of the famous COVID-19 victims have been athletes, not surprisingly from countries that report unusually high rates of infection (see list below).

History is largely written in the lives of famous disease victims. The “black death” of 1348 claimed only eleven well-known people, including the King of Spain, the Royal Consorts of England and France, four famous painters, and two Archbishops of Canterbury. In contrast, 62 famous people died during the “Spanish Influenza” pandemic, accounting for 39% of known causes of death in this population from 1918 to 1920!

COVID-19 in Athletes

  – fatal
  – soccer
– American football
– basketball
– cricket

Argentina

Ezequiel Garay 

Brazil

 Jonathas de Jesus

Denmark

 Thomas Kahlenberg

 Peter Madsen

England

 Callum Hudson-Odoi

 Norman Hunter 

 John Rowlands 

France

 Eliaquim Mangala

 Arnold Sowinski 

Gambia

 Omar Colley

Germany

 Jannes Horn

 Timo Hubers

 Luca Kilian

 Fabian Nurnberger

 Stefan Thesker

Italy

 Zaccaria Cometti 

 Fabio Depaoli

 Innocezo Donina

 Alessandro Favelli

 Luciano Federici 

 Manolo Gabbiadini

 Antonino La Gumina

 Daniele Rugani

 King Udoh

Netherlands

 Henk Overgoor

Norway

 Morten Thorsby

Pakistan

 Zafar Sarfraz   

Poland

 Bartosz Bereszynski

Serbia

 Dusan Vlahovic

Somalia

 Mohammed Farah

South Korea

 Hyun-jun Suk

Spain

 Baldiri Alavedra

 Mikel Arteta

 Goyo Benito

 Jose Luis Capon

 Jose Luis Gaya

 Benito Joanet

 Miguel Jones

Sweden

 Albin Ekdal

United States

 Tom Dempsey

 Rudy Gobert

 Orlando McDaniel

 Donoval Mitchell

 Christian Wood

PEOPLE shares Dr. Berger’s advice about how to correctly and safely wear a face mask

Wearing face masks is now a part of our everyday life. In early April, the CDC made the official recommendation that everyone should wear one to help slow the spread of COVID-19 after new research showed that 50% of people who get it don’t show symptoms. So they will likely be around for quite some time, but unfortunately, many people aren’t wearing them correctly and could be exposing themselves unnecessarily. 

Our founder, Dr. Stephen Berger, who is double board-certified in infectious disease and microbiology, provided important tips to People.

“Masks should be as closely fitted to the skin as possible,” Dr. Berger told PEOPLE. He added there shouldn’t be any gaps on the side of the masks and it should cover everything from your nose to your chin. 

Dr. Berger added, “The nose must be covered. Note that when people are tested for the virus, a swab is inserted into the nose — because that is where the virus is!”

Dr. Berger also provided tips for people who wear glasses and how they can avoid fogging up their lenses. 

You can read the entire article here

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates on our new interface!

LA Times: Dr. Berger Answers Questions About Food and COVID-19

LA Times Cooking Editor, Genevieve Ko, turned to GIDEON founder, Dr. Stephen Berger, to get an expert opinion about COVID-19 and food transmission. Dr. Berger provided answers to some common questions people are asking such as:

  • Can COVID-19 be transmitted through food? If so, how?

Dr. Berger: There have been no cases of COVID-19 associated with the ingestion of food, but the question is well-founded. COVID-19 is, after all, caused by a virus that enters the body through the nose or mouth. Food items are, after all, objects which may be contaminated with the virus and placed in the mouth — but like many other viruses, bacteria, and parasites, these will be swallowed and most likely destroyed by stomach acids. Should the virus survive into the intestine, no pathway will carry it to the lungs.

  • Can COVID-19 be transmitted in the process of consuming food or only through the respiratory system?

Dr. Berger: The virus of COVID-19 must enter the respiratory system to produce disease. There is the possibility that material could travel from the mouth through the larynx and into the lungs. It is thought that acquisition of COVID-19 through this route rarely, if ever, occurs.

  • If COVID-19 is on food, can it be killed by cooking? If so, at what temperatures?

Dr. Berger: SARS virus, a close relative of the virus of COVID-19, is inactivated at temperatures of 56 to 65 degrees Celsius (132.8 to 149 degrees Fahrenheit).

  • Can you acquire COVID-19 from food?

Dr. Berger: The bottom line answer is … no.

 

You can read the entire article here. 

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates on our new interface!

HealthDay talks to Dr. Berger about ‘best practices’ for disinfecting

If you are one of those people who think you need to scrub down everything after an outing, here’s some good news…you can save some of that disinfectant. GIDEON’s co-founder Dr. Stephen Berger provided practical advice about what items should be disinfected in your home. [Spoiler alert: It’s not your keys, money, or credit cards!] 

Here’s what Dr. Berger had to say to HealthDay

“We are all swimming through an invisible swamp of bacteria, viruses, fungi, and parasites. Those bookshelves and those pictures on the wall are teeming with ugly microbes. Not to mention your cellular phone, wristwatch, eyeglasses, and everything else in your world.”

But he did explain that there’s no need to scrub everything down once you return from outside. 

“The good news is that you are in no danger from most of this,” Dr. Berger said. “And you have no reason to compulsively avoid, or even clean, every object in your personal world. With one exception: your own hands!”

Proper handwashing is what the experts have been stressing from the beginning of the coronavirus pandemic and a message that Dr. Berger, who is double board-certified in infectious diseases and clinical microbiology, reinforces.

You can read the entire article here

And don’t forget to follow us on Twitter, Facebook, and LinkedIn. We’ve got exciting updates on our new interface!

What’s The Difference Between a Face Mask and a Condom?

Cloth surgical masks were first used in the late 19th century and were replaced by modern masks during the 1960s. Surgeons do not wear masks to protect themselves from the patient, but to protect the patient from their own oral and nasal bacteria. 

In any case, masks do protect the users themselves. A variety of masks are currently marketed in a wide range of design, material, filtering specifications, and prices. Both cloth and paper masks will offer protection against COVID-19…. but not one-hundred-percent protection. For this reason, we must observe additional precautions such as social distancing, hand washing, etc. 

Can COVID-19 get through the face mask?

Masks are designed to filter out small particles from the air. In theory, the virus that causes COVID-19 could easily evade even the high-quality masks that we see in our streets lately. More than 200,000 individual viruses would fit into the period at the end of this sentence. The good news is that we become infected through somewhat larger particles, consisting of the virus itself, mucus, cellular debris from the lungs and throat, etc. 

A face mask is not a substitute for social distancing

Sadly, masks also tend to give the user a false sense of security.

When I see neighbors in masks sitting next to others I will ask, “If I were to tell you that the other guy is actually infected with coronavirus, will you continue to sit with him? Or will you back away? After all, you do have a mask? If he is also wearing a mask, will you be reassured? 

I am reminded of the early days of the AIDS pandemic which continues to this day. Young travelers en-route to exotic countries would assure me that they will use condoms. I would ask them, “If you found out that this specific person is HIV-positive will you continue to partner with them? After all, you are wearing a condom!” 

How to properly wear a face mask

Masks should be as closely fitted to the skin as possible. The nose must also be covered. Note that when people are tested for the virus, a swab is inserted into the nose – because that is where the virus is

We often see medical professionals – and even doctors in the operating room – with masks worn below the nose. This is not only poor practice, it is blatantly illogical! Several years ago, we conducted an experiment to test the influence of mask position on contamination rates in an operating room – see Effect of Surgical Mask Position on Bacterial Contamination of the Operative Field

Regarding the problem of eyeglass fogging, my surgical colleagues recommend that the mask must be pressed tightly onto the skin under the eyes, but worn loosely under the chin to redirect the flow of exhaled air.

So, here’s a thought! Walking among strangers without a mask is like having unprotected casual sex. But, unlike venereal diseases (and even HIV / AIDS) COVID-19 can kill, and you may well become a danger to the lives of your loved ones!

GIDEON Sign In