by Mohamed Al-Ibrahim, MB ChB, FACP

There is great concern about the effects of COVID-19 in the United States population. Unfortunately, there are no helpful mortality estimates; there is simply no readily useful denominator. We will not get much further until we have accurate numbers for sero-positivity in the general population. This will take months. The sero-positivity in respiratory viral illness is typically >2x that of PCR (Polymerase Chain Reaction).*

The mortality numbers according to the John Hopkins University (JHU) map are literally all over the map and impossible to rely on: Italy 6.8%, Iran 4.8%, and S Korea 0.8%. According to JHU data, as of March 16, 2020, there are now 3,813 confirmed COVID-19 cases in the US and 69 deaths with a mortality of 1.8% (1). Of the 69 deaths, 42 (61%) of the total occurred in Washington State and 27 occurred in King County, WA. Twenty-two of 27 deaths in King County occurred in one nursing home facility in Kirkland. This is unfortunate but not unexpected for infectious disease outbreaks in such facilities and similar to influenza and norovirus gastroenteritis. Thus far, and thanks to poor federal government efforts, we have no idea how many individuals have been tested.

Johns Hopkins University & Medicine Coronavirus Resource Center (Click map to visit)

Once testing becomes more available in the next several weeks, an effort should be undertaken in several locations to test as many people as possible for the virus within 25 miles from the epicenter of a known cluster of cases. The deaths in these 25 mile circular regions would be the numerator for a death rate calculation. The number of individuals with positive test results in these regions would be the denominator. The result will be a more accurate estimate of the actual death rate of COVID-19.

*Polymerase chain reaction (PCR) is a method widely used in molecular biology to rapidly make millions to billions of copies of a specific DNA sample allowing scientists to take a very small sample of DNA and amplify it to a large enough amount to study in detail.

Mohamed S. Al-Ibrahim, MB ChB, FACP, is Senior Investigator at Pharmaron CPC in Baltimore, Maryland, and Adjunct Professor of Medicine at the University of Maryland School of Medicine. Dr Al-Ibrahim previously served as President of SNBL Clinical Pharmacology Center Inc. as well as Chief Operating Officer of SNBL from August 2007 to December 2011. He also served as Chief Medical Officer of Maryland General Hospital (University of Maryland Medical System) from 2004 to 2006. Dr. Al-Ibrahim served as Executive Chief of Staff at Department of Veterans Affairs, Maryland Health Care System from 1994 to 2004. Prior to this, he served as Chief Division of General Internal Medicine and Geriatrics from 1983 to 1994. Dr. Al-Ibrahim is Board Certified in Internal Medicine, Infectious Disease and Geriatrics. He received an MB ChB from Baghdad College of Medicine in 1967.

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