Post #833: The Presidential odds after contracting coronavirus.

Posted on October 2, 2020

Edit:  Adjusted for a better estimate of undiagnosed cases as a fraction of total, by age.

Best guess, I think the odds look something like this:

  • < 2.1% risk of hospitalization
  • < 0.9% risk of death.

How much less?  Best guess, conditional on early administration of remdesivir and other anti-virals, the true odds might be well under half of what is shown.

I’m just trying to get across two points.  First, by far, the most likely outcome is that there will be no publicly-identifiable health consequences, given the circumstances.  And, second, if that happens, it doesn’t mean that the President is somehow blessed, or that this isn’t a deadly disease.  It will mean that he’s average, given his age, physical condition, prompt diagnosis, and high-quality medical care.

Details follow.

Baseline estimate, no adjustments (the “raw numbers”)

In Virginia, as of today, the COVID-19 numbers look like this (note that each graph has a separate scale).

Behind this, not shown, would be a much larger population of un-reported cases, largely individuals who weren’t sick enough to seek medical attention.  As a guess, three to four times this many, based on one limited study of seroprevalence of antibodies for COVID-19 in the Virginia population.

Among diagnosed cases for individuals age 70-79, in Virginia, there is:

  • 27% chance of hospitalization
  • 11% chance of death

Adjust for prevalence of undiagnosed cases.

That’s almost certainly an huge exaggeration of the odds, in the case of the President, for the following reason.

The President would be tested regardless of presence of symptoms.  That means that the proper denominator in the Virginia data would include an estimate of all the asymptomatic and mildly symptomatic individuals who were infected, but never tested.  This is necessarily a crude adjustment, because it pools all ages, and it’s completely plausible that the fraction of cases undiagnosed falls with age.

Edit:  I found a plausible rough estimate in this citation, suggesting that undiagnosed infections are, in fact, far less frequent among the elderly.  Figure 2 from that analysis suggests that about 70% of those age 70 and older show symptoms, versus an all-population average of about 40%.  If I use that ratio to adjust the Virginia seroprevalence data, I would guess that there are only 2.5x as many total cases as diagnosed cases, for the elderly, compared to the 4x figure I used in my earlier draft of this. 

Adjusting for likely prevalence of undiagnosed infections in Virginia, estimated for the elderly only:

  • 10.7% chance of hospitalization
  • 4.5% chance of death

Adjust for known number of comorbidities

That too, is almost certainly an huge exaggeration of the odds, in the case of the President, for the following reasons.

Many of the hospitalizations and deaths in those older age brackets were for individuals in nursing homes.  Many were for individuals with multiple significant pre-existing conditions.

(To be clear, neither of those things is unique to COVID-19.  For the institutionalized, and those with severe chronic conditions, the likelihood of hospitalization or death is higher for just about every disease you can name.)

By contrast ,the President is ambulatory and has only one known risk factory (moderate obesity).

The CDC has done the analysis that allows you to infer the odds, separately for those with one or no comorbidities.  They say that those with 2 or more conditions are roughly five times more likely to be hospitalized, compared to those with one or no conditions.

It’s a little too early in the morning for me do do the proper algebra.  (The only other piece of information you need is that about 33% of the elderly have one or no chronic conditions, per this website. )  So I’m just going to do the crude thing and say, well, risk of hospitalization for those with zero or one comorbidity is about one-fifth of the average risk.  And then scale risk-of-death accordingly.

Adjusting again for apparent level of chronic conditions (zero or one):

  • 2.1% risk of hospitalization
  • 0.9% risk of death.

Unable to adjust for timeliness and quality of medical care

But that too, is almost certainly an huge exaggeration of the odds, in the case of the President, for the following reason.

You can be assured that, even now, the President is being given a cocktail of anti-viral medications which, if taken early, is known to reduce severity of COVID-19.  Because of the ongoing testing, this infection was caught before it even became symptomatic.  That’s an ideal candidate for effective use of existing anti-viral medications.  (By contrast, giving them to people that are already sick enough to be hospitalized has next-to-no impact.)

So, best guess, I think the odds are:

  • < 2.1% risk of hospitalization
  • < 0.9% risk of death.

How much less, I could not say.  Best guess, from my vague recollection of the medical literature, about half of what is shown, given prompt administration of remdesivir and other anti-viral medications.

Plus, at 74, the President is in the lower part of that age bracket. Because the mortality rates ramp up so steeply with age, my initial estimate (for all persons in the bracket) was likely a modest overstatement to begin with.