Post #846: The Presidential odds after contracting coronavirus, updated.

Posted on October 3, 2020

This is an update of a recent post in which I calculated the approximate odds the President’s hospitalization and death from COVID-19.  The calculation starts from the observed rates of hospitalization and death for the 70-79 year old population of Virginia, then makes appropriate adjustments.

I’m updating that to remove one large adjustment, dealing with COVID-19 infections in Virginia that are never formally diagnosed.  These tend to be people who have no or negligible symptoms of COVID-19.  That adjustment is obsolete, now that the President and First Lady are known to be symptomatic (fever, dry cough).  Clearly, at this point, had they been ordinary Virginia citizens, they would have been tested for COVID-19.  Hence, the large pool of low-severity cases that never received a formal COVID-19 diagnosis in Virginia is now irrelevant, and needs to be removed from the calculation.

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

  • Less than 5.4% risk of hospitalization
  • Less than 2.3% risk of death.

How much less?  Tough to say, but the key here is that this was diagnosed at more-or-less the earliest possible moment, and treatment began immediately.   Treatment includes the two best drug options currently available, such as they are. 

Treatment.  In my earlier post, I guessed that the President would be given the anti-viral remdesivir.  That has now occurred (per this news reporting).  He has also been given an experiment drug, REGN-COV2, not yet approved for general use.  That’s an infusion of monoclonal antibodies (MABs), a “manufactured immunity” as described briefly in Post #713 (dated 6/11/2020).  You can read the early results of the effectiveness of the MAB drug on the manufacturer’s website.

Either treatment, in isolation, results in a modest but noticeable improvement, particularly if given early in the course of disease.  Remdesivir was reported as reducing length-of-stay among hospitalized patients somewhat.  Assuming I’m reading the manufacturer’s press release correctly (cited above), the monoclonal antibody drug REGN-COV2 reduced the average viral load by about 45% (0.60 log10 reduction), after seven days, for people who where not already producing their own antibodies, compared to placebo.

Neither drug is a cure.  Both are about as good as it gets, for COVID-19 treatment.  And, as importantly, these use completely different mechanisms to attack the virus.  Remdesivir interacts with the virus to block some stage of viral replication.  The MAB REGN-COV2 drug helps the body to attack the fully-formed virus using its own natural defenses.  Presumably, the full effect of both drugs will be will be obtained, as they used completely different channels to attack the virus.

Information.  A final important note is the odd distinction, in this case, between being in the hospital, and being hospitalized.  I explained that in Post #845.  The President is physically at Walter Reed.  He is, in fact, in the hospital. But he’s not  hospitalized, in the sense of being sick enough to require and receive an inpatient level of care.  (As far as we know.)

As I stated in my last post, I think this pre-emptive move to Walter Reed was done to allow the President’s true medical condition to remain hidden.  If I have guessed right about that, it has clear implications for what you will see reported in the news.  And how you should interpret that.

What to watch for going forward:  No news is bad news. In all likelihood, the President will continue to get sicker for at least the next couple of days.  During that period, expect to see no information from the White House, only boilerplate.  If the President starts to recover, that will almost certainly be broadcast as soon as possible.  The upshot is that the news could be what you don’t see.  If you don’t see good news, out of the White House, in the next three to seven days, my guess is that will mean that the President has been quietly hospitalized.

Possibly the White House will be at least as forthcoming as the Brits were about Boris Johnson’s condition.  But given the “cult of personality” aspects of this administration, I would be surprised if that were true. My only real point is, if there’s good news, we’ll hear about it, loud and clear.  But if the President is hospitalized, intubated, and so on — I doubt we’ll hear much.

I now see that the Washington Post has called for transparency in disclosure of the President’s actual state of health.  Good luck with that.  If nothing else, everybody learned the lesson of Eisenhower’s heart attack.  That pretty much ended the era of truthful reporting about the President’s health.

Details of the revised calculation 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

Edit:  Drop this next adjustment, as discussed in the introduction, now that the President and First Lady are known to have COVID-19 symptoms.

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):

  • 5.4% risk of hospitalization
  • 2.3% 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.  This is now discussed fully in at the top of this post.

So, best guess, I think the odds are:

  • Less than 5.4% risk of hospitalization
  • Less than 2.3% risk of death.

How much less, I could not say.

In addition, 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.