Are up to 8 of each 9 COVID death reports in 2022 false?
Exploring the limits of plausibility on Omicron lethality
Kaiser Permanente followed 237,000 Omicron infections in southern California (here called the “KPSC study”) in order to record how lethal an Omicron infection can be.
They found 35 total deaths from 236,996 Omicron infections, or 1 death for every 6771 infections — which is about 7 times less death than you’d see if those infections had been all from the seasonal flu instead of from Omicron.
To account for random variation (the play of chance), I created a 99% Bayesian Credible Interval to find out which infection fatality rates (IFRs) are capable of causing the death which was seen in this study.
The interval itself is an “interval of plausibility” because I put 90 million random numbers through the process and recorded all of the IFRs which were capable of causing exactly 35 deaths in 236,996 infections.
If something cannot happen in even 90 million trials, then it is fair to say that the reason that it couldn’t happen in that many trials is because it is implausible.
The histogram at right shows the limits of the 99% credible interval, which captures the middle 99% of all probability. Notice the value at far right on the horizontal axis (0.03%; 1 death per 3,333 infections) and notice how that IFR “never happened” in 90 million trials.
That’s because it is too high of an IFR to be consistent with the known data. The highest plausible Omicron IFR which is still consistent with the observed death rate from the KPSC study is 0.023% — which is equivalent to 1 death for every 4,442 Omicron infections.
But if that is as bad as Omicron can get, then how come several states in the US have been reporting high COVID deaths after 10 Jan 2022, when Omicron had largely replaced all other variants?
Are the 2022 COVID death counts in US states even plausible?
I ran numbers using the worst-case scenario for Omicron IFR (1 death per 4,442 infections), but couldn’t even come close to explaining the COVID death reported in the 8 states which had the highest COVID death rate per million:
[click on the image above to enlarge it]
In New Mexico, for example, there were 2,644 COVID deaths reported in the 300 days between 10 Jan 2022 and 6 Nov 2022. But using the highest estimate of Omicron lethality (the 99% upper bound), their COVID death count implies over 5 Omicron infections for every single person in New Mexico in those 300 days.
A feasible estimate of Omicron spread is that it reaches 66% of the population, as was true in Denmark in a recent study. When that level of spread is assumed, along with the upper limit of lethality for Omicron, there are still 8 COVID death reports for every “plausible” COVID death.
As there is large financial incentive to report people as suffering or dying from COVID, diligent surveillance of the practices of hospitals and health officials is required.
Evidence from over 200,000 Omicron infections suggests that COVID deaths are currently being reported approximately 4 to 8 times more often than they are actually occurring.
Reference
[Omicron was 93% of US cases by 10 Jan 2022] — OWID. https://ourworldindata.org/covid-cases
[Simulating KPSC data: The plausible minimum number of Omicron infections required to produce a COVID death is 4,442; join data from tables S12 and S14 in the supplement to get the overall average] — Lewnard JA, Hong VX, Patel MM, Kahn R, Lipsitch M, Tartof SY. Clinical outcomes associated with SARS-CoV-2 Omicron (B.1.1.529) variant and BA.1/BA.1.1 or BA.2 subvariant infection in Southern California. Nat Med. 2022 Sep;28(9):1933-1943. doi: 10.1038/s41591-022-01887-z. Epub 2022 Jun 8. PMID: 35675841. https://doi.org/10.1038/s41591-022-01887-z
[8 states with high COVID death rates] — Worldometers Info. https://www.worldometers.info/coronavirus/country/us/
[a plausible estimate of Omicron spread is that it spreads to 66% of the population] — Erikstrup C, Laksafoss AD, Gladov J, Kaspersen KA, Mikkelsen S, Hindhede L, Boldsen JK, Jørgensen SW, Ethelberg S, Holm DK, Bruun MT, Nissen J, Schwinn M, Brodersen T, Mikkelsen C, Sækmose SG, Sørensen E, Harritshøj LH, Aagaard B, Dinh KM, Busch MP, Jørgensen CS, Krause TG, Ullum H, Ostrowski SR, Espenhain L, Pedersen OBV. Seroprevalence and infection fatality rate of the SARS-CoV-2 Omicron variant in Denmark: A nationwide serosurveillance study. Lancet Reg Health Eur. 2022 Oct;21:100479. doi: 10.1016/j.lanepe.2022.100479. Epub 2022 Aug 5. PMID: 35959415; PMCID: PMC9355516. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9355516/