Temporal estimates of case-fatality rate for COVID-19 outbreaks in Canada and the United States

BACKGROUND:Estimates of the case-fatality rate (CFR) associated with coronavirus disease 2019 (COVID-19) vary widely in different population settings. We sought to estimate and compare the COVID-19 CFR in Canada and the United States while adjusting for 2 potential biases in crude CFR.METHODS:We used the daily incidence of confirmed COVID-19 cases and deaths in Canada and the US from Jan. 31 to Apr. 22, 2020. We applied a statistical method to minimize bias in the crude CFR by accounting for the survival interval as the lag time between disease onset and death, while considering reporting rates of COVID-19 cases less than 50% (95% confidence interval 10%–50%).RESULTS:Using data for confirmed cases in Canada, we estimated the crude CFR to be 4.9% on Apr. 22, 2020, and the adjusted CFR to be 5.5% (credible interval [CrI] 4.9%–6.4%). After we accounted for various reporting rates less than 50%, the adjusted CFR was estimated at 1.6% (CrI 0.7%–3.1%). The US crude CFR was estimated to be 5.4% on Apr. 20, 2020, with an adjusted CFR of 6.1% (CrI 5.4%–6.9%). With reporting rates of less than 50%, the adjusted CFR for the US was 1.78 (CrI 0.8%–3.6%).INTERPRETATION:Our estimates suggest that, if the reporting rate is less than 50%, the adjusted CFR of COVID-19 in Canada is likely to be less than 2%. The CFR estimates for the US were higher than those for Canada, but the adjusted CFR still remained below 2%. Quantification of case reporting can provide a more accurate measure of the virulence and disease burden of severe acute respiratory syndrome coronavirus 2.

The risk of death associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is fundamental to the disease burden imposed by the coronavirus disease 2019 (COVID-19) pandemic. Quantification of this risk can provide critical information on the health and socioeconomic impact of the pandemic and identify population subgroups at highest risk for severe outcomes. The risk of death from a diagnosed infection, often referred to as the case-fatality rate (CFR), is the proportion of people who die from a disease among all those diagnosed with the disease over a certain period.Estimates of the COVID-19 CFR vary in different populations and at different stages of the outbreak, ranging from 0.4% in China¹ to 31.4% in the northwest region of Italy.² From individual-level data for patients in Hubei Province, Mainland China,³ an adjusted CFR of 3.6% (95% confidence interval [CI] 3.6%–3.8%) was estimated. For the outbreak on the Diamond Princess cruise ship, the age-adjusted CFR was estimated at 2.6% (95% CI 0.9%–6.7%) in all age groups but was substantially higher (13.0%, 95% CI 5.2%–26.0%) among those aged 70 years or older.⁴For ongoing outbreaks and especially during the exponential growth phase, the delay between onset of disease and knowledge of the final outcome may result in biased estimates of the CFR.⁵ Furthermore, underestimation of the number of COVID-19 cases will inflate the CFR. Limited ability to test or recognize mildly or moderately symptomatic people in both the United States and Canada has likely led to substantial underestimation of the rate of infection in affected communities.^6,7Given the importance of the CFR in public health planning, we sought to estimate the CFR for ongoing COVID-19 outbreaks in the US and Canada while accounting for preferential ascertainment of severe cases (leading to underestimation) and the lag time between disease onset and death.     

Climate change could alter the distribution of mountain pine beetle outbreaks in western Canada

Climate change can markedly impact biology, population ecology, and spatial patterns of eruptive insects due to the direct influence of temperature on insect development and population success. The mountain pine beetle Dendroctonus ponderosae (Coleoptera: Curculionidae), is a landscape‐altering insect that infests forests of North America. Abundant availability of host trees due to altered disturbance regimes has facilitated an unprecedented, landscape‐wide outbreak of this pest in British Columbia and Alberta, Canada, during the past decade. A previous outbreak in the 1980s, in central British Columbia, collapsed due to host depletion and extreme cold weather events. Despite the importance of such extreme weather events and other temperature‐related signals in modulating an outbreak, few landscape‐level models have studied the associations of extreme cold events with outbreak occurrences. We studied the individual associations of several biologically‐relevant cold temperature variables, and other temperature/degree‐day terms, with outbreak occurrences in a spatial‐temporal logistic regression model using data from the current outbreak. Timing, frequency, and duration of cold snaps had a severe negative association with occurrence of an outbreak in a given area. Large drops in temperature (>10°C) or extreme winter minimum temperatures reduced the outbreak probability. We then used the model to apply eight different climate change scenarios to the peak year of the current outbreak. Our scenarios involved combinations of increasing annual temperature and different variances about this trend. Our goal was to examine how spatial outbreak pattern would have changed in the face of changing thermal regime if the underlying outbreak behaviour remained consistent. We demonstrate that increases in mean temperature by 1°C to 4°C profoundly increased the risk of outbreaks with effects first being manifested at higher elevations and then at increasing latitudes. However, increasing the variance associated with a mean temperature increase did not change the overall trend in outbreak potential.     

Spatial synchrony of the two-year cycle budworm outbreaks in central British Columbia, Canada

Outbreaks of forest defoliating insects are usually synchronized over a large spatial scale. Observed records of past outbreaks are usually short and incomplete, therefore long proxy data are useful for better understanding of the spatial synchrony. In this study, we developed tree-ring proxy records of two-year cycle spruce budworm ( Choristoneura biennis Freeman) outbreaks in central British Columbia, Canada, and examined the spatial patterns of past outbreaks. This budworm is a major defoliating insect of the interior spruce ( Picea engelmannii Parry× P. glauca Moench) and subalpine fir ( Abies lasiocarpa [Hook.] Nutt.) forests in the Prince George Region of British Columbia. Four outbreaks occurred in relatively close synchrony over the entire region in the period 1880–1999, however, the initiation year, the intensity and extent of outbreaks varied spatially and from one outbreak to another. In some instances, the occurrence of outbreaks was restricted to only one area. The general synchrony of outbreaks suggested that a large-scale extrinsic factor, such as weather, was at play. However, the imperfect synchrony of outbreaks suggested that local stand characteristics, such as canopy structure, composition of tree species and host plant quality, probably played a major role in preconditioning outbreaks. Dispersal might play a role in synchronizing outbreaks, but the extent to which it contributed to the synchrony was limited in this mountainous region.