Unknown unknowns – COVID-19 and potential global mortality
Authors: Victor Grech
Journal: Early Human Development (2020)
Discipline: CLINICAL MEDICINE
Keywords: COVID-19; global pandemic; infection rates; mortality; treatment
Affiliations: Paediatric Dept, Mater Dei Hospital, Malta. Electronic address: .

Abstract:  COVID-19 (SARS-CoV-2) is currently a global pandemic. This paper will attempt to estimate global infection rates and potential resultant mortality in the absence of effective treatment and/or vaccination. Calculations are based on World Health Organisation data from Wuhan in China: 14% of infected cases are severe, 5% require intensive care and 4% die. Estimated infection rates and mortality rates at the level of continents and some individual countries (when these are of sufficient size) are tabulated. This pandemic may cause close to half a billion deaths, i.e. 6% of the global population - and potentially more. At the risk of sounding sensational, but with a sober sense of realism, healthcare risks being plunged into the Middle-Ages if the public do not do their part. Infection cannot occur in the absence of contact. The only way to mitigate these numbers is to apply social distancing and take the standard precautions so frequently reiterated by Public Health: hand washing, avoid touching the face and so on. These measures are crucial as the human cost is going to be unthinkable even in the best-case scenarios that epidemiologists are modelling. 

Retracted: Yes

PubPeer comments:
 Table 1 indicates an estimate of global mortality close to 440 million people, 439,764,020 to be exact. The source of the data indicated in Table 1 is indicated as  xxwho . Could the author please provide the data set and a clear source where these values were derived from. , 
 This article is one of 90 co-authored by Victor Grech that I have raised issue with in a recent letter to the journal, Early Human Development, and its publisher, Elsevier. These articles appear to have undergone little vetting and do not remotely fall within the stated scope of the journal. At worst, the articles suggest malpractice by the author and journal. Elsevier is currently assessing these issues and has called my concerns very serious . You can read press coverage of the story at https: retractionwatch.com 2020 12 10 elsevier-looking-into-very-serious-concerns-after-student-calls-out-journal-for-fleet-of-star-trek-articles-other-issues and read my letter of concern at https: github.com hggaddy public tree master EHD. However, I also hope to highlight a few of the problems with this article in particular. This article uses very worrying assumptions about COVID-19 to crudely estimate that 440 million people could die from the disease globally. After several global waves of the pandemic, the Johns Hopkins University COVID-19 Dashboard reports 1.63 million deaths attributed to COVID-19, as of 15 December 2020. The author reaches the figure of 440 million by assuming that each major region of the world would have either 10%, 60%, or 80% of its population become infected and either 4% or 10% of those infected die (Table 1). Putting aside the nearly impossible issue of forecasting final population infection rates, it is important to stress that the author s claim of a minimum 4% case fatality rate (CFR) was unreasonable at the time of submission and publication. In my opinion, the author s claim that the rates cited are best guesses should not be given the benefit of the doubt. The author s article was submitted and accepted on 23 March 2020 (implying no peer review), but on 27 March 2020, Rajgor et al. published a *review* in *Lancet* of the available CFR estimates and it suggests that 4% is not a plausible figure (doi:10.1016 S1473-3099(20)30244-9). Moreover, the author cites a WHO report from 1 March for their 4% CFR -- a curious choice, given submission on 23 March and the fact that the author could have easily updated their simplistic methodology with new rates -- but the stated report does not even contain that alleged 4% rate. On the basis of reports from China, it states that approximately 14% [of COVID-19 patients] experienced severe disease and 5% were critically ill . It later states that mortality in those with critical illness has been reported as over 50% , suggesting a ~2.5% CFR . In turn, that WHO report takes its data from Wu and McGoogan s *JAMA* article, published 24 February (doi:10.1001 jama.2020.2648), which reports a tentative CFR of 2.3% itself. The author also does not consider the fundamental issue of asymptomatic cases, which were already well-known at the time of submission (see Mizumoto et al., doi:10.2807 1560-7917.ES.2020.25.10.2000180, published 12 March). Any academic malpractice aside, the author s methodology and conclusion are fundamentally unreasonable and were at the time of submission and publication. , 
 See also https: retractionwatch.com 2021 03 31 beam-us-up-elsevier-pulls-26-covid-19-papers-by-researcher-with-a-penchant-for-star-trek , 
 **Retracted** on June 11, 2021: https: www.sciencedirect.com science article pii S0378378221000761 **Retraction note:**  This article has been retracted: please see Elsevier Policy on Article Withdrawal . The author has requested that Early Human Development retract this article. This article was based on very early data and reports from the World Health Organization and Ferguson et al. from which the article drew imprecise conclusions. We now have a far better, albeit still incomplete, understanding of COVID-19. The anticipated mortality will fortunately be far less than estimated in the paper itself. , 
 Even though the paper has been retracted, and there is a retraction notice, the actual paper has the entire text intact and the PDF file does not have  retracted placed on each page, as is required by COPE. ,