This accepted version of the article may differ from the final published version. This is an

Accepted Manuscript for Disaster Medicine and Public Health Preparedness as part of the

Cambridge Coronavirus Collection

DOI: 10.1017/dmp.2020.298

Public health lessons learned from biases in coronavirus mortality overestimation

Ronald B. Brown, PhD

School of Public Health and Health Systems

University of Waterloo, Waterloo, ON N2L 3G1, Canada

r26brown@uwaterloo.ca

Abstract

In testimony before U.S. Congress on March 11, 2020, members of the House Oversight and

Reform Committee were informed that estimated mortality for the novel coronavirus was tentimes higher than for seasonal influenza. Additional evidence, however, suggests the validity of

this estimation could benefit from vetting for biases and miscalculations. The main objective of

this article is to critically appraise the coronavirus mortality estimation presented to Congress.

Informational texts from the World Health Organization and the Centers for Disease Control

and Prevention are compared with coronavirus mortality calculations in Congressional

testimony. Results of this critical appraisal reveal information bias and selection bias in

coronavirus mortality overestimation, most likely caused by misclassifying an influenza

infection fatality rate as a case fatality rate. Public health lessons learned for future infectious

disease pandemics include: safeguarding against research biases that may underestimate or

overestimate an associated risk of disease and mortality; reassessing the ethics of fear-based

public health campaigns; and providing full public disclosure of adverse effects from severe

mitigation measures to contain viral transmission.

Keywords: coronavirus mortality overestimation; COVID-19; sampling bias; case fatality rate;

infection fatality rate

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/7ACD87D8FD2237285EB667BB28DCC6E9/S1935789320002980a.pdf/public_health_lessons_learned_from_biases_in_coronavirus_mortality_overestimation.pdf