I Have Tested Positive. Am I Going To Die?

I am not insensitive to the grief of so many around who have already lost someone close to this terrible disease. I feel and share their grief and anger having lost not just one but many from amongst my family and friends over the last few days. While they were gasping for life, all of them repeatedly asked me this question, “Am I going to die?” Many others, who were by their side, attended by the same medical teams, also asked this question recurrently. Of them, many survived but a few could not.

Our pain is unique to us, our relationship to the person we lost is unique, and the emotional processing can feel different to each person. It is acceptable for us to take the time we need and remove any expectation of how we should be performing as we process our grief.

When we lose a loved one, the pain we experience can feel unbearable. Understandably, grief is complicated and we sometimes wonder if the pain will ever end. We go through a variety of emotional experiences such as anger, confusion, and sadness.

This post reflects my concern for those who are battling for life and for their family and friends who are equally anxious.

“I have tested positive. Am I going to die?” is a straightforward question that most people would like answered. This simple question is hard to answer. Ask this to someone who has seen a dear one succumb to this disease and the frank answer would be, “to be true and forthright, yes you are going to die, unless some miracle happens.” Ask the same question to someone who has seen a dear one survive this disease and the likely answer would be, “it is going to be a long, painful and apprehensive battle, but don’t worry, everything will be fine.”

A forthright question, “I have tested positive. Am I going to die?” is remarkably challenging to be answered by a bystander to the agony of the raging pandemic, who can only look at numbers and statistics to support his answer.

When the risk of death from COVID-19 is discussed, the Case Fatality Rate, sometimes called Case Fatality Risk or Case Fatality Ratio, or CFR, is often used. The CFR is very easy to calculate. The number of people who have died, divided by the total number of people diagnosed with the disease is CFR.

CFR is the ratio between the number of confirmed deaths from the disease and the number of confirmed cases, not total cases. That means that it is not the same as the risk of death for an infected person and, in early stages of fast-changing situations like that of COVID-19, probably not even very close to the true risk for an infected person.

Recall the question we asked at the beginning- if someone is infected with COVID-19, how likely is it that they will die? What we want to know is not the Case Fatality Rate; it is the Infection Fatality Rate (IFR). CFR is not the answer to the question, for two reasons. First, CFR relies on the number of confirmed cases, and many cases are never confirmed; secondly, CFR relies on the total number of deaths, and with COVID-19, some people who are sick and may die soon, are not counted in total number of deaths until have not died. The first reason inflates CFR while the second one deflates it.

With the COVID-19 outbreak, it can take between two to eight weeks for people to go from first symptoms to death, according to data from early cases. With CFR data available for the last 67 weeks that this pandemic has been raging, it is seen that the CFR for a country is not fluctuating as wildly as it was in the first 40 weeks and the CFR for many countries, including India, have not seen large deviations from a stable trend line over the last 18 week.

It is exceptionally important however to note that CFR for cases under Home-Isolation, under Medical-care and under critical-care are different. Further, these CFRs vary across states and locations within India. National CFR is an aggregated mean of all of this CFRs. The cases under critical care are overwhelming the health-care-system at this time, for which the CFR is logically and expectedly much higher.

With IFR being non-available, CFR is being used, albeit quite cautiously, to answer the question, “I have COVID-19. Am I going to die?” and the tremendously relieving answer to the question with a very high chance of being true, at least for patients under home-isolation and those kept in quarantine is a very loud NO. I hope the COVID-19 survivors, who constitute over 98% of the confirmed cases of COVID-19 infections will join the chorus.

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First published 11 May 2021

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