Since the Trump administration will not provide realistic projections of the potential deaths and hospitalizations which may occur as a result of the COVID-19 pandemic, it has fallen to media outlets such as the New York Times to obtain and provide this information.
Officials at the U.S. Centers for Disease Control and Prevention and epidemic experts from universities around the world conferred last month about what might happen if the new coronavirus gained a foothold in the United States. How many people might die? How many would be infected and need hospitalization?
The conference was held by phone. A CDC disease modeler named Matthew Biggerstaff presented four scenarios (labeled A,B,C,D), “based on characteristics of the virus, including estimates of how transmissible it is and the severity of the illness it can cause.” The scenarios were then shared with expert teams for purposes of planning out a nationwide response. Although stipulated as valid until February 28, the scenarios remain “roughly the same” as of today, according to one of the researchers attending the meetings.
The Times article reveals the worst-case scenario, but emphasizes that this is what would occur only if there were no mitigation measures taken.
Between 160 million and 214 million people in the U.S. could be infected over the course of the epidemic, according to one projection. That could last months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities, experts said. As many as 200,000 to 1.7 million people could die.
And, the calculations based on the C.D.C.’s scenarios suggested, 2.4 million to 21 million people in the U.S. could require hospitalization, potentially crushing the nation’s medical system, which has only about 925,000 staffed hospital beds. Fewer than a tenth of those are for people who are critically ill.
To be clear, despite the paucity of guidance being provided at the national level, state and local communities are beginning to take action. And the CDC is revising its modelling accordingly, based on the degree and extent of those mitigation efforts. The “worst-case” scenario, described above, is therefore not what will occur.
The data have not been released publicly because, according to the CDC, there is still uncertainty about the rate of transmission by people who are asymptomatic, and the researchers realize that any public disclosure of such data to the public walks a fine line between creating complacency and panic. The Times was only able to obtain screenshots (apparently from a Power Point) which detail the data.
Strangely, when contacted by the Times, the CDC would not comment on this data and instead referred the Times to the White House, where a spokesman for the White House Coronavirus Task Force said that “senior health officials had not presented the findings to the group.” Assuming this statement is true, the question then becomes “why not?” As the article itself points out, “without an understanding of how the nation’s top experts believe the virus could ravage the country, and what measures could slow it, it remains unclear how far Americans will go in adopting—or accepting—socially disruptive steps that could also avert deaths.” At a bare minimum it seems highly implausible that the very task force designed to formulate our nation’s response to the pandemic was not in possession of these findings, which, according to the Times, were shared with “about 50 expert teams.”
The Times article does not specifically describe or detail the other three scenarios, possibly because it did not have access to the data (although that is not clear). Those scenarios all posit widely varying rates of transmission and subsequent hospitalization; however, the Times states that all of the scenarios fall within the projections of those developed by “independent experts.”
One of those experts, quoted in the Times article, is Dr. James Lawlor, who specializes in infectious diseases at the University of Nebraska Medical Center. Dr. Lawlor says that hospitals must begin preparing now to receive a huge influx of patients.
Dr. Lawler recently presented his own “best guess” projections to American hospital and health system executives at a private webinar convened by the American Hospital Association. He estimated that some 96 million people in the U.S. would be infected. Five out of every hundred would need hospitalization, which would mean close to five million hospital admissions, nearly two million of those patients requiring intensive care and about half of those needing the support of ventilators.
Dr. Lawler’s calculations suggested 480,000 deaths, which he said was conservative. By contrast, about 20,000 to 50,000 people have died from flu-related illnesses this season, according to the C.D.C. Unlike with seasonal influenza, the entire population is thought to be susceptible to the new coronavirus.
The Times notes that researchers are relying, in part, on data from the 1918 “Spanish Flu” pandemic, which caused an estimated 675,000 deaths in the U.S. The Institute for Disease Modeling has calculated that the transmission rate of COVID-19 is similar to that virus. Measures taken by major different cities during that time, such as closing of public places, theaters and schools, varied widely and their effectiveness varied accordingly.
Fortunately we are not living in 1918. Modern medicine, facilities and diagnostic tools are available to us that simply did not exist at that time. But, as the Times article points out, the U.S. population has exploded, “with 10 times as many people over 65 and 30 times as many over 85.” These are the people most vulnerable to the virus.
Again, these are estimates only, and they are wholly dependent on the scale of our nation’s response. The key, as the Times article emphasizes, is to institute massive preparations now, before the pandemic becomes uncontainable. If nothing else, these projections should refute the dangerous notion—whether peddled by the Trump administration or anyone else—that this virus will simply “go away.”
