When it comes to safeguarding the health of the US, there is no one I trust more than Dr. Anthony Fauci, head of NIAHD/NIH (whom I was fortunate to interview on TWiV in 2013). So when Dr. Fauci says that 100,000 people could die in the SARS-CoV-2 outbreak just in the US, I take notice. What exactly does he mean? Can we put this in perspective with other outbreaks?
As I’ve written before, the percentage of individuals who die from COVID-19 varies widely according to patient age and the kind of health care they receive. As of this writing, South Korea and Germany have the lowest at just under 1% and 0.2% respectively – the case fatality ratio, the number of deaths divided by the number of confirmed cases. In other countries it is much higher, such as Italy which as of this writing has lost nearly 8% of infected patients. A mjaor difference is the capacity of the health care system to take care of patients.
Let’s assume that in the US we can keep the CFR to 1%. That means if we have 1,000,000 infections, 10,000 people will die. We can get to Dr. Fauci’s number by increasing the number of infections tenfold, to 10,000,000. That would give 100,000 fatalities. Is ten million infections realistic?
The only country where the outbreak is subsiding is China. With a population of 1.4 billion, they had 81,000 confirmed infections, for a very low infection ratio. I don’t think we can use China as an example for two reasons. First, they instituted lockdown measures that likely will not be used here. Second, I’m not sure that all the infections have been reported. We don’t know much about infections in rural areas, where there is likely underreporting, and where many people live. Furthermore, not everyone who was infected was tested.
Do other pandemics provide insight? CDC estimates that 12,000 Americans died of 2009 H1N1 influenza (range 8,520 to 17,620). However, it is estimated that 112,000 Americans died during the 1968 H3N2 pandemic, 115,000 during the 1957 pandemic, and 675,000 during the 1918 pandemic. In other words, 100,000 deaths during a pandemic is not unusual. Those of us who lived through previous influenza pandemics remember them well.
I’m sure that Dr. Fauci and others hope that we will not have 100,000 deaths due to COVID-19. That is why they are recommending draconian measures to limit gatherings and travel, including school closings. If everyone takes these seriously, we can limit the number of infections. If not, then ten million infections may become a reality. While most (~80%) are mild, please do not take this as permission to go about your normal lives. Think of the lives you will save of older people who are most at risk for serious disease.