How many deaths caused by SARS-CoV-2 will there be in the US?

coronavirusWhen 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.

Comments on this entry are closed.

  • Pft 16 March 2020, 6:52 pm

    We have 3 million deaths a year in a normal year. Having 100,000 additional deaths in what most likely be born by mainly the elderly or those who are already sick, while sad, is hardly tragic. Having survived the 1957 and 1968 pandemics, causing over 100,000 deaths with half the population as today and a much younger population , and without the panic and disruption we see today, the response seems disproportionate

    While its right to dispute the accuracy of the reported cases here and in China, its always been known that reported cases understate actual cases with most infectious diseases. For example measles before vaccinations it was known actual cases were 10 times reported cases. A Harvard study reported that only 1/10 or 1/100 cases are reported for many diseases or adverse effects from drugs

    Looking at China. 1.4 billion people. 3000 deaths (mostly over 60’s), 80,000 reported cases. They probably have over 10 million deaths per year in a normal year. Even if only 1% of cases and deaths were reported thats 300,000 deaths (probably overstated as deaths are more likely to be tested and reported) and 800,000 cases in a 1.4 billion population (statistically just a blip). The earliest known case was known now to be November 17. They did not start lock down until after 2 months (Jan 23) .Given the population density in Wuhan is extremely high and its a major transportation hub for China, it had plenty of opportunity to spread and spread quickly.

    Frankly, if not for the lockdown 2 months into the disease on January 23 , the effects would have been minor. Reported cases spiked not because of more cases but because they did more testing starting from January 18 (after 16 consecutive days without new cases).

    The same is being seen in US. More cases because more testing. Most are with mild cases, those in nursing homes or over 70 account for most deaths

    Business closings and undue panic are causing much more damage than the virus

  • Justin Reilly 17 March 2020, 7:55 pm

    No one you trust more than Tony Fauci?! Your judgment is seriously impaired. He’s the consummate amoral politician. He’s sell his mother for some time on TV.

  • Therealmecfs 18 March 2020, 7:43 am

    As a person with ME/CFS and therefore at risk I find Pft’s comment deeply offensive and almost verging on eugenics in it’s tone.

  • Alicia Butcher Ehrhardt 20 March 2020, 5:40 am

    IF vulnerable people get sick, they WILL have a high death rate IF there is not enough medical personnel and hospital resources to help them stay alive.

    You cannot suddenly create more hospital ICUs and intensive care beds with breathing support. You cannot suddenly find a whole bunch of extra medical personnel who know how to take care of the people in these beds – and you can’t suddenly find enough protective gear to keep the medical personnel from having to quarantine THEMSELVES.

    Whatever we have, the only hope of avoiding major death rates is to flatten the curve so that it is significantly below the hospital capability line, which we have to assume is basically fixed. And that is not a given, especially with happenings such as kids on Spring Break on the Florida beaches together en masse.

    What happens when those kids go home – they can’t stay there forever, even if their schools are closed?

    As one of the people in the over 70, disabled, and chronically ill group (though otherwise in good health (!)), I worry. I live in a retirement community with 350 people like me, mostly in independent living, but some in higher care levels. We’re in virtual lockdown – but this management company has never handled an event of the magnitude of a pandemic, and one with our residents as the most vulnerable.

    I literally don’t know what’s going to happen – but I think we need to ask management some hard questions about their preparation and their ability to keep us safe while this passes over. We don’t want to be another Kirkland, WA, case.

  • Wendy Boutilier 20 March 2020, 9:21 am

    ‘PFT’
    Your remark; “Having 100,000 additional deaths in what most likely be born by mainly the elderly or those who are already sick, while sad, is hardly tragic” is both highly offensive and inaccurate. Canadian statistics show;
    31% of cases are patients older than 60.
    69% are travellers and 13% are close contact of travellers.
    52% are Male

  • MPH 20 March 2020, 3:45 pm

    The odds of survival once placed on a ventilator are low. “32 patients required invasive mechanical ventilation, of whom 31 (97%) died.” https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2930566-3

    I don’t think we need to worry about ventilator shortage.

  • msilcommand 23 March 2020, 12:55 pm

    Pft’s comment ending in “while sad, is hardly tragic” needs to be removed. Ignorant, unsympathetic, dangerous words like his in a time like this cannot be allowed. That is the moron, going about his days like nothing is amiss, telling others to do the same, passing on the infection and killing people’s grandmothers, grandfathers, mothers, fathers, sisters, brothers, etc.

    @Pft, we all understand that the CFR is not so high as to be causing widespread. We understand that the new is doing what they do, selling panic. You’re not some insightful genius telling us something we don’t know. The reality is that this is about the social responsibility that we all have to do everything we can to minimize spreading a virus that has such a very high CFR for elderly and ill people. Even if that means staying at home, or suffering an economic plunge. Are you really personally willing to risk infecting people by being irresponsible and having it result in their deaths, just so the economy doesn’t tank? If so, you are not mentally stable, and should be locked up.

  • msilcommand 23 March 2020, 12:56 pm

    *news

  • Benjamin Blumberg 27 March 2020, 7:54 pm

    Herd immunity theory says that an epidemic will fizzle out only when 80-86% of the population has become immune, either through vaccination or through infection. But I offer here a way to make COVID-19 into a more normal head cold.
    On the basis of 30 years bench experience with VSV, Sendai virus, measles virus, HIV-1/AIDS and HHV-6, I offer this remedy to ease the disease course in people already seriously infected with the new Coronavirus SARS-CoV-2:

    Take one teaspoonful of CsCl (cesium chloride) mixed in a glass of water (or better, in a glass of orange juice or tomato juice to hide the saltiness), wait 4-6 hours, then take a half-teaspoonful of KCl (potassium chloride) in juice, or eat a banana. The CsCl “bends” the viral polymerase and slows the viral rate of replication allowing the immune system to catch up. CsCl is currently FDA approved for clinical use (to reduce cachexia in late stage cancer patients), but has a serious side effect: it causes hypokalemia (low blood potassium, with attendant cardiac problems) when taken on a chronic basis. Therefore, patients should not take more than 3 doses of CsCl. The KCl and the banana (which is full of potassium) are taken to rebalance the electrolytes. CsCl and KCL are not prescription items, but are hard to find in pharmacies. They can be ordered online from e.g. Amazon.com. One teaspoonful of CsCl weighs about 19 grams; a half-teaspoonful of KCl weighs about 8 grams. To further boost the immune system, take multiple doses of AirBorne, which can be found in most pharmacies.
    This virus will continue to spread for three reasons. 1. SARS-CoV-2 is as infectious as measles or flu. 2. The 20-day incubation period for the virus means that there will be a LOT of infected but symptom-free people walking about. 3. At the moment, there is virtually no “herd immunity” in our population; everyone is susceptible. According to the theory of “herd immunity”, this epidemic will not stop spreading until 80-86% of the population acquires immunity, either through natural disease or through vaccination. An RNA vaccine may be ready in six months to a year, and I think it will work. However, SARS-CoV-2 has reportedly already thrown off a mutant, as RNA viruses do because the viral RNA polymerase lacks an editing function, and by the time the vaccine is ready it may no longer neutralize the circulating virus strain. Meanwhile, the CsCl remedy targets the viral RNA polymerase which does not mutate, it is ready NOW, it will ease the disease course, and might save your life.

    Benjamin M Blumberg, PhD