The Official Estimates of COVID-19 Deaths Are Way Too Low

While many states mull whether to relax social distancing rules and reopen their economies in May, there are some warning signs that the White House COVID-19 Task Force’s prediction of 100,000-240,000 deaths from the coronavirus may be way too low. 

That isn’t surprising, considering that Administration officials said this projection depended on us doing everything right. Of course, it appears that large sections of the country have done many things wrong—whether it’s Florida Governor Ron DeSantis’ reluctance to close houses of worship or the refusal of several state governors to issue stay at home orders. That doesn’t include Trump’s own refusal to admit the seriousness of the COVID-19 outbreak until mid-March and the continuing failure of the federal government to ensure an adequate supply of test kits, PPE and ventilators.

So here’s what all of this may be leading up to: a minimum of 600,000 COVID-related deaths in the U.S. over the next two years.

Three different lines of research all lead to this conclusion. This research includes expert projections of the likely number of infections, hospitalizations and ICU cases; a recent report on the potential cost of the pandemic to private health insurers; and a roundup of the latest studies on the mortality rate from COVID-19.

Let’s start with the expert estimates. Harvard epidemiologist Marc Lipsitch estimates that the coronavirus will infect between 20% and 60% of the U.S. population. At the low end of 20%, this translates to 65.6 million people. The Harvard Global Health Institute assumes that 15% of people who are infected will be hospitalized. Of these patients, the Kaiser Family Foundation says, 15% will require intensive care. In a few studies of COVID-19 patients, about 70% of ICU patientswith the disease were placed on ventilators. According to early reports from the U.K., China and the United States, as many as two-thirds of these critically ill patients didn’t survive.

If all these assumptions are true, and the infection rate is 20%, 682,000 Americans are likely to die before the pandemic runs its course.

Another approach to projecting the probable number of COVID-19 deaths comes from America’s Health Insurance Plans (AHIP), the industry trade association. AHIP recently released a report it had commissioned on how much the pandemic might cost private insurers. The report analyzed total costs during 2020 and 2021 for a population of 255 million people in commercial, Medicare Advantage and Medicaid managed care plans.

I won’t go into the cost estimates, which ranged up to half a trillion dollars. What’s relevant to this discussion is that, at a national infection rate of 20%, 5.5 million people would be hospitalized and 1.3 million people would end up in the ICU, according to the AHIP report. If 70% of these patients were kept alive on ventilators and two-thirds of those people died, as in the assumptions described above, there would be over 600,000 deaths from COVID-19.

In a recent piece in Medscape, F. Perry Wilson, MD, an associate professor of medicine and director of Yale’s Program of Applied Translational Research, summarized the research that has been done on estimating the mortality rate from COVID-19. After looking at the worst-case scenarios, Wilson described Icelandic studies showing that as many as 50% of those who tested positive were asymptomatic. If that finding applies equally in the U.S., he wrote, we can cut our current 1.7% mortality rate to 0.8% of COVID-19 cases.

If we apply that best-case scenario to an infection rate of 20% of our population, 524,800 Americans will probably die in this pandemic.

It isn’t statistically valid to consider the first and third estimates with the second one, which is only for people covered by private insurers. But for the sake of argument, if we averaged the three estimates—which are uncannily close to one another—we’d get about 600,000 deaths. That’s between 2.5 times and 6 times higher than the White House estimates.

In case you think this is alarmist thinking, people who are far better informed than myself are thinking along similar lines. Early in April, I covered a virtual news conference held by leaders of the Infectious Diseases Society of America. One of the speakers was Rochelle Walensky, MD, chief of the infectious diseases division at Massachusetts General Hospital in Boston.

Walensky noted that the Trump Administration’s estimate of 100,000 to 240,000 deaths was based on optimal social distancing all across the country. However, she said, “We’re not properly social distancing. We’re not doing enough. And in that case, the models were wrong. Our prevention activities were not as robust as the models suggested, so the number of deaths will be higher.”

I sat up straighter when I heard that, and so should all Americans. This murderous pandemic is likely to kill far more people than predicted by the White House, and it’s going to continue until an effective vaccine is invented, tested, manufactured and administered to most of us. The only hope we have of a lower mortality rate is to continue following the social distancing guidelines and to open up our economy gradually as vastly increased testing shows us the way.

Ken Terry is a journalist and author who has covered health care for more than 25 years. His latest bookPhysician-Led Health Care Reform: A New Approach to Medicare for All, was recently published by the American Association for Physician Leadership.

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