A major frustration with how the COVID19 cases and deaths are being presented is that they are without context. Raw case or death numbers, or mortality rates based off of them, just aren’t useful. Lets take a closer look at the State of New York, since we are starting to get some data there. Sorry, there will be math.
Nobody likes to think about death. The fact is people die every day from a variety of causes. Death is part of life. Where diseases or accidents are concerned, what we worry about is “excess mortality” – in other words, how many people die that, all things equal, probably shouldn’t have? Death rates change during the year – higher in winter, lower in summer. Daily rates are very “noisy”, so it’s probably best to use weekly aggregations. For weeks 10 and 11 (mid March, where we are now), between 2015 and 2019 there were between 2000 and 2300 deaths per week in week 11 in New York (about half in the City). Pneumonia and influenza – “P&I” deaths – are the cause in about 10% of those cases this time of year, or ~190 per week.
So, this week we will probably see 60-70 deaths from COVID19 in New York (60 as of this morning). That’s significant – but in perspective, only a 3% or so increase in average mortality. Assuming the rates are hitting the steep part of the curve, we can probably expect to see on the order of 350 a week for the peak week, or 15% higher than a “bad” influenza week, and that rate sustained over a couple of scary weeks until it drops. The media will go berserk – and the strain on hospitals and health care workers will be horrific – but the big picture is that, for the major of people, it’s not a catastrophe. You can do a similar exercise on the Italy numbers. Yes, they are scary. And not to take away from the individual tragedies of each death, or the toll on the health care system, the increases we are seeing in overall population mortality are not catastrophic in whole population terms. If we start to see the numbers go above 500 in a week in New York, or the rates stay above 300 for more than three or four weeks, there may be something else going on.
For what it’s worth, my viewpoint hasn’t really changed: We are just entering the steep part of the curve. It will be very scary as cases numbers seem to jump up from day to day – but keep it all in context. If these trends hold, the US can expect about 30 to 35 million people to be “symptomatic” (most mild, and given the testing problem, many will never know it), 400,000 to 600,000 need hospitalization, and 35-60 thousand deaths. The economic damage from this is going to be far greater than I anticipated a month ago ($85 Billion), largely because I overestimated the advance planning being done by western governments (who screwed this up big time), and therefore underestimated the overall reaction later. I think we’re in for a rough ride this year – probably on the order of 10 times that in direct impacts, or $850 Billion to a Trillion (!) dollars (out of a roughly $20 Trillion economy). Some of that are “paper” losses, but for small businesses I fear it will be all too real and many won’t make it.
As noted before, for perspective compare to the 2017 influenza season: 45 million symptomatic, 810,000 hospitalized, 61,000 died, probably in the ball park of $80 Billion in economic impacts. HOWEVER, rather than coming over 20 weeks or so, the bulk of the COVID19 cases will come over maybe 4 weeks -five times faster. The US health care system can’t really keep up with a normal flu season; there is no way it can handle this influx. That is why COVID19 is so dangerous, and why everyone needs to take it seriously, following the CDC guidelines, exercising social distancing and hygiene protocols, and otherwise doing everything you can to try to slow down the spread. It’s more than likely not about you. It’s about that 1% of so of the population who will get very sick, and may not get enough care because the system will be overloaded.
At this point, there are way too many people doing way too much speculation based on way too little accurate data. I don’t want to contribute to that. Fixating on every up or down tick in the numbers, and chasing down every wild number or wild theory making the rounds is just not sensible or conducive to sanity. So unless something drastic changes, and it’s relevant to my areas of research, this will be my last COVID19 post for a while. My advice is to be careful, keep watch over those around you, take advantage of the time off as you can, check the news maybe once a day to see if anything has really changed as to what you should do, but don’t drive yourself crazy hitting refresh; this is a slow motion disaster. April will be the cruelest month – but by the last week things should be looking up.