Living Dangerously

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On a week-to-week basis, the United States as a whole continues to see some decline in new deaths from the coronavirus. The worst increase was during the week beginning April 19, with 18,482 new deaths reported, increasing total mortality by 90%. The following week’s increase was 14,224, increasing total mortality 36%. This past week, we saw 12,527 new deaths, increasing total mortality 23% (from 53,314 to 65,841).

Because mortality is not dropping as fast as expected, the Institute for Health Metrics and Evaluation has increased its total projected mortality from this wave of the virus from 67,641 to 72,433. That means that only 6,592 more deaths would occur, a very low number considering that 12,527 occurred just this week. The institute acknowledges, however, an important limitation of its projection:

Our present modeling framework does not yet capture how the risk for more COVID-19 cases – and potentially deaths – could increase due to increased interaction among individuals. This is particularly true if locations have not fully instituted strong containment strategies like widely available testing and contact tracing.

In other words, the modeling does not yet take into account the rush to re-open the economy. Although the country as a whole has experienced slowing mortality, the trend has been very uneven from state to state. Most of the states that are moving to lift restrictions are doing so sooner than recommended, according to both IHME and CDC guidelines. They are not waiting until new cases in their state have declined for two weeks, or until they have “strong containment strategies like widely available testing and contact tracing.” That suggests three scenarios:

  1. The warnings from epidemiologists are exaggerated, and the lifting of restrictions will have little effect on the mortality trend
  2. The lifting of restrictions will raise the infection rate somewhat, but not enough to overwhelm medical systems or increase mortality dramatically
  3. The lifting of restrictions will touch off serious outbreaks with exponential increases in mortality in at least some states

I don’t pretend to know which of these will occur. We do know that just a few weeks of careful preparation and prudent restraint can make a big difference when dealing with something that moves as quickly as an infectious disease. We should find out very soon which states are doing the right thing.


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