Living Dangerously (part 2)

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Two days ago, I reported that the Institute for Health Metrics and Evaluation at the University of Washington had revised its projection of the ultimate US death toll for this wave of covid-19 from 67,641 to 72,433. Given the number of deaths that had occurred already and the current rate of increase—about 1,700 a day in the preceding week—I didn’t see how that projection could stand up. IHME acknowledged that its model did not yet include increased interactions due to the easing of restrictions on public activity.

Yesterday, the Institute released a more sophisticated model that included greater attention to the mobility of populations as well as some other variables. The result is a dramatic increase in the projected death toll, to 134,475 deaths by August 4. As usual, there is a large margin of error, resulting in a range from 95,092 to 242,890. A death toll of 134,475 would far exceed that of any other country. It is about sixteen times the projection for Germany, although the United States has only four times the population of Germany.

The Institute said that its revision upward “is primarily due to longer peaks and slower declines for locations that have passed their peaks.” In addition, “for a subset of states, the easing of social distancing policies has begun and mobility patterns are on the rise.” Those states include Alabama, Florida, Georgia, Idaho, Louisiana, Minnesota, Montana and Texas.

The Institute did not predict an increase of deaths per day, only a slower decline, from about 1,700 now to about 800 by June 1. There is a much more pessimistic document circulating within the federal government that does project such an increase. Deaths per day would start going up in mid-May, reach 3,000 per day by June 1—that’s like having a 9/11 every day—and continue upward from there. The Centers for Disease Control says that this was only a working model that was not finished or ready for release. But apparently someone is taking seriously the possibility that the relaxation of restrictions will lead to a new surge of exponential growth.

The three scenarios I mentioned remain possible:

  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

Of the three, #1 looks increasingly unlikely, and the choice now facing the country is between bad and very bad.

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