US could experience 20 million Coronavirus deaths by June 2020
For the past few weeks, an increasing number of experts, professionals, and observers have been worried about the exponential growth of Coronavirus COVID-19 cases in the US.
As one of them, after tracking the worldwide and US case growth for weeks, I published this article on March 10, illustrating how the US could reach the then-unbelievable number of 200,000 cases by July 2020, and as many as 1,000,000 cases by the end of 2020.
The actual infection rate, unfortunately, turned out a lot faster. The US reached 100,000 cases on March 29 (SR69), and is currently on track to reach 1,000,000 cases by early April and hundreds of millions of cases in the next two months (see this, this, this).
And yet, when discussing these frightening prospects, many people seem unaware of the disastrous consequences that would happen if the number exceed significantly the capacity of the US healthcare system.
The purpose of this article is to clearly call out the consequences of such a dramatic increase, and where we are at the moment.
In summary, if infection numbers rise and stay continuously above the maximum capacity of of the US health care system, we should expect the following:
- Death rate of 10% for those infected
- Up to 20,000,000 US deaths by end of June 2020 if current rate persists
- Social breakdown and related disasters
While it is unclear what the maximum capacity of the health care system is, it is safe to assume it is no higher than 1.5 million cases at one time — see estimates below.
Furthermore, we are on track to reach 200,000,000 cases by end of June 2020 or sooner, which could make true the above prediction of 20 million deaths or more.
I you only remember one thing from this article, let it be this:
If infection numbers reach and stay above 1.5 million cases, there could be millions of deaths due to COVID-19
Consequence 1: Death rate of 10% for those infected
According to a recent CDC report, between 20% and 30% of cases need some hospitalization, and between 5% and 11.5% of cases need admission to intensive care unit (ICU).
Let us assume that at some point in the future the number of cases significantly exceeds the capacity of hospitals and ICUs — for example exceeding them by 10 times or more.
At that point, we could reasonably assume that a quarter of those needing hospitalization (i.e. a quarter of 20% above, or 5% of all cases) may die.
Furthermore, we could reasonably assume that most of the cases that need ICU would also die (i.e. 80% of the 5% above, or another 4% of all cases).
Finally, if the maximum possible number of ICU and hospital beds is converted to COVID-19 treatment, and are fully utilized, a number of other patients will be turned away. While we can’t predict how many those would be, an estimate equivalent to 1% of COVID-19 infections does not seem out of line.
All told, we could easily be looking at deaths around 10% of the number of infections.
Consider also that we used the lower bound of the CDC estimations for hospitalization and ICU needs. If we had used the higher bound, the mortality number would change from 10% to 16% — almost one in six people.
Then, let’s look at what the maximum realistic number of ICUs in the near future. According to the American Health Association 2020 report, the US has grand total of 107,000 ICUs, including those for cardiac, neonatal, and pediatric intensive care.
Let’s assume as many as 75,000 of those could be converted for COVID-19 cases, and also that somehow magically we could double the count to 150,000 units just for COVID-19 cases — with ventilators, PPE, and trained staff.
Even in that widely optimistic case, the ICUs will be fully booked once we reach 3 million cases, according to the optimistic projections of only 5% of patients needing ICUs, or a maximum of 1.5 million cases in the more conservative estimate.
Similarly, if the number of beds dedicated to COVID-19 could be as high as 300,000 beds (a third of all the hospital beds in the US) that still puts an upper limit of 1.5 infections at a time before hospital beds are fully utilized.
Since these two sets of patients are largely moving between hospitalization and ICU, we should look at them largely as an overlapping set. Therefore, we should assume, conservatively, that the health care system will be completely overwhelmed by 1.5 million infections.
The breaking point of the US health care system seems to be at no more than 1.5 million infections at one time — and possibly lower. The death rate in cases above that threshold is likely to be 10% or more.
Finally, as a sanity check, let’s compare our estimate against the reality of other countries.
In South Korea — the best case of how a country can handle this outbreak, there are 1.6% dead patients to the current number of infections, and around 3% of death to recovered ratio.
To date, South Korea represents the best case of a country handling of this outbreak, by a significant margin. The rest of the 12 countries with most infections have an average Death To Confirmed percentage of 3% and Recovered To Death Ratio of under 5 — that of all closed cases, 1 death for every 5 recovered cases — or a death rate of around 17% of closed cases.
In this context, given that the US readiness and actions are closer to that of the European countries than the Asian countries, a 10% mortality rate estimate in the US is certainly justifiable, if not unreasonably optimistic.
Consequence 2: Number of deaths up to 20,000,000 in US
Given how efficient SARS-COV-2 (the Coronavirus causing COVID-19) is at spreading and infecting, most experts and models predict that over time some 50% to 70% of the population will become infected (see this and this).
Consider what would happen if the US reaches 200,000,000 infections by end of June, 2020.
This may seem impossible, but at the current rate of growth of 8x per week, we could have 200 million cases by the end of April. Having 200 million cases by end of June assumes a growth rate per week of only 2x, a rate which at this point it is not clear if the US can maintain.
As hospitals are unable to handle more than a few million cases between now and end of June, the vast majority of those infected would suffer the 10% death rate estimated above. Therefore, we could have as many as 20,000,000 deaths by end of June, 2020.
There is nothing more to say on this one — if the prediction on the first consequence is correct (i.e. 10% or more death rate if the number of cases completely overwhelm the health care system), this second consequence will be an automatic outcome of the above.
Consequence 3: Social breakdown and related disasters
As if the first two consequences were not dire enough, a number of additional terrible outcomes would come about if the first two consequences were to happen.
Consider, for example, that these estimates predict 20 million deaths in a few short months. The US has a consistent rate of 4 million deaths per year as the normal course of life in a regular year.
How are we going to handle 5x more deaths in 3x less time, in terms of the physical aspect of it (cremations, burials, ceremonies)? How are we going to handle the emotional trauma that will be experienced by every single family at the same time? Who will remain sane?
What would happen when desperate parents or relatives are told that due to insufficient ventilators, the ventilator that was keeping their loved ones alive must be removed since the patient likely won’t make progress fast enough, and there are other cases that need the ventilator and have a better chance of living? Especially in a country with more handguns than people.
What would happen to social order and security if a significant percentage of the police force and military is infected and incapacitated? What would happen if the country disintegrates into violence and looting?
What would happen if…
The list can go on and on. The point of this last section is not to engage our darkest fantasies and draw one dystopian scenario after another. The point is to acknowledge that however bad the first two consequences are, there are even more negative outcomes that we will experience, should the first two occur.
What now???
Thank you for reading thus far. We got through the worst — the picture of what could happen and how quickly it could happen.
Now that it’s all laid out, let’s focus on what we can all do to prevent this disastrous future.
I am an optimist by nature, and I believe that there are lots of things we can do. And that we’ll be able to get to the other side of this, together.
Now that it’s clear how big the stakes are, I intend to start writing about the things we can and should do to survive — as individuals and as a society. Here is the first of those posts:
Please keep an eye on this last section here for updates with links to articles and ideas, and follow me on Medium.com, on Twitter, or on Facebook.
And remember, this too shall pass :-)
I wish you all the best.
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