Hold the champagne!

  

You might notice, in the table below, that I’m now projecting a decrease in the number of new reported Covid-19 deaths this week. This is because I base my death projections entirely on the rate of increase in reported deaths over the last three days; yesterday, that rate fell from 17% to 14%, so all of the numbers below went down (although most of the weekly rates remained about the same as they were yesterday).

However, the reason the three-day rate has declined so much is because there was a spike in total deaths (on the Worldometers.info site, from which all of my numbers have come in the five weeks or so that I’ve been writing this blog) on April 14, no doubt due to the fact that New York City had just added 3,700 deaths to their total on April 12. This was to account for deaths of people since February who clearly had Covid-19 but were never tested.  That caused the 3-day rate to close to double – and it’s been coming down ever since. However, yesterday’s deaths were about 400 more than the previous days, and the daily rate of increase rose from 4 to 5%. The 3-day rate will probably rise again tomorrow, and who knows when it will start falling again?

But even if the 3-day rate stays at yesterday’s 14% through the end of June, we’ll still end up with a little more than one million deaths from March through June, vs. 1.8 million projected yesterday (and the average number of deaths per day in June is over 25,000). I still think a million reported deaths is pretty high, especially since that will almost certainly be some multiple of total deaths in the rest of the world.

And there are three even stronger considerations which makes it likely total deaths in the US from Covid-19 will be more than a million, not less. First, the risks to the growth rate in total deaths are all on the upside now. It’s no accident that the peak increase in deaths came a little more than two weeks after a majority of states (and all of the most populous ones) issued some sort of stay-at-home orders. But the trend now is to open up, not lock down even more, since the president has made it very clear last Friday that he doesn’t care about the sensible guidelines for opening up that he himself presented last Thursday evening. He wants all states to open up right away, testing and contact tracing capacity be damned. This will without a doubt result in the rate of increase in deaths going back up soon, even if it might go down again for a few days.

Second, I pointed out yesterday that, not only is it likely that the decline in new deaths will turn around soon; it’s almost certain now that the Covid-19 epidemic in the US will drag on until a vaccine is found and produced in sufficient quantities. This is because the only way we’ll ever stop deaths from growing is to do a total lockdown of the country, with completely closed borders (or at least quarantining all new arrivals for 14 days) and no non-emergency travel except for very short distances. There seems to be almost no appetite for that now – so we have to just wait for the vaccine.

And how long will that wait be? It will take at a minimum a year and a half to identify a good candidate for a vaccine and get it tested to the point where it’s clear that it’s safe. However, then it has to be manufactured in the quantity needed to distribute it to the whole population. And here’s the challenge: the vaccine will be much more complicated to manufacture than previous ones like the flu vaccine, which are made by injecting a lot of chicken eggs. There are only a few facilities now that could make this type of vaccine, and those few can produce a maximum of 10-15 million vaccines a year.

Thus, there needs to be a huge – and very expensive - effort, starting now, to build the factories needed to produce the vaccine, so that they’re ready when the vaccine is finally approved. Take a guess: Do you think this is the number one priority of the White House right now, given that their main concern is pretending that everything is normal? How can they possibly start calling for this massive effort now, especially since a lot of money will inevitably be wasted on it, because the process required to manufacture the virus won’t be known for sure until after it is developed?

But even more importantly, there’s no assurance we’ll ever have a vaccine for Covid-19. I stated yesterday that the mumps vaccine had taken four years just to develop, and I implied that might be an upper limit. But my friend Reid Blickenstaff pointed out to me that there still isn’t a vaccine for AIDS (which first appeared in the US in the early 1980’s), although fortunately there’s a (very expensive) treatment which allows patients to live close-to-normal lives. Hopefully, if there never is a Covid-19 vaccine, there will at least be such a treatment. But that means we’ll always have to have a lot of social distancing (and large sporting events or other gatherings will probably be permanent banned), unless we want to take the chance that literally every person in the country will become a Covid-19 patient.

Third, the Times today published a great article (with eye-popping graphs) calling attention to the fact that reported deaths from all causes are up sharply over their averages for this time of year in countries across the globe, and in New York City. Some of these deaths are probably due to Covid-19 cases that were never diagnosed, but a lot of them are deaths from other causes that we need to assume are due to the Covid-19 crisis (and a good reason to draw that conclusion is the huge jump in total deaths in each country’s graph starting around March. In other words, for at least the first two months of the year, there was nothing to indicate deaths would have been at anything more than normal levels for the year).

There are two causes why this might be the case. The first is the well-documented fact that, when ERs and ICUs become overwhelmed with Covid-19 cases, they need to be much more selective about which other types of patients they allow. For example, EMTs in New York City have been instructed not to even bring to the hospital a person who has had a heart attack and whose heart has stopped (and presumably the EMT has tried unsuccessfully to restart the heart onsite). Previously, they would still have brought the person in, and in some cases the ER doctors would have been able to restart the person’s heart.

But the other cause is less well-documented. I believe I described 2-3 weeks ago a Times story I’d just read, written by a doctor in NYC who had noticed – and confirmed with colleagues in other hospitals in NYC and elsewhere – that the number of patients who even showed up at the hospital for causes other than Covid-19 had fallen very low, even though at the time there were still a lot of open beds. It seems clear that a lot of people, who would normally rush to the ER for a problem that isn’t life-threatening but clearly needs to be looked at, have made the calculation that the risk of catching Covid-19 in the hospital (no matter how well founded) outweighs the risk that whatever problem they’re having will grow so quickly that they won’t even make it to the hospital in time. I’m sure a lot of people have taken this gamble and lost.

Of course, I’m going to keep projecting reported Covid-19 deaths, since there’s no other verifiable reported number. But keep in mind that my projections, no matter how large, are in fact an underestimate of true deaths due to the pandemic.

The numbers

These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into these numbers – they are all projections based on yesterday’s 3-day rate of increase in total Covid-19 deaths, which was 14%.

Week ending	Deaths reported during week/month	Avg. deaths per day during week/month	Pct. Change from previous week/month
March 7	18	3
March 14	38	5	111%
March 21	244	35	542%
March 28	1,928	275	690%
Month of March	4,058	131
April 4	6,225	889	223%
April 11	12,126	1,732	95%
April 18	18,434	2,633	52%
April 25	14,129	2,018	-23%
Month of April	62,901	2,097	1550%
May 2	18,831	2,833	40%
May 9	27,433	3,919	38%
May 16	36,364	5,195	33%
May 23	51,037	7,291	40%
May 30	70,602	10,086	38%
Month of May	201,722	6,507	321%
June 6	93,586	13,369	33%
June 13	131,349	18,764	40%
June 20	181,701	25,957	38%
June 27	240,855	34,408	33%
Month of June	768,200	25,607	381%
Total March - June	1,036,881

Red = projected numbers

I. Total deaths

Total US deaths as of yesterday: 42,518

Increase in deaths since previous day: 1,953 (vs. 1,551 yesterday)

Percent increase in deaths since previous day: 5%  

Yesterday’s 3-day rate of increase in total deaths: 14% (used to project deaths in table above)

II. Total reported cases

Total US confirmed cases: 792,938

Increase in cases since previous day: 28,673

Percent increase in cases since yesterday: 4%

Percent increase in cases since 3 days previous: 12%

III. Reported case mortality rate so far in the pandemic in the US:

Total Recoveries in US as of yesterday: 72,389

Total Deaths as of yesterday: 42,518

Deaths so far as percentage of closed cases (=deaths + recoveries): 37% (vs. 36% yesterday) Let’s be clear. This means that, of all the coronavirus cases that have been closed so far in the US, 37% of them have resulted in death. Of course, this number will come down as time goes on and more cases are closed in which the victim recovered. But this number has gone down and up since Worldometers started publishing the recovery rate on March 26 (when it was 41%), and on about half the days, it’s gone up; there is still no sign of a downward trend, and other countries like Italy and France show comparable percentages.