Covid-19 cases are emerging across the United States’ solar belt, the region from southern California to Florida. More than 137,000 Americans have died and more than 3 million have been infected.
But as cases increased, the daily deaths associated with the pandemic did not increase to the seismic figures seen in April, when the virus took over New York City.
More than 2,429 were reported killed by the coronavirus on April 21 nationwide, one of a set of horrible days that month. On July 17, 977 people were reported killed, even as infections are rapidly increasing in the south and west.
Politicians have taken advantage of this, including Donald Trump, who has perpetuated falsehoods about the death rate even as hospitals across the region begin to fill up.
What measures the mortality rate?
First, let’s talk about what it doesn’t: the probability that an infected person will die. That measure is called the case fatality rate and that is why we know that Covid-19 causes much more severe illness and death than a typical flu.
“It is very important to understand the fatality of a pandemic,” said Dr. Howard Markel, a pandemic historian, infectious disease expert and pediatrician at the University of Michigan School of Public Health.
Covid-19 has a high case fatality rate, which is why the authorities believe that it is worth interrupting our lives to stop it. Like many metrics with Covid-19, the case fatality rate is based on preliminary data that may be incomplete.
To find the case fatality rate, divide the total number of people diagnosed with Covid-19 by the number of people who have died. It is easy. The reason it is probably not accurate is because the total number of confirmed Covid-19 cases will not represent all cases.
Some people will have the disease, but they will never be tested. Perhaps because they have no symptoms, perhaps because they fear paying for a test, or perhaps because there are no tests available. There are innumerable reasons. The number of confirmed people who died from Covid-19 is also almost certainly an insufficient count.
For these reasons, the case fatality rate does not accurately represent the risk of death of a person infected with Covid-19, although estimates place it at between 3% and 5%, according to Markel.
Well then what it is the mortality rate?
The “death rate” that Trump often refers to is the number of deaths in proportion to a population. In other words, it measures the risk of Covid-19 death in an entire population.
Of the 20 nations most affected by Covid-19 today, the United States has the second-highest death rate with approximately 42 people killed by Covid-19 per 100,000, according to the Johns Hopkins University Covid Resource Center monitoring project. The UK alone is highest, with 67 people per 100,000 killed by Covid-19. Of all the countries in the world, the United States has the sixth highest death rate, behind Belgium, the United Kingdom, Spain, Italy, Sweden and France.
But keep in mind that experts also view these data with skepticism.
“People in my line of work have to take this information with a grain of salt,” said Dr. Steven Woolf, a professor in Virginia Commonwealth University’s department of family medicine and population health.
Generally, disease-specific death rates take years to be issued by the US Centers for Disease Control and Prevention. Now, they are being rushed into a crisis, and it will probably be a long time before we can make solid “apples to apples” comparisons.
Is the United States doing a good job then?
The short answer is no. Many experts are concerned and predict an increase in deaths to come, in line with infection and hospitalization rates.
There are a number of reasons why the death rate has not yet increased, but the most important is that death is a lagging indicator.
“If you look at the start of the pandemic in the United States, it wasn’t really until mid-April that we saw the huge increase in deaths in New York and New Jersey,” Woolf said. “I am hopeful that the fact that we have not seen the death count begin to increase exponentially is because we are now more effective in treatment, but I am quite concerned that this will occur.”
For other reasons, the death rate can never reach the levels seen in New York City. The average age of Covid-19 diagnosis has decreased since the start of the pandemic. That means the outbreak is now being fueled by young people who are less likely to die from Covid-19, which could be a factor in lowering the death rate.
Second, the increase spans a broader geographic area than that which overwhelms hospitals in New York City. “Mortality can increase as hospitals become overwhelmed and have fewer resources,” Johns Hopkins experts have said. If hospitals are overwhelmed, nurses may be forced to care for more patients, and care may be affected.
Finally, there are unknowns. The coronavirus has been with us since January, or about seven months. It is still “novel”.
What could happen next?
The CDC predicts that up to 170,000 Americans could have died of Covid-19 before August 8, with the worst-hit states coinciding with the worst disease outbreaks or where residents are in the worst health. Arizona, Florida, Idaho, Montana, Oklahoma, South Carolina, Tennessee, Texas, Utah, the Virgin Islands and West Virginia are expected to have the highest number of deaths.
“We see a pattern in which states ignored the public health guide and opened up too soon,” Woolf said. “The result is that not only are we seeing an increase in cases of public health crises in those states, but the economy that they were trying to preserve by opening early is now in jeopardy.”
Even the extraordinary cost already charged by Covid-19 is likely to be a great count. In research published in the Journal of the American Medical Association Network, Woolf and her co-authors reported that up to a third of Covid-19 deaths can be lost in official accounts. Although the study only looked at an eight-week window, if the findings are true, it could represent tens of thousands of Americans nationwide.
“You really don’t have to be an epidemiologist to see the numbers on the nightly news and know that something is terribly wrong in the United States,” Woolf said. “It is not a subtle difference that you can eliminate with statistical analysis.”
