Will a million Americans die due to the COVID-19 pandemic? I doubt that the casualties will get this high, but it is not unthinkable.
When I was young, the “unthinkable” was the possibility of human-caused nuclear war. Today, we face the reality of human-caused pandemic diseases. The destruction from this pandemic probably won’t be quite as grim as an all-out nuclear war. But it is getting into, perhaps, the terror of a limited nuclear exchange.
Coming up with a good answer to the question of the pandemic’s ultimate outcome is not just a strictly scientific problem about viruses and epidemiology; it is also a political one. It is political both because politics could alter the course of the pandemic, but also because whom we regard as an expert is itself a political decision. Is it Anthony Fauci, Michael Greger, or the very stable genius leading our nation? Moreover, this is not a question that we can let the scientific community sort out at their leisure. It matters to us, now. We want to be objective, but in a hurry.
Let’s go with what seems to me to be the more-or-less mainstream scientific consensus and see where that takes us. Informed conventional wisdom is that mortality of COVID-19 is in the range of 0.5% to 0.8%, about 1 death for every 125 to 200 cases of the disease. Dr. Anthony Fauci, of Presidential briefing fame, has said that it will be 12 to 18 months before we have a vaccine, but others have said that even this may be optimistic. Informed conventional wisdom is also that recovering from the virus confers at least some immunity, though we don’t know for how long. We don’t know how fast it spreads (the “R0” value), although all reports are that it is highly contagious in “natural” conditions, e. g. “business as usual” with no face masks or other precautions.
The default option seems to be what is happening in many countries, including many of the states in the United States: do nothing, or do little, and let the disease take its course. We will acquire “herd immunity” when enough people recover from virus, and thereby get immunity. This option requires the least political effort and we can always blame the Chinese to avoid any untoward political results.
Something like this happened during the 1918 pandemic. Wartime censorship suppressed news of the pandemic. It was called “the Spanish flu” when neutral Spain didn’t censor the awful news. People died, but the economy didn’t shut down as much as it could have.
We might “declare victory” and send people back to work even though medically the virus would still be active and still be sickening and killing people. Alternately, we could allow the pandemic to continue but on a “slow burn”: just enough restrictions (face masks or whatever) to prevent the hospitals from being overloaded with COVID-19 patients, which would cause otherwise preventable deaths for those unable to find hospital beds.
So when will “herd immunity” kick in? COVID-19 appears to be highly contagious; you can be sick and contagious for days without showing any symptoms. One recent and troubling estimate for R0 is 5.7 — each person is infecting, on average, 5.7 other people, based on the early transmission of COVID-19 in China. Of course, we can “artificially” reduce the R0 value through social isolation, wearing masks, and so forth, but it seems that the “natural” value of R0 is quite high.
Herd immunity will kick in when the percentage immunized (either by surviving the disease or by being vaccinated) would be 1 – 1/R0. That would be, let’s see, 1 – 1/5.7 = 82% of the population. That’s almost everyone! If immunity is acquired by surviving the disease, then that means the minimum number of people dying in the United States will be: 330 million people * 82% * 0.5% mortality = over 1.3 million. Yikes! That’s more than the 1918 pandemic, which “only” killed 675,000 Americans.
I am not “predicting” that 1.3 million Americans will die. I’m just trying to establish some sort of reasonable ballpark type estimate to give us an idea what we are talking about. The vaccine, or an effective treatment (remdesivir?), might be here by this July — or only after four years, or never. The “natural” R0 could be considerably less than 5.7. Mortality might turn out to be considerably less than 0.5%. And some people (me, for example) are going to stay inside regardless of what the President says.
Or — I know this is a stretch, but stay with me here! — we might actually come up with an effective strategy. Some countries (and some states in the United States) are coping well with COVID-19. Successful strategies are similar to the aggressive methods taken in South Korea and elsewhere. They lay emphasis on methods such as strict lockdown, travel restrictions, massive testing, contact tracing, and masks.
So how likely is it that we will be able to adopt some version of this more aggressive option? The problem is the current state of politics. Unlike in Plato’s Republic, philosopher-scientists are not ruling in our cities right now. Adopting a different strategy requires some accurate science and a tremendous amount of political cooperation and goodwill in an increasingly complex and polarized world.
All of this seems remote right now. But it’s not impossible. In emergency situations, people understand the need for personal sacrifices and altering our accustomed habits. Dealing with the pandemic will be good practice for all of the upcoming challenges that limits to economic growth now pose — the next pandemic, climate change, peak oil, resource depletion, soil erosion, and the staggering social inequality that blocks us from addressing these problems in a fair way. These problems will be just as serious as, or more serious than, the current pandemic.