The numbers seem catastrophic, overwhelming, beyond a magnitude that the human mind or heart can grasp: What do 60,000 — or even 240,000 — deaths look like?

Those are roughly the lower and upper limits of projected fatalities in the U.S. from Covid-19 in models that have been informing U.S. policy. Last month, when the lower estimate was 100,000, the White House recommended nationwide countermeasures. Those started with a ban on gatherings and quickly escalated to closing schools and businesses, advising people to wear face masks, and reminding them to stay physically apart. This week, when the lower estimate (from the Institute for Health Metrics and Evaluation) dropped to 60,000, reflecting how well those measures are working, it stoked optimism that the epidemic might soon end with less loss of life.

The lower number, 60,000, is a little more than the capacity of Dodger Stadium in Los Angeles. It is the number of passengers in 180 full jumbo jets. It is more than the number of U.S. combat deaths in the Vietnam War.

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And 240,000, of course, is four times any of the above.

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But are these large numbers or small numbers? At the beginning of the pandemic’s spread in the U.S., President Trump dismissed early projections of thousands, even tens of thousands, of U.S. deaths as no worse than the lives lost in an average influenza year. So far this season, flu deaths total 24,000 to 63,000 (data from the Centers for Disease Control and Prevention are estimates with wide uncertainties).

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Whether you think a multiple of up to 10 on top of that is a tragedy or merely unfortunate is a personal call. For what it’s worth, about 8,000 Americans die every day from, almost overwhelmingly, diseases and other natural causes. Those, of course, haven’t stopped; Covid-19 deaths are in addition to those (with a caveat noted below).

To make these numbers easier to grasp, we show how 60,000 to 240,000 compares to some of the leading causes of death and to previous pandemics.

Epidemic Graph 4
Hyacinth Empinado/STAT

One note about methodology: The projected Covid-19 deaths come from models that see the number of cases and deaths plateauing nationally in the next few weeks, as they have already done in Seattle, San Francisco, and other places that were hit first. If stay-at-home orders and other countermeasures keep working, there should be few deaths after July. We therefore treated the 60,000 to 240,000 deaths as occurring over five months, from March to July, as the IHME researchers do, and therefore calculated five months worth of cancer, heart disease, and other deaths. Of course, as Anthony Fauci, a member of the White House Covid-19 task force, told a JAMA webcast this week, the new coronavirus “is not going to disappear from the planet, for sure,” after July.

But the concentration of deaths is “truncated into weeks,” said Fauci, director of the National Institute of Allergy and Infectious Diseases. That is what captures our attention and overwhelms hospitals.

Disease Graph
Hyacinth Empinado/STAT

Covid-19 is particularly severe in — and more likely to kill — the elderly and people with existing illnesses, including heart disease. Some people taken by Covid-19 would likely have died from these diseases even in the five-month time frame. We do not try to calculate how many of the Covid-19 deaths “substitute” for other deaths; that is an important calculation that researchers will be eager to do once the crisis passes.

You may believe a different methodology paints a truer picture of how Covid-19 deaths compare to others. As we said, how to think about deaths is deeply personal.

  • All of these models lack one crucial bit of information, without which estimates can be off by an order of magnitude. We need to know how many infected (and subsequently immune) individuals are out there. Only an exhaustive population-based antibody testing campaign can answer this question. If the results are the same as in Vo, Italy (I would like to see the QC of their test, by the way) all models are way off. See what one of the most credible contemporary minds in medicine has to say https://www.straight.com/covid-19-pandemic/stanford-university-researcher-john-ioannidis-relies-on-data-to-puncture-some-of-myths-about

  • Is there a reason the flu pandemic of 1956-7 (Asian flu) and the pandemic of 1968-9 (Hong Kong flu) not even mentioned in this article? The 56-7 killed 116, 000 Americans and Hong Kong killed 100,000 with an estimated over 1 million worldwide in each. To bring up the 1918 and leave out the more recent flu more relatable to current health care and medical infrastructure is very troubling

    • Please feel free to check the many published articles about both of the previous pandemics I brought up. The CDC website has plenty of info on each, however, it was archived recently (Feb of 2020) it is still searchable and easy to find.

  • Is the New York/Italian variety of the virus worse than the Asian/Californian variety?
    I read a study had shown the people in New York got the virus from Europe, and those in California got it from Asia – there is apparently enough mutation already to see genetic differences.
    Now, they are not SAYING their is any difference in pathogenicity, but New York is so much worse off than California – the NY governor was more resistant to public health measures and implemented them later – that is given as the reason NY and NYC are so much worse off, but NY state, granted much of it is very urban – has 32 times the death per capita of California. If you start at the same place and one area has twice the rate of another, it takes 5 weeks for one to be 32 times worse off – so, that implies NY got far more cases early on – but their strain is supposed to come from Europe, which is another place the virus had to go before coming to America, whereas countless people got on planes in China and November, December, January and got off, and went to their homes in California. It makes perfect intuitive sense that Santa Clara county, full of Asians, real Asians born in Asia who go home to visit, or for business, has the highest number of patients here – but it seems to make no sense to many New Yorkers have it so early. Maybe the cold weather makes it vastly easier to get infected? Or there is a difference between the two strains beyond random mutations, the East Coast strain is more pathogenic?

    • My Comment is very poorly written. I am asking a very sincere question so please read if you have knowledge to help answer it:
      I have read there are at least two varieties of the virus. Apparently random mutations make it possible to identify if a person in the US was infected by way of Europe, as the virus coming from there is distinct from the one coming direct from China.
      I have read the virus in New York was shown to come by way of Europe.
      Looking at the stats for New York compared to California.

    • It appears the New York epidemic is much worse than the California epidemic.
      The claim is made California tamped down the epidemic better by taking strong actions earlier, however, even assuming exponential growth in the epidemic, this appears to not fully explain the huge differences in infection and death rates.
      I do not have all the numbers for the differences, but New York is shown as having nine times the numbers of cases and 15 times the deaths California has.
      This implies, if they started out with the same numbers of cases some time in January, New York’s cases grew at double the rate of California’s for a full 4 weeks.
      But, we are told New York got the virus from Europe, whereas California’s cases came in from people flying directly from China to California. So the European strain would have needed time to grow, in Europe, before coming here, one would think. So, from the Patient Zero in China, you would think the path to California was much shorter – and yet, despite only a slightly longer period of social isolation, California is vastly better off – AND, in Europe, the death rates for many countries are very, very high.
      Maybe the European strain of the virus is much more lethal in some way as yet understood? Any virology epidemiology people care to comment?

    • I’m sorry to say that I don’t have the expertise to answer your questions. I do want to say though that your post was not poorly written. Your sincerity comes through, and the questions are intriguing, especially considering the data you’ve crunched. Your theory makes a lot of sense to me, and I look forward to the experts checking in.

  • You guys are way off. Upper Limit Deaths for USA will be in the Millions. If the kill rate is only 1.5% and every American gets infected that is over 5 Million deaths. Not a simple 240,000. At this point how is anyone not going to get infected? Now for a more sobering reality. For closed cases the kill rate is well over 20%. That would be 67 Million American Deaths or there abouts.

  • Treating this virus differently than other flu strains was, I suspect, because this was a “novel” corona virus not ever seen before. They already knew the lethal potential of SARS and MERS, both corona viruses. At the beginning, they saw the extremely contagious quality of it, and they didn’t know if it was spread in the air, which it can. They didn’t know who it would affect, how it could spread on surfaces or even mosquitoes. Lack of knowledge about the potential of this and initial evidence that it did not discriminate plus other weird qualities of it led to the shutdowns. Not just the numbers of dead, which I keep hearing. It has been an unknown enemy, and all hands were called on deck.

    • The early reports, and even up until five or so days ago, were telling us not to bother with masks or gloves, and this was from medical officials. Now they have changed their minds. I find that to be horrific and totally puzzling.

    • The experts have consistently said that masks will not significantly protect the wearer from Covid-19, and that N95 masks should be reserved for medical professionals working in a high-risk environment. That has not changed. The new recommendation to wear masks or bandanas is for the protection of OTHERS. The experts are still calling for N95 masks to be reserved for those on the front lines. However, as it is becoming more clear that Covid-19 can be spread through the air, and from an asymptomatic host, it becomes more important for everybody to filter the breath that we’re putting out there.

  • Dear Ms Begley and Ms Empinado:
    Would love to see you publish more of these analyses- perhaps a regular weekly column? Your objective presentation of the data is both informative and calming- this disease compared with normal, expected, and accepted (without fanfare) death rates from other conditions. Your work provides a much needed perspective..

  • How can any person with common sense believe that China has only 3300 deaths but has a population of 1.3 billion ? Why doesn’t the media investigate this inaccurate reporting by the Chinese government ? And why do they not report about the corrupt W.H.O. ? Could it be that the liberal left ‘s only agenda for the past 4 years is to take down Trump at any cost including thousand’s of american deaths.

    • Trump takes no responsibility, constantly blames others and regularly whines about how badly he’s being treated. Now you posit the ludicrous notion that we libs are somehow letting thousands of people die to take down Trump. And we’re the snowflakes?

  • Thank you Ms. Begley for (1.) dealing with a subject that is not an easy one and (2.) to do it with inspiring discipline and objectivity. One does not need to read The Escape from Peril of John Dewey or The Plague of Albert Camus to profoundly understand how big of a root the concept of Death is the anyone’s mind (conscious but mostly unconscious). However, I would like to invite readers, who’s opinion has been triggered, to self reflect on the subject before judging this work, and to check out those previous literary references 🙂 Best wishes!
    Here is the “why” behind my interest for the topic you wrote about. My grandmother died two weeks ago. She had symptoms of covid-19, namely strong fever and pulmonary pain. The day before she had a phone call with my mom, and informed her that she had those symptoms. My mom wanted to join her to take care of her. My grandmother refused firmly, considering the risks of contamination of her old-folks home, where, supposedly, the/a virus had already spread. She also declined more attention from a nurse, reassuring her that she will be fine. Her doctor told us that she died during the night. Today, my family has no proof about which biological agent my grandmother died of. But there was an almost complete consensus, among my family (some people could’nt help it), that it did not matter to know; that this question was not honouring her death and our mourning. Indeed she was quite old and could have died from too much bacteria from french cheese or some other form of biological threat.
    Through that experience, I have been very much interested by the “substitution” aspect that Ms. Begley concluded about. Not to feed my opinion, but rather to further quantify the covid-19 phenomenon to better understand it. Specifically, quantifying “substitution” is, I believe, one of the keys to processing this overwhelming situation, both at a World or State level, but also at a personal level; for everyone to better wrap their mind around “the Peril” or “the Plague” the World is going through.

    I would love to know more about substitution, when data will speak to scientists. Please, keep publishing on the subject!

    • Please accept my condolences on the death of your grandmother. She was a brave, wise, and selfless woman. I cannot imagine a more honorable passing!

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