The United States could see hundreds of thousands more deaths this year than earlier anticipated, as COVID-19 cases surge across several states.
Epidemiologists and demographers painted a dark picture in conversations with TPM, estimating that total U.S. COVID-19 deaths this calendar year could range from 260,000 to 500,000.
Those projections of the total U.S. death toll in 2020 come as questions about the disease’s fatality rate persist, with new outbreaks in southern states leading to large numbers of people infected and hospitalized daily, but with the number of recorded deaths — a lagging indicator — remaining relatively low, and on the decrease in some areas.
Andrew Noymer, a demographer and associate professor of public health at the University of California, Irvine, is predicting a COVID-related death toll on the high end of the range, but he emphasized the number of variables that could affect the final numbers.
“It partly depends on us,” Noymer said. “It depends whether there’s a fall wave in the Northeast, and whether people get some religion when it comes to masking, and it depends on the effect of restarting K-12, all of which are things that nobody really knows the answer to.”
The range comes with caveats that are largely based on the behavior of both people and their governments. How they respond to the current outbreak will likely determine its case fatality rate, the proportion of people who die out of the total number who are infected.
“This is a living, breathing system with humans making decisions, and those decisions are impacting the course of this outbreak,” said Nicholas Reich, an associate professor at University of Massachusetts-Amherst who aggregates predictive models for public health uses.
The projections come as the U.S. has hit new daily records for COVID-19 cases, exceeding the levels set when the virus peaked in the New York City area in March and April. The estimates also come as some hospitals in Arizona, Texas, and Florida near capacity amid an inundation of COVID-19 patients.
The publicly released U.S. government projections — compiled by the Centers for Disease Control — don’t go beyond a few weeks out.
Noymer estimated that the U.S. will see 500,000 excess deaths in 2020. Excess deaths include direct COVID-19 fatalities as well as deaths from missed COVID-19 cases, people who forego treatment and die of other illnesses, and other indirect deaths. Noymer said that in a normal, non-pandemic year 3 million Americans would die. He projects 3.5 million Americans will die in 2020.
Dr. Ali Mokdad of the Institute for Health Metrics and Evaluation estimated an additional 130,000 COVID-19 deaths from the current total “unless we are very careful.”
“This virus is going to increase until March without coming down,” Mokdad said. “It all depends on how Americans will behave, and on how our government will react.”
Even though COVID-19 is ravaging Texas, Arizona, and Florida, the fatality rates in those states so far have been lower than in New York City’s outbreak in March in part because cases in the Sunbelt have been concentrated among younger people, who are less vulnerable, epidemiologists told TPM.
Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security, told TPM that advances in understanding the disease have also helped keep death rates lower than they were in March and April.
“June/July 2020 is much different than March 2020, even though we’re hearing about hospitals being stressed,” Adalja said. “We may be able to treat it better, so that hopefully will modulate the death rate.”
Adalja noted that more than 40 percent of COVID-19 deaths to date have occurred among nursing home residents. If future outbreaks can be contained to less vulnerable populations, he reasoned, the death rate could be kept at bay.
“You have to look at who is getting infected, and do they transmit it to vulnerable individuals who then go on to get hospitalized and end up on a ventilator,” told TPM.
Deaths remain a lagging indicator in COVID-19.
It takes weeks to die of the disease, meaning that peak death rates tend to lag two to three weeks after the virus is infecting the most people.
In New York City, for example, the city hit a peak death rate around three weeks after Gov. Andrew Cuomo (D) and Mayor Bill de Blasio issued stay-at-home directives.
By the same token, Mokdad noted, it could take several weeks before the virus “leaps” from the younger generation to the older.
“It’s given us the false sense of security that cases are going up, but mortality is not going up,” Mokdad said. “But the younger generation is going to get in touch with the older one.”
Understanding the medium-term effects of the new outbreaks that continue to surge across the Sunbelt is complicated by the amount of variables at play. People can change their behavior. They may wear masks more frequently or come into close contact with others less frequently, lessening the spread.
“No matter how good they are, the perfect simulations can only simulate what’s happening now,” Dr. Ben Linas, an associate professor of epidemiology at Boston University, told TPM.
Alternatively, new and unforeseen treatments or strategies aimed at keeping the disease from spreading into at-risk populations like the elderly could succeed, keeping COVID-19’s death toll down.
Justin Lessler, an epidemiologist at Johns Hopkins who models the spread of infectious diseases, told TPM that early in the pandemic, many projections showed high death rates from “an uncontrolled outbreak of COVID.”
“But then, we had huge amounts of social distancing, informally people changed their behavior, and formally it was changed through stay-at-home orders,” he said.
UCLA’s QuanQuan Gu changed his model in June to reflect what he described to TPM as a “second peak” – a situation where reopening would lead to further increases in cases.
Gu’s model found an additional 25,000 deaths from July 7 – the day of his conversation with TPM – to September 7 that would not have occurred had distancing and other mitigation measures remained in place.
But attempts to project a U.S. death toll are complicated further by our still-limited knowledge of the virus. And experts remain frustrated by their own inability to spur the kind of extreme public health measures needed to match the successes other countries have had in staving off the the pandemic.
The mounting U.S. toll comes even as declining case rates are being observed around the world, while in the U.S. 39 out of 50 states are seeing consistent growth in cases.
The Washington Post quoted a former Trump administration official familiar with White House thinking on Monday as saying that “they’re of the belief that people will get over it or if we stop highlighting it, the base will move on and the public will learn to accept 50,000 to 100,000 new cases a day.”
To Noymer, the UC-Irvine demographer, the broader picture was of a country stumbling over the same roadblocks, over and over again.
“The U.S. is making mistakes and to my mind, what’s more important and poignant is that we’re not learning from them,” he said.