Going into June, the United States as a whole seemed to be making progress slowing the spread of COVID-19. Heading out of June, those who prefer to avoid bad news should probably follow a modified version of baseball legend Satchel Paige’s most famous bit of advice: Don’t look back. COVID might be gaining on you.
During the period where much of the nation was locked down, the U.S. was making progress in slowing the spread of the disease. The positivity rate – a statistic calculated by dividing the number of positive test reports by the total number of tests whose results were reported in a given day – had dropped from a high (based on a seven-day running average) of more than 21% to a low of 4.5% between June 9 and June 12.
But, as many public health experts feared, the premature opening of many state economies, accompanied by inadequate testing and contact-tracing efforts and lackluster public adherence to infection prevention recommendations such as wearing face masks in public, has led to a resurgence of the disease in many parts of the country.
In a little more than two weeks, the positivity rate has increased to more than 6.9% as of the time I write this column.
Because of the lockdown Virginia has been making some progress on that front. The commonwealth’s positivity rate decreased from a high well above 20% in mid-April to a bit below 5% now. It took time for Virginia to ramp up its testing capacity, but the data show that Gov. Ralph Northam’s cautious reopening approach has been working.
On the other hand, I see quite a few people ignoring the requirement to wear face masks, especially in enclosed spaces. That may very well undermine the progress the state has made so far.
I hope I am wrong, but I doubt I will be. The COVID-19 virus cares little about any individual’s notion of “freedom.” No matter what your political persuasion, if you give the virus an opening, there is a good chance it will make you wish you were dead – if not speed you to a premature demise.
Some of you are still not worried. It’s just like the flu, you say.
I hate to disabuse you of that notion. No matter how much you want to believe it is butter, it remains some concoction made of vegetable oils and trans fats.
How can I be so sure?
Well, let us look at another statistic: the crude mortality rate.
You don’t get this number by going to something like the Johns Hopkins COVID-19 Dashboard. On that site, if you divide the number of deaths by the number of confirmed cases, you will get the case fatality rate. The problem with the case fatality rate is that the number of confirmed cases is lower than the number of actual cases. You will get a horrific number – right now, about 5% of infections in the U.S. leading to a fatality.
That is a horrific number, but it also is an exaggeration. Because of the inadequate U.S. testing effort from the start, we don’t know how many people have actually been infected with the virus . . . Thursday, Dr. Robert Redfield, director of the Centers for Disease Control and Protection, gave an indication on how far off our current assessment of the disease is.
“It’s clear that many individuals in this nation are still susceptible,” he said on a conference call with reporters. “Our best estimate right now is that for every case that was reported, there actually are 10 more infections.”
If Redfield is right that the number of actual infections is about 10 times greater than known, that would produce a case fatality ratio of 0.5%. That is still pretty bad.
But we do not need to rely upon guesstimates of the pandemic’s total impact to get a handle on how bad it actually is. We know how many deaths have been reported so far – keeping in mind that that, too, may be an undercount – and divide that number by the total U.S. population to get something called the crude mortality rate. The crude mortality rate allows us to compare COVID-19 with other causes of death in the nation to get a reasonably solid handle on how bad it is.
In 2017, the crude mortality rate from all causes of death in the U.S. was 871 per 100,000. The top 10 causes of death that year were 1) heart disease: 200 per 100,000; 2) cancer: 186; 3) accidents: 53; 4) chronic lower respiratory disease: 50; 5) cerebrovascular disease: 45; 6) Alzheimer disease: 38; 7) diabetes (all types): 26; 8) influenza and pneumonia: 17; 9) kidney disease: 16; and 10) suicide: 15.
If the COVID-19 outbreak was happening in 2017, it would already be No. 6 on the list, with it likely leapfrogging cerebrovascular diseases into the five-spot in a matter of weeks – and likely finish the year as the No. 3 killer of Americans.
We probably will not know how COVID-19 ranks among the top 10 killers of Americans until 2022 at the earliest, but I am certain it will finish in the top five if not the top three – barring some other unmitigated disaster.
Lest you think the mortality data is bad, consider the effects on the survivors. As Dan Ferber, one of the nation’s top science writers, put it:
“[The crude mortality rate] doesn’t take into account the medical costs or loss of healthy lifespan due to lasting heart or kidney or lung damage or . . . diabetes in survivors of severe cases, nor the suffering in those who grapple for more than a month with severe exhaustion. Those effects will all be on top of mortality.”
To everyone in a rush to get back to the life they had before this pandemic, I can only paraphrase Bette Davis: Fasten your seatbelts. We’re in for a bumpy ride.
Dave Lawrence can be reached at firstname.lastname@example.org.