Death, on a Pale Horse

When the Lamb opened the fourth seal, I heard the voice of the fourth living creature say, "Come and see!" I looked and there before me was a pale horse. Its rider was named Death, and Hades was following close behind him. They were given power over a fourth of the earth to kill by sword, famine, and plague, and by the wild beasts of the earth. (Revelations 6:7-8)

Yesterday’s numbers (from Worldometers, as of about 7 PM EDT March 27)

Total US confirmed cases: 104,256

Increase in cases since previous day: 18,507 (vs. 17,155 increase yesterday)

Percent increase in cases since yesterday: 22% (vs. 25% yesterday)

Percent increase in cases since 7 days previous: 438% (vs. 522% yesterday)

Total US deaths as of yesterday: 1,704

Increase in deaths since previous day: 400

Percent increase in deaths since previous day: 31% (vs. 26% yesterday)

Minimum expected US deaths over course of pandemic: 60,003, based on yesterday’s cases (assumes complete lockdown of US starting today, with new cases dropping to zero 14 days from now)

Projected as of April 3 (7 days from yesterday):

Total expected* cases: 456,641

Total expected* deaths over course of pandemic (based on 4/17 case figure, but with same assumptions as above): 262,812

Projected** number of actual deaths on 4/3 alone: 2,150

Case mortality rate used to compute total pandemic death estimates: 3%

Projected as of April 10 (14 days from yesterday):

Total expected* cases: 2,000,089

Total expected* deaths over course of pandemic (based on 4/24 case figure): 1,151,115

Projected** number of deaths on 4/10 alone: 11,530

* Calculated by growing yesterday’s case number by growth rate in cases for last 7 days: 438% (Note: this is the lowest this rate has been since the beginning of March. It’s probably an outlier, but the number I should use (785%, or the average of the 7-day growth rates over the last 7 days) is too horrible to consider at the moment).

** Calculated by growing yesterday’s death number by average of 7-day growth rates in deaths for last 7 days: 536%.

Total Recoveries in US as of yesterday (3/27): 2,525

Total Deaths as of yesterday: 1,704

Deaths as percentage of closed cases (=deaths + recoveries): 40%

I have revamped the numbers I show today (and plan to continue with them, until I revamp them again), since the ones I used before were hard to understand (even for me). There are still two hard numbers driving the others: total confirmed cases (i.e. tested positive) and total deaths. What has changed is the projections I’m making off of those two numbers:

1. Going forward, I plan to grow the total cases number by the average of the 7-day growth rates over the past 7 days. Of course, total expected deaths over the pandemic is directly tied to total cases, since expected deaths (as of day X) equal total cases (as of day X) times the case mortality rate (i.e. the number of cases that end in death – this number can only be known after the pandemic is over).
2. But when I put together the spreadsheet this morning, the projections based on the 7-day average of 7-day growth rate in tests (785%, based on yesterday’s figures) were too horrible to publish here, and I allowed myself to be swayed by the fact that yesterday’s 7-day growth rate in cases was the lowest since the beginning of March (when my data begin). That rate was 438%, while previous 7-day rates were between 522% and 839%. So rather than use the 7-day average of the 7-day growth rates, I used yesterday’s number, on the theory that maybe the limited social distancing that’s been put in place in a number of states was beginning to have an effect. Hopefully, the numbers will bear me out shortly, and this trend will continue.
3. I’ve been using 3% as the case mortality rate so far, but that may be too low for three reasons. First, the rate worked out to be around 3.9% in China, which is more or less at the end of the pandemic. Second, if you look at the data so far (at the bottom of my numbers above), the mortality rate for closed cases so far in the US is 40%. This is presumably artificially inflated by the fact that closing a case when the person is still alive will normally lag a long time, since no doctor will want to close a case and then have it turn out the patient was still sick. It will come down, but will it come down to 3%? 4%? 10%? Too soon to say. Third and most importantly, the mortality rate is very dependent on the degree of hospital overcrowding – shortage of beds, shortage of ventilators, shortage of masks for the staff members, etc. In the next two weeks, as the full onslaught hits NYC, we’ll see how serious this overcrowding and lack of resources turns out to be.
4. I was previously publishing a number for estimated deaths across the pandemic, based simply on the day’s case number times the 3% mortality rate. But I realized this morning that this is a cop-out. It assumes that, by some truly miraculous occurrence, there will be no new cases after today. Of course, given the number of people out there who have the virus but haven’t been tested yet (either because they haven’t showed any symptoms, or because they’ve tried to get tested and haven’t been able to), this is completely unrealistic.
5. My new realistic minimum number assumes that as of the day in question, a total lockdown on the country is imposed – in fact, every member of a family is locked down separately from every other member of that family (as eventually happened in Wuhan, since whole families ended up infected before they did this), and the lockdown works perfectly. Given the 14-day incubation period, this means that by the end of 14 days, the authorities will have identified every case anywhere (because it will have shown symptoms or else it will have gone away). They can then lock down each of these people; they don’t have to trace contacts, since after the person has been isolated for 14 days, they won’t be able to spread the virus because they don’t have it – at least that’s how it works in theory. In other words, everything goes perfectly. This is of course not realistic, but hopefully a close-to-total lockdown would lead to a close-to-total identification of all current cases. We’re currently far away from being able to do either of those, of course.
6. So I get my new estimate for total cases during the pandemic by finding the total projected cases 14 days later; total deaths during the pandemic are 3% of that case number. This means that, by my previous method, I would have said total expected cases given yesterday’s case number were 3,128. By the new method, total expected deaths as of yesterday are equal to the projected case number on April 10 (2,000,089) times 3%, or 60,003.
7. For the first time, I’ve started projecting actual daily deaths (i.e. the number you hear on the news – it was 1,704 yesterday), not just deaths over the course of the epidemic. I previously didn’t do this because the only good way to estimate it would be based on medical knowledge of how the virus will progress in each person, etc. But nobody has this knowledge yet anyway, so I decided to grow the daily reported number by – again – the 7-day average of the 7-day growth rates. This yields an estimate for each day going into the future.

Now let’s look at the results, and – even though they are probably all underestimates – they’re truly horrific:

1. As I already said, just using the actual case figure from yesterday and the projection based on a lowballed growth rate, the minimum number of US deaths over the course of the pandemic are 60,000. And that’s based on the assumption that the entire country was locked down as of yesterday, which obviously didn’t happen. So 60,000 is the bare minimum number of deaths we can expect going forward. This is 2,000 more than the total number of Americans that died of all causes in the Vietnam War. Note that actual deaths reported yesterday were 1,704.
2. Let’s say we wait until April 3 (next Friday) and do our total lockdown that day. Then, total deaths over the course of the pandemic are 262,812. However, the projected deaths on that day are 2,150.
3. Now we’ll go to April 10 (two weeks from yesterday), and start the lockdown that day. Then, total pandemic deaths are – are you sitting down? – 1,151,115. Just as horrific, on that day alone, reported deaths will be 11,530.

And believe me, this trend continues. What will stop it? A total lockdown is the only thing that will help. Italy tried a partial lockdown at first (just applying it to the north, where the hotspots were), and found that did very little good. And the reason for that is simple, as I’ve said earlier: Given that growth of the virus is exponential, it will keep growing exponentially outside of the places you’ve locked down.  And with exponential growth, you end up with the same numbers you would have had if you hadn’t locked down at all, just a little later. I read today that Trump wants to lock down NY state, NJ and Connecticut. This isn’t likely to have much ultimate impact, since the other hotspots will continue to grow, and new ones will keep appearing (remember, the virus had plenty of time to spread through the country undetected in February, due to lack of tests. It’s everywhere now). A couple weeks after the total lockdown (which of course isn’t quite total. It never can be), the rate of new infections is falling, but Italy can’t loosen up at all until it’s fallen to zero. If they do, infections will just spring back again – remember, exponential.

So you now know the cost of waiting to impose the total lockdown. If we did it yesterday, there would “only” be 60,000 deaths over the epidemic in the US. If we wait until next Friday, total deaths will be 263,000. The following Friday, we’re at well over a million, plus our daily rate of deaths is now close to 12,000 – which is equal to close to four times total deaths on 9/11. In fact, starting about Sunday or Monday, April 5 or 6, the daily death toll will go above the 9/11 total toll – and that will continue to be true for probably months. Do you remember the trauma of 9/11, and how it reverberated for months and years? How much trauma do you think there will be when there’s a 9/11 every day, then two 9/11’s, then four 9/11’s, then…This is why I said earlier that April will be hell on Earth. And May will be worse, barring a drastic change in policy from Washington.

I know you’ll find these numbers unbelievable. So do I. But I’ve played with the numbers a lot today (so much for getting any work done on my day job!), and if anything I think they’re too low. But if anyone can point out anything I’m doing wrong – or if you want to discuss any of the assumptions I’ve made – I’d love to do it.

So get ready. For the next 2-3 months at least, Death will be sweeping through the country. Riding on a pale horse. Reaping a terrible toll. God help us.

Comments and questions are welcome. You can reach me at tom@tomalrich.com.