It turns out having Covid-19 isn’t such a great thing, even if you don’t…um…die.



I think that most people – certainly including myself – have been thinking of Covid-19 as a serious disease, but mainly because of the possibility that it can cause death. We’ve all had the idea that people who don’t die emerge from their experience and can get on with normal lives.

However, the New York Times reported yesterday on a talk that Dr. Anthony Fauci gave to biotech executives, in which he pointed out that Covid-19 is a tremendously complicated disease, and nobody knows yet what the long-term effects will be. But given some of the serious complications it’s already known to cause, it’s likely that many survivors will experience serious long-term effects. To quote the article:

…much is still unknown about the disease and how it attacks the body — research that Dr. Fauci described as “a work in progress.” He said that he had spent much of his career studying H.I.V., and that the disease it causes is “really simple compared to what’s going on with Covid-19.”

The differences, he said, include Covid’s broad range of severity, from no symptoms at all to critical illness and death, with lung damage, intense immune responses and clotting disorders that have caused strokes even in young people, as well as a separate inflammatory syndrome causing severe illness in some children. “Oh my goodness,” Dr. Fauci said. “Where is it going to end? We’re still at the beginning of really understanding.”
Another looming question, he said, is whether survivors who were seriously ill will fully recover.

This means we need to look at the number of cases as not just an indicator of future deaths (as I’ve been), but as a bad thing in itself. A certain number of those cases will be closed (because the person doesn’t have any more of the novel coronavirus in their system, at least in the areas that can be reached by the test), yet those people may experience significant negative effects that might last for the rest of their lives. And it will obviously be many months or even years before we know how serious these effects are.

When I started this blog in mid-March, I was focusing on reported cases as a measure of how serious the epidemic was. I stopped doing that when I realized that testing was so inadequate that increases in positive tests just measured the availability of tests – the more testing we did, the more positive tests we’d have. However, I recently realized that the testing has caught up with actual cases to some degree (maybe actual cases are now only three times reported ones, vs. ten or more times previously), so we can focus on reported cases as not only a rough indicator of future deaths, but also as an indicator of people who might have serious long-term consequences from their bout with the coronavirus.

In other words, we can be sure there will be a certain percentage X of Covid-19 cases that will result in serious long-term consequences, but not death. We don’t know the value of X, and even when we do know it to some degree, we won’t know whether and how it will vary. But we can be sure it’s greater than zero.

So what’s been happening with cases? They’re still growing quite nicely, thank you, and passed 2 million (which is almost a third of total cases in the world) three days ago. I read somewhere today that new cases have been declining since early April. That’s simply not true. Daily new cases increased until April 4, but since then they’ve been moving around in a range of 25,000 to 45,000 (and the 45K number was hit on June 5). Given that testing is getting better, unreported cases are probably shrinking relative to reported cases – so the reported number is getting closer to the real number. But that’s the only good news I can see at the moment.

Bottom line: Even if there were no more Covid-19 deaths after today, as long as cases keep growing as they are, there will be a lot of damage to a lot of people.


The numbers
These numbers are updated every day, based on reported US Covid-19 deaths the day before (taken from the Worldometers.info site, where I’ve been getting my numbers all along). No other variables go into these numbers – they are all projections based on yesterday’s 7-day rate of increase in total Covid-19 deaths, which was 6%.

Note that the “accuracy” of the projected numbers diminishes greatly after 3-4 weeks. This is because, up until 3-4 weeks, deaths could in theory be predicted very accurately, if one knew the real number of cases. In other words, the people who are going to die in the next 3-4 weeks of Covid-19 are already sick with the disease, even though they may not know it yet. But this means that the trend in deaths should be some indicator of the level of infection 3-4 weeks previous.

However, once we get beyond 3-4 weeks, deaths become more and more dependent on policies and practices that are put in place – or removed, as is more the case nowadays - after today (as well as other factors like the widespread availability of an effective treatment, if not a real “cure”). Yet I still think there’s value in just trending out the current rate of increase in deaths, since it gives some indication of what will happen in the near term if there are no intervening changes.

However, it’s 100% certain that deaths won’t stop at the end of June! They might decline some more this summer, but Drs. Redfield (CDC head) and Fauci both predict there will be a new wave of the virus in the fall, and one noted study said there was a good probability the fall wave would be greater than the one we’re in now, as happened in the 1918 pandemic.

Week ending
Deaths reported during week/month
Avg. deaths per day during week/month
Deaths as percentage of previous month’s
March 7
18
3

March 14
38
5

March 21
244
35

March 28
1,928
275

Month of March
4,058
131

April 4
6,225
889

April 11
12,126
1,732

April 18
18,434
2,633

April 25
15,251
2,179

Month of April
59,812
1,994 (= 1 death every 44 seconds)
1,474%
May 2
13,183
1,883

May 9
12,592
1,799

May 16
10,073
1,439

May 23
8,570
1,224

May 30
6,874
982

Month of May
42,327
1,365 (=1 death every 63 seconds)
71%
June 6
6,544
935

June 13
6,302
900

June 20
6,656
951

June 27
7,030
1,004

Month of June
28,316
944 (= 1 death every 92 seconds)
67%
Total March - June
134,513


Red = projected numbers

I. Total deaths
Total US deaths as of yesterday: 114,159
Increase in deaths since previous day: 1,053 (vs. 635 yesterday)
Percent increase in deaths since previous day: 1% (this number was 1% yesterday)
Yesterday’s 7-day rate of increase in total deaths: 6% (This number is used to project deaths in the table above – it was 6% yesterday. There is a 7-day cycle in deaths, caused by lack of reporting over the weekends from closed state offices. So this is the only reliable indicator of a trend in deaths, not the three-day percent increase I used to focus on, and certainly not the one-day percent increase, which mainly reflects where we are in the 7-day cycle).

II. Total reported cases
Total US reported cases: 2,045,984
Increase in reported cases since previous day: 19,115
Percent increase in reported cases since yesterday: 1%
Percent increase in reported cases since 7 days previous: 9%

III. Deaths as a percentage of closed cases so far in the US:
Total Recoveries in US as of yesterday: 788,885
Total Deaths as of yesterday: 114,159
Deaths so far as percentage of closed cases (=deaths + recoveries): 13% (vs. 13% yesterday)
For a discussion of what this number means – and why it’s so important – see this post.


I would love to hear any comments or questions you have on this post. Drop me an email at tom@tomalrich.com

Comments

Post a Comment

Popular posts from this blog

The tragedy in India

For a great account of what’s going on in India, read this WaPo article. And read this Atlantic article for a good commentary on how India’s wealthier class ignored the lessons of the 1984 Bhopal disaster and let the health care system stagnate, leaving the country unable to handle this sudden surge in the virus. Although it's wrong to say the system stagnated. For the wealthy, it became (and remains) world-class. Does this remind you of another health care system that, at least in the early days of the pandemic, was overwhelmed?  Both articles call attention to the Modi government’s failures, but they both try to spread the blame around. Yes, others are responsible, but the fact that – after a terrible response to the first wave of the virus – the government got lulled into thinking they’d beaten it, so they could open up completely (including holding big political rallies and allowing the annual Kumbh Mela to take place – this year in Haridwar, which I’ve visited and can ...
Read more

The Indian variant

The numbers keep improving every week. Both new cases and deaths grew at the same 0.7% rate in the past week, vs. 0.9% for both cases and deaths the previous week. And average daily deaths in the past week were 573. For perspective, the last time deaths were this low was March 31, 2020. But given that daily deaths hadn’t gone above 10 until March 15, the fact that they’d accelerated to 468 on March 31 was a bad sign (at the time, my big concern was that total deaths would end up in the low tens of thousands. In fact, they passed 600,000 last week). This morning, WaPo ran a story on the new Indian variant’s arrival in Britain, where it passed 2,000 cases recently. It seems to be at least 50% more transmissible than what we used to call the UK variant, but which is now the dominant variant in both the US and Britain. And that variant in turn easily displaced what had been the previous dominant variant in both countries, since the beginning of the pandemic (in fact, I remember a lot o...
Read more

More than ever, we’re on our own

Leana Wen, a physician and former public health commissioner for Baltimore, wrote another great op-ed piece for the Post today entitled “We’ve reached 200,000 deaths. Our response has gotten even worse than it was at 100,000.” It makes the stark point: By the most important measures of public health, we’re doing worse on a national scale than we were in late May, when the US passed 100,000 Covid deaths. Here are some of her points: “In late May, we had about 20,000 new infections per day. Now we are at double that, with  around 40,000  new daily infections. This is a high baseline to have entering the fall and winter, when the combination of quarantine fatigue and cold weather could drive people to congregate indoors and substantially increase transmission.” “In addition, restrictions keep getting lifted, even in states with surging infections. The nearly 2  million  students returning for in-person instruction will surely lead to more outbreaks, as some colleg...
Read more