2.2 Million American Deaths from Covid-19?

The strange career of a fanciful projection

|The Volokh Conspiracy |

You have probably seen the headlines. The Intercept, for example, blared: 2.2 MILLION PEOPLE IN THE U.S. COULD DIE IF CORONAVIRUS GOES UNCHECKED. A Nicholas Kristof column was headlined The Best-Case Outcome for the Coronavirus, and the Worst Will we endure 2.2 million deaths? Or will we manage to turn things around? Kristof reported, "Dr. Neil M. Ferguson, a British epidemiologist who is regarded as one of the best disease modelers in the world, produced a sophisticated model with a worst case of 2.2 million deaths in the United States." News reports suggest that President Trump's Covid-19 advisers told him about the 2.2 million death worst-case scenario, and that helped spur him to extend federal social-distancing policies through the end of April. He has also suggested, falsely, that if we fall far short of 2.2 million deaths, it would mean that his policies have been successful.

Given all the attention the 2.2 million "worst-case scenario" figure has received, it's worth exploring where it came from. On March 16, a group of public health specialists in the UK published on March 16th what has become known as the Imperial College study. I'll leave it to the professionals to debate whether their math regarding virus spread and so forth is right, what I want to focus on here is something that requires no expertise to discuss, which is the underlying assumption that drove the 2.2 million figure. Here is the relevant paragraph from the study, with the key assumption in bold:

In the (unlikely) absence of any control measures or spontaneous changes in individual behaviour, we would expect a peak in mortality (daily deaths) to occur after approximately 3 months (Figure 1A). In such scenarios, given an estimated R0 of 2.4, we predict 81% of the GB and US populations would be infected over the course of the epidemic. Epidemic timings are approximate given the limitations of surveillance data in both countries: The epidemic is predicted to be broader in the US than in GB and to peak slightly later. This is due to the larger geographic scale of the US, resulting in more distinct localised epidemics across states (Figure 1B) than seen across GB. The higher peak in mortality in GB 16 March 2020 Imperial College COVID-19 Response Team is due to the smaller size of the country and its older population compared with the US. In total, in an unmitigated epidemic, we would predict approximately 510,000 deaths in GB and 2.2 million in the US, not accounting for the potential negative effects of health systems being overwhelmed on mortality.

You got that? The 2.2 million figure was a projection based on a scenario where not only do the government and private companies not engage in any "control measures," but individuals don't on their own change their behavior to avoid contracting or spreading the virus. The study refers to this possibility as "unlikely," but let's be blunt: it's entirely fanciful. The notion that no one is going to do anything different even as the death toll from the virus mounts into the five and then six figures is not "unlikely," it's entirely contrary to common sense and common human experience, not to mention data about how people said in early February they would react if the virus spread. (I, for one, started carrying around and using hand sanitizer and trying to avoid crowds in late February.)

Some will argue that the statistic was worth putting out there anyway, just to give us an idea of what toll a completely uncontrolled virus spread would look like. Perhaps. Unfortunately, the media generally failed to make clear that this was not a real-world projection, and were abetted in that malfeasance by the lead author of the study, Neil Ferguson. For example, Dr. Ferguson told the New York Times on March 16th that the potential health impacts were comparable to the devastating 1918 influenza outbreak. That outbreak killed approximately .6% of the U.S. population, which today would amount to around two million people, or very close to the fanciful 2.2 million projection. Nor does Ferguson seem to have made any effort to correct Kristof et al. when they wrongly claimed that 2.2 million was a realistic worst-case scenario.

And the media continues to misreport what the study said. For example, here is Wired yesterday: "The report, which also predicted 2.2 million American deaths if the government [what about private parties?] did nothing…" (One of the few journalists to get it right was Jacob Sullum of our own Reason.com: "Although those horrifying numbers got a lot of attention, they were never plausible, as the paper itself said, because they were based on the clearly unrealistic premise that 'nothing' is done to contain, suppress, or mitigate the epidemic.")

When I pointed out on social media that the 2.2 million figure was fanciful, some accused me of being in league with virus deniers and/or Trumpism. Now that Trump has embraced the figure, perhaps we can lay that one to rest. Others have argued that to the extent the figure spread and scared people, that was a good thing, because it spurred governments and individuals into necessary action. Perhaps in the short-term that's true. In the long-term, providing false or exaggerated information to the public that supposedly reflects the judgment of "experts" will erode confidence in both those who are reporting those judgments and in the experts themselves, a prospect which may have devastating public health consequences in the future.

Moreover, while the spread of exaggerated predictions may compensate to some extent for "virus deniers" and other forms of underprediction, there are also some immediate costs. If the government overreacts, there is the toll on the economy from unnecessary precaution. Beyond that, overprediction feeds anxiety disorders, and also leads to asymptomatic people or people with minor symptoms demanding testing, going to the emergency room, etc., which not only helps overwhelm the medical system, but may itself increase the spread of the virus when these people leave their homes to seek medical attention. At the very least, we should recognize that exaggerated projections reported without caveat have significant potential costs.

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  1. If we wind up with 30% unemployment and runaway hyperinflation from all the spending, how many people will THAT kill.

    I’m thinking the economic mess of the German Weimar Republic, in a country that is far more divided than Germany was, and remembering what happened next…

    1. Dr. Ed, fun fact. Compared to more-socialized healthcare systems abroad, the U.S. healthcare system exacts punitive per-capita payments in excess of those imposed on Germans by the Treaty of Versailles. So if you are worried about Wiemar-on-the-Potomac, back M4A.

      1. in terms of deaths per million we are doing way better than Europe with its vaunted single payer system. Only Germany is slightly better, but we are 250% better than the UK, and 500% better than France.

        The Netherlands and Belgium are probably outright killing anyone over 65 that comes thru the door so their totals are likely inflated, while Spain and Italy’s higher number is due to incompetence. So we should probably just stick to Germany, France and the UK as our peers.

        Country Deaths /1M pop
        Italy 205
        Spain 177.0
        France 52.6
        United States 10.5
        United Kingdom 26.9
        Netherlands 60.3
        Belgium 61.7
        Germany 8.2

        1. Unfortunately, our efforts to control the virus have been nowhere near as good as Germany’s, as a result of which our death rate is likely to be much higher. https://news.sky.com/story/coronavirus-why-germany-has-such-a-low-covid-19-death-rate-11964051 France is probably a more accurate indicator, although our health care may not be as good as that of France. It’s true that at the moment our death rate is a lot less than that of France, but that’s because France is next door to Italy, so it got started there before it did here. I’m willing to bet that in 2 weeks our death rate will be higher than the current rate in France. BTW, France today went from up to 54 per million; we went up to 12. Given the current exponential growth in the number of cases, we’ll have no trouble hitting France’s numbers. And if we run out of ventilators and ICU beds, the numbers will get worse.

      2. Compared to more-socialized healthcare systems abroad, the U.S. healthcare system exacts punitive per-capita payments in excess of those imposed on Germans by the Treaty of Versailles.

        You are highly confused. The U.S. healthcare system doesn’t “exact” anything, let alone anything “punitive.” The U.S. healthcare system offers treatment in exchange for money. It’s a benefit, not a punishment.

        1. Nah, the bill comes in two pieces. Piece one, for the treatment, is paid for by the fraction of the costs which match what is paid for similar or better treatment elsewhere. Piece two, the Versailles-sized exaction, is the fraction Americans pay over and above what pays for the treatment.

    2. Dear Ed,

      Unemployment is already over 30%. It just hasn’t made it into reporting yet. But my own conspiracy theory is that this is partly intentional. Not in a grand-scheme sort of way; just that a useless ditherer in chief is perfect for a number of people, domestic and foreign, who believe they stand to benefit.

      It is also notable that David apparently cares not at all about the bullshit estimates coming from the government low-balling the estimates. Presumably he thinks underestimates will hurt his 401K less.

      1. “Presumably he thinks underestimates will hurt his 401K less.”

        That is quite the presumption. Based on…what?

    3. The 30% unemployment projection is pretty similar to the 2.2 million death projection in that each assumes there is no mitigation effort.

  2. Let us not forget the evolving narrative of Dr. Anthony “chicken little’ Fauci.

    Dr. Fauci, in an article that he co-authored in the New England Journal of Medicine, wrote that Covid-19 was no worse than a very bad flu, but nothing like SARS or MERS.

    Professor Tom DiLorenzo accurately described chicken little as “The Two Faces of Anthony Fauci” in a March 28, 2020 blog post at LewRockwell.com.

    1. Adding your own “accurately” does not make it so.

    2. When the facts change, I change my mind. What do you do, sir?

      I suppose quoting Keynes to a libertarian is just waving a red flag in front of a bull, but that maxim seems to have worked for Keynes. He was one of the few economists ever who was able to make himself rich off investments.

      1. I have no reason to believe such an unsubstantiated claim, but for the sake of arguments, let’s go with that. He was also quite influential in government circles. How much of his investments paid off from insider knowledge?

        1. A fine thing to ask. Right after we get answers from the politicians we already know have illicitly benefited, including Trump.

      2. No sale. I am going to throw you a Bert “be home by eleven” Blyleven curve ball:

        Hard to disagree with Keynes’ observation that in the long run, we’re all dead.

    3. What Fauci wrote was (my emphasis) “the ,overall clinical consequences of Covid-19 may ultimately be more akin to those of a severe seasonal influenza.”

      That statement does not cover the epidemiological consequences of Covid-19. The rest of the article endorses the restrictive measures because of epidemiological considerations such as the basic reproduction number.

      1. What, someone who labeled an esteemed scientist with juvenile nicknames misrepresented what that esteemed scientist said? I am shocked, shocked to discover there is politically-motivated misrepresentation of facts in this establishment!

    4. Why are you quoting an economist that is a professional fraud of an historian on epidemiology?

  3. Bad flu kills thousands of Americans every year, mostly the old and immune compromised, but those with asthma or lung disease can be hit hard as well. Old people who are self-reliant and those with existing health issues should keep away from people and stay at home until this all blows over, as it will eventually. Either there will be a vaccine by the fall or herd immunity gotten the old fashioned way will slow or stop the spread enough for those at risk to get back outside.

  4. When I pointed out on social media that the 2.2 million figure was fanciful, some accused me of being in league with virus deniers and/or Trumpism. Now that Trump has embraced the figure, perhaps we can lay that one to rest.

    If Trump has “embraced the figure” it is so that when the real* number comes out at 62,907 he will be able to say :

    (a) look how brilliant I was saving 2,137,093 lives and
    (b) yes it did cost a lot of jobs, but it was worth it

    * and the “real” number is in any event a rather doubtful proposition. If total mortality during the emergency is appreciably higher than during the same period in 2019, 2018, 2017 etc then we can be reasonably confident that a good chunk of the increase is down to the new coronavirus. But if not, we will never have a good answer to how many people have died as a result of it, who wouldn’t have died anyway in the same timescale.

    1. And those who pushed the 2.2 million figure in part to attack Trump for “not doing enough” won’t have much to say when he takes credit for averting that (never-plausible) outcome.

      1. Oh I rather think they will 🙂

        They have a very large memory hole to put things in.

      2. Are you interested in truth, saving people, or political point scoring?

      3. Biden attacked Trump for his xenophobic China travel ban, and now Pelosi is already asking what did he know and when did he know it.

        By the way, Politifact is calling the claim that Biden called Trumps Chinese travel ban xenophobic as mostly false, here is their astonishing rationale:
        “Biden used the phrase “xenophobic” in reply to a Trump tweet about limiting entry to travelers from China and in which Trump described the coronavirus as the “Chinese virus.” Biden did not spell out which part of Trump’s tweet was xenophobic.”

        1. Kazinski,

          To be fair, fact checkers also flagged as mostly false when people reported that Trump called the coronavirus pandemic a hoax when Trump talked about the coronavirus at his rally, mentioned there were only 15 cases, and said “This is their new hoax.” The reasoning being that he was limiting “hoax” to the Democrats’ criticism of his response or Democrats’ supposed alarmism (at that time) as the hoax.

          Of course, Trump was minimizing the seriousness of the coronavirus at that time (continuing to predict the number of cases would soon be zero, asserting that we have it contained, and the like) and did not act as quickly as he should have in a number of respects, but especially with regard to testing, so, however “hoax” is defined, he was wrong. It wasn’t a hoax.

          1. You can’t lay the testing on Trump, that was all FDA/CDC. Trump gets a lot of criticism for not following the “science”, and some of its is warranted. But the testing problem is clearly something where Trump has to defer to the experts, and they muddled it, but it worked out better than importing a bunch of Chinese/WHO kits with a 30% accuracy rate.

            1. Trump did not misdesign the CDC tests, true. He did, however, spend six weeks conveying the message that coronavirus was a hoax and therefore there was no urgency in dealing with it.

              1. Kazinski,

                What’s your theory, that Trump was down playing the risk of the pandemic (hoax, now 15 but soon 0, we have it contained, gone by April) because:

                a. He (as he says now) knew all along it was a pandemic and was throwing every US resource at developing tests and policies designed to contain and mitigate the virus, but lied to the American public; or

                b. He genuinely thought it was only like the flu and would fizzle out like* other maybe-pandemic scares, so did not adopt the urgency that was obviously quite warranted.

                I am not sure either option makes Trump look good. I guess (a) saves you from having to rethink you position that Trump has no responsibility for the lack of early testing (everyone who wants a test can get a test! We have millions of tests!). He just made bad choices in putting all our eggs in one (CDC) basket rather than recognizing that maybe allowing private companies to develop their own tests and/or follow the German model (or South Korean or other models) to have additional testing right away.

                It was still a bad choice, but if he genuinely got the advice not to do that and he was otherwise throwing resources at the CDC and other experts to stop this thing, then I guess he isn’t culpable for the failure to test. But then he intentionally mislead the country about the largest health crisis we have faced in our lifetime. I am not sure that’s so much a defense as an alternative indictment for dereliction of duty.

                Your other option is that the expert he was relying on was national hero Rush “Freedom Medal and coronavirus is just the flu” Limbaugh.

                In either case, he committed an unquestionably fireable offense.

      4. Really, they won’t have much to say? Trump first said the number of cases would soon be zero and claimed coronavirus was contained while, it would appear, he turned down WHO tests and otherwise failed to act with urgency. Then he jumps on the 2 million number so he can later sell his initial failures as a success.

        (Kind of like his: Obama didn’t restock the emergency reserves. [reporter points out he has been president for 3 years]. Well, I have restocked the reserves multiple times and beautifully! [um, then what does Obama have to do with it? The point is, as you know, he hates when people try to hold him accountable for things he has said. That exchange captured beautifully the fact that Trump will say, in any given moment, what is to his advantage in that very moment, regardless of fact or what he has previously said, even just 15 seconds before. Why anyone is okay with that quality in a president, I will never understand.)

        Granted, most voters have an incredible memory deficient, but surely you remember his false statements and irresponsible predictions?

        Whether it as responsible to report that experts were predicting 2 million deaths without accurately conveying the nuance is a different issue. You seem very worked up about the 2 million number. Do you have a prediction?

        I don’t see how we escape without 200,000 U.S. deaths. (Say it has a mortality rate of 0.1% and, because no one has developed immunity to the novel virus, 200 million (a little more than half the population) becomes infected. That’s 200,000 deaths. If 70% become infected, it’ll be higher. If the mortality rate is higher than 0.1% (either naturally or because of overloaded hospitals), the accumulated deaths will be more. To get under 200,00 deaths, this coronavirus either has to be much less deadly than it currently appears or much less virulent than it currently appears or we develop treatments/vaccine much more quickly than appears likely. But that is the roughest of back of the envelope calculations.

  5. As of now, after a days-long steady upward trend, the Johns Hopkins-reported world-wide death rate stands at 5%. Given the notable role in that statistic played by Chinese and other less-than-forthright sources, 5% probably under-reports the deaths. We do not yet have reliable reports to tell us what the real denominator ought to be, and may not have until a retrospective look at the epidemic receives study.

    The OP makes use of the word, “fanciful,” to describe the study. Also fanciful? The exclusion from Bernstein’s critique of any mention that the study reported that it did not take presumed account of overwhelmed hospital systems. We know that has happened in Italy, and likely elsewhere. It seems to be a serious threat in the U.S. as of now. Thus, to the extent hospital systems are overwhelmed, that would drive death rates higher, compared to the study results Bernstein says are too high.

    We can all hope, or pray, that those study results are too high. It is not unreasonable to point to factors which suggest events will turn out better. It is far too soon to state with confidence that millions of Americans will not die in this pandemic.

    1. 5% of what? Infected as guessed by symptoms? By actual testing?

      You are just another fear-mongerer.

      1. Not me. Your accusation of fear mongering is better directed at Johns Hopkins. Others will choose which seems more plausible as a medical information source, Johns Hopkins, or Á àß äẞç ãþÇđ âÞ¢Đæ ǎB€Ðëf ảhf.

      2. You have just accurately characterized SL’s mindset on this topic. Of course, I have it on good authority that adding my own “accurately” does not make it so.

      3. Here you go.

        Check it out yourself. Data sources are provided.

        1. So this answers the question. The 5% is the percentage of confirmed deaths to total confirmed cases. There is no epidemiologist who has said that the Case Fatality Ratio is an accurate figure of the actual “death rate” of the disease. It couldn’t be, because it would assume that 100% of the people who have the infection are a “confirmed case”.

    2. For a different perspective on what “John Hopkins-reported world-wide death rate” is, see here:

      “The case fatality rate is probably higher than seasonal influenza (≤0.1%) but may be lower than initially reported (~ 2-4%) but limited testing and lack of careful epidemiology survey makes this difficult to define but may be different in some countries as social distancing interventions and other factors differ.”

      Note that the Case Fatality Ratio is different from the actual fatality ratio of infection. Note that even in the 2.2M dead prediction report, the Imperial Academy assumed an infection fatality ratio of .6% (from a study from China), and then adjusted it up to .9% for the United Kingdom based on demographics susceptibility differences in the population.

      Yesterday The Lancet also issued a model-based analysis estimating the infection fatality ratio at 0.657%, with a 95% confidence interval that it was between 0.389% and 1.33%. I will post a link to The Lancet paper in a reply.

        1. Note that Neil Ferguson is a co-author if the Lancet Report.

    3. FFS, you cannot use Confirmed Cases as your Denominator. And if you’re going to use it, you should at least be quite clear about that instead of throwing “5%” out there and letting everyone infer.

    4. Given the notable role in that statistic played by Chinese and other less-than-forthright sources, 5% probably under-reports the deaths.

      I’d agree with that statement if you replace “under-reports” with “grossly over-reports.” For example, we’ve known for nearly two weeks that Italy is reporting all deaths of people who tested positive, regardless of premobidities or likely actual cause of death. Based on one retrospective sample by the NIH, they’ve been over-reporting by about 700%. This has been widely discussed, e.g., here.

      It is far too soon to state with confidence that millions of Americans will not die in this pandemic.

      I respectfully disagree, provided we don’t fall into the same trap discussed above and just start reporting all deaths that are accompanied by a positive test. Nobody is predicting that order of magnitude other than the math- and common sense-impaired, doomsday-no-really-this-time-we-mean-it media crowd.

      1. Could you reply with the link? The one above is not working for me.

        1. Oops, sorry. Try this.

          1. Life of Brian, your link reads like an argument that when someone with coronavirus dies—someone who had preexisting vulnerabilities with which that person had been living successfully for years—a preexisting condition ought to be listed as the cause of death, and not the coronavirus.

            Or maybe it would be more accurate to say that is your argument, and the link provides information you want interpreted that way. Can you say more? I am having trouble following that reasoning. Have I misunderstood you?

            1. I’m not speaking for Life of Brian, but the point from the link is straight-forward. A person who tests positive for the underlying coronavirus, and dies, is counted (in some jurisdictions) as dying from COVID. However, that person may not have died from COVID. They may not have had COVID at all. (Having the virus is not the same thing as having the disease it calls.) And even if they had COVID, they may not have died from it.

              There are close questions. If COVID directly causes a heart attack because of inflamation, that is probably a COVID-caused death. But you’d have to know the underlying cause of the heart attack to make that determination. Understandably, jurisdictions don’t have the resources to do full-scale, exhaustive autopsies on every death. The easy fix is to just say COVID-caused death if coronavirus was present in the deceased. That’s not 100% accurate, but it’s probably good enough. We should be mindful of the fact that this method will over-estimate COVID-caused deaths.

              1. Can you explain Italy’s motivation to over-inflate Covid-related death figures? I can think of lots of reason why a state or country would want to UNDERstate them . . . impact on future tourism, reduced likelihood of panic during the crisis, etc.. But I can’t really think of why Italy would over-dramatize their death rate. Can you elaborate?

                1. Why would they need a motive ? They way they’re doing it looks like the easiest way to count the numbers, and if their health services are under stress, easy is good.

              2. If COVID directly causes a heart attack because of inflamation, that is probably a COVID-caused death.

                I’m unclear on the use of the word “probably” in that sentence. It’s definitionally a COVID-caused death in that hypothetical.

                We should be mindful of the fact that this method will over-estimate COVID-caused deaths.

                We should also be mindful of the fact that if they don’t test everyone who dies, that method (count everyone who tests positive as a COVID death) will underestimate COVID-caused deaths.

                For example, see this counter-argument:
                https://talkingpointsmemo.com/edblog/this-is-very-important-from-italy-please-read

                1. NTOJ : If COVID directly causes a heart attack because of inflamation, that is probably a COVID-caused death.

                  Nieporent : I’m unclear on the use of the word “probably” in that sentence. It’s definitionally a COVID-caused death in that hypothetical.

                  Well that depends on your definitional scheme. If having a pre-existing condition, say diabetes, causes a COVID infection to take root and multiply out of control more quickly, and then the COVID causes a heart attack which causes death, is that a “COVID caused death” ? ie do we count anything where COVID was in the chain of causation ? Or do we score that one up to diabetes ?

                  Or let’s take Sentor Paul. If his COVID takes a turn for the worse and he dies of pneumonia, because he gets a more severe dose of COVID, because of his damaged lungs, caused by the attack by his neighbor, is that a COVID caused death or a neighbor caused death ?

                  Your scheme might count each item in the chain of causation in which case your death count measured by summing the deaths from each cause will add up to a multiple of the total number of deaths.

                  Or you’re going to have to assign a percentage score to each cause – which nobody has time for, and which is in any event philosophically complicated when the causes are in series rather than in parallel.

                  Or else you’re going to have to pick a rule for assigning 100% responsibility – such as the immediate cause of death, or the biggest contributor.

                2. Probably is because there can be contributing causes. If a COVID caused inflammation increases the likelihood of a heart attack by a tiny percent, but the patient’s pre-existing condition increases the likelihood of a heart attack by a much larger percentage, there’s a judgment call to be made. (List multiple causes of death, pick the most likely, etc.)

                3. I think everywhere should be testing people who die.

                  1. Since we don’t have enough tests for actual patients, we’re not going to be using some of the precious ones we do have on dead people.

                    That would’ve made sense eight weeks ago, when identifying the small number of people who died would have enabled us to isolate those in contact with them to prevent the spread. But now, we’re far beyond contact tracing.

                    1. We should increase testing capacity, instanter.

      2. While I appreciate the contribution of Robert Turner, founder of “Cre8tive Media,” I’m not quite ready to defer to his “expertise” in the peer-reviewed publication of Medium.com.

    5. I think we can safely say that the absolute maximum death rate is 1.65%. Why because that’s the South Korean death rate, and they have the most thorough testing regimen, and they are late in the curve, with more people recovering every day than getting infected.

      But it’s likely still much less than that because Korea likely caught almost every death but probably missed at least half the cases because they were mild or asymptomatic.

      1. Kazinski, what would make someone suppose that cherry picking one national example invalidates the data from every other country? Suppose, for instance, that South Korea did a better job finding patients early, and treating them more effectively, than did Italy. Does that mean the less-efficiently-treated patients in Italy were not killed by the virus?

        Is your argument that no coronavirus-related fatalities should be counted unless they received the absolute maximally best treatment possible, and in the most timely way? Are you saying that folks who did not get that quality of care should be counted as killed by bad care, and not by the virus?

        1. “Suppose, for instance, that South Korea did a better job finding patients early, and treating them more effectively, than did Italy. Does that mean the less-efficiently-treated patients in Italy were not killed by the virus?”

          No, but since the vast majority of people treated in both Italy and South Korea survive the illness, the difference in death rates should be minor. Your argument makes more sense comparing Iran to Italy. But it doesn’t matter, because the under-counting of the infected is much larger than any possible regional differences in treatment.

          Basically the entire difference between South Korea and Italy can be explained by who they tested. And that’s the point. Since South Korea tested a set of people that is more like the overall population distribution, it’s probably closer to the actual IFR. But the IFR won’t be higher than what the CFR is in South Korea. Hence “absolute maximum death rate is 1.65%.” It’s unlikely that the actual IFR is lower than the reported CFR from any jurisdiction because testing is (understandably) biased towards people who exhibit symptoms and need medical attention. Most people who get COVID don’t need medical attention. It’s possible that most people who get coronavirus don’t even exhibit symptoms.

          1. NToJ, are you assuming that someone who does not exhibit symptoms, and is never even conscious of harboring the virus, is therefore a case whom you can count exclusively in the denominator when you calculate a death rate? If so, I suggest you think that over.

            Wouldn’t someone like that be potentially threatening as a vector for the disease. Indeed, you might have to ask whether symptomless carriers could be more effective at spreading the virus than those who do get symptoms. The latter will tend to be removed from social circulation fairly shortly after being identified. The former may have far more opportunity to spread disease. They may turn into super-spreaders. Perhaps the death totals in the numerator owe more than we know to the folks the virus minimizers are demanding be counted only in the denominator.

            1. Yes. I’m laboring under the impression that an infected person who never experiences symptoms and does not die from coronavirus belongs exclusively in the denominator (total number of infected).

              If you’re trying to say that, the infinitessimile number of people who are (1) asymptotic and (2) die from caronavirus (3) And correctly diagnosed as death by caronavirus, is >0, we agree.

              I think from your second paragraph you’re trying to say high spreading increases the nominator (eventually). But you can’t model worse effects from the disease by greater spread. As the disease’s r-naught goes up, all models of IFR go down. That’s the point. It’s either a super spreader or a super killer but not both. It’s not about hiding a future, hypothetical nominator.

            2. We aren’t starting your usual: “lets go back and redefine all our terms and assumptions from scratch” method are we?

              There is already a clear standard for calculating the death rate from a disease: number of deaths/total number infected. The fact that a lot of people are asymptomatic even though they are affected has to be counted in the denominator, especially since they are presumably immune from further infection in a second wave.

              1. And the fact that a lot of people die even though they’ve never been tested and confirmed to have coronavirus has to be counted in the numerator. You don’t get to fiddle with just one number to make the data say what you want it to say.

                1. That should be uncontroversial.

                  1. That is true but as of today the numerator is much more accurate than the denominator. Undoubtedly some die of coronavirus without being confirmed cases but the ratio of confirmed to infected is off by a huge margin,

                    The only way to get an accurate numerator and denominator is to administer antibody tests to the whole population, and to use it as part of an autopsy.

                    1. That is true but as of today the numerator is much more accurate than the denominator. Undoubtedly some die of coronavirus without being confirmed cases but the ratio of confirmed to infected is off by a huge margin,

                      How do you know that?

                      That’s not a rhetorical question. How do you know that the numerator isn’t off by orders of magnitude?

                      I would point out that another complicating factor is those people who died because of coronavirus without having been infected. If you have a stroke but die because there are no ICU beds available due to them being occupied with coronavirus victims, coronavirus was not a medical cause of your death, but it was a factual cause of it.

                    2. I can’t prove it but it seems likely that most of the people who die from coronavirus end up in the hospital where they get tested. Not all do but most I think. As for the unconfirmed cases I base that on the lack of test kits. My wife and I had it, at least we think we did, but we have been unable to get tested. We are out here in the hinterland and are not celebrities or sports stars and we didn’t require hospitalization so no test for us. Others are not symptomatic or have a mild enough case that they don’t seek treatment.

      2. South Korea is not a good indicator because their massive testing and containment prevented their hospitals from being overwhelmed, thereby enormously reducing their death toll. We screwed up the testing and containment stage; while I’m hoping we won’t do as badly as Italy, it now looks like we won’t be able to avoid being overwhelmed in parts of the country; e.g. Louisiana and New York.

  6. Some will argue that the statistic was worth putting out there anyway, just to give us an idea of what toll a completely uncontrolled virus spread would look like. Perhaps.

    No perhaps to it. Of course it’s a good idea to get a baseline of how bad the problem is if you do nothing. That ought to be fundamental to planning any sort of response.

    Unfortunately, the media generally failed to make clear that this was not a real-world projection, and were abetted in that malfeasance by the lead author of the study, Neil Ferguson. For example, Dr. Ferguson told the New York Times on March 16th that the potential health impacts were comparable to the devastating 1918 influenza outbreak.

    Here’s the relevant part of the article:

    Dr. Ferguson said the potential health impacts were comparable to the devastating 1918 influenza outbreak, and would “kind of overwhelm health system capacity in any developed country, including the United States,” unless measures to reduce the spread of the virus were taken.

    I’m wondering if you consider the publicity given this figure worse than Trump’s month or more of happy talk about how this was absolutely no problem in the US. What did that cost?

  7. At the very least, we should recognize that exaggerated projections reported without caveat have significant potential costs.

    Indeed. And so does talk about how well-contained it all is, and how we’ll soon go from 15 patients to zero, etc. , especially when that guides policy, or the lack thereof. Since you put the criticism of Trump for “not doing enough” in scare quotes, do I take it you think it’s invalid?

  8. “When I pointed out on social media that the 2.2 million figure was fanciful, some accused me of being in league with virus deniers and/or Trumpism. Now that Trump has embraced the figure, perhaps we can lay that one to rest.”

    Well, it wouldn’t be a Bernstein post without whining about being misjudged by others.

    1. Well that’s just anti-Semitic.

      1. Heh

    2. All of us are misunderstood.

  9. This morning headline pretty much tells you what you need to know, and that is there will be a lot of deaths.

    https://www.yahoo.com/news/wuhan-residents-dismiss-official-coronavirus-164859600.html

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