COVID-19; What is Angela Merkel telling us?
“We have to understand that many people will be infected, … The consensus among experts is that 60 to 70 percent of the population will be infected as long as this remains the situation.”
Angela Merkel, March 11th, 2020
Last week I was wrapping a 2-week trip to Israel and Jordan – a church-based pilgrimage tour – when Angela Merkel was quoted in the press with the simple declaration above. Our church group was facing a rapidly deteriorating situation, with borders closing, flights being canceled and catastrophic tornadoes in Nashville, our hometown. It felt like the return of the 10 biblical plaques; we were on the watch for frogs and locusts. Ms. Merkel’s simple declaration was the first clear truth that I had heard from any of the world’s leaders, that simply described the challenge presented by COVID-19 in factual, comprehensible terms. And it got me thinking – what would a 60 – 70% infection rate mean in terms of total deaths in the US.
The arithmetic is simple; (US population) x (infection rate) x (mortality rate) = number of US deaths from COVID-19. Substituting actual numbers produces:
- US population approximately = 330,000,000
- Infection rate (midpoint of Ms. Merkel’s range) = 65%
- Mortality rate (also called Case fatality ratio) = 3.5% (as reported in the press)
Or: 330 million* .65* .035 = 7,507,500 expected fatalities from COVID-19. That’s a very big number, and very bad news. To put this in perspective, total deaths in the US from all causes last year were 2,813,503. Influenza deaths were 34,157, about a normal year. COVID-19 preferentially sickens and kills older people, and those with multiple disease conditions. Assuming that half of the fatalities were due from patients who would have died of other causes in the year, we still see a net increase in the number of deaths by 6.1 million, or 237%. A catastrophe.
This result was troubling, and I first looked through all of the data on actual fatalities (here) and the WHO data (here) on actual and assumed case fatality rates for COVID-19. For folks interested, the WHO data is excellent, and they put out a daily situation report. Based on my reading and research, the lowest estimate that I could come up with was a case fatality rate (CFR) of 1.0%. I re-ran the numbers with a 1.0% CFR, with the expected reduction in total deaths due to COVID-19 from 7.5 to 4.96 million. That is still a huge number of deaths and based on hopeful rather than calculated CFRs.
Looking at other diseases, the CFR for COVID-19 is certainly less fatal than other diseases that humankind has faced in the past. It is noteworthy that the CFR of COVID-19 is considerably less than the documented rates of the other coronaviruses, MERS and SARS at 30-40% and 10% respectively.
|Pathogen||History||Case-Fatality Ratio||Transmission Mechanism|
|MERS||Coronavirus||First reported 2012||30%-40%||Droplet based|
|SARS||Coronavirus||First reported 2003||10%||Droplet based|
|COVID-19||COVID-19||First reported in||1-3.5%||Droplet based|
|Plague or Black Death||Bacteria Yersinia pestis||Largest killer in history||30-100%||Flea bite, direct contact, inhalation|
|Avian and Swine Influenza – Spanish Flu 1918||Influenza Virus, A,B,C,D||Worldwide pandemics||0.1%-2-3%; 60% H5N1||Droplet based transmission|
|Poliomyelitis||Enterovirus||Multiple Epidemics in mid-20th century||2%-5% Children, 15%-30% Adults||Through the gut|
|Seasonal Influenza 2018/2019
|Influenza Virus, A,B,C,D||Annual worldwide. 290-650K deaths per year||0.1%||
Droplet based transmission
It is important to note that COVID-19 is much more dangerous for older citizens. Based on data from China, the CFR is 14.8% for patients over 80 years of age. Conversely, the CFR is 0.2% for children 10 to 19 years, and there have been no reported deaths in children under 10 as of 3/13/2020.
The normal seasonal flu is also much more deadly for people over 65 years of age. As illustrated in the chart below, last year 75% of influenza deaths were concentrated in people over 65 years of age. If COVID-19 has similar CFR in that population, and we suffer a 3.5% total CFR ratio and 65% total infection rate, we would lose 5.1 million seniors or about 11% of the total population over 65 years.
2018/2019 Influenza US
|Age Group||Persons with Symptomatic Illness||Total Medical Visits||Total Hospital-
|Total Deaths||% Total Deaths||Calculated Case-Fatality Ratio||% US Population 2017|
The other key variable in this simple equation is the total incidence rate. As noted by Ms. Merkel, there is no immunity in the population to COVID-19. If we get it, it is up to our immune systems to beat it – or not. There are no effective treatments and no vaccines.
So how fast is it spreading? Check out the chart below.
Source: WHO (COVID-19) Situation Report – 53, 3/13/2020
Other experts in the field have the following thoughts:
“People in my field have been saying for well over a month that 30 to 60 percent of the world’s population will get infected,”
Dr. Elizabeth Halloran, a biostatistician at the Fred Hutchinson Cancer Research Center and the University of Washington.
“I would say it could be closer to 30 to 50 percent attack rate, meaning the fraction of the population infected,” he said. “This is the number you get from looking at when the disease has infected enough people to burn out spontaneously.” Alessandro Vespignani, Professor of computer and health sciences at Northeastern University in Boston
It is worth noting that the Chinese efforts to curtail community-based transmission has been quite successful, dramatically lowering the new infection rate from hundreds per day to only 15 on March 11th. Most new cases in China are now reportedly coming from outside rather than community transmission. There is hope, but from draconian measures. And it is unclear how this could be imposed on a worldwide basis without enormous reductions in trade in goods and services.
Ms. Merkel’s comments were honest, clear and provocative. I have spent some time thinking about what they imply, and have shared it here. She finished her comments last Wednesday with the following thoughts, and I share her hope and trust in our collective ability to proceed to the best resolution to a tough challenge.
“This is putting our solidarity, our common sense and our openheartedness for one another to the test,” she said. “I hope that we will pass it.”
Angela Merkel, March 11th, 2020