If the prediction for 2020 proves accurate, it would put COVID-19 as Alaska’s seventh leading cause of death, just behind suicide.
Cardiovascular disease, a largely preventable condition, was closed behind with 831 deaths, and accidents killed 431. Chronic lower respiratory disease and stroke each were slightly more deadly than suicide, which left 193 dead.
The number of deaths in the study conducted by Dr. Christopher Murray, the director of the Institute for Health Metrics and Evaluation (IHME) at UW, are orders of magnitude lower than the numbers some have bandied about.
Over a million dead?
The Spanish flu of 1918 killed approximately 675,000 people in the U.S., according the CDC. It hit especially hard in Western Alaska where some villages were devastated.
Flu deaths elsewhere in Alaska varied from a fraction of a percent in the Interior where only three of 9,585 residents were reported to have died to 3 percent along the Gulf Coast to 3.5 percent in Southeast.
“The 1918 flu, which was known as the Spanish flu, didn’t actually originate in Spain,” CNBC’s Berkeley Lovelace Jr. wrote. “It had a mortality rate of 2.5 percent and killed more people — 30 million to 50 million — than the 20 million who died in World War I. If the 4.5 mortality mortality rate of COVID-19 drops, it won’t be as bad as the 1918 flu. If it continues on its current trajectory, it will be almost twice as deadly.”
Twice as many would put U.S. deaths at about 1.35 million – more than 16 times Murray’s prediction.
The mortality rate for COVID-19 is actually unknown. The 4.5 percent cited by Lovelace is the case fatality rate (CFR), which records the number of people who died after being diagnosed with the disease. That number is now biased by the fact that in many cases only people who show severe signs and symptoms of are being tested because of limited testing capabilities.
Actual mortality calculations depend on the infection fatality rate, and epidemiologists are having a devil of a time wrestling with how to calculate that.
They know many people who are infected with COVID-19 suffer no symptoms or very mild systems, but they don’t know how many of these people exist because of a lack of testing.
The CFR onboard the luxury line was approximately 2 percent, but the IFR dropped below 1 percent.
The Centre for Evidence-Based Medicine at Oxford University on Saturday reported that Iceland is now broadly testing. Give the “higher rates of testing, the smaller population, and their ability to ascertain all those with Sars-CoV-2 means they will likely provide an accurate estimate of the CFR and the IFR, the Centre reported. “Current data from Iceland suggests their IFR is somewhere between 0.01 percent and 0.19 percent.”
Murray got around the issue of CFR versus IFR numbers by simply ignoring them and developing his own metric.
Using the “exponential growth in the cumulative death rate seen in
Wuhan (China) after Level 4 social distancing was implemented, adjusted for the median time from incidence to death,” he constructed a bell curve to document the progressive number of deaths to be expected in the U.S. as the infection spreads and the expected decline as it fades.
Almost every interaction of life and death in nature graphs as a bell curve or what is otherwise known as a Gaussian distribution of probability. Medical authorities all agree COVID-19 will follow a bell curve as it starts slowly, builds to its peak and then declines.
Alaska, like some other states, is now witnessing the building period. The state suffered its first in-state death today.
Murray’s model predicts U.S. death rates will peak around the second week of April. The model is intended to help guide hospitals in their preparations for how to deal with the evolving pandemic.
“Demand for health services rapidly increases in the last week of March and first two weeks of April and then slowly declines through the rest of April and May, with demand continuing well into June,” Murray writes. “The shape of the curve reflects both the epidemic curves within each state and the staggered nature of the epidemic around the country. Daily deaths in the mean forecast exceed 2,300 by the second week of April.”
The study predicts that the demand for hospital beds – especially beds in intensive care units (ICUs) – will exceed the supply sometime in early April, and ventilators – the machines that can help people breath by forcing oxygen into their lungs – could be in short supply.
“We have not been able to estimate current ventilator capacity; however, the number of ventilators implied by the peak, 19,481, also suggests potentially large gaps in availability of ventilators,” Murray wrote.
A hospital bed shortage is likely to be “particularly high in states such as New York, New Jersey, Connecticut, and Michigan,” his study concludes, while a shortage of “ICU beds is more of an issue across all states and is highest in the same set of states listed above as well as Louisiana, Missouri, Nevada, Vermont and Massachusetts.”
Though the numbers sound precise, Murray admits the path of the pandemic is hard to predict and largely dependent on people maintaining “social distancing” – basically staying far enough away from each other that a virus can’t jump from one person to another.
Who to stay away from in this case is almost everyone given what appear to be large numbers of people infected by COVID-19, but showing no or little sign of infection. The virus has also been shown to have a long life on cardboard, plastic and stainless steel, meaning objects touched by a COVID-19 infected individual could be passed along by those means.
Murray concedes the accuracy of his forecast will depend to a considerable degree on how Americans respond to these recommendations on self protection.
He forecast that all 50 states will within a week have implemented at least three of four formal, social-distancing measures – “school closures, closing non-essential services, shelter-in-place and major travel restrictions.”
Alaska enacted the fourth of those on Friday when Gov. Mike Dunleavy ordered “all in-state travel between communities, whether resident, worker, or visitor, is prohibited unless travel is to support critical infrastructure; or for critical personal needs.”The ban runs through April 11, but could be extended.
Murray projected that implementing three of the four measures will be “enough to follow a trajectory similar to Wuhan, but it is plausible that it requires all four measures. As more data accumulate, especially on the timing of deceleration of daily deaths, we may be able to empirically test which of these measures is more correlated with slowing the epidemic curve and reducing the ultimate death toll.”
Slowing the curve – or flattening the curve as many have put it – is intended to lower the burden on hospitals, allowing for better treatment of the minority of people whose lives are threatened by the disease. That is expected to bring down the death rate.
COVID-19 has proven especially deadly to those over age 60 and those with pre-existing medical conditions. Among the hospitalized, the disease kills almost 15 percent age 80 or older and 10.5 percent already suffering from cardiovascular disease.
Murray admitted no one knows how well Americans will adhere to “social
distancing mandates; it will take time to evaluate whether social distancing adherence is fundamentally different in the US compared to Wuhan.”
Not a vacation
Concerns have been raised about Americans treating too much like a holiday the widespread economic shutdown caused by COVID-19.
Ricky Gease, the director of Alaska State Parks and Outdoor Recreation, Friday said that Chugach State Park, a half-million-acre wilderness reserve that sits hard against Alaska’s largest city, has seen a surge in activity since non-essential services were ordered stopped, leaving thousands who would have been going to work looking for something else to do.
The agency was Friday pleading with people to keep their distance from each other.
“As Alaska maneuvers through this pandemic, it is crucial for our mental and physical health to be able to get outside and get fresh air,” an agency statement said, “but social distancing is essential, even in the fresh air.”
The statement suggested that if people refuse to maintain social-distancing standards and cooperate in maintaining clean restrooms, park trailheads could be closed:
“Please help us keep our parks open by following strict social distancing guidelines:
- “Maintain six feet of distance between you and others at all times
- “If you feel sick AT ALL– stay at home
- “Bring your own sanitizers for the restrooms and wipe down surfaces before and after use
- “If parking lots are full, go to a different location.”
Outdoor recreation has become an issue in some Lower 48 states with some contending it is irresponsible to engage in outdoor activities that might result in injuries leading to a need for medical personnel to be diverted to rescue operations or lead to a recreationist taking up a bed in an already overworked hospital.
“Healthcare workers are begging people to stay home and avoid unnecessary risk that may put more strain on an already over-saturated system. Yet my Instagram feed is flooded with skiers ticking off dream lines and hitting massive jumps all in the name of social distancing,” John Howland wrote at Powder magazine, where he chastised others for their social media posts.
“You’re telling people who have little experience managing risk, to get off their couch, go outside, make an extra stop at the gas station or the grocery store, and get after it. We don’t need this right now. Our health care workers don’t need this right now.”
Without social media, the TV those couch potatoes are watching would only be telling them to go to the liquor store to buy beer and the grocery store to buy snacks.
Update and correction: This story was updated from the original on March 28 to include information on the infection fatality rate (IFR) in Iceland and correct a misleading definition of case fatality rate (CFR).