A 2% Fatality Rate is not ok; it’s catastrophic.

“We can’t predict when, but given the continual emergence of new pathogens, the increasing risk of a bioterror attack, and the ever-increasing connectedness of our world, there is a significant probability that a large and lethal modern-day pandemic will occur in our lifetime,”- Bill Gates speaking in 2018

If you spend any significant amount of time watching cable news or on social media, you will repeatedly hear that COVID-19 has just a 2% fatality rate. “80% of illness is mild” and “young, healthy people with no preexisting conditions have nothing to worry about” are the current watchwords of the day. These statements are not only wrong for practical reasons; they are morally and ethically offensive. Every human death from disease is a tragedy. If take what we know about COVID-19 seriously, we are looking at a catastrophe of unprecedented proportions for the modern world over the coming year. So how much do we know about COVID-19’s mortality rate?

There is a great deal of misunderstanding around Fatality Rate Statistics

“People could see while they were being told on the one hand that it’s ordinary influenza, on the other hand they are seeing their spouse die in 24 hours or less, bleeding from their eyes, ears, nose and mouth, turning so dark that people thought it was the black death” — Kenneth Crotty, survivor of the Spanish Flu of 1918

The World Health Organization recently put the fatality rate at 3.4%, while multiple government entities have suggested the case fatality rate to be 1%-2%. From what we know so far, we can estimate with reasonable confidence that when proper treatment is available, the case fatality rate is at the very least substantially below the World Health Organization’s estimate. However, in strained healthcare settings, that number begins increasing dramatically as thousands aren’t able to access respiratory support. Recently a study from the University of Bern concluded that the overall case-fatality rate for Hubei Province, China was around 1.6%. In contrast, a study from Michael Famulare of the Institute for Disease Modeling predicted an overall .94% CFR (with a range from .34%-2.9%) under normal healthcare conditions.

Case Fatality Rate estimates from the University of Bern Study

Using the University of Bern study, we can ascertain several salient points. As age increases, the risk from COVID-19 increases exponentially, peaking at an 18% fatality rate for those over 80. In the United States, millions of older adults live in care homes, such as the one currently at the mini-epicenter of Kirkland, Washington. COVID-19 has the potential to sweep through these communities, leaving devastation and heartbreak in its wake. These are grandparents, aunts, uncles, husbands, and wives. We are not talking about a mild flu; this is a tragedy of epic proportions.

“It’s like the angel of death for older individuals.” — Dr. Peter Hotez, Dean of Tropical Medicine at Baylor College of Medicine, speaking about COVID-19.

You will often hear COVID-19 being downplayed on social media since many users are young and relatively healthy. A .18% fatality rate for those in their 30s is the equivalent of a 1/555. If you had a 1/555 chance of dying in a plane crash and a 1/100 chance of ending up hospitalized, would you board the plane? Young and healthy individuals do die from COVID-19. While these represent a minority of deaths, we are still talking about potentially tens of thousands of healthy young adults dying in an epidemic of COVID-19 across the U.S., particularly as state healthcare systems buckle under the weight of hundreds of thousands of sick.

We are a nation of preexisting conditions.

We know from the Chinese CDC’s study that preexisting conditions substantially increase the risk associated with COVID-19. In the United States, 97.2 million people suffer from hypertension, and 24.3 million people have cardiovascular disease. Another 30.3 million suffer from type one or type two diabetes, and 33.2 million have chronic lung disease. 78% of people over 55 have at least one chronic illness, and 47% have two. We are a nation of the chronically ill. COVID-19 has a chance to destroy families, lives, and communities.

Case Fatality Rate statistics based on the Chinese CDC study, Diabetes, Cardiovascular disease, Respiratory Disease and Hypertension result in death rates of 5%+

Mortality rates increase dramatically for those with heart conditions, diabetes, hypertension, and chronic lung ailments. Based on Chinese data, we can expect to see fatality rates at 5%+ for those with preexisting conditions, particularly heart disease and diabetes. If epidemiologists are correct and COVID-19 is allowed to propagate unchecked throughout the United States, we could quickly be faced with hundreds of thousands or even millions dead within exceedingly short periods. These numbers could eclipse the total number of dead from every war in U.S. History, combined in a matter of months. COVID-19 is something that every American, regardless of age, health status, or disability, should be deeply concerned about. The propensity to disrupt our society is massive, and we lose our option to control the course of the epidemic every day in which we do not take decisive action.

Total Population of individuals with preexisting conditions in the United States (blue+red), along with potential mortality rates if infection was to reach 100% of that population (red). Based on data from the Chinese CDC.

This is not a minor disease. Estimates for the fatality rate of the Spanish Flu range from 2–3%. It is extremely likely that we are currently facing the second-worst pandemic in a century with an outside possibility that we are facing the worst. Epidemiologists are currently estimating that between 20%-60% of the global population will contract COVID-19. If we are to assume that 50% become ill, that means that 3.85 billion will be stricken COVID-19. At a 1% fatality rate, 38,500,000 people will die. At a 2% fatality rate, that number is 77,000,000, and these two estimates exclude worst-case scenarios. In nominal terms, we could be looking at a year that rivals the Spanish Flu, and even possibly the Black Death. Major U.S. Cities being put on lockdown, mandatory quarantines, and widespread social disruption are not out of the question. The sooner we act on a large scale to mitigate spread the less disruption there will be. Now is the time for decisive action, a wait and see approach is not an option.