A U.S. News analysis of coronavirus deaths in eight countries indicates the pandemic is approaching a crucial point in America, when an aggressive and sustained national response could save thousands – perhaps millions – of lives and protect health systems in hard-hit areas from collapse.

The analysis indicates that the death toll in the U.S. is surging and soon will likely top 300 deaths per day. Without a comprehensive response to prevent new infections and care for those who are sick, the U.S. is poised to follow the paths of other nations with rising infection rates and mounting deaths.

Plotting daily deaths over time offers a sense of which measures were most effective at bending the curve and saving lives in other countries. In China, for example, aggressive testing, isolation and quarantine efforts that began in the third week of January culminated in a pivotal moment in mid-February, the analysis shows, when the number of new deaths fell to about 100 to touch off a steep decline.

In Iran, where leaders initially downplayed the threat and saw a surge in deaths, the tide appears to have turned for the better around March 22. In Italy, the death toll reached a critical milestone the same day, topping 500 reported deaths for the first time. But in the last few days, the toll appears to be leveling out and may decline.

The brunt of the pandemic hit the U.S. later than in other countries, but deaths have been rising rapidly in recent days. There were more than 200 new deaths reported Wednesday to push the total past 1,000 – and the analysis shows that, barring considerable intervention, the daily death toll is poised to accelerate.

Dr. William Schaffner, a professor of preventive medicine and infectious diseases at the Vanderbilt University School of Medicine, says the findings underscore the critical need for people to continue to stay at home and physically distance themselves from others.

"If they don't, it's likely that there will be a substantial increase in deaths from coronavirus in the United States," Schaffner says.

Deaths represent the most reliable measure of COVID-19's spread and the arc of the pandemic. Trying to track infections and hospitalizations is much more challenging due to fragmented testing and reporting across counties, states and countries. In the U.S., it can even be difficult to track deaths, as the federal government and other institutions, such as Johns Hopkins University, regularly publish different numbers.

"Deaths may be the best measure of the incidence of coronavirus," says Dr. James Curran, dean of the Emory University Rollins School of Public Health, who led the Centers for Disease Control and Prevention's AIDS task force. "The reason to follow deaths and analyze them carefully is to see how we're doing at saving lives."

Yet policymakers, health officials and the public have, for the most part, focused on surging case counts in epicenters like New York City and Seattle, trying to fashion a response based on an incomplete picture of the virus' spread. The U.S. News comparison offers a window into different scenarios that may unfold depending on how aggressively the U.S. acts in the coming days.

Some parts of the country are already at a crisis point. This week, New York Gov. Andrew Cuomo pleaded with the Trump administration to provide 30,000 ventilators, which he said will be crucial when a tidal wave of coronavirus cases hits the state in two to three weeks. New York's roughly 31,000 cases so far represent about 6% of those diagnosed worldwide, and the state has the highest death toll in the U.S., with more than 320 dead – though New York's population density might produce a higher infection rate and death toll than other parts of the country, experts say.

In Washington state, which was the country's first hot spot and now has one-tenth as many cases as New York, the coronavirus has killed more than 130 people, with most of the deaths in the Seattle area and many linked to a nursing home.

Louisiana appears headed for the same precipice. Three weeks ago, the state had no confirmed cases of the coronavirus. There are now about 1,800 cases in the state, and Gov. John Bel Edwards, who issued a stay-at-home order on March 22, said hospitals in the New Orleans area could be overwhelmed by April 4.

"We're already low on protective equipment," says Dr. Rebekah Gee, who until recently served as Louisiana's health secretary and now leads the LSU Health Care Services Division. "The biggest issue is personnel, because you can make masks and you can actually create field hospitals, but you can't make pulmonary critical care specialists in a week."

With the number of COVID-19 cases growing at a faster pace in some places than in others, Americans are constantly flooded with news and information, much of it conflicting and difficult to interpret, says Rocco Perla, co-founder of nonprofit The Health Initiative and an assistant professor of biostatistics at the University of Massachusetts Medical School.

Perla carried out the analysis with Lloyd Provost, principal statistician at Associates in Process Improvement, with help from Shannon Provost, a lecturer at the McCombs School of Business at the University of Texas in Austin, and shared it with U.S. News.

This barrage of information, on some days frightening and on others reassuring, "encourages a cycle of panic and relief" that keeps the public guessing and stokes the sense of alarm, Perla says. Most importantly, Perla and Provost say, most of the data released by health agencies in the U.S. and abroad doesn't account for random variation.

Without statistical analysis, there's no way to know whether these ups and downs in the data are random or convey "something important about whether things are getting worse or better," they say in a description of their analysis, which uses coronavirus data from Our World in Data – a nonprofit affiliated with the University of Oxford that draws on information from the European Centre for Disease Prevention and Control – and the World Health Organization's daily situation reports.

The data in the analysis represents the best information available, Perla says; it also reflects the dates new daily deaths were reported, not necessarily when they occurred. Viewing the data in its entirety and over time offers a clearer window into the trajectory of the outbreak, one that isn't clouded by noise and can detect meaningful differences in patterns that can inform official public guidance and decision-making.

"With all the talk of 'flattening the curve,' we think the approach we used and our analysis sheds light on early signals of when the increase in new deaths peaks and the curve begins to flatten," Perla and Provost say.

The analysis indicates a pivotal point where the death toll deviated from its expected course in various countries – whether for better or worse. Comparing the U.S. curve with those from other countries offers insight into the value of measures that can slow the pandemic's growth.

Experts who reviewed the data say China's curve reflects its draconian crackdown on the virus. On Jan. 23, with about 835 infections and 26 deaths in the country, Chinese officials quarantined Wuhan, a city of 11 million that was the center of the outbreak at the time. As cases continued climbing, authorities put more cities on lockdown and began aggressively screening and contact tracing. Sick patients were separated from their families, workers went to homes looking for illnesses and residents were paid to monitor and report on quarantine-violating neighbors.

"They put into force a truly amazing response that was brutal and oppressive, that was unprecedented in scale, that was intolerant of dissent, intolerant of the free flow of information, untransparent and rapidly scaled," says Steve Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies, a think tank in the nation's capital. "And it worked."

On Feb. 17, 25 days after the country cut off Wuhan, the number of new deaths reported in China fell to 105 in the first signal that deaths would soon begin dropping, the U.S. News analysis shows – even as the number of total cases there remained high. On March 22, China reported just six new deaths.

But by then, the virus had taken hold across the world. In Italy, as China began gaining traction against the pandemic, the governing Democratic Party leader, Nicola Zingaretti downplayed the risk of the virus, encouraging people "not to change our habits."

Today, the country has about 74,000 confirmed cases and more than 7,500 coronavirus deaths, the Johns Hopkins tracker shows – though the true number of infections may be much higher, according to Angelo Borrelli, who heads Italy's Civil Protection Agency. About 9% of the country's infections have occurred among health workers.

In Italy, the death toll hit a peak on March 22, when 795 deaths were reported. New deaths fell below the expected trajectory in more recent days, according to the U.S. News analysis, indicating they may begin to decline. Many in the country have died because the health system is overwhelmed and can't care for a flood of critically ill patients needing ventilators and other respiratory support.

"It's just a measure of how ill-prepared they were for this," Morrison says.

A look at Iran offers another view of the global pandemic. Leaders in the secretive state said in February that the virus wouldn't spread in the country, but a steep upward climb in deaths began around March 9, the analysis shows. Satellite images show mass graves in Qom – the country's first coronavirus hot spot – and that week, authorities shut down popular religious shrines in Qom and Mashhad and authorized the military to intervene, The New York Times reported. Iran now has more than 29,000 cases and 2,200 deaths, according to the Johns Hopkins tracker.

Even so, while new deaths reported in Iran remained high at 123 on March 22, the analysis indicates that had the outbreak maintained its recent trajectory, that number actually would have been higher – meaning restrictive measures at the state and individual levels may be starting to blunt the uptick in deaths.

That trend still could be reversed, especially if the data are inaccurate or delayed due to reporting issues, Perla notes. But it gives the strongest indication of Iran's current coronavirus trajectory.

South Korea offers a contrast to other countries in the analysis. Its response, which involved a dedicated public health campaign of testing, contact tracing and isolation, was so successful that the country kept its death toll low and prevented a surge of cases.

The country was hit hard by another coronavirus – one that causes Middle East Respiratory Syndrome – in 2015, and already had the laws and emergency infrastructure in place to manage such an outbreak.

"We have the blueprints for the solution – we just need to follow them," says Gee from Louisiana. "We understand what worked in South Korea and in China, and if we do these things, they will work here."

A soon-to-be released analysis by the University of Washington's Institute for Health Metrics and Evaluation buttresses the U.S. News findings. The IHME research team also examined deaths globally, from the start of each country's outbreak – the date the death rate hit 0.3 per 1 million – to the moment it gained momentum.

The IHME analysis additionally delved deeper and found that each country's trajectory is driven by the pandemic's arc in different communities, some of which – such as the Lombardy and Liguria regions in Italy – experienced explosive growth, while others, such as Venice, are seeing deaths mount more slowly.

Spain is now one of the hardest hit countries in Europe, driven by a surge of deaths in Madrid, says Dr. Christopher Murray, IHME's director, who describes the situation in Madrid as "really alarming."

Madrid's death rate 14 days after the start of its epidemic is 10 times higher than Wuhan's was at that same point: "Madrid's going to be the worst by far of the European cities," Murray says.

In all, the results of both the U.S. News and IHME analyses "confirm that early, decisive action toward self-isolation, social distancing, will pay off," says Dr. Julio Frenk, the president of the University of Miami, former dean of the Harvard T.H. Chan School of Public Health and chairman of IHME's board.

Frenk says social distancing measures can help curb the outbreak in three ways: They interrupt transmission of the virus, and ensure that even if the same number of people are infected, those infections occur over a longer period of time, preventing health systems from becoming overwhelmed – "the famous flattening of the curve," Frenk says.

Perhaps most importantly, he says, slowing the spread of the virus buys scientists time to develop better ways to screen, diagnose and treat patients.

"We need to work together, because physical distancing gives us more time for those scientific solutions to emerge and be tested and deployed," Frenk says.

With roughly a fifth of Americans under orders to stay at home, the U.S. News analysis also reinforces agreement among health experts that short-term business and school closures will not be enough to meaningfully turn the tide on the outbreak.

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President Donald Trump this week signaled a desire to have the country "opened" by Easter on April 12 to curb the virus' damaging economic effects. The virus' astonishingly rapid potential for spread makes this a potentially dangerous move, and Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, advised "flexibility" in determining when to relax stay-at-home orders.

"On a literally day-by-day and week-by-week basis, you need to evaluate the feasibility of what you're trying to do," Fauci said. "I think people might get the misinterpretation you're just going to lift everything up and ... that's not going to happen. It's going to be looking at the data."

In the U.S., the best approach to the virus emphasizes the voluntary measures now in place, says Dr. Clay Marsh, vice president and executive dean for health sciences at the West Virginia University Health Sciences Center. His state – which just recorded its first instance of community transmission at a nursing home – is aggressively trying to avoid a wave of cases similar to the one that now threatens to capsize New York City's health system.

If 75% of people heed those stay-at-home warnings, Marsh says, the tsunami of cases could be transformed into a steady stream of patients that health workers can manage. If 90% of people heed the order, "you don't see a surge," he says.

IHME's Murray says it won't be long before we learn whether these measures are working.