The Health 202: Number of U.S. coronavirus deaths will depend on how many older people are exposed

THE PROGNOSIS

Could tens of thousands of Americans die of the coronavirus? Maybe, if the elderly aren’t sufficiently sheltered from it. 

That will likely be the key factor in keeping the fatality rate from skyrocketing in the U.S., since the covid-19 has proved especially deadly for those over 80 while rarely killing children, young adults or even those in middle age. 

“If we are going to have death rates in the tens of thousands in the U.S., it will be because [nursing home] capacity is overrun and these high-risk populations are exposed,” Andy Slavitt, who ran the Centers for Medicare and Medicaid Services under President Barack Obama, wrote in an email. 

“Everyone over 60 should become a hermit for a month,” Scott Gottlieb, former commissioner of the Food and Drug Administration, texted me. In China, 22 percent of Chinese patients over age 80 have died, according to WHO figures. 

The next few weeks are critical for how broadly the virus will ultimately spread in the United States, as governments, workplaces, schools and other institutions across the nation cancel mass gatherings and take steps to keep people away from one another as much as possible. 

The World Health Organization took the monumental step yesterday of declaring the spread a pandemic, as the number of cases surpassed 120,000 worldwide. German Chancellor Angela Merkel has said 70 percent of her country’s residents could become infected.

President Trump last night took the drastic move of banning travel from most of Europe to the United States for the next 30 days, announcing the ban in an address from the Oval Office where he also announced a series of economic relief plans, including low-interest loans to affected small businesses and calling on Congress to provide “immediate payroll tax relief,” my Washington Post colleagues report.

“This is the most aggressive and comprehensive effort to confront a foreign virus in modern history,” Trump said.

Trump tweeted this last night:

And earlier in the day:

So far, deaths in the United States number only several dozen. That’s a far cry from the country’s 70,000 fatalities during the bird flu pandemic back in 1957. 

Though when it comes to infections alone, which will number many times the fatalities, they could reach the hundreds of thousands and even millions in the United States. 

Experts and officials are warning that the virus is spreading rapidly and will infect many more people in the United States before it subsides. And because there have been testing delays, there’s a strong likelihood that many more people are infected with the virus than have been reported.

Yesterday’s declaration by the WHO — which had for weeks hesitated to declare a pandemic for fear of inciting undue panic — reflects a growing and serious alarm over the virus’s global spread. 

“We are deeply concerned both by the alarming levels of spread and severity and by the alarming levels of inaction,” WHO Director General Tedros Adhanom Ghebreyesus said. 

The question in the United States, Slavitt feels, is whether the nation will experience the moderate scenario or the severe scenario. The chance for a best-case scenario of containment has already come and gone, he said.  

Under the most severe scenario, the virus would spread so quickly that it outstrips the ventilator, intensive care and workforce capacity of medical facilities. 

Here’s what other experts are predicting:

— Former Centers for Disease Control Director Tom Frieden has projected that deaths in the U.S. could range widely – from 327 deaths to 1.6 million deaths – depending on rate of infection and how lethal it proves to be, my colleagues Joel Achenbach, William Wan and Lena H. Sun report.

“Frieden…says that in a worst-case scenario, but one that is not implausible, half the U.S. population would become infected and more than 1 million people would die,” they write.

His team reached its projections by using case fatality ratios ranging from .1, similar to seasonal flu, to .5, a moderately severe pandemic, and 1.0, a severe one. The infection rate ranged from 0.1 percent of the population to 50 percent. The deaths would not necessarily happen over a month or a year, but could occur over two or three years, Frieden told my colleagues.

Anthony Fauci, head of infectious diseases at the National Institutes of Health, told the House Oversight Committee yesterday that “things will get worse than they are right now.”

How much worse depends on two things, Fauci said — the United States’s ability to contain the influx of people coming into the country who are already infected and its ability to contain and mitigate within its own borders.

“Bottom line, it’s going to get worse,” Fauci told the lawmakers.

— The in-house doctor for Congress told Capitol Hill staffers yesterday that he expects 70 million to 150 million people in the United States (so, between 20 percent and 40 percent) to contract the coronavirus, Axios reports.

Brian Monahan, attending physician for Congress, told chiefs of staff, staff directors, administrative managers and chief clerks to prepare for the worst, Jonathan Swan and Alanya Treene write.

— Farzad Mostashari, who coordinated health information technology under the Obama administration, told me it’s “reasonable to assume” the coronavirus outbreak could cause far more casualties than the 1957 bird flu, if left unchecked.

He figures that if 2.5 percent of the U.S. population were to become infected, that would include about 1.5 million seniors. If the fatality rate for this population is about 20 percent, that could result in 300,000 deaths.

“However, this is not predestined,” Mostashari wrote me. “We can and must take immediate steps to contain the virus where we can … and mitigate its spread when containment is no longer feasible.”

More coronavirus news: 

– Actor Tom Hanks has covid-19. The 63-year-old Oscar winner announced on social media last night that he and his wife, the actress Rita Wilson, have tested positive. Hanks is currently in Australia for the preproduction stage of an Elvis Presley biopic, my Post colleagues write.

Hanks noted in a statement shared on his Facebook, Twitter and Instagram accounts that he and Wilson, also 63, started to feel “a bit tired, like we had colds, and some body aches.”

“Rita had some chills that came and went,” he wrote. “Slight fevers too. To play things right, as is needed in the world right now, we were tested for the Coronavirus, and were found to be positive.” 

Slavitt tweeted: 

— March has taken madness to a new level.

  • The NCAA men’s and women’s basketball tournaments will be played in nearly empty arenas because of concerns about the virus, NCAA President Mark Emmert announced yesterday afternoon. The games, which begin Tuesday night in Dayton, Ohio, will be played “with only essential staff and limited family attendance,” Emmert said in a release.
  • The NBA has announced the 2019-20 season has been suspended indefinitely after Utah Jazz center Rudy Gobert tested positive.

Wesley Lowery, a correspondent for “60 Minutes:”

— House Democrats have teed up a vote today on a broad coronavirus relief package that will include expanded unemployment insurance, paid sick leave and food security assistance, The Post’s Erica Werner, Mike DeBonis and Jeff Stein report.

“The effort shows the urgency with which political leaders are moving to contain the economic turmoil caused by the coronavirus outbreak,” they write. “Although the Senate seems unlikely to act before a congressional recess scheduled for next week, a number of Republican senators indicated openness Wednesday to at least some elements of the House plan and said it was important to act quickly.”

HuffPost reporter Matt Fuller:

— Authorities have deemed a drug Gilead Sciences tested for treating Ebola as the most promising of possible coronavirus treatments, Christopher Rowland reports.

“The drug, called remdesivir, had blocked the Ebola virus in laboratories and in animal experiments, Chris writes. “But it did such a bad job extending survival in humans compared to two of the other treatments that researchers decided in August not to try it on any more patients. Now the drug, created by pharmaceutical giant Gilead Sciences, is being tested in new clinical trials … Because it is a ‘broad spectrum’ drug that has been effective against multiple viral targets in the lab and in animals, the strategy could work, experts said.”

Some coronavirus humor from Sam Geraci, a vice president at American Family Insurance:

AHH, OOF and OUCH

AHH: Sen. Bernie Sanders (I-Vt.) will stay in the race for the Democratic presidential nomination even after a disappointing showing during Tuesday night’s contests – ensuring that his Medicare-for-all plan stays part of the national discussion. 

During a 10-minute appearance in his hometown, Sanders “conceded that he was losing the nominating contest to former vice president Joe Biden and had failed to persuade Democrats that he was more electable, sounding the notes of a candidate who had come to terms with his shortcomings and was ready to accept defeat,” our Post colleague Sean Sullivan reports. 

“But he also made clear that he was staying in the race, at least for a few more days, determined to meet Biden in a one-on-one debate Sunday that he said would expose important distinctions between their records,” he added. “He even listed a number of challenges he said he would issue to Biden, including how he would fight poverty and how he would handle health care.” 

— At the news conference, Sanders said his struggles were partly because voters agree with what his campaign stands for but are voting for Biden because they think he can beat Trump. “Exit polling confirms this dynamic played out on the issue of health care in Michigan,” The Post’s Scott Clement reports.

In Michigan, almost 6 in 10 primary voters said they support replacing all private health insurance with a single government plan for everyone – which mirrors Sanders’s signature Medicare-for-all proposal. But half of those voters said Biden has the best chance of beating the president in November.

— Sanders said he’ll challenge Biden on key issues, including health care and fighting poverty, at Sunday night’s one-on-one debate. That’s a tactic Sanders deployed against Hillary Clinton in 2016. 

“Long after Sanders no longer had a viable path to the nomination four years ago, he continued to hold off on endorsing Clinton, seeking negotiations between the campaigns on several policy issues — including higher education and health care — and input on the Democratic Party platform,” our Post colleague John Wagner reports. Clinton announced then her support for a public option, which while short of Sanders’s single-payer push, gained his praise for an “important step forward.”

OOF: The Trump administration announced a new Medicare pilot program that could cap the cost of insulin at $35 per prescription for seniors, the New York Times’s Katie Thomas reports. 

Nearly 3.5 million Medicare beneficiaries take a form of insulin, which had an average list price of about $450 in 2016 and has risen in price since.

“If insulin manufacturers and insurers agree to offer the plans — which are voluntary — then people 65 and older who need insulin could save an average of $446 a year beginning in January 2021, according to Medicare officials,” Katie reports. 

She adds: “The proposal could also give a political boost to President Trump in an election year. If insurers agree to offer the capped program, people could begin signing up Oct. 15, at the height of his campaign.”

OUCH: Why are people buying out supermarkets’ supplies of toilet paper amid rising anxiety of the coronavirus outbreak? Psychologists told CNBC it’s in part to manage emotions, CNBC’s Chloe Taylor writes

Paul Marsden, a consumer psychologist at the University of the Arts London said similar to the way consumers use retail therapy to cope, the panic-purchasing of goods is about “’taking back control in a world where you feel out of control,” he said.  

“Meanwhile, Sander van der Linden, an assistant professor of social psychology at Cambridge University, said there were both generalized and coronavirus-specific factors at play,” Chloe writes. 

“In the U.S., people are receiving conflicting messages from the CDC and the Trump administration,” he said. “When one organization is saying it’s urgent and another says it’s under control, it makes people worry.”

Dimitrios Tsivrikos, lecturer in consumer and business psychology at University College London, called toilet paper a symbol of mass panic. “In other disaster conditions like a flood, we can prepare because we know how many supplies we need, but we have a virus now we know nothing about,” he said. 

REPRODUCTIVE WARS

— A federal appeals court reviewed an Ohio law that restricts abortions when a woman fears the fetus has Down syndrome. 

“Abortion opponents say the case is winnable in one of the nation’s most conservative legal venues and could send the issue to the Supreme Court,” the Wall Street Journal’s Jacob Gershman reports. “… No federal appeals court has upheld such a restraint on abortion, and several federal court rulings have blocked similar provisions enacted elsewhere. The Supreme Court has barred laws that ‘place a substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability.’”

The vast majority of pregnancies in the U.S. are terminated when the fetus is found to have Down syndrome. Lawyers representing Ohio measure argue it protects a vulnerable population. 

— And here are a few more good reads:

SECOND OPINION

AGENCY ALERT

The Trump administration this week expanded the use of video hearings for immigrant children, having dozens of them held in Houston appear before a judge based in Atlanta. Advocates believe the effort could portend a nationwide expansion of video courts to process the immigration claims of children in U.S. government custody.

Associated Press

STATE SCAN

MEDICAL MISSIVES

DAYBOOK

Today

  • The House Oversight and Reform Committee holds a hearing on coronavirus preparedness and response. 
  • The Senate Small Business and Entrepreneurship Committee holds a hearing on the coronavirus and America’s small business supply chain. 
  • The Senate Agriculture, Nutrition and Forestry Committee holds a hearing to examine agriculture innovation and the Federal biotechnology regulatory framework.

SUGAR RUSH

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