Dr. Nicole Saphier: Coronavirus projections – this is what the models couldn’t measure
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When we look back on how the COVID-19 pandemic affected the United States, it will be clear who led the charge to defeat it: the American people.
Less than two months ago, epidemiological modeling from the Imperial College of London suggested nearly 2 million Americans could die during the COVID-19 crisis. The earliest model from the Centers for Disease Control and Prevention (CDC) suggested the number of U.S. deaths could range from 200,000 to as many as 1.7 million.
Thanks to the ingenuity of Americans everywhere, we are currently proving them wrong.
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Now, in an update published last week, the University of Washington’s Institute for Health Metrics and Evaluation (IHME) lowered its projection of total deaths from 68,841 to just over 60,308 (with an estimated range of 34,063 to 140,381).
Why were the prior models so off?
Models have no control over our country, but Americans do.
Epidemiological estimates can be useful tools but should not be over-interpreted as we need to allow them to be fluid, accounting for important and unanticipated effects, which makes them only useful in the short term. So, the models of last month, last week and maybe even yesterday will be wrong, because they underestimate the resolve of the American people.
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The scientific side of modeling is straight-forward, but model outcomes vary extensively depending on the characteristics and transmission of a pathogen. In the case of COVID-19, the spread of the virus hinges on exactly what is done to stop cases from doubling, hence the stay-at-home orders to slow community transmission.
We are beating all the projections by taking common-sense steps to protect ourselves and the people we care for. Here’s the thing: that’s not something we’ve ever tried before.
The abysmal estimates were based on the reality that Americans frequently depend on doctors and medications to save them, rather than taking charge of reducing their individual risk of illness. We know this because of the alarming rate of preventable, chronic illness throughout the country.
According to the Centers for Disease Control and Prevention (CDC), six in 10 Americans live with at least one chronic disease, such as heart disease, stroke, cancer or diabetes. Not only are these the leading driver in health care costs in our country, but they also are the leading causes of death and disability.
The nation’s aging population, coupled with existing risk factors (tobacco use, poor diet, sedentary lifestyles), coupled with medical advances that extend longevity, tell us that the chronic disease problem will only worsen as our population ages. A recent Milken Institute analysis estimates that modest reductions in unhealthy behaviors could delay or even prevent 40 million cases of chronic sickness per year.
Although it feels like an eternity, less than a month after stay-at-home orders were enacted, the courageous actions of our country have made a tremendous difference as we see promising signs of flattening the curve
If we learn how to effectively prevent chronic conditions through lifestyle changes, thus avoiding hospitalizations and serious complications, the health care system would be better equipped to handle any recurrent spikes in COVID-19 cases and future pandemics. Not to mention that decreasing hospitalizations would reduce the cost burden we all share in addition to improving the quality of life for millions of Americans.
Although it feels like an eternity, less than a month after stay-at-home orders were enacted, the courageous actions of our country have made a tremendous difference as we see promising signs of flattening the curve. But we can’t do this forever.
As our unemployment is ticking closer 20 percent from people staying home, we must be reminded of a grave reality: based on information from the National Bureau of Economic Research: with every 1 percent increase in unemployment, we can see up to a 3.6 percent increase in overdose deaths and a 1 percent increase in suicide across the country. If unemployment hits 32 percent – the worst-case scenario prediction of a St. Louis Federal Reserve economist – some 77,000 Americans may die in addition to those who were stricken with COVID-19.
Just as the threat of staying shut down is absolute, the danger in reopening and relaxing measures, however, is also very real. Singapore experienced a spike in new COVID-19 cases last week after initially seeing major successes as a result of its lockdown measures. This could happen here as well
But a national shutdown is not a sustainable long-term solution.
That means, absent a vaccine or effective COVID-19 treatment, reopening must be gradual and specific to individual states. Reopening measures can only occur when the rate of new infections has slowed substantially, hospital capacity is manageable, effective outpatient testing is in place and we are consistently able to contact trace and quarantine the infected and potentially infected.
In addition to securing adequate personal protective equipment, another key to maintain hospital preparedness for reopening is by lessening the burden on the system through healthy lifestyle choices such as improving our diets, increasing physical activity and getting our recommended wellness screenings for early disease detection.
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Social distancing measures and healthy behaviors recommended by health officials don’t just lower disease mortality, they can reduce a pandemic’s long-term adverse economic effects. Unlike the secular stagnation that plagued America during the Great Depression, our country is chomping at the bit to reopen with people even protesting to be able to leave their homes again.
As our government attempts to put together the most appropriate opening strategy, the best economic package will be the best public health one. Even when stay-at-home orders are lifted the only way to improve the economy is to make Americans feel safe enough to go out and spend money rather than continuing to remain in the protection of their homes.
Until we have a vaccine or treatment to lessen the severity of this novel coronavirus, we must rely on what we do have right now: the amazing ingenuity of the American people. I look to the private business sector to implement measures that ensure proper sanitization, enhance contact-free delivery and payment systems, and encourage digital platform utilization to limit unnecessary crowding of small spaces.
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For the rest of us, we can all contribute to a healthier America through continued use of social distancing, common-sense measures like avoiding large crowds, staying home when sick, washing hands frequently throughout the day, wearing a mask if in close contact with others, and living the healthiest lives we can.
The renaissance will come, and it will be in an America with better hygiene and less chronic disease. I am counting on you, America, to make it happen.
