Heather Mac Donald on "Keeping the coronavirus death toll in perspective"
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As governors and mayors debate when to lift their coronavirus stay-at-home orders, public health experts predict a flood of deaths should businesses be allowed to reopen before universal testing or a vaccine for the disease is available. These are the same experts whose previous apocalyptic models of coronavirus fatalities and shortages of hospital beds and ventilators have proved wildly inaccurate. It may be useful to look at some numbers for perspective.
As of 3 p.m. Eastern on April 16, there were 30,920 coronavirus deaths in the U.S. New York state accounted for 14,198 — or 46 percent — of those deaths. New York City accounted for 11,477 of New York state’s deaths and 37 percent of national deaths. This week, New York City started counting deaths as coronavirus fatalities if the patient had not been tested for the disease but was suspected postmortem of having it. This relaxed standard increased the U.S. death count by 17 percent. Other jurisdictions will inevitably follow suit.
The national coronavirus deaths represent a death rate of 9.4 per 100,000 of the U.S. population. Take out the New York fatalities and the New York share of the national population, and the coronavirus death rate for the rest of the country is 5.4 per 100,000 of the U.S. population.
In 2018, there were 2.8 million deaths in the U.S. from all causes. That is a death rate of 723.6 per 100,000, 77 times the national coronavirus death rate. The death rate for heart disease in 2018 was 163.6 per 100,000, or 17.4 times the national coronavirus death rate. (There were 647,457 heart disease deaths in 2017, the last year for which such numbers are available.) The influential Institute for Health Metrics and Evaluation model is now predicting 68,841 U.S. coronavirus deaths by August. Even if this latest estimate is accurate for once, that would make for a death rate of about 21 per 100,000, comparable to the 21.4 per 100,000 death rate for diabetes in 2018.
The year 2018 saw 708,000 deaths every three months. We are destroying tens of millions of people’s livelihoods for 30,000 deaths over three months, a number that will barely move the needle on the all-cause death count. The loss of each of those 30,000 victims is heartbreaking to their families and acquaintances, especially when the victim dies in isolation.
But the damage being wrought by the economic shutdown is also heartbreaking and is also a public health issue. New York Gov. Andrew Cuomo (D) announced on April 15 that New York would decide which businesses could reopen based on how “essential” they were. To its employees, every business is essential. The judgement of necessity is either arbitrary or political, as the forced closure of abortion clinics in several states demonstrates.
Many of the 22 million workers who have been laid off recently (more than a tenth of the workforce) now have no way to pay their bills and are becoming desperate. There were more than 67,000 drug overdose deaths in 2018; these so-called deaths of despair will very likely increase this year.
Up to a third of small businesses may never reopen. The effects of the shutdown are cascading through every aspect of society in ways too complex to fully comprehend. Supply chains have been thrown into chaos by the mandated closures. Planning future production is almost impossible with consumer and business demand so unpredictable. Manufacturing output has seen the largest decline in more than 70 years. Less developed countries that depend on exporting their raw materials face civil unrest if their populations remain unemployed. Poverty is the greatest cause of death worldwide. The coronavirus panic will stunt the lives of millions of children across the globe.
To be concerned about the effects of the global shutdown is not to be indifferent to human suffering; it is to be moved by that suffering. Public health experts are understandably focused on one thing: using every possible mechanism to eradicate the virus. But balancing those efforts against other social needs lies outside their professional competence. Funding for current and future public health initiatives alone depends on keeping private economic activity alive, but the tax base is being decimated.
The outbreak in New York City is not a harbinger of things to come for the rest of the country. New York City combines a high immigrant population, high residential density and high use of public transport. Los Angeles and Orange counties in California also have large immigrant populations, but most of those immigrants travel by car, and they live in neighborhoods still characterized by the suburban bungalow. California has over 1,000 deaths as of April 18; that number is not going to explode 13 times in the coming weeks to reach New York State's 13,362. Iowa had 53 deaths as of April 16. Should it be in lockdown?
New York is representative in two senses, however: the high proportion of nursing home deaths and the profile of the deceased. Sixteen percent of New York’s coronavirus deaths occurred in nursing homes as of April 10. Nationwide, if a state is seeing a spike, it is happening in facilities for the elderly. More than 3,000 deaths nationwide are linked to such institutions, according to the Associated Press. They serve a tragically and uniquely vulnerable population. The nursing home industry was already a national shame before this pandemic. Whether or not this high death rate forces a reconsideration of how Americans care for aging parents and how much they are willing to pay for that care, for now it is imperative that nursing homes step up their game regarding cleanliness and disinfection.
The coronavirus targets the elderly frail with preexisting morbidities, as had been apparent from the highly detailed Italian data. As of April 12 in New York City, 97 percent of all coronavirus deaths had serious preexisting conditions, where the presence or absence of underlying conditions was known. The death rate for coronavirus among individuals 75 and older is 63 times higher than the death rate for New Yorkers aged 18 to 44. More than three-quarters of all deaths have been among people over 65 in New York City, a proportion replicated or exceeded elsewhere. This concentration of cases and deaths among the already sick elderly means that sweeping stay-at-home orders and business shutdowns are overly broad.
Future efforts should focus on protecting at-risk seniors, but businesses should be allowed to reopen at their discretion. Some may not if their employees don’t feel safe. Consumers have been so spooked by the nonstop media images of hazmat suits and hearses that they may stay away anyway. Nearly four-fifths of respondents in a CNN poll taken April 3 through April 6 knew no one infected by the coronavirus, yet 47 percent thought it was likely that they or someone in their family would contract the disease — an unrealistic assessment of their risk.
On Wednesday, Cuomo said that the pandemic response will be over “when people know ‘I’m 100 percent safe, and I don’t have to worry about this.’” That 100 percent safety expectation is not how we conduct the rest of our lives. There are upward of 40,000 highway deaths a year because we value our time and convenience more than the safety that could be achieved by lowering driving speeds to 25 miles an hour.
There will be more lives lost to the coronavirus, each of them tragic. But a greater tragedy is unfolding before us from this exclusive focus on one cause of death and the draconian measures being taken to avert it.
Heather Mac Donald is the Thomas W. Smith fellow at the Manhattan Institute and the author of “The Diversity Delusion.”
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