Recent data on infections and deaths due to COVID-19 continue to improve. Below data for April 16-25 have been added to my earlier chart showing daily growth rates of cases and deaths related to COVID-19:
Average daily growth rates of confirmed COVID-19 cases and related deaths:
Worldwide United States New York State
Cases Deaths Cases Deaths Cases Deaths
March 26-31 11.7% 12.5% 13.9% 28.8% 16.2% 32.6%
April 1-6 7.7% 10.3% 11.4% 18.4% 9.5% 20.6%
April 7-15 4.8% 6.5% 6.4% 10.9% 5.7% 10.4%
April 16-19 4.4% 6.3% 2.8% 11.5% 3.2% 12.1%
April 20-25 3.1% 3.3% 3.9% 4.7% 2.5% 2.8%
Apr 26-May 5 2.4% 2.4% 2.5% 2.8% 1.3% 1.4%
May 6-13 2,3% 1.9% 1.9% 2.2% 0.8% 1.1%
May 14-20 1.9% 1.4% 1.5% 1.4% 0.8% *
- Error in data source for New York deaths in this period.
The exceptional fall off in growth rates of death worldwide, in the US and in New York is very encouraging. Yet there are still hot spots and reversals in some locales. Regardless of the summary data, we are not likely to have confidence that this virus will be a less worthy foe until we have testing for antibodies and a vaccine both in mass production and distribution. The data behind this table is nevertheless useful in bursting some popular myths and asking useful questions.
Myth number one: “The United States has not managed the pandemic well!” This myth results from too much focus on the number of cases and deaths and not enough attention paid to rates of growth and ratios of cases and deaths to population. As of April 25, The US has logged 54,268 deaths, more than any other country in the world. But we should expect a country with more lives to have more deaths. Those 54,268 deaths represent 164 fatalities per million population, 1.6 deaths for every 10,000 people or 0.016% fatalities. Belgium and Spain each have fatalities at over three times that rate. Italy, France, and the UK have twice or more that rate. The United States record of controlling contagion so far is not the best, but is among the best in industrial countries in the Western Hemisphere. We will come back to Asia.
Myth number two: “We failed to do enough testing soon enough!” Even where tests are available, very few are used on patients without serious symptoms. There is no incentive for the patient because no treatment is available without symptoms. If people think they might be sick, they are as careful not to infect their loved ones as those who know they have the virus. The reason this virus is so contagious is that so many people who do not suspect they are infected spread it for long periods. To be of any use curbing contagion, broad swaths of the population would have to be tested frequently. The best available test for controlling contagion is checking body temperature multiple times daily. Repeated temperature testing along with masks, gloves, severely disciplined quarantines and social distancing where possible is the control process being used successfully in China, Taiwan and South Korea to re-open factories.
Myth number three: “The whole idea of closing down our economy is a bad joke. This virus has killed fewer than a normal flu. Deaths are over counted. Deaths from pneumonia and other flus are down for the year to date. Total U.S. deaths are down for the year to date. Look at Sweden. They did not lock down and had among the fewest deaths on Europe.
Clearly there are things we do not understand about this virus and pandemic, and many mistakes will be obvious in retrospect. Even so, when you are in a conversation with E.R. professionals in New York or Louisiana or Spain or Italy, be careful how you explain there is no danger or nothing different with this virus. When you brag about Sweden, don’t forget that Sweden is a small country. With 10.3 million people Sweden has about the population of Georgia or North Carolina. The Charlotte metro population is over twice that of greater Stockholm. Atlanta metro is five times that of greater Stockholm. Sweden’s population lives on three times more land area than either Georgia or North Carolina. Less urban and more dispersed, one would expect Sweden to have a lower virus fatality rate, but it does not. As of April 25 Sweden lost 2192 citizens to the virus, or 212 lives per million population. That death rate would make it the seventh deadliest state in America. Compare this to 164 deaths per million for the entire U.S., 105 for the U.S. excluding New York, 75 for Georgia and 23 for North Carolina. One could make the argument that using Sweden’s approach in the United States would have cost at least an additional 150,000 American lives and probably many more. Who could prove that to be right or wrong?
Myth number four, from the Wall Street Journal, Monday April 27, 2020, page one headline: “Coronavirus Means the Era Of Big government Is Back.” It is more likely the opposite is true! The dollars being pumped into the economy and into vaccine research are unprecedented, but there are no new bureaucracies or regulations; nothing comparable to the Consumer Finance Protection Agency, and no stress tests for hospitals. There have been many accelerants that make government less restrictive including faster FDA approvals, faster approval of SBA loans, and force fitting telemedicine into insurance paradigms. There is immense collaboration with and delegation to State Governors. Every Governor is in control in his or her state. The Federal role is not to set up a new bureaucracy but to re-organize existing resources, to provide best available information, guidance and emergency resources. The result is to leverage and empower the state health organizations. This is Federalism at its best and the Governors will realize they should and can exercise the same control in many places, not the least education, labor law, land use, and welfare. Private industry has been called into consultation and service on a scale not seen since World War II. The era of de-regulation will accelerate. The additional debt assumed to bring us through this crisis underlines the critical need to control our federal deficits and debt.
I wrote on March 20 that we would see infection rates drop steeply by May 1, followed by diverse recoveries managed locally, full of uncertainty, and requiring great care. All of this is becoming more obvious daily.
April 28, 2020, Table updated May 21, 2020