Do we have reason to hope that the US will avoid hitting the projected death toll from the COVID-19 panic? It seems an odd question to ask the day after deaths hit a new peak both nationwide and in our biggest hot spot, New York City. However, both the Washington Post and The Hill feature pieces this morning highlighting new optimism that the pandemic’s eventual death count might be much lower than currently projected.
NBC’s Savannah Guthrie put the question bluntly to Dr. Deborah Birx this morning on Today, who didn’t sound quite so specifically optimistic. Birx also emphasized that the optimism is based on maintaining current policies that have suppressed most economic and social activity, for at least to the end of April:
— TODAY (@TODAYshow) April 8, 2020
— TODAY (@TODAYshow) April 8, 2020
Death counts might continue to hit new highs over the next few days, but as The Hill points out, deaths are a “grim lagging indicator.” Birx makes this point too without using that explicit term; death levels reflect the disease status from 2-3 weeks earlier, not the spread now. That is the reason why Trump administration officials have emphasized for days that the next two weeks will be horrible, and that Americans need to prepare themselves for these numbers.
The optimism comes from a drop in hospitalizations, but that has its limitations too:
In Europe, the two worst hot spots, Italy and Spain, are beginning to cool, even though their problems remain severe.
In New York, by far the worst-hit U.S. state, there has been a notable drop in new hospitalizations related to the coronavirus — even as the Empire State recorded its highest one-day death toll, with 731 new deaths, on Monday.
Deaths are, however, a grim lagging indicator of the spread of COVID-19. New admissions to intensive care units in New York have fallen sharply. Having run at a rate of more than 300 per day for the six days from March 29 to April 3, there were only 89 such admissions on April 6.
The danger, as far as public health officials see it, is of social distancing measures slackening too fast and allowing the coronavirus to establish a new foothold. A related dilemma is how to manage public expectations and behavior if people feel either that the nadir is past or that some worst-case scenarios won’t come true.
France and Spain are also seeing new spikes in their death tolls overnight, so that take also focuses on hospitalizations. The problem with that as a solid measure, however, is that many people are choosing to not go to the hospital even when they should, under normal circumstances. Even those who likely have a COVID-19 infection will want to stay home as long as possible, and those who can’t tell the difference won’t want to risk getting exposed in hospital environments. On top of that, the lack of hospital capacity in hot spots provides yet another disincentive. Allahpundit wrote about this phenomenon a couple of times yesterday, which makes this at best an indirect measure of the intensity of the pandemic in some areas of the US. Too many people are dying at home without getting tested to be sure we’ve turned a corner.
That problem won’t get fixed until we have enough widespread testing to really determine the spread of the coronavirus and the status of various cities and regions. Once we start testing the symptomatic and the asymptomatic and do regional population checks, we may see more solid reasons for optimism. That is still the critical missing piece, and it’s still the part of the Trump administration’s response most vulnerable to legitimate criticism. We’re still flying blind until that point, which is another good reason to stay the course for a few more weeks.