What We Know About COVID-19 in the US: The Most Common Questions
This is a “live” article updated weekly to reflect fast-changing numbers — last update: April 8th, 2020.
Who is this virus affecting and how is it spreading?
The virus is affecting people of all ages but is most negatively impacting older men. Although older people are experiencing more negative consequences in the form of higher rates of hospitalizations and death, young people are not immune, contrary to what some public figures have said. Young people are seeing high rates of hospitalizations (close to 10%).
The virus, a “coronavirus” known as Sars-cov-2, produces a disease known as COVID-19. Not all people who get the virus will develop COVID-19. Those who do, however, will develop severe acute respiratory syndrome (SARS) which can be life-threatening — along with other symptoms.
The virus can survive for long periods of time on surfaces depending on the type surface — some estimate that it can survive as long as 72 hours on stainless steel. The virus has also been found in infected people’s feces. This is why it’s important for people to wash their hands often (especially after using the restroom) and use a hand sanitizer which contains at least 60% alcohol. The virus is also spreading through the air. Although the virus isn’t technically “airborne” — research suggests that aerosolized virus particles are rare in real-world conditions, it can be caught by someone who is in close proximity to someone who has the virus that has sneezed or coughed. Further, the virus can be spread by people who show no symptoms. This is why it’s important for us to maintain a safe distance from others — a physical distancing (not social distancing) of at least 6 feet.
Much of the available data on the virus is unreliable due to issues with not enough data collection, faulty reporting by governments, and issues with properly classifying deaths. Here’s what we can surmise given the limitations.
How many people are having to be hospitalized?
People who are older are more at risk of requiring hospitalization than the young. People that are 75–84 years make up anywhere between an astounding 30.5–58.7% of hospitalizations. And it goes even higher for those who are 85 or older — up to 70%! Although the older are requiring more hospitalization than the young, the young (22–54) still end up requiring hospitalization in anywhere between 14.3–28.3% of cases. However, this does not necessarily mean that the young are more likely to end up in the hospital if they contract the Sars-Cov-2 virus (these numbers only reflect the percentage of patients currently in hospitalization). For this, we need to look at hospitalization rates.
As of March 30th, using the limited data available from New York at the time, we can see just how badly this virus is in terms of leading to hospitalizations. For people aged 65–74, hospitalizations rates are 35% and almost 50% for people over 75! Younger people aren’t safe either. Nearly 1 in 10 people under the age of 44 end up in the hospital because of this virus.
Fortunately, this hospitalization rate has begun to slow as of April 8th. According to the New York Times, “…there were nearly 4,600 patients on ventilators in New York, far fewer than pessimistic projections in recent weeks had said there might be.” The total amount of people hospitalized in the state is 17,493; out of the total 138,836 cases in the state, this puts their hospitalization rate at about 13%.
The high hospitalization rate is a cause for concern even if it doesn’t translate to a high mortality rate across all age groups. If hospitals are swamped then they can’t treat everyone that needs help. The more people that need help, but can’t get it due to an overworked healthcare system, the higher the mortality rates go. And, this does not only impact people with COVID-19 but also people who may suffer from other life-threatening conditions (heart attacks, complicated urinary tract infections, etc) who may also not be able to get the treatment they need due to a shortage of hospital workers to give them adequate care. This is why many experts advocate for “flattening the curve;” doing so will lead to lower overall death and smaller mortality rates. This is also why it’s important for you, even if you’re young, to avoid getting and transmitting the virus — stay at home and avoid crowds.
How Deadly is this virus?
The virus has killed just about 14,500 people in the US out of the under 422,400 that have been infected — a 3.4% mortality rate against confirmed cases as of April 2nd. Keep in mind, that this mortality rate is actually much smaller due to the fact that a high percentage of coronavirus cases go unconfirmed. In fact, it is estimated that for every confirmed case there are somewhere between 5–10 that have not been confirmed, according to researchers at Columbia University (although this is not necessarily the case across all countries). Meaning that, in actuality, there could be anywhere between 2.1–4.2 million cases in the United States. This would translate to — assuming that the majority of COVID-19 deaths have been accounted for — a mortality rate of well below 1% (as low as .07% but still much deadlier than the flu). Keep in mind that these are assumptions based on the current availability of data, on how many cases actually exist, as well as how many people will continue to die (these mortality rates are always changing).
This does not mean that the virus is not to be taken seriously. This virus will kill hundreds of thousands to millions of people in the US alone. Already, there have been nearly 15,000 people that have died from COVID-19 in the US. This is because of how contagious it is and how quickly it can spread. And, just because your chances of death may be low as a younger person, doesn’t mean you should take a risk of getting infected. Young people are dying and being hospitalized at high rates, too. Often, what prevents people from dying is access to healthcare, specifically ventilators — of which many in the US are expecting a shortage. If you are young, and in need of a ventilator, and there aren’t enough to go around — you are in big trouble.
Consider this: If I were to hand you a gun that, if shot, had a 1 in a 500 chance of firing an actual bullet, would you put it up against your head and fire it? Why not? Because there’s no reason to do so. There’s no reward for putting that gun up against your head and pulling the trigger. In the same way, there’s no reward for exposing yourself to this virus and the chance that you will die from it — and put the lives of those you love at risk as well.
Also, consider that if you or a loved one becomes sick, no one will be allowed to visit. If your loved one becomes sick enough to the point where they may die, you will not be next to them to comfort them — to say your last goodbyes.
Who is this virus affecting the most?
COVID-19, the disease that arises in some who are infected with Sars-Cov-2, is most likely to kill the elderly or those with already compromised immune systems. The vast majority of deaths are happening in those who are 55 and older. If you’re between the ages of 55 and 64, your mortality rate is as low as 1.4% but can be as high as 2.6% (a percentage derived using confirmed cases). For those who are 85 and older, the mortality rate is estimated to be as high as 27.3%.
Data on which underlying conditions are most likely to be associated with death are sparse. As of March 28th, of the 122,653 laboratory-confirmed COVID-19 cases in the US at the time, only 7,162 (5.8%) came along with any information about underlying conditions (this will tend to create biases in the data, so take this info with a grain of salt). Of those cases that provide any info about underlying conditions, about one-third reported patients having an underlying condition (2,692, 37.6%) or risk factor. The underlying conditions that were most common are seen below.
The disease seems to be affecting diabetics the most — partly due to the fact that a large percentage of Americans are diabetic (34.2 million people, or 10.5% of the U.S. population, have diabetes). Out of all confirmed diabetes cases, A whopping 32% of diabetes patients required hospitalization and 19% required intensive care. We know that people that end up in ICU have an unfortunately large mortality rate — early studies are claiming that about 50% of people in ICU due to the coronavirus die — so it’s possible that diabetics are seeing about 10% chance of mortality.
Keep in mind that these conclusions are limited for various reasons. For one, we don’t have enough data on all those cases who didn’t report any information on underlying conditions. Second, it’s likely that the people who are reporting diabetes are also suffering from other conditions that aren’t listed here (such as obesity). Third, because we don’t have information on all non-confirmed coronavirus cases, we can’t know whether a high percentage of non-confirmed mild cases are also people with diabetes. Lastly, because these data aren’t adjusted for age, it’s likely were seeing some correlation with age (the average age of a diabetic in the US is 45).
In this same report, it was found that of all patients requiring admission, 78% had at least one underlying condition. 94% of the patients who died while in hospitalization also had at least one underlying health condition. Again, given that only a small fragment of hospitalizations report any information on underlying conditions, you should take these conclusions with a grain of salt.
How does this virus compare to other major outbreaks?
The virus spreads at a much faster pace compared to other major outbreaks — this is in part what makes it so deadly. The flu has an infection rate of 1.3% per infected person whereas Sars-cov-2 infects at a rate of anywhere between 1.5–3.5%. MERS, also a coronavirus which originated in the middle east, has an infection rate of less than 1% per infected person. The Ebola outbreak (2012) and the first SARS outbreak (2002) had an infection rate of between 1.5–2.5% and 3%, respectively.
Luckily, the current outbreak has a much smaller estimated mortality rate than other outbreaks (based on available data which is not always reliable) but is much more deadly than the seasonal flu. This coronavirus has a mortality rate of about 2.2% — although this number can vary widely by country for various reasons. In comparison, Ebola has a mortality rate of just over 40%, MERS of nearly 35%, and the first SARS of just under 10%.
Although the current coronavirus has a much lower mortality rate, it has managed to kill more people than these three outbreaks combined thanks to its rapid rate of spread combined with increased global interconnectedness. As of April 8th, this coronavirus has managed to lock in over 1.5 million confirmed cases (which could mean anywhere between 7.5–15 million actual cases). In the US, there are now just over 422,370 cases — the largest amount in the world by a long shot. Although, the US’s first-place position should be taken with a grain of salt due to the fact that China has proven itself to be unreliable with reporting their data. This has translated to just over 14,400 deaths in the US — a mortality rate of about 3.4%.
