Buckle up.
You might have anak merogol ibu cerita lucahheard that fewer Americans may get sick and die from COVID-19 than previously estimated. According to leading projections — namely from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington which has been referenced by the White House — death estimates are now significantly lower than last week. As of April 9, the group now estimates 60,415 deaths by August, a stark drop from the 93,531 deaths projected a week ago. (This is just the first waveof deaths, and doesn’t include a likely second wave of infections come fall).
This is, by all means, "good news." But, critically, the IHME assumes that current unprecedented social distancing efforts — closed restaurants, schools, and beaches along with canceled professional sports, concerts, and pretty much everything else — will remain in effect through the end of May, which could bring this grim wave of infections to a close by early June. Even then, life probably won’t promptly return to normal. We’ll need mass-testing and a willingness to social distance when the virus inevitably pops up again.
Fewer projected deaths, then, doesn’t mean we're out of the dark, pathogenic woods. Just the opposite. Because the U.S. government failed to start rigorous testing when the virus hit — led by a president who said “We have it totally under control” in January and later proclaimed at a big campaign rally that the virus would just “miraculously” go away — the microbial parasite couldn’t be contained. It’s everywhere. So an optimistic hope for fewer deaths, infections, and hospitalizations requires U.S. society to continue to commit to extreme social distancing.
"The more optimistic models for the impacts of COVID-19 on the healthcare system — like the IHME model from the University of Washington — assume a very high level of compliance with the various social distancing mandates that have been implemented by the governors as part of their emergency declarations," said Jennifer Horney, the director of the Epidemiology program in the College of Health Sciences at the University of Delaware.
Take it from Christopher Murray, the director of IHME. "If social distancing measures are relaxed or not implemented, the US will see greater death tolls, the death peak will be later, the burden on hospitals will be much greater, and the economic costs will continue to grow," Murray said in a statement on Sunday.
The social distancing message for Americans, then, remains unchanged.
"Stick to it," said Henry Raymond, an associate professor in the Department of Biostatistics and Epidemiology at the Rutgers School of Public Health. "I don't like to use military metaphors, but we don't want to declare victory too soon."
"Social distancing is one of the only tools we have," emphasized Brian Labus, a professor in the University of Nevada, Las Vegas’ School of Public Health. "It's not like we have treatments. It's not like we have a vaccine." (A vaccine is at besta year to 18 months away.)
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The future projections, or models, of deaths and sickness from coronavirus are invaluable. They don't give perfect numbers — they're not supposed to. But they give us a map of where we're headed. "We’re trying to get an idea of what we're up against," said Labus. "Models give us a ballpark idea of where things are going."
These models, of course, take a lot into account besides social distancing, and updated numbers about deaths and infections are very valuable to researchers. (IHME now tunes its U.S. projections based on how seven other places have successfully flattened their curve by using robust social distancing, like areas in Spain and Italy). IHME relies on incoming death rate numbers to project how many will die, and estimates how many people on average one infected person will infect, among other data.
Infectious disease models are challenging to make, especially for the insidious coronavirus, which often takes days to make someone sick. It might be a week before they have symptoms, another week before they get tested, and at least another week before this information gets to epidemic modelers. “We're trying to get next week's weather by sitting in a closed room and looking at the weather three weeks ago," said Labus.
But social distancing is clearly a big driver of where countries are headed on the coronavirus highway. Research from the Imperial College of London found that 11 European countries with strong social distancing policies averted nearly 60,000 deaths in March — in over just three weeks. In the U.S., the White House estimated on March 31 (with modeling from the likes of Harvard University, Columbia University, Northeastern University) that there would be between 1.5 and 2.2 million American deaths without social distancing measures — but with social distancing and handwashing, they projected the much lower range of 100,000 to 240,000 deaths during the first infection wave of 2020.
"Stick to it."
Social distancing measures are likely already having a big impact in the U.S. The number of hospitalizations is slowing in beleaguered New York City. “This is not an act of God we’re looking at,” New York Governor Andrew Cuomo said Tuesday. “It’s an act of what society actually does.” New Jersey is seeing a spike in deaths (from people who became infected weeks ago), but its growth in new hospitalizations has stalled.
“This suggests indirectly that social distancing is helping,” said Rutgers’ Raymond, noting that there’s no direct way to confirm social distancing is flattening the curve. But it’s quite likely, because many people are holed-up at home. They simply can’t pass the virus — which can spread just by talking — at bars, work, and on the train.
The latest optimistic models, however, will miss certain social distancing lapses that may result in the spread of disease. Of note, Wisconsin held in-person primary elections amid the pandemic on Tuesday, after the Supreme Court allowed the election to proceed. Voters in Milwaukee waited in profoundly long lines while Wisconsin State Assembly Speaker Robin Vos — donning a protective gown, mask, and gloves — told voters it's "incredibly safe" to be out voting. What model could have predicted that?
“That was a huge 12-hour break of social distancing,” said Amanda Simanek, an epidemiologist at the University of Wisconsin-Milwaukee. “We potentially derailed much of the social distancing we had been doing.”
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In its Wisconsin modeling, the IHME assumes the state’s stay-at-home orders and closure of non-essential businesses were occurring and will continue.
Anywhere in the U.S., easing up on social distancing too early — before the daily number of cases continually falls, before we can provide extensive testing, and before we develop the ability to rapidly test and isolate infected people — will mean a rise in infections. Without these rigorous virus control efforts, the nation’s top infectious disease experts know the virus will reemerge and be difficult to contain when social distancing stops.
“The take-home message remains that when we begin to ease social distancing measures we will see an uptick in cases,” said the University of Delaware’s Horney.