Deaths, COVID-19 and 'Acceptable Losses'

 I was appalled to see a survey that said 57% of republicans believe that 170,000 deaths due to COVID-19 are ‘acceptable’.  Even in the current polarized political atmosphere this is beyond the pale.

I have heard people justify this viewpoint by saying that the primary victims of the pandemic are old and/or medically compromised, and that the pandemic is not much worse than the flu, which kills a large number of people each year.  Another rationalization is that the losses are acceptable in relationship to the risks of economic collapse and its ramifications.

First of all, the flu is a very different phenomenon than COVID-19.  It is not at all clear how many deaths are actually due to the flu.  Almost no one dies from the flu itself.  The deaths attributed to the flu are typically those involving secondary infections of pneumonia or coronary failure.  The estimates of death are purely based on statistical analysis of overall deaths with a lot of assumptions thrown in.  The flu is not tested for or confirmed in the great majority of the deaths that are attributed to it.

Until 2003, the numbers of deaths reported for the flu were very low.  The CDC began to publicize much higher estimates after 2003 in order to provide motivation for people to get vaccinated.

Even given the reported fatality rates, the flu is still much less dangerous than COVID-19.  The reproduction number for the flu is much lower, as is its fatality rate.  Additionally, the long gestation period and, the number of asymptomatic carriers make COVID-19 even more contagious.  If there had not been a near total shutdown of society in the March to May timeframe, we could have seen our healthcare systems overwhelmed and half a million deaths.  The catastrophic scenes in Italy, Spain, France, the UK and New York City would have spread across our nation.  There is no valid comparison between a typical flu season and what occurred in those places.

Moreover, many, if not most of the COVID-19 victims die directly from the disease, not from secondary infections.  Front line physicians and epidemiologists are unified in their portrayal of COVID-19 as a dramatically more brutal and dangerous disease than the flu.  It also can randomly overwhelm young healthy adults and kill them, something the flu almost never does.

Death rates from COVID-19 have decreased as healthcare experts have become more adept at managing treatment regimes.  But cases have continued to spread quite rapidly in the USA even with most cities and states in partial shutdown and people generally keeping social distance and wearing masks.

People were going to die from COVID-19.  It caught the world by surprise.  However, it is the responsibility of each country’s leader to prevent unnecessary deaths.  The initial deaths in the Northeast hub states were tragic, and certainly there were mistakes made and there was mass confusion, but that only accounts for about 60,000 of the current 180,000 deaths. 

By failing to take executive action to lead the nation in battling COVID-19, Trump must accept primary responsibility for most of the deaths that occurred after the beginning of June.  The shortened lockdown, due in great part to Trump’s reelection-conscious drum-beating to ‘get the economy back’, as well as the lack of a national testing, tracking, tracing and quarantine strategy, doomed the USA to a continuous rise in cases and deaths.

Here is the starkest comparison:  Germany, a country with similar people, technology, and healthcare capabilities, enforced their shutdown until the levels of new cases were low enough to test, track and quarantine.  Germany’s population is approximately one fourth of the US population, but the population density is higher, which should make it more difficult to control contagion.  Germany has had bars, restaurants and schools open since late May.  They continue to social distance and wear masks. 

Germany’s testing positivity rate (the % of tests that are positive) is well below 1%, usually between .3 and .6.  Compare this with the US positivity rate of 8-12%.  One cannot adequately monitor and control the contagion with positivity rates that high.

The table below shows the incredibly dramatic difference between Germany’s cases and deaths from June 1 to August 24 versus the USA’s.  The USA has had a hundred times as many deaths and cases with only 4 times the population! 

	Number of new cases from June 1 to August 24	Number of Deaths from June 1 to August 24
USA	4,037,630	71,470
Germany	52,352	718

Interestingly, the fatality rate for Germany’s known cases during this period is about 1.4%.  Given that they are testing at such a low positivity rate and testing so extensively based on tracing each infection, the number of positive tests is probably close to the true total number of people infected.   That would mean that this fatality rate is accurate for the disease in an advanced healthcare system when at risk people are taking extra precautions.  It would be higher in a developing country.  In any event, a fatality rate of 1.4% would be about 14 times the theoretical fatality rate of influenza, which 0.1%.  Again, a strong indication that COVID-19 is very dangerous.

By the way, Germany has had far fewer negative economic ramifications from its longer, but more effective initial shutdown than the USA.  Their unemployment is at about 5.6%, whereas the US is at 10.2%. 

Deaths from disease are only ‘acceptable’ when they could not have reasonably been prevented.  There is absolutely no doubt that the USA could have prevented tens of thousands of deaths had it been resolved to do so and followed the example of Germany and other successful countries.  It is heartless and willfully ignorant to claim that these deaths are 'acceptable'.