March 20, 2020

# What’s the Potential Number of People Who Could Die from The Coronavirus?

This article is an update to one I started last week where my goal was illustrate why the potential danger of the Coronavirus was greater than the danger from the Common Flu in response to numerous people who said that more people died from the Common Flu in the United States last year than have died from the Coronavirus and so that people were more likely to die from the Common Flu than from the Coronavirus.

It seems like many people now think the risk of the Coronavirus is greater than the risk of the Common Flu.

This article will help you understand and Potential Total Deaths from the Coronavirus. Nobody can know for certain, and so predictions are based on estimations and extrapolations based on what people believe. This article will help you estimate Total Deaths for yourself, based on what you believe.

# The Coronavirus is Deadly Because

The Coronavirus has the potential to be a very deadly disease for the following reasons:

1. EVERYBODY Can Catch the Coronavirus as Nobody is Immune and There Is No Vaccine
2. The Coronavirus spreads quickly and easily so number of Infections Has Been Doubling every 2 to 3 days (Exponential Growth) so it will Infect most of the United States (60% – 90%) within two months we don’t take steps to prevent the spread of The Coronavirus
3. High Death Rates for both Treated Patients (1%) and Untreated Patients (3% – 5%)
1. 5% – 10% of Infected Patients Require Ventilators and Their Death Rate is 50% or
4. Limited Treatment Capacity: we only have 62,000 adult Ventilators in the United States, and an estimated 10% or more of Infected Patients will need Ventilators — if these patients don’t get have access to Ventilators, they will die at very high rates (50% – 100%)
5. Enough People Likely Already Have The Coronavirus so a Large Portion of the US Population Is Likely to Catch the Coronavirus Even with Strong Containment Measures
Furthermore:
6. Infected Patients Who Survive and Recover May Have Permanent Lung Damage and Disability

Here is some more detail on each of the above factors:

### 1) EVERYBODY Can Catch the Coronavirus

Since there is no vaccine, and nobody has immunity (because this is a new disease), everybody can catch The Coronavirus and would be able to Infect other people even if they don’t become incredibly sick themselves.

With the Common Flu, many people have immunity to a given strain and there is a Flu vaccine each year that Millions of people take each year that gives them immunity. Furthermore many other people have strong enough immune systems to fight off the Common Flu if they do come into contact with it, so they do not Infect other people with the Common Flu.

The net result is that Millions of Americans and cannot be infected the Common Flu, or do not become Infected even if they come into contact with it. As a result, less than 10% of the American population becomes experiences an illness from the Common Flu every year.

### 2) The Coronavirus Spreads Quickly and Easily

The Coronavirus spreads quickly and easily for several reasons, and the number of Infections has been Doubling every 2 to 3 days. Many experts believe it is likely to infect more than 200 Million Americans within the next few months if very strong measures are not taken to limit the spread of the disease and contain the disease.

If this seems unlikely, consider what the evidence points to.

It appears that Infected people can spread this disease to other within 6 feet by breathing, coughing, and sneezing, as the virus can be in water droplets released by a person breathing, coughing, or sneezing. Also, it appears this disease can spread through touch so anything that an infected person touched, or has been within 6 feet of an infected person could have the virus form the infected person’s breathing/coughing/sneezing. Some experts even believe that The Coronavirus can be spread up to 9 feet (3 meters) through breathing/coughing/sneezing.

### People Can Spread The Coronavirus Without Being Sick

Many people under 30 who becoming Infected with The Coronavirus and then carry and can spread the disease do not become sick, and so do not know they are Infected. Thus they can then infect older people like their parents, grandparents, family members, teachers, colleagues, and anybody they come in contact with

As mentioned, everybody can carry this disease and pass it on to others even if they don’t become very sick themselves. Second, Infected Patients can Infect others before they become sick, and some Infected Patients don’t become sick for 5 to 7 days. Infected Patients can infect others for what appears to be of 3 to 5 weeks in total. Some Infected people don’t become sick and so don’t realize they are infected, and so infect other people.

So think about all the people who have been within 6 feet of you at the office, or in school, on the street, on the bus or train, in a restaurant, in an elevator. Now think of everything you touched which may have been touched by another person.

You’ll quickly see that the Coronavirus can spread very quickly.

It’s very plausible that each Infected person can Infect 1 or 2 more people within 3 days. Thus, the total number of Infections could double every 3 days (this is called the Doubling Time or Doubling Period). If we are at 1,000 Total Infections today, then within 1 month we will have 1 Million Infections. Then within another month the entire US Population of 330 Million would be infected.

While some people may avoid infection, most experts believe that if the virus becomes widespread, 200 Million or more Americans would become infected.

Even if the Doubling Time is 6 days instead of 3 days, we still have most of the United States infected within 4 months instead of 2 months.

### 3) High Death Rates for both Treated Patients (1%) and Untreated Patients (3% – 5%)

People Infected with The Coronavirus experience high Death Rates of 1% for Untreated Patients and 3% – 5% for Untreated patients with older patients experience even higher Death Rates, and younger patients experiencing lower Death Rates.

### a) 5% – 10% of Coronavirus Infected Patients Require Ventilators

This information is based on reports from Italy, France, and Spain. While many Patients infected with the Coronavirus experience a strong flu, research indicates that 5% – 10% (or more) of Infected Patients sustain significant damage and inflammation to their lungs and cannot breath properly on their own, so they require Ventilators (machines that breathe for them), and potentially advanced medical care.

If these Infected Patients don’t have access to Ventilators (and other medical care), their Death Rate is likely 50% or higher (this is only for the portion of patients requiring Ventilators, not the Overall Death Rate). Countries and cities that don’t have enough Ventilators or capacity to provide other advanced medical care, often see an Overall Death Rate of Infected Patients of about about 5%.

Even patients who are in good health and not elderly may require Ventilators and some of these patients have died (some people think this disease only kills the elderly — it can kill younger people).

### 4) Limited Treatment Capacity

We likely only have enough Ventilators to treat less than 1.5 Million patients who require Ventilators in the next 12 months, which corresponds to about 30 Million total Infected Patients in the United States. We are likely to see many more than 1.5 Million Infected Patients who require Ventilators if this disease becomes widely spread.

### 5) Enough People Likely Already Have the Coronavirus So We May Not Be Able To Limit Its Spread

Several thousand people in the United States are known to have the Coronavirus in many cities and towns and will continue to spread the disease unless people drastically reduce contact with others.

Some people are infected and don’t realize it.

Some are infected, and don’t care if they infect others and are out and about.

Also, keep in mind that any number of Infected Patients you see published or hear on the news are Known Infections — meaning these people have tested positive for the Coronavirus. However, we don’t have enough tests to test everybody who feels sick and thinks they might have it. Therefore, there are likely many Infected people who aren’t included in the official numbers because they haven’t been tested.

Furthermore, there is a delay between when people become infected and when they get tested, so the number of Actual Infections is likely much higher than the number of Known Infections.

For these reasons, we likely have over 10,000 Actual Infections in the United States and each of these could be spreading the disease. Containing the spread of the Coronavirus when this many people are infected will be very difficult, and so the Coronavirus might spread to over 200 Million Americans.

### Infected Patients Who Survive and Recover May Have Permanent Lung Damage and Disability

Even Infected Patients who survive may have significant damage to their lungs kidneys and other vital organs so they may have trouble breathing and exercising for he rest of their life. We need more information to determine the longer term impact of The Coronavirus.

## Summary

These are the main ideas behind why this The Coronavirus could be so deadly. I estimate we could see over 4 Million Deaths in the United States alone unless strong measures are taken.

Luckily, many strong measures are being taken by cities and states across the country, so we will likely not see this many Deaths, but the explains why these measures are being taken.

We’ll explore the actual numbers behind this in the next section.

# Viral Math

In this section we’ll explore the math behind each of the forces described above.

## Many Coronavirus Patients Require Ventilators and Have High Death Rates without them.

You may have heard that the Death Rates for Coronavirus are perhaps slightly higher than the Common Flu and so for healthy people there isn’t much to worry about.

I do not believe that this is accurate.

I think the most important thing to point out is that reports I have read indicate that the Overall Death Rate (Death Rate for all Infected Patients) increases substantially from about 1% for patients who have access to medical care (things like ventilators) to about 5% for those who do not have access to adequate proper medical care and medical equipment like Ventilators.
https://www.weforum.org/agenda/2020/03/suddenly-the-er-is-collapsing-a-doctors-stark-warning-from-italys-coronavirus-epicentre/

These are my findings based on researching reports by Medical staff from Italy, France, and Spain where information is more freely available.

Coronavirus attaches and kills cells in the lungs. The immune response often further destroys lung tissue. The result is that a certain percentage of those infected require hospitalization, which we will call the Hospitalization Rate, and which some sources estimate around 14%.

Furthermore, a smaller set have very high large amounts of lung tissue destroyed which requires significant medical care and these patients often require ventilators to enable the patient to breathe. We will call situations where patients require ventilators “Severe” Cases.

Some experts estimate that 5% – 10% of infected Patients may be Severe Cases requiring Ventilators. We will call this rate the Ventilator Rate (the proportion of those infected who require ventilators, and these patients Ventilator Patients. Again Ventilator Patients likely have a Death Rate in the range of 50% – 100% if they don’t receive Ventilators and significant medical care, and will likely have a Death Rate of 5% – 10% if they do receive Ventilators (this is for the Ventilator Patients, not overall).

Note that other sources may have different definitions for the term “Severe” and may use “Critical” instead, or use both terms with “Severe” meaning they require hospitalization, and “Critical” meaning they require treatment in an Intensive Care Unit (Intensive Care).

Of course, Death Rates are higher for people who are older or have compromised immune systems, but people under 50 have still died from the Coronavirus who were otherwise healthy.

Some of the damage comes from the immune response which destroys healthy lung tissue, and a certain portion of Infected Patients will have such a response. Furthermore, the Death Rates for the Coronavirus for elderly people are much higher than the Death Rates from the Common Flu.

# A Very Viral Virus!

The previous discusses what happens to people who are Infected with The Coronavirus. In this section we’ll discuss the number of people who could become Infected in the United States in the near future.

I’m going to walk through the calculations so that a broad audience can follow, and people can modify the numbers based on what they believe.

This is mainly a mathematical exercise. I am using values based on research of primary sources and drawing conclusions based on them. If you believe the values like Death Rates are different from the ones I use, this article will help you do your own calculations.

The Coronavirus is spreading quickly for several reasons:

## The Coronavirus Spreads Very Easily!

The Coronavirus is extremely contagious and can be spread just by being near people who are infected, and doesn’t require physical contact according to the latest research.

As mentioned, it appears that Infected people can spread this disease to other within 6 feet by breathing, coughing, and sneezing, as the virus can be in water droplets released by a person breathing, coughing, or sneezing. Also, it appears this disease can spread through touch so anything that an infected person touched, or has been within 6 feet of an infected person could have The Coronavirus form the infected person’s breathing/coughing/sneezing.

Furthermore, people can spread The Coronavirus without showing signs of being sick because:

• Most people don’t show symptoms for 3 to 7 days after they are Infected
• Some people don’t become sick after being Infected — this applies to a high proportion of people under the age of 35.

So many people don’t know they are Infected (yet) and don’t isolate themselves and will Infect others.

## Rapid Growth

Some reports estimate that the number of Coronavirus Infections doubles about every 2 to 3 days in the United States. This seems reasonable for people who may be infected for two weeks before they realize it and take steps to isolate themselves. That is, if somebody is infected, they could easily infect one other person every three days.

This seems reasonable given how easily it spreads and how much contact many people cities and in medium size towns have with other people and how often they touch things that have been touched by others.

So think about all the people who have been within 6 feet of you at the office, or in school, on the street, on the bus or train, in a restaurant, in an elevator. Now think of everything you touched which may have been touched by another person.

You’ll quickly see that the Coronavirus can spread very quickly.

It’s very plausible that each Infected person can Infect 1 or 2 more people within 3 days. Thus, the total number of Infections could double every 3 days (this is called the Doubling Time or Doubling Period).

The biggest risk is from people who are in contact with others because of their job. There was a report of a Coronavirus screener at Los Angeles airport who caught The Coronavirus from airline passengers. Now think about how many other people that person Infected before they became aware they were Infected. There was also an usher on Broadway in New York who was Infected and could have Infected many others. These two people had contact with people from many different geographies so their risk of being Infected was pretty high.

Now think about where the people they might have Infected have gone.

Now think about all the restaurant servers, delivery personnel, gas station attendants, cashiers, bar-tenders, clearing personnel, and other people who rout inline come into contact with others or handle items touched by members of the public. Any one of these people could be Infected and Infect many others.

Given this, I think it is very possible that the number of Infected persons could Double every 3 days (or less). Now we’ll walk through the numerical implications of what will occur if Doubling Time is 3 days and if it is 6 days.

Question: off the number of Coronavirus Infections doubles (is multiplied by 2) every 3 days, what happens in 30 days?

Well, 30 days is $\big( (3 \text{ days}) \times 10\big)$ and if the number of Cases is multiplied by 2 in 3 days, then the number of Infections should be multiplied by $(2\times 10=\boldsymbol{20})$ in 630 days. That is, if we have 1,000 Infections today, in 60 days we should have 20,000 Infections — right?

### Wrong!!

This is exponential growth remember.

If we have 1,000 Cases today (Day 0), in 3 days (Day 3) we have 2,000 Cases (Double the 1,000 starting number of Infections. Then in another 3 days (Day 6) we have 4,000 Cases (as $4=2\times 2$). Then on Day 9 ( days later) we have 8,000 Cases.

To make the numbering easier let’s count the number of days in the future, so today is Day 0 (rather than Day 1).

Below is a table showing Infections by number the Days in the future starting with 1,000 Cases now (Day 0) and using Doubling Time of 3 days.

### Doubling Time: 3 Days.

What this means is that after 30 days we have over 1 Million infections.

That is, in 30 days the number of Infections is multiplied by over 1000 (it is multiplied by 1024).

The Doubling Time is 3 Days, and we Double a total of 10 times.

$\boldsymbol{2^{10}=1,024}$

So the number of Infections is multiple by 1,024 over 10 Doubling Periods, and we have over 1 Million Infections within 1 month. Remember, a Million is a Thousand times a Thousand (a Thousand Thousands).

A good thing to remember is that if somethings grows exponentially, that after 10 Doubling Periods, the new value will be more than 1,000 times the value at the beginning of these Doubling Periods (it will be 1,024 times the initial value).

To reiterate: after 10 Doubling Periods, the value at the end is more than times 1,000 value at the beginning. The table below shows what happens after the first 30 days:

Within two months essentially everybody in the United States is infected (Total Population is about 330 Million) unless people take tips to Isolate themselves — I don’t think the term Social Distancing describes what people will need to do.

While some people may avoid infection, most experts believe that if the virus becomes widespread, 200 Million or more Americans would become infected.

If the Doubling Time is 6 days, then this happens within 4 months, assuming there are at least 1,000 Infections now, and there are at least 3,000 Known Infections as of Sunday March 15th.

Using a Doubling Time of 6 days doesn’t just the overall outcome very much. It still takes 10 Doubling Periods to grow from over 1,000 Infections to over 1 Million Infections which happens in 60 days instead of 30 days. Essentially the number of days in the future for different events is just multiple by 2 compared to a 3 day Doubling Period.

### Doubling Time: 6 Days.

For a 6 Day Doubling Time it takes 4 months days before the entire US Population is infected.

## Capacity to Treat Infected Patients

The last section discussed the number of people who are likely to be Infected. This section discusses the capacity to treat Infected Patients.

As discussed, some proportion of people infected with Coronavirus requirer Ventilators and advanced medical care, and their Death Rates increase dramatically from say 5% – 10% if they do receive adequate treatment to 50% to 100% if they do not.

This is consistent with the reports that the Overall Death Rate increases substantially from about 1% for patients who have access to medical care (things like ventilators) to about 5% for those who do not have access to adequate proper medical care and equipment like Ventilators.

These are my findings based on researching reports by Medical staff from Italy, Spain, and France where information is more freely available.

So availability of Ventilators and their capacity to treat Infected Patients who need them will have a big impact on the overall number of Deaths.

I am focusing on Ventilators because that is a measurable quantity that cannot be increased quickly, but there are other limiting factors as well such as number of Intensive Care Unit beds, and trained medical staff who can care of patients with Severe Infections. Some reports indicate that up to 15% – 20% of Infected people may require hospitalization and some sort of medical care.

If you calculate new infections in any given period and estimate that 1% (which is a very low estimate) of new Infections are Severe and will require Ventilators for two weeks, then pretty quickly all the ventilators get used up.

Here’s the math

There are about 62,000 ventilators in the US which adults can use.

If 1% of Infections require ventilators, then 6.2 Million people can be infected in a two week period before the all ventilators are used. As 1% of 6.2 Million is 62,000 (mathematically 62,000 ÷ 1% = 6.2 Million). Dividing by 1% is equivalent to multiplying by 100. That is, if 1 in 100 Infections patents require a ventilator, the total number of infected people that can be handled with 62,000 ventilators is $62,000 \times 100 = 6.2 \text { Million}$.

As you can saw from our prior data, the number of Infections reaches 6.2 Million between Day 30 and Day 45. So by Day 42 (in less than two months) if not earlier, all the ventilators in the entire country would be in use, with a 1 % Ventilation Rate, when in reality it is likely to be 5%– 10%.

So if the ventilators are used in less than two months when there are more than 6 Million new infections in a 3 day period, nearly everybody who becomes infected after that won’t receive proper medical care, and will have the a higher Death Rate estimated at 5%.

### Ventilator Capacity

For some data, a study estimates that the US has about 62,000 Ventilators which are fully-featured and suitable or adults (and another 24,000 for respirators for children, infants, and premature babies).
https://www.ncbi.nlm.nih.gov/pubmed/21149215

Infected patients who require ventilators, will need ventilators for at least 15 days and up to 30 days, otherwise their Death Rate increases. We will call this amount of time the Treatment Period.

If we use a 15 day treatment period than this means that in 1 month, we can treat two batches of 62,000 patients each month which is 124,000 Ventilator Patients per month:

$2\times 62,000=124,000$

If we a large number of Infections over a 2 month period (which will occur with a 3 day doubling period), then during this 2-mont period we can only treat less than 250,000 Ventilator Patients as $(2\times 124,000 = 248,000)$.

If a large number of Infections happens over a 4 month period (which corresponds to 6-day Doubling Period), we can treat under 500,000 Ventilator Patients as $(4\times 124,000=498,000)$.

Remember that with a 6-Day Doubling Period, within 4 months the disease could infect the entire US Population.

This analysis also assumes that all 62,000 Ventilators are available for Coronavirus Patients, when in fact some of them are already being used for other patients. So our actual capacity for Coronavirus Ventilator Patients will be less than 124,000 per month.

## Estimating Total Deaths

Now we’ll use all of this information to estimate the Total Deaths that could occur under different scenarios. I’ll walk you through what the most important things to consider are, and the specific values I use. I’ll also show you how to do calculate potential Total Deaths yourself using the  specific number you believe.

## Author’s Note

This is not so much of a prediction, but an analysis of what is likely to happen, if the United States does not take strong action to close schools, restaurants, gatherings and in person contact.

When I first starting researching information for this article on March 10th 2020, this had not begun to happen in the United States.

Fortunately, as of March 16th 2020, many major US cities have take strong actions to reduce the spread of The Coronavirus.

The analysis below is the reason why so many cities have taken action by closing schools, cancelling large events, and limiting capacity at or closing bars and restaurants. This analysis is what would happen if we didn’t make changes.

Also, more information is available now that will change the numbers below. For example, we would like to update the analysis with Death Rates and Ventilation Rates by age group.

Furthermore, it has become clear that “Flattening the Curve” will not be enough, and Isolation is likely required to stop the spread of The Coronavirus.

If you’d like to see the analysis updated with the most recent information then please consider making a donation to the FastMath Institute to support independent quantitive research for the benefit of the General Public.

### Upper Bound

A high estimate is to use a 5% Death Rate for the entire US Population of 330 Million which will give us 16.5 Million deaths. This is an Upper Bound, and a worst-worst-case scenario (from a mathematical perspective). Hopefully this will not occur.

Later in this article, we perform an analysis that uses Death Rates by Age Group and the percentage of the US population in each Age Group.

### Lower Bound

A low estimate for number of Deaths given a wide Outbreak in the United States to use a 0.5% Death Rate and estimate that half the US population becomes infected. This will give a total of 825,000 Deaths, or almost a Million Deaths.

$330 \text{ Million} \times 50\% \times 0.5\%$$=165\text{\ Million}\times 0.5\%$$=825,000$

I want to put the number 1 Million in context.

Let’s say you want to deliver medicine via injection to 1 Million people. If you can treat one person every minute, and you work 10 hours a day, 5 days a week, how long will it take you to treat (deliver the medicine to) 1 Million people?

Try to do it without using a calculator.

Here’s the Math
If you can treat 1 person per minute, that is 60 people per hour (60 minters per hour).

Working 10 hours a day is 600 people per day $\boldsymbol{(10 \times 60=600)}$

Working 5 days a week is 3,000 people per week $\boldsymbol{(5\times 600=3,000)}$

If you work 50 weeks a year (and take two weeks off), you can treat 150,000 per year:

$\boldsymbol{50 \times 3,000=150,000}$

Working 6 years would allow you to treat 900,00 people as:

$\boldsymbol{6 \times 150,000 = 900,000}$

You would therefore need to work 6 years 8 months to treat 1 Million people.
Working 7 years would allow you to treat 1 Million and 50 Thousand people.

For comparison, 6 Million people is about the population of the State of Colorado.

# Death Rates Very High for Elderly Patients

Below is the by Death rate by age (in years) from patients in Hubei Province in China, which is where Wuhan is located, which was the center of the outbreak. Thus, in this region, the capacity of the medical system to provide care was overloaded, and the chart represents the Overall Death Rate for patents who do not have access to adequate medical care.

This data includes all Infected Patients, including those who did not become Sick, and were identified by extensive testing in China.

The graph shows that the Death Rate is much higher Elderly Infected patients, and is very low (0.1%) for patients under 30 years old.

So these are likely the Death Rates we can expect by age group if a large number of Americans become infected. Remember, we have very limited treatment capacity.

Source is here.

# Method I: Estimating Potential Deaths By Age Group

The number of people and percentage of the American population who would become infected by Age is difficult to predict. While Elderly Americans may have contact with fewer people, many are also in care facilities like Nursing Homes and Assisted Living facilities where if a staff member were to be infected, many of the residents would also be infected.

In a Nursing Home in Kirkland Washington outside Seattle, had 120 Residents or which 51 people became Infected with The Coronavirus and 26 of the residents died, which is a Death Rate of over 50%. This could easily happen in Nursing Homes and Assisted Living facilities around the country.
Source is here.

We will estimate Total Deaths by Age group and population using a the same Infection Rate across all age groups, and using the Death Rates by Age from the above chart. One can certainly make estimations based on different Infection Rates by  age Group.

We used the US Census population data from 2018 to calculate the percentage of the US Population in each Age Group, and used the to the US Census Population Estimate for 2019 of 329.45 Million people living in the United States.

Below is our calculations for an Infection Rate of 60% across all Age Group.

US Census Population Data is available here.

Thus, an overall Infection Rate of 60% results in 4.28 Million Deaths in the United States.

Again, these Deaths are potential Deaths if we do nothing are not a forecast given that the United States is taking action.

The calculations use Death Rates by Age Group from other regions that experienced Outbreaks that overwhelmed the capacity of the healthcare system to provide treatment.

### Variations

One can reasonably use different Death Rates by Age Group and different Overall Infection Rates and arrive at different numbers. It is notable that all reasonable (or likely) estimates for different values if we do not take collective action result in Millions of Deaths.

The Death Rate for Infected Patients 80 years of age or older is 18% in the above table. If this seems high, be aware that the Death Rate was over 50% for residents of Life Care Center long term care facility for Seniors in Kirkland Washington who were Infected with The Coronavirus.

Even using a Death Rate for this group of 10% (comparable to the Death Rate for Age Group of 70 – 79 years old), still results in 3.66 Million Deaths because the percentage of the population Age 80 years or older is relatively small (at 3.9% of the Total Population) and is the smallest of any Age Group, so reducing the Death Rate for this group has a small impact on Total Deaths.

Older people also will make up the majority of Deaths: people who are 60 years old or older will constitute 88% of Total Deaths.

Total Deaths could be reduced any and all of the following measures:

• Lowering the Overall Infection Rate  through Isolation, Social Distancing, and Quarantine
• Lowering the Infection Rate for Older Age Groups through safety precautions in Nursing Homes and Assisted Living facilities,
• Increasing Treatment Capacity to lower the Death Rate in each Age Group which will require procuring substantially more Ventilators!

Below is what Total Deaths look like as you modify the Overall Infection Rate (the portion of the total population that is Infected).

As the Overall Infection Rate increases, the number of Total Deaths also increases.

This is what would likely occur without the strong measures the United States and the rest of the world is taking to reduce the spread of the virus.

At a 90% Overall Infection Rate would result in about 6.4 Million Deaths given the observed Death Rates by Age Group.

For comparison 6 Million people is is higher than the individual populations of Colorado, Minnesota, Wisconsin, Alabama, Louisiana, and Kentucky US states entire states, and the average population of a US State is 6.6 Million.

### Imagine all of Colorado gone!

The ease with which The Coronavirus spreads makes it very realistic that the number of Infections will grow at an accelerated rate, and that the total number of Infected people would Double every few days.

If the number of Infected people Doubles between every 3 and 6 days, the The Coronavirus would Infect most of the population of the United States within 2 to 4 months. This will most likely happen unless people take strong Isolation measures.

We might be able to reduce the number of Total Deaths amount by increasing Treatment Capacity to reduce the Death Rate in each Age Group (by providing Ventilators) but it also certainly makes sense to try to reduce the Overall Infection Rate by controlling the spread of the virus through Social Distancing, Isolation, and Quarantine.

## Variations

For further analysis, we could gather additional data on Death Rate by Age Group in different countries and try to determine more accurate figures for Deaths by Age Group with and without Treatment, and better understand overall Treatment Capacity in the United States.

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## Why Isolation Measures Are Being Implemented

For further analysis, we could gather additional data on Death Rate by Age Group in different countries and try to determine more accurate figures for Deaths by Age Group with and without Treatment, and better understand overall Treatment Capacity in the United States.

The results of this type of quantitive analysis are why such strong measures are being taken.

Official estimates might be lower than this. For example, the New York Times published an article recently that stated that researches from the UK estimated that the US could experience 2.2 Million deaths if no action as taken.
Sources:
https://www.nytimes.com/2020/03/16/us/coronavirus-fatality-rate-white-house.html

Those published numbers are likely using lower values for Overall Infection Rates and Death Rates in order to not scare the public too much, but still have a high enough number to convince people to change their behavior. That is, they don’t want to induce mass panic, but they do want to encourage behavior changes.

They may also have used lower Death Rates by age group. This is reasonable as Death Rates by Age Group do vary across countries and depend heavily on whether there is sufficient capacity for medical treatment and medical equipment like Ventilators. Having sufficient Ventilators and trained medical staff can drastically reduce the Death Rate, but is still costly to actually implement.

## What Would Make These Estimates Inaccurate

These estimates would be too high if any of the following are true:

• If other countries experience higher Death Rates than the United States.
• For example, one reason a country might have a higher Death Rate is if smokers have a higher Death Rate than non-smokers (because smoking has damaged their lungs) and the country has a higher percentage of smokers than the United States. We don’t have enough data to conclude that smokers have a higher Death Rate but it is plausible and smoking rates vary by country.
• The spread of the virus is contained so that fewer people are Infected Overall
• The United States has begun taking steps that will reduce the spread of the infection.
• If we can dramatically increase the Treatment Capacity by obtaining many more Ventilators we can increase the number of patients who can be treated who will have a lower Death Rate and this will reduce the Overall Death Rate.
• A vaccine other medical treatment is developed and widely distributed before many people become Infected.

# Recommendations for Saving Lives

Based on the higher Death Rates of older people, citizens who are 60 years old or older are forecasted to account for 88% of Total Deaths. This gorp will still constitute 86% of Total Deaths even if people age 80 years and older have a Death Rate of 10% (comparable to people 70 – 79 years old) instead of 18%.

Given this, the most effective way to save lives is to protect older people!

If staff at Nursing Homes and Assisted Living Facilities become Infected, they are likely to Infect the Residents and a very high percentage of them would die.

Therefore, I would suggest the following:

• Insure all staff at Elderly Residential Facilities (Nursing Homes and Assisted Living Facilities) receive effective training on how to prevent being Infected outside of work, and are given protective gear and training to reduce the risk that they Infect Residents or other staff a the Elderly Resident Facilities.
• Elderly people not in Residential Facilities should observe strict Isolation and only allow visitors who have contact with others who are also taking strong Isolation precautions.
• For Elderly in your family outside of these facilities, ensure that there is a family member who is observing strict Isolation Measures to be the primary care-giver (if needed) and to buy food and other necessities. People 60 years old and older people should minimize the amount of time they spend outside their home.

Isolation means not having contact (within 6 feet) with others who are outside of your immediate household unless. You may make exceptions and have contact with 1 – 2 other people at a time if you are sure they are taking similar measures, and it has been more than 7 days since they had contact with somebody not observing strict Isolation.

This relies on trust, and you have to trust the people you are having contact with.

# Summary

So that’s what you can expect if nothing is done: somewhere between 3.5 and 6 Million Deaths in the United States alone within the next year.

This is why the isolation measures are being done. This is an inevitability of the math behind Infections Doubling every 3 days, and a high Death Rate, especially for Untreated Patients, and Limited Treatment Capacity. These factors taken together will certainly result in Millions of Deaths.

The most effective method to reduce Deaths will be to reduce the number of people who get infected through Social Distancing, Isolation, and Quarantine.

# Next Topics

If there is sufficient interest, we will write out Guidelines and Best Practices for making sure you and your family (especially your older relatives) do not become Infected with The Coronavirus.

If you found this research informative then please consider making a donation to the FastMath Institute which is performs quantitive and statistical research to promote the Public Interest.

## Appendix: Method II — Estimating Potential Deaths With Average Death Rate

This is an approach we took earlier to estimate Total Deaths using an average Date Rate. It is slightly out of date given the analysis of Death Rate by Age Group and we include it for your reference.

Here is our approach to estimating Total Deaths, and the important parameters to look at. We can adjust the specific values later to see what the numbers look like.

I am going to estimate that a 10% of Infections require Ventilators. We will call this proportion the Ventilator Rate, and call these Infections/Patients “Patients Requiring Ventilators.” As mentioned there is a limited supply of ventilators. This rate could be considered analogous to the to the Severe Infection Rate discussed earlier.

For Infected patients who require ventilators, we will estimate that they will need ventilators for 15 days, what we will call the Treatment Period. If they have Ventilators for this amount of time, they have a Death Rate of 10% (of the patients Requiring Ventilators). We will call this Rate the Treated Death Rate. If they do not have ventilators for 15 days, they have Death Rate of 50%. We will call this the Un-treated Death Rate. Note that these Rates only apply to Patients Requiring Ventilators which is 10% of overall Infections.

This approach is consistent with a 1% Overall Death Rate when Infected Patients receive adequate treatment and a 5% Overall Death Rate when Infected Patents do not receive adequate treatment.

We’ll ignore deaths form patients who do not require ventilators.

We believe at least 60% of the US population is likely to be Infected if The Coronavirus is not contained. We call this the Total Infection Rate.

The Number of Available Ventilators is also relevant and is less than 62,000 as there are only 62,000 ventilators in the United States.

We also need to know the time period over which the infections will occur. This could be as low as 2 months (3 day doubling period) to 4 months (6 day doubling period) or longer if Isolation measures prove effective. We’ll use 4 months as a middle-ground estimate.

We don’t know for certain what these values are, but we can do the calculations with different values and adjust over time.

We could also do a similar calculation that defines Severe Infections as those needing treatment in Intensive Care Units and applying Death Rates for Severe Infections that do and do not get treated in Intensive Care Units. You would need a value for the number of patients that can be treated in Intensive Care Units at any given time.

## Estimation Numbers

If you use these values, pretty quickly you see that since ventilators are very limited they are all used up by the time we reach 620,000 total Infections, if the Ventilation Rate is 10%

Thus, half of all further Patients Requiring Ventilators die.

The US Population is approximately 330 Million. This means that if 60% of the US Population is infected then nearly 200 Million people will become infected in the United States:

$60\%\times 330 \text{ Million}$$=198\text{ Million}$

We will round this to 200 Million Total Infections.

200 Million Total Infections is only likely if steps are not taken to stop the exponential growth of the number of people Infected with The Coronavirus. As discussed earlier, if the number of Infected people Doubles every 3 days, then within two months everybody in the United States becomes Infected.

If we contain the spread of the virus, hopefully 200 Million people will not become Infected.

If the Ventilation Rate is 10%, then there are 20 Million Ventilator Patients:

10% of 200 Million = 20 Million

We have at most 62,000 Ventilators and if each Ventilators Patients need one for 15 days, we can only treat 124,000 Ventilator Patients each month.

This is an Upper Bound, as there will likely be less than 62,000 Ventilators Available, and Ventilator Patients may need them for up to 30 days.

If the mass Infections occur over a 4 month period (6-day Doubling Period), we can treat under 500,000 Ventilator Patients as $(4\times 124,000=498,000)$ .

Remember that with a 6-Day Doubling Period, within 4 months the disease could infect the entire US population — but we assume it the maximum percentage infected is 60% of the Population (this is the Total Infection Rate).

Half of all the other Ventilator Patients die!

Thus, even with a 6-Day Doubling Period, and Treating 500,000 Ventilator Patients, there are 19.5 Million Untreated Ventilator Patients, as 500,000 is 0.5 Million.

Half of 19.5 Million is 9.75 Million — so 9.75 Million people die.

This will likely not occur because average Death Rates will be lower than these numbers. See prior analysis on Deaths by Age Group.

For comparison 9 Million is larger than many US states entire states, and the average population of a US State is 6.6 Million.

### Different Outcomes

This analysis use one particular set of numbers. Outcomes change pretty dramatically depending on rates at which people require ventilators and advanced medical care (the Ventilator Rate), and the availability of that Ventilators and medical care, and the Death Rates for Treated and Untreated Ventilator Patients.

But it’s pretty clear that if a large portion of the US population is infected, even with low estimates (lower than what we believe the values to actually be) for the Ventilator Rate  and Death Rates, that all the Ventilators and lead to Millions of Deaths

So what happens if we adjust the numbers and use a Ventilation Rate of 5%, but assume that Ventilator Patients who don’t get access to ventilators have a 100% Death Rate. This is consistent with an overall 5% Death Rate for patients who don’t have access to adequate medical care, which is what existing numbers show.

If you do this, we still have about 500,000 Treated Ventilator Patients over a 4 month period (assuming a 6 Day Doubling Period).

We still have 200 Million people infected, but only 5% are Ventilator Patients.

$5\%\times 200\text{ Million}$$=10\text{ Million}$$\text{ Ventilator Patients}$

We can treat 0.5 Million (500,000), the rest die!

So this is 9.5 Million deaths, compared to 9.75 Million deaths with the earlier scenario, which estimates a Ventilator Rate of 10% but that half of untreated Ventilator Patients survive.

As you can see the second variation reduces deaths by 0.25 Million or 250,000, but more than 9 Million people die.

It is unlikely that the Ventilation Rate (the percentage of Infected Patients who require a Ventilator and who will have an increased Death Rate if they don’t have access to it) is lower than 5% because we have observed overall Death Rates of 5% in overwhelmed areas already.

## What Would Make These Estimates Inaccurate

These estimates would be too high if any of the following are true:

• The Ventilation Rate is much lower than 5% – 10%,
• The actual Death Rates for either Treated or Untreated Ventilator Patents are lower than the estimates used,
• The spread of the virus is contained so that fewer people are Infected Overall
• The United States has begun taking steps that will reduce the spread of the infection.
• A vaccine other medical treatment is developed and widely distributed before many people become Infected.
• If other countries experience higher Death Rates than the United States.
• For example, one reason a country might have a higher Death Rate is if smokers have a higher Death Rate than non-smokers (because smoking has damaged their lungs) and the country has a higher percentage of smokers than the United States. We don’t have enough data to conclude that smokers have a higher Death Rate but it is plausible and smoking rates vary by country.

The most likely circumstances that would make these estimates too high would be if the Death Rates skewed by the Death Rates of Elderly people who have been Infected and not based on Death Rates for Total Infections, which would include younger people who would die at lower rates.

This is a possibility and we will need more time to understand for sure what is going on.

Let me explain the concept in more detail. The basic idea is that “Young and Healthy” people who are Infected will die at a lower rate than older people (say 60 years old or older) or those with health problems. Some “Young and Health” people may become infected and may not get sick, or may have symptoms that feel like a bad Flu, and not seek treatment. Thus doctors won’t know they are Infected with The Coronavirus and they won’t be included in the official count of the number of Infected Patients. They will also die at a lower rate.

So to make the idea clear. Let’s say that there are 200 people who are Infected: 100 who are “Young” and “100 Elderly.” The Young Infected Patients don’t report their conditions and Survive. The elderly get sick and go to the hospital where they are diagnosed The Coronavirus, and 5% of them die.

Therefore 5 Elderly Patents died. The Hospital only knows about the 100 Elderly Patients, so they think the Death Rate is 5 out of 100, which is 5%. In reality there were 200 Infected Patients (100 Young and 100 Elderly), so the Actual Death Rate is 5 out of 200, which is 2.5%.

This is what we mean when we say that the Reported or Measured Death Rate is being “Skewed” by a certain population or way of being measured. It means that certain circumstances make the measurement not accurate from reality.

The actual numbers might be different but the concept is the same. Older people who are infected are more likely to get sick and die, and be included in the official count of Infections than Younger people, so the reported Death Rates may be lower than the Actual Death Rate.