By the end of the year, scientists are predicting that the number of COVID-19 victims will be significantly higher than it is now. But decisive steps could prevent the worst.
By Marco Evers
The year 2020 is 280 days old, and the virus that has dominated our lives in recent months isn’t all that much older than that. Yet it has still managed to circle to globe many times and has lodged itself in the respiratory passages of at least 34 million people.
The coronavirus, which is only 100 millionths of a millimeter in size, continues to spread: At the moment, there are more than 300,000 new infections each day. And that figure is likely to continue to rise, especially in the northern hemisphere as temperatures drop and people spend more time indoors. This autumn and winter, experts are expecting a massive increase in COVID-19 infections, in Europe especially, but also in the United States.
Last week, the virus passed a sad milestone. According to official data, evaluated by Johns Hopkins University, the 1 millionth person has now died of COVID-19, with the number of known deaths having doubled within just three months. However, given that not every victim of the disease is recognized as such, the true number of coronavirus-related deaths could actually be higher.
Meanwhile, the dying continues. Medical statisticians at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington expect that we will (officially) surpass 2 million deaths from the virus by mid-December.
New Year’s Eve will make the anniversary of the first time that China informed the regional office of the World Health Organization about cases of pneumonia from an unknown cause. The current model from the IHME researchers in Seattle predicts that more than 2.5 million people worldwide will have died by that anniversary.
A Low Point
In just one year. No virus since the Spanish flu of 1918-1919 has ever brought as much suffering to the world so quickly. Even with AIDS, it took around 75 years to reach a death toll of 1 million. Researchers believe that the HIV virus had already spread from chimpanzees to humans in western Central Africa around 1920, but it took decades before it was even noticed.
As such, in the history of infectious diseases, 2020 will mark a low point. The long-predicted loss of control over the ever-changing cosmos of bacteria, viruses and fungi appears to be taking shape. Experts had been warning about the eventuality for years and WHO published an alarming report as recently as September 2019. But politicians ignored the warnings, and the numbers emerging now are horrific. COVID-19 will kill more people this year than any other infectious disease. If the statisticians are correct in their projection for the year as a whole, COVID-19 will kill more than three times as many people as HIV/AIDS and five times more than malaria did last year.
COVID-19 is by no means “just a harmless flu” as doctors initially hoped and conspiracy theorists still believe (that is, if they even believe in the virus at all).
Even the total global traffic deaths, with 1.3 million victims annually, are unlikely to prove nearly as lethal as SARS-CoV-2. Around 60 million people are expected to die this year from heart failure, cancer, accidents, viruses and bacteria – and the coronavirus will be the culprit in one out of 25 of those deaths.
And this is just the beginning. The pandemic will only end once the virus is no longer able to find new people to infect. At present, there are still more than 7 billion people who have neither been vaccinated nor survived an infection to develop immunity.
In contrast to other epidemics, this time it’s not predominately in faraway slums of poor countries with a dearth of doctors and medicines where the dying is happening. It’s happening everywhere – in rich and working-class neighborhoods, on distant islands and at the best university hospitals of the richest cities in the world.
Learning to Live and Die with the Virus
Many people die all alone, perhaps in the care of nurses who are wrapped in plastic to keep them safe. In many places, graves are dug in large numbers close together, and relatives are forced to eschew the kinds of funerals or farewells that we took for granted until January.
It’s likely that there will be several vaccines of differing effectiveness and that improved medicines will be available. But although it will likely be easier to control in the future, the virus has a large reservoir in humans and animals, making it impossible to completely eradicate. Like the flu and cold viruses, it will be a constant presence. And we will have to learn how to live with it, and to die with it.
Despite the enormous number of victims, many are still unwilling to grasp the full force of the pandemic. There are a variety of reasons for this. Impressions locally can be deceptive. Germany has got off lightly so far, with only around 9,500 deaths. In contrast to other countries, the number of victims dying from COVID-19 here is, at least so far, comparable to mortality figures for an average flu.
This seemingly minor danger is leading many people to underestimate the seriousness of the situation, leading to anger at and disregard for the rules aimed at preventing the further spread of the virus. But Germans aren’t somehow magically more immune than other countries. Without the rules Germany imposed early in the course of the epidemic, the country would be in a far worse position today.
In the neighboring Netherlands, for example, enforcement of policies on the wearing of face masks and social distancing have been extremely lax Football fans there could still be seen shouting in the streets a week ago, celebrating cheek to cheek. There isn’t even a mask requirement in retirement homes. According to official figures, twice as many people are currently infected there as during the worst days in April. The next lockdown looms on the horizon, threatening to inflict deep economic wounds.
The situation is even more dramatic in some regions of Spain, France and Britain. Meanwhile, the Czech Republic has announced another state of emergency as a result of COVID-19. This winter is likely to be a real ordeal for many countries.
Given how virus has settled in and won’t disappear on its own, most countries only have one option at their disposal: They will have to fight the pandemic with tough measures and then ease up to allow the economy and peoples’ psyches to recover. Inevitably, the virus will regain strength after a while, followed by the next phase of tougher measures.
At best, politicians and government authorities will find ways to not have to impose blanket restrictions lasting for months at a time. But they also find themselves walking a fine line between virological necessity and the need to not lose the support of the populace.
There’s also another reason the virus is making a massive return: the frivolity of youth. COVID-19 primarily kills elderly people, especially home residents and people with pre-existing conditions. The risk of dying from COVID-19 increases from the age of 50, but the vast majority of the dead have been over 70 years old.
But no one can feel safe just because they are 20 or 40. Although most patients in that age group experience relatively mild symptoms, COVID-19 has also killed young people, including children and adolescents. The risk is particularly high for the obese, diabetics and people with lung problems.
Some of the younger patients are also recovering much more slowly than initially expected. Some survivors have reported months of fatigue, headaches, muscle pain and shortness of breath. The disease can lead to permanent damage to the heart, blood vessels and the nervous system, for example.
Even after almost a year, doctors still haven’t been able to conclusively assess how dangerous SARS-CoV-2 is. Anyone, regardless of age, is therefore advised to do everything possible to avoid getting infected in the first place and further spreading the virus. That means it’s better to meet friends outside than inside. It’s better to ride a bicycle than to take the bus. It’s better to order take-out food rather than dining in a restaurant. Masks need to be worn, social distancing is paramount and we should all stay home if we are experiencing even the slightest of symptoms. And when indoors, take extra steps to ensure proper ventilation.
The virus also may not be solely responsible for all the damage it does. Richard Horton, editor-in-chief of the British medical journal The Lancet sees more than a pandemic at work here. He also sees a “syndemic.” The argument is that the virus is only winning because it has encountered a population that isn’t really healthy in the first place. In his editorial in The Lancet, Horton points to the huge task facing us of making health-care systems better able to get through the current and future pandemics. What’s needed is an improvement of the overall human constitution: less obesity, less diabetes, less high blood pressure and less exclusion of the socially disadvantaged and minorities.
Genetically, viruses are extremely similar in all countries. But they have strikingly varying effects worldwide because not all societies are equally healthy, equally fat, equally elderly or equally well-prepared.
Just Seven Deaths
Take Taiwan, for example. The country has had a total of seven deaths in a population of over 23 million people. In Vietnam, which is home to 96 million residents, 35 have died. Both countries were severely affected by the first SARS virus in 2002-2003, and the shock they experienced also taught them some lessons that they applied to their public health systems, which they have since expanded in response. They produced enough masks and protective clothing, made pandemic plans and prepared quarantine hotels. On top of that, they also have epidemic-tested professionals in hospitals and health authorities.
Even a country as poor as Rwanda appears to be getting through the crisis relatively well: Out of 12 million inhabitants, only 29 people have died there. The country benefits from its young population and from the medical infrastructure that was built to handle the HIV crisis. Liberia and Sierra Leone aren’t doing badly either, with official deaths at 82 and 72 respectively. Both countries contained the spread of the coronavirus early on by strictly isolating infected persons and quarantining their contacts – strategies they internalized in the fight against Ebola.
New Zealand, a country with almost 5 million people, of whom on 25 died of COVID-19, had a hard lockdown, coupled with a border closure consistent with its status as an island nation. The government under Jacinda Ardern communicated clearly about the measures, shoulder to shoulder with the country’s scientists. The population rewarded the approach with trust and support.
The situation was altogether different in the United States, the leading power in the Western world. The country is home to only 4 percent of the world’s population, but it has experienced 20 percent of the world’s coronavirus infections and deaths. Over 200,000 Americans have been killed by the pathogen thus far – more than three times the number of U.S. soldiers who died in Vietnam.
U.S. President Donald Trump has actively thwarted the kind of effective pandemic management that proved so successful in Taiwan. He has thrown epidemiologically sensible measures, like the temporary closure of churches, into a death spiral of political polarization – and important institutions such as the Centers for Disease Control and Prevention (CDC) along with it.
The consequence being that statisticians at IHME expect the number of deaths in the U.S. to rise to around 382,000 by the end of the year. That would be half the number of people who died in the U.S. Civil War. Or 125 times as many as died in the 9/11 terrorist attacks. Or 155 times as many as at Pearl Harbor.
The Importance of Masks
By comparison: A model run by IMHE indicates that Taiwan will have a total of 10 COVID-19 deaths by the end of the year, three more than have died so far.
The statisticians in Seattle also ran through a scenario for Germany. Their continuously changing model estimates that there could be double the number of deaths in the country by the end of the year, with the total figure rising to 24,600. That projection is based on the assumption that the current moderate corona rules will be maintained. Chancellor Angela Merkel issued a similar warning the week before last, saying there could be 19,000 new infections in Germany each day by Christmas if the numbers continue to double each month.
But that’s not a foregone conclusion. The number of infections is rising significantly in the country. And the measures to contain it are also being tightened. The IHME experts also wrote that if the Germans are as vigilant as Singapore when it comes to wearing face masks (meaning almost always when they are outside their homes), which in their opinion is the most important means of protection, around 13,000 deaths could be prevented by the end of the year.
But the models used by the statisticians are not without controversy. Dozens of research groups are producing estimates, and each works with different sets of assumptions and methods. Only some of their results are similar, and most of the predictions will be inaccurate. It’s just not clear which ones. IHME’s June forecast on the number of deaths in the U.S. has more or less come true, although it was slightly too optimistic.
And yet all forecasts fail to take into account what is really happening. In truth, the situation is even more serious because people are not just dying from the coronavirus, but also because of it.
In large parts of Africa, for example, pest control operations against the malaria-carrying Anopheles mosquito have been scaled back because of the pandemic. As a consequence, malaria is likely to cause more deaths now than it did in 2019. Vaccination campaigns against measles, the whooping cough, tetanus and diphtheria have also been interrupted, as well as measures against AIDS and tuberculosis. Thousands and thousands of people could die as a result and the global progress that has been made in protecting against these infectious diseases could be set back by years.
Polio, brought to the brink of extinction after billions of dollars in efforts, could even resurface as a result of SARS-CoV-2. The poorest countries – Afghanistan, Yemen, South Sudan and Haiti – are facing famines that have been exacerbated because of the coronavirus.
Wealthy countries haven’t been spared from the collateral damage caused by the coronavirus either. Operations and treatments have been postponed because of the pandemic. Cases of domestic violence are increasing, as are those of alcoholism, depression and anxiety.
Sooner or later, once the medical possibilities have been refined and entire societies and health systems have been reorganized, SARS-CoV-2 will have lost much of its horror. At that point, hopefully those voices that have been warning us for years will also carry some weight: Because we will be facing pandemics with new pathogens again in the future. And it won’t just be one. There will be many.