CDC’s Worst-Case Coronavirus Model: 214 Million Infected, 1.7 Million Dead

A nurse swabs for coronavirus at the University of Washington Medical center on March 13, 2020 in Seattle, Washington. UW Medical staff feeling COVID-19 type symptoms were asked to pass through a drive-through screen center on campus for testing. Photo: John Moore/Getty Images

A recent CDC projection estimated that the U.S. coronavirus epidemic could infect between 160 million and 214 million people over a period of more than a year — and kill anywhere from 200,000 to 1.7 million people in the country. A top CDC disease modeler presented the estimates to CDC officials and epidemic experts during a conference call last month, the New York Times revealed on Friday. The scenario did not factor in the efforts now underway to address the epidemic, but rather what could happen if no action was taken to slow the spread of of the disease.

Per the Times, the model was one of four presented by CDC disease modeler Matthew Biggerstaff which reflected different assumptions about the nature of the coronavirus and the possible U.S. response. The projections also suggested that a U.S. epidemic could lead to the hospitalization of anywhere from 2.4 million to 21 million people. Depending on the timing, that burden could devastate the U.S. health-care system, as U.S. hospitals only have a capacity of roughly 925,000 beds (and fewer than 100,000 beds for critically ill patients). The Times reported that experts said the U.S. epidemic could last “months or even over a year, with infections concentrated in shorter periods, staggered across time in different communities.” However:

The assumptions fueling those scenarios are mitigated by the fact that cities, states, businesses and individuals are beginning to take steps to slow transmission, even if some are acting less aggressively than others. The C.D.C.-led effort is developing more sophisticated models showing how interventions might decrease the worst-case numbers, though their projections have not been made public …

The four scenarios have different parameters, which is why the projections range so widely. They variously assume that each person with the coronavirus would infect either two or three people; that the hospitalization rate would be either 3 percent or 12; and that either 1 percent or a quarter of a percent of people experiencing symptoms would die. Those assumptions are based on what is known so far about how the virus has behaved in other contexts, including in China.

The White House Coronavirus Task Force has apparently not been briefed on the findings, a task-force spokesperson told the Times. The Hill, which reported a slightly lower maximum number of U.S. cases via the worst-case model (210 million), published a statement from the CDC explaining that such projections are a normal part of the response to an outbreak in order to anticipate and prepare for possible outcomes. A CDC spokesperson also stressed that it remains unclear how the coronavirus outbreak will ultimately play out in the U.S.:

CDC is working with federal partners on modeling efforts to estimate how many COVID-19 illnesses, hospitalizations and deaths might occur under various hypothetical scenarios and what the economic impact of COVID-19 might be on the United States. This type of modeling work is commonly used as a planning tool during outbreaks and can help inform the public health response, as well as other policies (e.g., economic policies) to mitigate the potential impact on the United States.

As the Hill notes, another model produced by the nonprofit Resolve to Save Lives and the Council on Foreign Relations estimated that if half of Americans contract COVID-19, anywhere from 163,500 to 1.6 million people could be killed. The lower number assumes the coronavirus is as deadly as the flu, while the higher number was based on a mortality rate of one percent.

Another recent estimate by Dr. James Lawler, an infectious disease and public-health expert at the University of Nebraska Medical Center, projected that 96 million Americans would contract COVID-19, 5 million of whom would require hospitalization. Lawler’s conservative estimate was that 480,000 Americans would be killed in that scenario.

As of Friday, more than 2,100 coronavirus infections have been discovered across 48 states, and the virus has led to the deaths of at least 48 people. How well the U.S. avoids the various worst-case projections will depend on how well government and public-health officials — and businesses and individuals — are able to respond to the outbreak.

This post has been updated to note the different totals reported by the Times and the Hill regarding the CDC modeler’s maximum number of estimated cases.

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CDC’s Worst-Case Coronavirus Model: 214M Infected, 1.7M Dead