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In testimony before the House Oversight and Reform Committee on Wednesday, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease, said that the coronavirus is at least 10 times “more lethal” than the common flu — even if the mortality rate falls below the World Health Organization’s estimate (based on confirmed cases) of 3.4 percent. It’s a rate made all the more concerning by a reported estimate from Dr. Brian Monahan, the attending physician of Congress, who anticipates that 70 million to 150 million Americans will become infected by COVID-19.
That 3.4 percent mortality rate, though still fluid, is formidable, even compared next to the case fatality rates (the number of deaths compared to the total number of those diagnosed) for other recent outbreaks. The CFR for the SARS epidemic was around 9 to 10 percent, while MERS, first identified in 2012, is around 35 percent. The outbreak of H1N1 beginning in 2009 had a CFR of around 0.01 to 0.08 percent. Of the 61 million Americans who were estimated to have contracted the virus, 12,469 died.
However, the lethality of the virus will not land evenly across age groups: According to data from the outbreaks in Italy and China, mortality rates rise significantly among older patients. In a study that has not yet been peer-reviewed, researchers at the University of Bern in Switzerland used data from the Chinese Center for Disease Control to determine that mortality rates among those infected in January and February in Hubei province shot up with each decade:
Age Group — Mortality Rate
0-9 — <.01 percent
10-19 — .02 percent
20-29 — .09 percent
30-39 — .18 percent
40-49 — .40 percent
50-59 — 1.3 percent
60-69 — 4.6 percent
70-79 — 9.8 percent
80 & up — 18 percent
With around 23 percent of the population over 65-years-old, Italy has one of the world’s oldest populations, and the coronavirus is taking a horrific toll among the elderly: In an analysis last week from the National Institute of Health, researchers determined that of the 105 Italians who died from the coronavirus, the average age was 81 — 20 years older than the average age of patients who tested positive.
The dramatic rise in mortality rates among older populations can be attributed largely to two factors. First, the immune system becomes weaker as we age, with infections becoming more severe, and taking longer to recover from. Second, older people are more likely to have underlying health concerns: Of the 105 Italians who had died from the coronavirus as of March 4, two-thirds had at least three preexisting conditions, the most common of which were hypertension, coronary heart disease, and diabetes.
Though the coronavirus might not consider you to be old unless you’re advanced enough to still be in the running in the Democratic primary, its mortality rate is significantly higher for people with chronic diseases of any age. In a World Health Organization report on the outbreak in China, researchers found that the case fatality rate for people with no chronic diseases was 1.4 percent. But for those with cancer, it rose to 7.6 percent. For those with chronic respiratory disease, it was 8 percent. For those with cardiovascular disease, it was 13.2 percent.
The high mortality rate among older coronavirus patients is a major concern as the pandemic spreads in the United States, where the population of Americans age 65 or older was around 52 million in 2018. According to one estimate by Obama administration health information technology expert Farzad Mostashari, if 2.4 percent of the population gets the coronavirus, that would include around 1.5 million seniors. Assuming a fatality rate of around 20 percent, that would mean 300,000 deaths in that group.
The high mortality rate is made even more concerning by America’s low surge capacity — a hospital or medical system’s ability to triage and care for a major increase in patients in a short amount of time. As pediatrician Aaron E. Carroll notes in the New York Times: “It’s estimated that we have about 45,000 intensive care unit beds in the United States. In a moderate outbreak, about 200,000 Americans would need one.” New York’s David Wallace-Wells adds that with an outbreak of upper respiratory infections, “It’s not the number of beds, though. It’s the number of ventilators.”