Researchers answer that question by considering two factors. First: how infectious the coronavirus is. Second: how deadly.
Back in March, we developed the above table. At that time, we didn’t know the infection fatality ratio, but guessed it could be as low as 1 in 1,000 and probably no higher than 1 in 100. We now know it’s about 0.5 (1 in 200).
What proportion of the country will get infected? Last March, we stopped at projecting the number of deaths that would occur if 50% of the entire U.S. population got infected. That would be more than 800,000 deaths, unless treatment improves. But with the new, more transmissible strain, the COVID death toll could easily top that.
About 25% of Americans have already been infected, and every day there are about a million more infections. At the rate the virus is spreading, that’s about another 8% each month. That adds up quickly — and that's BEFORE the new variant spreads widely here.
So today I’d have to answer the question of whether COVID could kill a million Americans: "Quite possibly, especially if a more transmissible strain spreads widely." That's more Americans than were killed in all wars of the 20th Century and close to the number killed in all wars since 1776.
Here's how we concluded that essay 10 months ago: "It’s been said that a week is a long time in politics. With COVID-19, a week is not a long time, it’s an eternity. The sooner we act, the more we can decrease the likelihood of a million deaths in the US."
Here are 5 things we can do starting right now.
1 — Scale up vaccination, especially for nursing home residents and staff, and for people over age 65. This will greatly reduce deaths, even without changing the epidemic trajectory, because the elderly are much more likely to be killed if infected. In other words, vaccination of the most vulnerable can make the pandemic less deadly, but isn’t likely to substantially decrease the total number of cases for months.
2 — Scale up effective treatment. Monoclonal antibodies given early in illness likely prevent hospitalizations. We need to scale up their use to spare hospitals. This will likely save lives.
3 — Limit time indoors other than with household members. Outdoors is generally OK. The more time you spend indoors with people from outside your household, the more the virus spreads. Limit travel, because when we travel, the virus travels and viral spread accelerates.
4 — Mask up. Almost any mask greatly reduces spread from someone with the virus. But to protect ourselves better, we may need N95/KN95 masks when indoors near others. A more infectious strain requires stronger defenses, including wearing masks all the time whenever you’re indoors around others not from your household.
5 —The "Box It In" strategy — test, trace, isolate, quarantine — to find and stop outbreaks. Antigen tests have limits, but widespread testing can reduce the number of superspreading events. Anyone feeling ill must isolate. Exposed susceptible people must quarantine. And communities must support both groups to do so.
We are absolutely getting numb to the numbers. 23,000 dead in the past week alone. 100,000 per month. 500,000 by March 1 or before.
Until the vast majority of Americans receive vaccines — which won’t be for many more months –– we must double down on protection protocols. Federal, state, city and local governments; health departments and health care providers; civic organizations — everyone — must work together on these five measures: vaccinate, treat, limit indoor time, mask, and test and follow-up to stop outbreaks.
A pandemic isn’t like the weather — able to be described and sometimes predicted but not controlled. We can get better control over COVID. All of our actions matter — a lot.
The right answer, if asked today, to the question, "Could COVID kill a million Americans?"
"Only if we let it."