Dying… In Perspective…

We’ve broken the glass and pulled the red handle to shut down our social and economic lives, but we don’t have very clear ideas about what comes next, after the fast-approaching tsunami of virus infections crashes ashore. Reputable people making best guesses predict 160,000 to 1,600,000 COVID-19 deaths in the US over a period of six months to two years. We don’t know if it will be seasonal like the flu, or continuous, or fluctuate in some novel way. We don’t know whether or when effective vaccines and antiviral treatments will become available. Nevertheless, this is not our first pandemic rodeo. Humans have been coping with infectious diseases for longer than we’ve been human. Here’s a framework for thinking about how this will turn out.

A lot of people will die of COVID-19. Hundreds of thousands at least in the US, many millions worldwide. Though it may sound callous to say it, remember that 2.8 million people die annually in the US, 56 million globally. Even in that context, this is will be a very substantial and disruptive tragedy.

However, over the next few years, as a majority of the world’s population is infected and recovers, some degree of herd immunity will begin to emerge. At the same time, vaccines and antivirals may be successfully created and deployed, some of our new preventative habits may prove effective and not too onerous, and we’ll doubtless be offered a plethora of antiviral products to reduce our risk. The annual COVID-19 death rate will fall significantly during the first few years following the initial wave.

This is difficult to think about, but a lot of the early deaths will be among people already at risk of dying soon of something else; the coronavirus will “cut in line” to take them first. Thus, the deaths from COVID-19 will not entirely be added on to our current total annual deaths, but will replace some of them from other causes.  Grandpa will die of COVID-19 this spring instead of dying of the flu next spring. Also difficult to consider: if the virus selectively takes the most vulnerable, the surviving population will become, on average, a bit less vulnerable. This will also drop the COVID-19 death rate over time, and show up as a wrinkle in life expectancy.

Presumably the CDC’s cause-of-death category “Influenza & Pneumonia” will include COVID-19, since it kills by causing pneumonia. In 2017, this was the cause of 55,000 deaths in the US, good enough for 8^th place on the CDC’s ranked list of causes of death. For perspective, Diseases of the Heart was in 1^st place, with 647,000 deaths. After the initial wave, Influenza and Pneumonia might overtake 7^th-place Diabetes (83,000) or even 6^th-place Alzheimer’s (121,000). It will be surprising if COVID-19 doesn’t eventually settle in to be a disease somewhat like the flu, constrained by vaccines, killing less than 100,000 annually in the US.

Once the annual rate stabilizes at a not-too-high level, we’ll get used to it. After all, we don’t grind our lives to a halt to prevent 47,000 annual suicides (mostly by guns), 15,000 non-suicide gun deaths, 37,000 motor vehicle deaths, or 70,000 drug overdose deaths (mostly opioids). As the nation grows and ages, the total annual deaths tick upward anyway. We’ll be at 3 million/year soon enough, with or without this virus.

The economy will take years to recover from what is likely to be a severe global blow. There will be personal losses beyond counting, and immeasurable suffering and grieving. We will, however, resume our economic and social activities, step by step, as we normalize the reduced predations of the virus. Perhaps we’ll get a better healthcare system out of it, and better public health resources. Unless God is exceptionally cruel, we’ll get a better President, and maybe a renewed sense of our common humanity, and common vulnerability.