Putting Coronavirus Danger in Perspective — Three Steps

By Douglas Axe Published on March 25, 2020

My piece yesterday with William Briggs and Jay Richards received a lot of questions. We suggest, based on the numbers from Italy, that the coronavirus may be less deadly than has been feared. Rather than answer every question, let me try to put the danger from the virus in perspective.

There are, I think, three steps to doing that.

Step 1: Let go of the idea that authority and expertise are guarantees of truth.

When the public presses for answers to urgent questions, the answers that come may not be reliable. Even if the experts who first gave the answers tried to qualify them with caveats. They might say “our best guess is…” or “there is growing evidence that.” Those hedges get lost in the shuffle.

Get used to the fact that limited and imperfect information is what we have in times like these, because that is a fact.

Step 2: Learn to recognize the kinds of questions that can’t be answered accurately.

We all want to know how many people in our region or our country are infected with coronavirus. We want to know how many will be infected, or whether we will become infected. If in Google you trust, then you’ll get answers.

But just think for a moment. Without testing everyone daily, how would anyone know for sure how many are infected? And even if we knew that, how could anyone know for sure how the virus will spread? The answers we get vary widely because they’re all guestimates. They depend heavily on assumptions, most of which are unstated or ignored — because we just want the answer.

We’re asking whether Charles would now be alive if the virus had not been present. But the honest truth is, we don’t know.

Picture an eighty-year old man, Charles. He has a weakened immune system and is hospitalized with pneumonia-like symptoms. A nurse takes a swab sample from Charles’ throat on Tuesday. That sample tests positive for coronavirus and pneumococcus (bacterial infection) on Thursday. By that point Charles is in critical condition. Sadly, he dies in the early hours of Friday. Did the virus cause his death? We want the answer to be simple, but it just isn’t. In effect, we’re asking whether Charles would now be alive if the virus had not been present. But the honest truth is, we don’t know.

Spanish flu

Men in an Alberta field wear masks during the Spanish flu, fall 1918, Canada.

Step 3: Use what we really do know.

We know when people die. And with extensive testing for COVID-19 in people with respiratory conditions, we know how many of these people die with the virus in their bodies. We also know how many people die each month, on average, when there is no pandemic.

Now combine these solid numbers with the same information from the Spanish flu pandemic of 1918, which the Centers for Disease Control and Prevention calls “the most severe pandemic in recent history.” We now see that these are just not the same pandemic. The big circles in the diagram below represent the whole population of Italy today (left) and the whole population of the United States back in 1918 (right). Inside these big circles are two small circles. One represents the fraction of the whole population that dies in a normal pandemic-free month. The other (solid black) represents the fraction of the whole population that died as the respective pandemics were peaking.

COVID-19 data from Worldometer; Spanish flu data from history.com.

Areas of the circles represent the actual proportions for the two cases. The scale is a bit smaller on the right. That’s because the U.S. population was just over 100 million in 1918, whereas the Italian population is just over 60 million now.

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There are several obvious differences. First, while the unfilled circles representing normal monthly deaths are the same size on left and right, the solid circle on the left is much smaller than the one on the right. Furthermore, the solid one on the right is much larger than the normal monthly deaths circle. The solid circle on the left is tiny in comparison. What does this mean?

What does the data tell us?

Well, based on what we know (death counts) the Spanish flu caused a huge surge in deaths. That is, one or more months had an extremely high number of deaths. With the coronavirus, this hasn’t happened. And keep in mind, this is Italy, where the current pandemic has been most extreme.

The other obvious difference is that the tiny solid circle on the left overlaps the normal monthly deaths circle, while the one on the right is off on its own. I drew the diagram this way to represent an important fact. Italians whose deaths are attributed to coronavirus averaged 78.5 years, and the vast majority of them have other underlying health problems. In stark contrast, the Spanish flu hit children under 5 especially hard, among other normally healthy segments of the population. According to the CDC, “the high mortality in healthy people, including those in the 20-40 year age group, was a unique feature of this pandemic.”

The question here is whether the best evidence supports our fear that whole populations could be decimated by COVID-19. Thankfully, the answer to that is clearly no.

This picture holds up wherever we look. The state of Washington has had a disproportionately high number of coronavirus-associated deaths. But at 110 deaths for the past month, this is a smidgen of the state’s normal monthly death count of 5,400. And for the first epicenter of the current pandemic — the city of Wuhan in China, where 2,700 deaths were attributed to coronavirus in the worst month — the normal death count, at 6,500, is much larger.

Now the recent social-distancing efforts are based on the assumption that we’re seeing a repeat of the pandemic of 1918. But, if COVID-19 is as deadly as the Spanish flu virus, why has there not been a single example of a major population that experienced a true surge in deaths from COVID-19?

All the solid evidence — the numbers that aren’t squishy — suggests that COVID-19 is mostly affecting people who are nearing the end of their lives for reasons that have nothing to do with coronavirus. The question we want to answer is this: Are the COVID-associated deaths are on top of normal ones or just part of normal ones? At the moment, we don’t know. The best guess is that the coronavirus deaths overlap the normal ones. But by how much? Again, we don’t know.

Every life matters. That’s not in dispute. The question here is whether the best evidence supports our fear that whole populations could be decimated by COVID-19. Thankfully, the answer to that is clearly no.


Douglas Axe is Maxwell Professor of Molecular Biology at Biola University, director of Biologic Institute and author of Undeniable: How Biology Confirms Our Intuition That Life Is Designed (HarperOne). Follow him on Twitter @DougAxe.

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