The One Number That Will Signal the Pandemic’s End

The most obvious interpretation of “beating COVID-19” would be that transmission of the coronavirus has stopped, a scenario some public-health experts have hashtagged #ZeroCOVID. But the experts I spoke with all agreed that this won’t happen in the U.S. in the foreseeable future. “This would require very high levels of vaccination coverage,” said Celine Gounder, an infectious-disease specialist at NYU who served on Joe Biden’s coronavirus task force during the transition. The U.S. may never reach vaccination rates of 75 to 85 percent, the experts said.

“The question is not when do we eliminate the virus in the country,” said Paul Offit, the director of the Vaccine Education Center and an expert in virology and immunology at the Children’s Hospital of Philadelphia. Rather, it’s when do we have the virus sufficiently under control. “We’ll have a much, much lower case count, hospitalization count, death count,” Offit said. “What is that number that people are comfortable with?” In his view, “the doors will open” when the country gets to fewer than 5,000 new cases a day, and fewer than 100 deaths.

That latter threshold, of 100 COVID-19 deaths a day, was repeated by other experts, following the logic that it approximates the nation’s average death toll from influenza. In most recent years, the flu has killed 20,000 to 50,000 Americans annually, which averages out to 55 to 140 deaths a day, said Joseph Eisenberg, an epidemiologist at the University of Michigan. “This risk was largely considered acceptable by the public,” Eisenberg said. Monica Gandhi, an infectious-disease specialist at UC San Francisco, made a similar calculation. “The end to the emergency portion of the pandemic in the United States should be heralded completely by the curtailing of severe illness, hospitalizations, and deaths from COVID-19,” she said. “Fewer than 100 deaths a day—to mirror the typical mortality of influenza in the U.S. over a typical year—is an appropriate goal.”

The “flu test” proposed here is not a perfect apples-to-apples comparison. Deaths attributed to COVID-19 are directly reported to public-health authorities, while the mortality numbers from seasonal flu are CDC estimates based on national surveillance data that have been fed into statistical models. But researchers believe that the straightforward counts of influenza deaths—just 3,448 to 15,620 in recent years—are substantially too low; while direct counts of COVID-19 deaths are likely to be more accurate. One big reason: Far more COVID-19 tests are done in a single day than flu tests in an entire year, and flu tests have a greater tendency to return false negatives.

In any case, we are nowhere near 100 COVID-19 deaths a day. Since last spring, no state has reported fewer than 474 deaths a day, as measured by a rolling seven-day average at the COVID Tracking Project at The Atlantic. Right now, the country as a whole is still reporting close to 2,000 deaths a day, and just two weeks ago that number was more than 3,000. So, if we’re going by the flu test, we still have a very long way to go.

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