vox--2020-04-01--Trump could have reopened health care enrollment for coronavirus. He chose not to.

The Trump administration has reportedly declined to reopen enrollment under the Affordable Care Act so that people without health insurance — including some newly laid-off workers — can enroll in coverage during the coronavirus pandemic .
Trump administration officials had initially said they were considering creating a special enrollment period on Healthcare.gov for the pandemic after insurance companies and Democrats asked them to , but ultimately ruled against it , telling Politico they were “ exploring other options.
” There are concerns of a significant increase in the uninsured rate after mass layoffs over the last month , as health @ @ @ @ @ @ @ .
Three million people filed initial claims for unemployment two weeks ago , according to Department of Labor data released last Thursday .
Many of those people whose jobs did offer benefits now face losing their health insurance on top of everything else .
They , at least , will be able to enroll in a new insurance plan through the exchanges if they so choose : Though open enrollment for ACA plans ended on December 15 , losing previous coverage is a qualifying life event that allows people their own special enrollment @ @ @ @ @ @ @ jobs but not health coverage — including if they didn ’ t have any because their employers didn ’ t offer it — can ’ t purchase health insurance .
If their household income drops low enough , they may qualify for Medicaid in the following month , but it ’ s not guaranteed .
“ The administration has broad authority under the ACA to set the timing and length of open enrollment periods and qualifying factors for special enrollment periods , ” Kaiser Family Foundation executive vice president Larry Leavitt told Vox @ @ @ @ @ @ @ opposing broader enrollment periods , and they are supporting it , so it ’ s hard to see the administration ’ s opposition as anything but ideological opposition to the ACA.
” The administration ’ s decision will only affect people in the 38 states for which the federal government administers the health exchange .
Other states have created their own exchanges and can choose to reopen their markets if they wish — New York , California , and several other states , along with the District of Columbia , have already done @ @ @ @ @ @ @ confined to those states , however .
There are confirmed cases in each of the 50 states in the US , and with people less likely to seek medical help if they are uninsured , the lack of coverage could present a risk to public health .
The decision follows a long-established pattern by the administration to weaken and discourage enrollees to the ACA at nearly every turn possible .
Administration officials also signaled Monday that they would be proceeding with supporting a federal lawsuit scheduled for oral arguments this fall at the @ @ @ @ @ @ @ ACA altogether .
That would result in millions of people getting thrown off their ACA health insurance plans .
But in the meantime , the country is struggling to manage critical care for Covid-19 , the disease caused by the novel coronavirus , and major disruptions in the insurance system could deepen the crisis .
What happens when people lose their jobs during a pandemic ?
Workers laid off because of the pandemic face a hodgepodge health insurance system that isn ’ t designed to ensure that everyone can be covered and options @ @ @ @ @ @ @ s circumstances .
Most workers who previously had employer-sponsored health insurance can either continue their previous coverage under COBRA , which can be extremely pricy , or choose to enroll in an ACA plan , even without a national special enrollment period .
Some of them could also qualify for Medicaid .
But many of the workers who will take the brunt of the layoffs are likely to come from industries that don ’ t generally offer employee health insurance , as explained by Vox ’ s Dylan Scott : The workers most @ @ @ @ @ @ @ were more likely to work in the service or retail industries , and they were more likely to be low-wage workers .
Survey data from the Kaiser Family Foundation indicates cooks , waiters and waitresses , sales workers , and cashiers are some of the jobs with the highest uninsured rates in the US .
The food service industry has the most workers on Medicaid , according to KFF , with about 1.4 million already covered by the government program .
These jobs don ’ t pay particularly well , and the businesses @ @ @ @ @ @ @ to offer health insurance at all .
About one-third of retail firms provide health benefits , and the service industry also ranks behind most others in providing health coverage .
So because of our fractured system , which depends on employers to cover health benefits for a lot of workers , the people who lost their jobs as the coronavirus economic panic set in were already at more of a disadvantage when it comes to getting covered .
Those workers face more obstacles to obtaining health insurance in the time of coronavirus .
@ @ @ @ @ @ @ may qualify for Medicaid , but those facing reduced hours or partial employment may not be eligible , especially if they live in one of the 14 states that currently have not expanded Medicaid coverage .
It ’ s those folks , who were already uninsured before getting laid off and aren ’ t eligible for Medicaid , who will be hurt the most by the Trump administration ’ s decision not to reopen the ACA marketplace .
That ’ s why New York , California , and other states have decided to @ @ @ @ @ @ @ Though the CDC told Vox that the agency has the authority to cover testing and treatment specifically for Covid-19 , stories have begun popping up of individuals with the virus getting turned away for lack of insurance or getting hit with large bills .
With an already strained health care system , the country ’ s makeshift health insurance system could become an impediment to public health during the pandemic .

The Trump administration has reportedly declined to reopen enrollment under the Affordable Care Act so that people without health insurance — including some newly laid-off workers — can enroll in coverage during the coronavirus pandemic.
Trump administration officials had initially said they were considering creating a special enrollment period on Healthcare.gov for the pandemic after insurance companies and Democrats asked them to, but ultimately ruled against it, telling Politico they were “exploring other options.”
There are concerns of a significant increase in the uninsured rate after mass layoffs over the last month, as health insurance in the US is largely employment-based. Three million people filed initial claims for unemployment two weeks ago, according to Department of Labor data released last Thursday. Many of those people whose jobs did offer benefits now face losing their health insurance on top of everything else.
They, at least, will be able to enroll in a new insurance plan through the exchanges if they so choose: Though open enrollment for ACA plans ended on December 15, losing previous coverage is a qualifying life event that allows people their own special enrollment period.
But many who lost their jobs but not health coverage — including if they didn’t have any because their employers didn’t offer it — can’t purchase health insurance. If their household income drops low enough, they may qualify for Medicaid in the following month, but it’s not guaranteed.
“The administration has broad authority under the ACA to set the timing and length of open enrollment periods and qualifying factors for special enrollment periods,” Kaiser Family Foundation executive vice president Larry Leavitt told Vox. “Insurers are usually the constituency opposing broader enrollment periods, and they are supporting it, so it’s hard to see the administration’s opposition as anything but ideological opposition to the ACA.”
The administration’s decision will only affect people in the 38 states for which the federal government administers the health exchange. Other states have created their own exchanges and can choose to reopen their markets if they wish — New York, California, and several other states, along with the District of Columbia, have already done so.
The coronavirus pandemic is not confined to those states, however. There are confirmed cases in each of the 50 states in the US, and with people less likely to seek medical help if they are uninsured, the lack of coverage could present a risk to public health.
The decision follows a long-established pattern by the administration to weaken and discourage enrollees to the ACA at nearly every turn possible. Administration officials also signaled Monday that they would be proceeding with supporting a federal lawsuit scheduled for oral arguments this fall at the Supreme Court which could potentially end the ACA altogether. That would result in millions of people getting thrown off their ACA health insurance plans.
But in the meantime, the country is struggling to manage critical care for Covid-19, the disease caused by the novel coronavirus, and major disruptions in the insurance system could deepen the crisis.
What happens when people lose their jobs during a pandemic?
Workers laid off because of the pandemic face a hodgepodge health insurance system that isn’t designed to ensure that everyone can be covered and options mainly depend on an individual worker’s circumstances.
Most workers who previously had employer-sponsored health insurance can either continue their previous coverage under COBRA, which can be extremely pricy, or choose to enroll in an ACA plan, even without a national special enrollment period. Some of them could also qualify for Medicaid.
But many of the workers who will take the brunt of the layoffs are likely to come from industries that don’t generally offer employee health insurance, as explained by Vox’s Dylan Scott:
The workers most vulnerable to losing their jobs from Covid-19 were more likely to work in the service or retail industries, and they were more likely to be low-wage workers. Survey data from the Kaiser Family Foundation indicates cooks, waiters and waitresses, sales workers, and cashiers are some of the jobs with the highest uninsured rates in the US. The food service industry has the most workers on Medicaid, according to KFF, with about 1.4 million already covered by the government program. These jobs don’t pay particularly well, and the businesses that employ these workers are less likely to offer health insurance at all. About one-third of retail firms provide health benefits, and the service industry also ranks behind most others in providing health coverage. So because of our fractured system, which depends on employers to cover health benefits for a lot of workers, the people who lost their jobs as the coronavirus economic panic set in were already at more of a disadvantage when it comes to getting covered.
Those workers face more obstacles to obtaining health insurance in the time of coronavirus. Some who are completely out of work may qualify for Medicaid, but those facing reduced hours or partial employment may not be eligible, especially if they live in one of the 14 states that currently have not expanded Medicaid coverage.
It’s those folks, who were already uninsured before getting laid off and aren’t eligible for Medicaid, who will be hurt the most by the Trump administration’s decision not to reopen the ACA marketplace. That’s why New York, California, and other states have decided to do so in their own marketplaces.
Though the CDC told Vox that the agency has the authority to cover testing and treatment specifically for Covid-19, stories have begun popping up of individuals with the virus getting turned away for lack of insurance or getting hit with large bills.
With an already strained health care system, the country’s makeshift health insurance system could become an impediment to public health during the pandemic.
Additional reporting from Dylan Scott.


vox--2020-04-01--Watch: Coronavirus is not the flu. It’s worse.

Covid-19 , the disease caused by the coronavirus , can look very similar to the flu .
They have similar symptoms — a fever , cough , and the possibility of leading to pneumonia — and even spread the same way .
So wanting to compare the two is natural and , frankly , understandable .
But Covid-19 is very different from the flu .
It ’ s more dangerous in almost every way .
Not only is it twice as contagious , but the time it takes you to realize you are contagious is much longer .
With the @ @ @ @ @ @ @ you to feel sick from the moment you become sick ( called the incubation period ) is two days .
With Covid-19 , most people don ’ t realize they ’ re sick — and possibly contagious — for five days ; it can take up to 12 or even 14 days .
You can also show no symptoms and still be contagious .
And when you become sick , you have a higher chance of needing to be hospitalized .
( Yes , even young people . )
While the flu can @ @ @ @ @ @ @ , the flu ’ s fatality rate is still just 0.1 percent .
Covid-19 ’ s fatality rate by some estimates is 10 times that , especially for older people .
Watch the video above to learn more about the differences between coronavirus and the flu , and why we have to take Covid-19 so seriously .
Or read more from Vox ’ s senior science reporter Brian Resnick .
You can find this video and all of Vox ’ s videos on YouTube .
And if you ’ re interested in supporting @ @ @ @ @ @ @ a member of the Vox Video Lab on YouTube .

Covid-19, the disease caused by the coronavirus, can look very similar to the flu. They have similar symptoms — a fever, cough, and the possibility of leading to pneumonia — and even spread the same way. So wanting to compare the two is natural and, frankly, understandable.
But Covid-19 is very different from the flu. It’s more dangerous in almost every way.
Not only is it twice as contagious, but the time it takes you to realize you are contagious is much longer. With the flu, the average time it takes you to feel sick from the moment you become sick (called the incubation period) is two days.
With Covid-19, most people don’t realize they’re sick — and possibly contagious — for five days; it can take up to 12 or even 14 days. You can also show no symptoms and still be contagious.
And when you become sick, you have a higher chance of needing to be hospitalized. (Yes, even young people.) While the flu can kill nearly 60,000 Americans in a year, the flu’s fatality rate is still just 0.1 percent. Covid-19’s fatality rate by some estimates is 10 times that, especially for older people.
Watch the video above to learn more about the differences between coronavirus and the flu, and why we have to take Covid-19 so seriously. Or read more from Vox’s senior science reporter Brian Resnick.
You can find this video and all of Vox’s videos on YouTube. And if you’re interested in supporting our video journalism, you can become a member of the Vox Video Lab on YouTube.


vox--2020-04-01--The coronavirus’s unpredictable impact on next year’s health insurance rates, explained

Evidence-based explanations of the coronavirus crisis , from how it started to how it might end to how to protect yourself and others .
The coronavirus outbreak is going to cost the US health system a lot of money , and if it doesn ’ t get under control soon , that might mean dramatic increases in insurance premiums next year .
The cost to health insurers for covering Covid-19 testing and treatment , especially as many of them waive cost-sharing for patients , could be enormous .
Analysts for California ’ s insurance marketplace recently projected insurers nationwide could @ @ @ @ @ @ @ 251 billion to cover care for coronavirus patients .
Arguably the most important variable for 2021 insurance premiums is whether the Covid-19 pandemic extends into next year or is brought under control before then .
That ’ s because legally insurers can ’ t just hike their rates astronomically next year to make up for those costs .
Their proposed rates should reflect their expected costs in 2021 , not what they spent in 2020 .
State regulators can push back against proposed hikes that they don ’ t think are justified by @ @ @ @ @ @ @ .
“ When issuers develop rates for 2021 , it must be based on 2021 expected costs .
Issuers are not allowed to include past losses in prospective premium rates if those costs are not expected to persist , ” Dave Dillon , a Dallas-based insurance actuary who is a member of the Society of Actuaries , told me .
“ Therefore , for the majority of health insurance issuers , premiums would not be expected to increase as a result of Covid-19-related costs if the pandemic is limited to 2020.
” The @ @ @ @ @ @ @ some major questions need to be answered before they could begin to know what will happen to premiums in 2021 : • Is the pandemic over by 2021 or is it still going ?
• Do insurers need to dip into their financial reserves to cover coronavirus costs ?
• How many elective surgeries end up getting postponed into 2021 ?
• Does Congress do anything to help health insurers absorb their losses from the pandemic ?
The range of possible outcomes is pretty big : The California analysis projected premiums could increase @ @ @ @ @ @ @ to 40 percent because of the Covid-19 outbreak .
These variables will likely dictate how big the increase is .
Let ’ s run through them .
Is the pandemic over by 2021 or is it still going ?
This one is pretty straightforward .
If we can end ( or greatly contain ) the pandemic soon , and most of the expected costs for the outbreak come in 2020 , then there will be less justification for insurers to increase their rates in 2021 because they expect more Covid-19 patients .
Right @ @ @ @ @ @ @ peak in the spring and summer , but we don ’ t know if the virus could rebound in the cooler months later this year .
When insurers file their proposed 2021 rates , they will actually be looking at their 2019 data to calculate what next year ’ s expected costs should be and how high they should set their premiums , says Cynthia Cox , senior vice president at the Kaiser Family Foundation .
“ Nowhere in those calculations can they say , ‘ We ’ re gon na lose this @ @ @ @ @ @ @ she says .
On the other hand , if the virus lingers and people continue to get sick , get tested , or end up in the hospital , then insurers could fairly assume they will continue to have new expenses related to the outbreak next year .
Under that scenario , we could be looking at the upper bound of these early 2021 projections , with double-digit increases potentially being the norm .
The costs for covering Covid-19 patients aren ’ t fully understood yet .
But for people who end up @ @ @ @ @ @ @ 5 cases so far in the US , we ’ re talking thousands of dollars even for a patient with no complications .
If there are major complications , the bill could reach up to $ 20,000 or more .
There could still be some Covid-19-associated expenses for insurers in 2021 , even if the outbreak is under control .
If a vaccine comes on the market , for example , insurers could account for those costs .
The effect is unlikely to be zero , but the difference between a 4 percent @ @ @ @ @ @ @ depends largely on our controlling the pandemic as soon as possible .
Do insurers need to dip into their financial reserves to cover coronavirus costs ?
But Dillon , with the Society of Actuaries , did say there is an important exception to the general rule that insurers can ’ t cite 2020 losses to justify 2021 rate hikes : if they have to dip deep into their capital reserves — the unspent funds they ’ ve built up over the years in case of an emergency such as this — to cover @ @ @ @ @ @ @ listed a few factors that could contribute to such a financial emergency for health insurers : • “ A catastrophic increase in 2020 claims ” because of the extent of the coronavirus outbreak , which means a lot of people getting very sick and racking up big bills for their medical care • In the same vein , health insurers are paying even more of their customers ’ health care costs than usual , which could drive up their costs and deplete their reserves • Given the ongoing economic crisis , a significant @ @ @ @ @ @ @ afford their premiums , meaning insurers aren ’ t bringing in as much money to cover claims Insurers must meet certain statutory requirements for their capital reserves , which is based on a “ risk-based capital ” framework , Dillon says ( and I ’ ll leave it at that except to say the formula is based on their risk exposure ) .
If they eat too much into their reserves because of Covid-19 , they may actually have a legal obligation to increase rates so they can build those reserves back up @ @ @ @ @ @ @ be another consideration in the rate review process .
As Cox told me , the issue usually is insurers will propose a rate hike and the state regulator will point to their ample reserves as one reason why the increase isn ’ t warranted .
But we may see the reverse if this pandemic is really hard on insurers ’ books .
How many elective surgeries end up getting postponed into 2021 ?
Many US hospitals have been postponing elective surgeries because of the coronavirus outbreak , hoping to free up more beds @ @ @ @ @ @ @ crisis .
Despite the name , these “ elective ” procedures cover a lot of things .
Some of them are still quite urgent , say for cancer or heart conditions , while others , like joint replacements , are not as much of a medical priority .
Elective surgeries fall into at least three different buckets : those that can be easily postponed , those that are still very urgent , and the trickiest ones that fall somewhere in between , with the decision depending on the medical opinion of doctors , @ @ @ @ @ @ @ Certain elective procedures could be postponed for a long time .
A lot of hip and knee replacements , for example , could be delayed for a long time , ” Cox said .
“ Next year , there could be a lot of pent-up demand for those types of procedures.
” This cuts both ways .
Insurers could price their 2021 rates expecting a surge in elective surgeries because people are delaying less urgent medical services for now .
On the other hand , if a decrease in other claims helps them @ @ @ @ @ @ @ will be stronger heading into 2021 , which dampens the statutory justification for a big hike .
“ Many issuers are receiving significantly lower call volumes , which is considered a key predictor for future claims , ” Dillon says .
“ Therefore , it appears that 2020 Covid-19-related losses may be offset by reduced spending in other areas in the short term.
” It ’ s a complicated formula and we simply can ’ t say right now what it comes out to .
And that ’ s all before you account @ @ @ @ @ @ @ do anything to help health insurers absorb their losses from the pandemic ?
The other thing that could offset insurers ’ coronavirus-related losses and blunt the premium increases for 2021 is a lot of federal funding .
Insurers were not among the industries to get a bailout in the first stimulus bills passed by Congress , but they are still pushing for help from Washington .
There is at least one big reason for lawmakers to act : If insurers get spooked by the exorbitant costs of coronavirus , they might simply decide @ @ @ @ @ @ @ markets that cover about 20 million people .
We could be back to where we were in 2017 , when until the last minute it looked like some counties across the country would be left with no insurance options because no health plan was willing to sell on their marketplace .
“ They might decide not to participate if it ’ s too hard to predict what their costs are going to be , ” Cox said .
In mid-March , the main health insurance industry trade groups sent a letter to Senate @ @ @ @ @ @ @ Nancy Pelosi laying out their requests .
Among them was a risk mitigation program that would be triggered only when an insurer suffered real financial losses because of the pandemic .
The trade associations said the new federal money would be “ to ensure that health care premiums do not spike , and that benefits are stable in the future.
” In their most recent stimulus proposal , House Democrats did include a program that would cover “ extreme losses ” for health insurers with the goal of mitigating premium increases .
At @ @ @ @ @ @ @ to charge ahead with another stimulus bill , though Senate Republicans have sounded more reticent .
So , as with so many questions about Covid-19 and the future , we ’ ll just have to wait and see .

The coronavirus outbreak is going to cost the US health system a lot of money, and if it doesn’t get under control soon, that might mean dramatic increases in insurance premiums next year.
The cost to health insurers for covering Covid-19 testing and treatment, especially as many of them waive cost-sharing for patients, could be enormous. Analysts for California’s insurance marketplace recently projected insurers nationwide could end up spending as much as $251 billion to cover care for coronavirus patients.
Arguably the most important variable for 2021 insurance premiums is whether the Covid-19 pandemic extends into next year or is brought under control before then.
That’s because legally insurers can’t just hike their rates astronomically next year to make up for those costs. Their proposed rates should reflect their expected costs in 2021, not what they spent in 2020. State regulators can push back against proposed hikes that they don’t think are justified by the anticipated costs for the upcoming year.
“When issuers develop rates for 2021, it must be based on 2021 expected costs. Issuers are not allowed to include past losses in prospective premium rates if those costs are not expected to persist,” Dave Dillon, a Dallas-based insurance actuary who is a member of the Society of Actuaries, told me. “Therefore, for the majority of health insurance issuers, premiums would not be expected to increase as a result of Covid-19-related costs if the pandemic is limited to 2020.”
The actuaries and experts I spoke with said some major questions need to be answered before they could begin to know what will happen to premiums in 2021:
Is the pandemic over by 2021 or is it still going?
Do insurers need to dip into their financial reserves to cover coronavirus costs?
How many elective surgeries end up getting postponed into 2021?
Does Congress do anything to help health insurers absorb their losses from the pandemic?
The range of possible outcomes is pretty big: The California analysis projected premiums could increase in 2021 by anywhere from 4 percent to 40 percent because of the Covid-19 outbreak. These variables will likely dictate how big the increase is. Let’s run through them.
Is the pandemic over by 2021 or is it still going?
This one is pretty straightforward. If we can end (or greatly contain) the pandemic soon, and most of the expected costs for the outbreak come in 2020, then there will be less justification for insurers to increase their rates in 2021 because they expect more Covid-19 patients. Right now, experts project the outbreak will peak in the spring and summer, but we don’t know if the virus could rebound in the cooler months later this year.
When insurers file their proposed 2021 rates, they will actually be looking at their 2019 data to calculate what next year’s expected costs should be and how high they should set their premiums, says Cynthia Cox, senior vice president at the Kaiser Family Foundation.
“Nowhere in those calculations can they say, ‘We’re gonna lose this much money in 2020,’” she says.
On the other hand, if the virus lingers and people continue to get sick, get tested, or end up in the hospital, then insurers could fairly assume they will continue to have new expenses related to the outbreak next year. Under that scenario, we could be looking at the upper bound of these early 2021 projections, with double-digit increases potentially being the norm.
The costs for covering Covid-19 patients aren’t fully understood yet. But for people who end up in the hospital, about 1 in 5 cases so far in the US, we’re talking thousands of dollars even for a patient with no complications. If there are major complications, the bill could reach up to $20,000 or more.
There could still be some Covid-19-associated expenses for insurers in 2021, even if the outbreak is under control. If a vaccine comes on the market, for example, insurers could account for those costs. The effect is unlikely to be zero, but the difference between a 4 percent Covid-19 hike and a 40 percent hike depends largely on our controlling the pandemic as soon as possible.
Do insurers need to dip into their financial reserves to cover coronavirus costs?
But Dillon, with the Society of Actuaries, did say there is an important exception to the general rule that insurers can’t cite 2020 losses to justify 2021 rate hikes: if they have to dip deep into their capital reserves — the unspent funds they’ve built up over the years in case of an emergency such as this — to cover the coronavirus’s costs.
He listed a few factors that could contribute to such a financial emergency for health insurers:
“A catastrophic increase in 2020 claims” because of the extent of the coronavirus outbreak, which means a lot of people getting very sick and racking up big bills for their medical care
In the same vein, health insurers are paying even more of their customers’ health care costs than usual, which could drive up their costs and deplete their reserves
Given the ongoing economic crisis, a significant number of people could be unable to afford their premiums, meaning insurers aren’t bringing in as much money to cover claims
Insurers must meet certain statutory requirements for their capital reserves, which is based on a “risk-based capital” framework, Dillon says (and I’ll leave it at that except to say the formula is based on their risk exposure). If they eat too much into their reserves because of Covid-19, they may actually have a legal obligation to increase rates so they can build those reserves back up for the next emergency.
This will be another consideration in the rate review process. As Cox told me, the issue usually is insurers will propose a rate hike and the state regulator will point to their ample reserves as one reason why the increase isn’t warranted. But we may see the reverse if this pandemic is really hard on insurers’ books.
How many elective surgeries end up getting postponed into 2021?
Many US hospitals have been postponing elective surgeries because of the coronavirus outbreak, hoping to free up more beds and staff to deal with the current crisis. Despite the name, these “elective” procedures cover a lot of things. Some of them are still quite urgent, say for cancer or heart conditions, while others, like joint replacements, are not as much of a medical priority.
Elective surgeries fall into at least three different buckets: those that can be easily postponed, those that are still very urgent, and the trickiest ones that fall somewhere in between, with the decision depending on the medical opinion of doctors, in consultation with their patients.
“Certain elective procedures could be postponed for a long time. A lot of hip and knee replacements, for example, could be delayed for a long time,” Cox said. “Next year, there could be a lot of pent-up demand for those types of procedures.”
This cuts both ways. Insurers could price their 2021 rates expecting a surge in elective surgeries because people are delaying less urgent medical services for now. On the other hand, if a decrease in other claims helps them financially weather the coronavirus, their reserves will be stronger heading into 2021, which dampens the statutory justification for a big hike.
“Many issuers are receiving significantly lower call volumes, which is considered a key predictor for future claims,” Dillon says. “Therefore, it appears that 2020 Covid-19-related losses may be offset by reduced spending in other areas in the short term.”
It’s a complicated formula and we simply can’t say right now what it comes out to. And that’s all before you account for the federal government.
Does Congress do anything to help health insurers absorb their losses from the pandemic?
The other thing that could offset insurers’ coronavirus-related losses and blunt the premium increases for 2021 is a lot of federal funding. Insurers were not among the industries to get a bailout in the first stimulus bills passed by Congress, but they are still pushing for help from Washington.
There is at least one big reason for lawmakers to act: If insurers get spooked by the exorbitant costs of coronavirus, they might simply decide to pull out of the individual insurance markets that cover about 20 million people. We could be back to where we were in 2017, when until the last minute it looked like some counties across the country would be left with no insurance options because no health plan was willing to sell on their marketplace.
“They might decide not to participate if it’s too hard to predict what their costs are going to be,” Cox said.
In mid-March, the main health insurance industry trade groups sent a letter to Senate Majority Leader Mitch McConnell and House Speaker Nancy Pelosi laying out their requests. Among them was a risk mitigation program that would be triggered only when an insurer suffered real financial losses because of the pandemic.
The trade associations said the new federal money would be “to ensure that health care premiums do not spike, and that benefits are stable in the future.” In their most recent stimulus proposal, House Democrats did include a program that would cover “extreme losses” for health insurers with the goal of mitigating premium increases. At this point, the House seems ready to charge ahead with another stimulus bill, though Senate Republicans have sounded more reticent.
So, as with so many questions about Covid-19 and the future, we’ll just have to wait and see.


vox--2020-04-01--Trump’s coronavirus death toll estimate exposes his failure

President Donald Trump revealed a grim projection in the coronavirus pandemic on Tuesday : Even with the social distancing the US is doing now , 100,000 to 200,000 Americans will likely die as a result of the ongoing outbreak .
“ When you see 100,000 people , that ’ s a minimum number , ” Trump said .
It ’ s a horrifying figure .
That ’ s more people than ever died in a single year from HIV/AIDS , drug overdoses , gun violence , or car crashes in the US .
It ’ s more than American casualties @ @ @ @ @ @ @ it ’ s also a horrifying number , in part , because much of it was likely preventable .
If the US — including the Trump administration — had better prepared for pandemics , the country likely could have avoided ever talking about 100,000 to 200,000 deaths .
The estimated death toll “ was not inevitable , ” Céline Gounder , an epidemiologist at New York University , told me .
“ If we ’ d jumped into contract tracing and testing , social distancing , and health system preparedness as soon as @ @ @ @ @ @ @ ’ d be in a very different situation now.
” Under Trump , the US had years to prepare .
With warnings from President Barack Obama ’ s administration and activists like Bill Gates , it was always clear that America was vulnerable to a pandemic .
( Vox did a whole episode about it for Netflix . )
For many , the 2014- ’ 16 Ebola outbreak exposed the threat ; Jeremy Konyndyk , who worked in the Obama administration during the Ebola outbreak , told me he “ came away from @ @ @ @ @ @ @ unready we would be for something more dangerous than Ebola , ” which , thankfully , was relatively hard to transmit .
In the years leading to the coronavirus outbreak , though , Trump did not take the concerns seriously .
His administration shut down the White House office , set up after the Ebola outbreak , that oversaw disease outbreaks and pandemics .
It repeatedly proposed cuts to the Centers for Disease Control and Prevention ( CDC ) and other public health agencies ( although Congress largely rejected those cuts ) .
@ @ @ @ @ @ @ that was meant to help detect disease outbreaks in China , where the coronavirus outbreak began .
By the time it became clear that the world was facing a serious threat in January and February , Trump and his administration were again slow to act .
Despite declaring a public health emergency , the administration failed to establish the infrastructure for nationwide testing — holding up private testing labs with bureaucratic and regulatory hurdles while sending out its own faulty test kits .
The administration did nothing of substance to really scale up @ @ @ @ @ @ @ PPE ) for health care workers , allowing a shortage to take root .
Trump still hasn ’ t leveraged the full might of the Defense Production Act to get medical supplies to hospitals and clinics that need them to fight the outbreak .
The failure on testing alone is massive — one that remains today .
As Johns Hopkins University epidemiologist Jennifer Nuzzo told the New York Times , “ Had we had done more testing from the very beginning and caught cases earlier , we would be in a far different @ @ @ @ @ @ @ that looks very different in the US than in the few countries , like South Korea and Taiwan , that have better contained Covid-19 , the disease caused by the SARS-CoV-2 coronavirus .
This isn ’ t solely on Trump .
Some of it comes down to chance — that the coronavirus is popping up now and is so deadly and contagious is obviously not under any president ’ s control .
Konyndyk ’ s experience under Obama shows the previous administration wasn ’ t ready for a pandemic either .
Experts and @ @ @ @ @ @ @ with public health more broadly , is notoriously underfunded not just in the US but around the world .
Some local and state officials , such as in New York City and Florida , have also underreacted to the crisis , making it worse .
But Trump , perhaps more than any other president , had plenty of warning about what was to come .
He squandered all the opportunities given to him to do better , leaving much of the aggressive action that has reduced the death toll — down from the @ @ @ @ @ @ @ is possible without interventions — to local and state officials who simply don ’ t have the reach of the federal government .
So now 100,000 to 200,000 Americans are likely to die .
Trump failed to prepare , then downplayed the coronavirus outbreak Every step of the way , the Trump administration failed to take the threat of a pandemic seriously .
The threat was long well-known , including to the federal government .
Government simulations and exercises before the outbreak revealed that there were a lot of problems , from the @ @ @ @ @ @ @ between the cities , states , and many federal agencies about who ’ s in charge during a crisis .
Trump reacted to the risks by deprioritizing pandemic preparedness .
In 2018 , then–National Security Adviser John Bolton fired Tom Bossert , a homeland security adviser who , the Washington Post reported , “ had called for a comprehensive biodefense strategy against pandemics and biological attacks.
” Then Bolton let go the head of pandemic response , Rear Adm. Timothy Ziemer , and his global health security team .
The team , the @ @ @ @ @ @ @ , was the main group within the White House for pandemic preparedness — and it was never replaced .
At the time , the Trump administration and Bolton said the cuts were needed to streamline the National Security Council .
But what it did , experts have told me , is leave the US unready for a crisis of the magnitude it ’ s facing now .
“ The basic systems need to be in place for global , state , and local responses , ” Jen Kates , director of global health @ @ @ @ @ @ @ Foundation , previously told me .
“ When you don ’ t shore those up , you ’ re not starting from scratch , but you ’ re catching up every single time.
” Even once it became clear that the coronavirus pandemic was a real threat , Trump downplayed the outbreak .
He compared the novel coronavirus to the seasonal flu , when the coronavirus is in fact much deadlier and more contagious than the flu .
He called concerns about the virus a “ hoax.
” He said on national television @ @ @ @ @ @ @ a self-admitted “ hunch , ” the death rate of the disease was much lower than public health officials projected .
Even after his administration invoked social distancing guidelines , Trump talked up the idea of doing away with them by Easter to allow for “ packed churches.
” Ashish Jha , director of the Harvard Global Health Institute , described the administration ’ s early messaging as “ deeply disturbing , ” adding that it ’ s “ left the country far less prepared than it needs to be for what is @ @ @ @ @ @ @ ’ s tone has changed in recent weeks .
He ultimately extended his task force ’ s social distancing guidelines through April .
On Tuesday , he went after the claim — that , again , he repeatedly made before — that coronavirus is like flu : “ It ’ s not the flu .
It ’ s vicious , ” he said .
But however Trump may feel now , his administration ’ s failure to take this threat seriously early on left the country in a much worse place .
A @ @ @ @ @ @ @ exposed how the Trump administration failed to scale up testing .
The CDC developed its own test for coronavirus — seemingly to make a more accurate test than what was available from other places — but the test turned out to be faulty , and the CDC took weeks to provide a fix .
Meanwhile , the administration put up all sorts of regulatory hurdles that prevented private labs from rolling out their own tests .
The result : The US was only testing about 100 samples a day by mid-February , according @ @ @ @ @ @ @ , “ Across the government , [ experts ] said , three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough .
Even as scientists looked at China and sounded alarms , none of the agencies ’ directors conveyed the urgency required to spur a no-holds-barred defense.
” This failure alone doomed the US to a much bigger outbreak , forcing Americans to rely far more on social distancing and suffer many more deaths .
That ’ s because testing is crucial , especially in the early @ @ @ @ @ @ @ First , it lets public health officials identify sick people , isolate them , and trace their recent contacts to make sure those people aren ’ t sick and get them into quarantine as well .
Second , testing lets officials detect which places are hardest hit and , therefore , require the most attention and help .
Yet , even today , testing remains a problem .
Maryland Gov .
Larry Hogan ( R ) said this week that Trump ’ s claim that testing is no longer a problem is “ @ @ @ @ @ @ @ still “ flying blind ” due to insufficient testing .
Testing is only one example among many .
The country is also experiencing a shortage of PPE for health care workers and ventilators for treatment .
Both problems were repeatedly raised in pandemic simulations , but the federal government failed to replenish its Strategic National Stockpile and failed to scale up domestic production and supply chains .
Even now , Trump has refused to use the full powers of the Defense Production Act , which would allow the federal government to demand more @ @ @ @ @ @ @ it ’ d likely take at least weeks for this production to scale up ) .
The lack of medical supplies is one reason experts worry the US won ’ t have the health care capacity to deal with a flood of Covid-19 patients , leading to sickness , suffering , and death due to insufficient treatment .
Again , a lot of this goes back to poor preparation in the years before the Covid-19 pandemic — and , indeed , the years before Trump was in office — but Trump and his @ @ @ @ @ @ @ threat of the coronavirus became clear .
There ’ s another way this could have gone These outcomes weren ’ t inevitable .
Other countries that were more aggressive earlier seemed to reduce their potential death tolls .
Just take a look at this chart comparing Covid-19 cases between different countries and places : The US ’ s trajectory in this chart is exponential : The number of cases is clearly rising every single day .
But while US cases seemed to explode about two weeks after the 100th case , a few @ @ @ @ @ @ @ , and Hong Kong — managed to flatten their curves with early , aggressive action around the same time .
South Korea did this , as Max Fisher and Choe Sang-Hun reported at the New York Times , with a lot of testing .
While the US was still doing at most 100 tests a day , South Korea was pumping them out in the thousands , if not tens of thousands , a day .
This allowed officials in South Korea to detect where outbreaks were happening and contain them — particularly @ @ @ @ @ @ @ , along with some restrictions on movement , travel , and socializing — before things got too out of control .
The US is obviously not South Korea .
It ’ s much bigger , more sprawling , and more populous .
But the South Korean experience shows that aggressive testing , as one example , could help contain coronavirus .
The US , due largely to the Trump administration ’ s failures , just didn ’ t have the capabilities South Korea did here .
There ’ s plenty of other evidence @ @ @ @ @ @ @ contain epidemics .
During the 1918 flu pandemic , some US cities took quick , decisive action while others didn ’ t .
A 2007 study in PNAS exposed the different outcomes in St. Louis , which quickly imposed restrictions to force social distancing , and Philadelphia , which didn ’ t , in this telling chart : The study concluded that “ cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates ≈50 % lower than those that did not and had less-steep epidemic @ @ @ @ @ @ @ were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality , but the difference was smaller ( ≈20 % ) and less statistically significant than that for peak death rates.
” If Trump had acted sooner , the US could have had a better chance at replicating the results from St. Louis in 1918 or South Korea in 2020 .
But that moment has passed — and Americans are now facing the deaths of potentially hundreds of thousands of their friends , family , and @ @ @ @ @

President Donald Trump revealed a grim projection in the coronavirus pandemic on Tuesday: Even with the social distancing the US is doing now, 100,000 to 200,000 Americans will likely die as a result of the ongoing outbreak. “When you see 100,000 people, that’s a minimum number,” Trump said.
It’s a horrifying figure. That’s more people than ever died in a single year from HIV/AIDS, drug overdoses, gun violence, or car crashes in the US. It’s more than American casualties during the entire Vietnam War.
But it’s also a horrifying number, in part, because much of it was likely preventable. If the US — including the Trump administration — had better prepared for pandemics, the country likely could have avoided ever talking about 100,000 to 200,000 deaths.
The estimated death toll “was not inevitable,” Céline Gounder, an epidemiologist at New York University, told me. “If we’d jumped into contract tracing and testing, social distancing, and health system preparedness as soon as we heard reports from China, we’d be in a very different situation now.”
Under Trump, the US had years to prepare. With warnings from President Barack Obama’s administration and activists like Bill Gates, it was always clear that America was vulnerable to a pandemic. (Vox did a whole episode about it for Netflix.) For many, the 2014-’16 Ebola outbreak exposed the threat; Jeremy Konyndyk, who worked in the Obama administration during the Ebola outbreak, told me he “came away from that experience just completely horrified at how unready we would be for something more dangerous than Ebola,” which, thankfully, was relatively hard to transmit.
In the years leading to the coronavirus outbreak, though, Trump did not take the concerns seriously. His administration shut down the White House office, set up after the Ebola outbreak, that oversaw disease outbreaks and pandemics. It repeatedly proposed cuts to the Centers for Disease Control and Prevention (CDC) and other public health agencies (although Congress largely rejected those cuts). The administration cut a public health position that was meant to help detect disease outbreaks in China, where the coronavirus outbreak began.
By the time it became clear that the world was facing a serious threat in January and February, Trump and his administration were again slow to act. Despite declaring a public health emergency, the administration failed to establish the infrastructure for nationwide testing — holding up private testing labs with bureaucratic and regulatory hurdles while sending out its own faulty test kits. The administration did nothing of substance to really scale up the production of personal protective equipment (PPE) for health care workers, allowing a shortage to take root. Trump still hasn’t leveraged the full might of the Defense Production Act to get medical supplies to hospitals and clinics that need them to fight the outbreak.
The failure on testing alone is massive — one that remains today. As Johns Hopkins University epidemiologist Jennifer Nuzzo told the New York Times, “Had we had done more testing from the very beginning and caught cases earlier, we would be in a far different place.”
The result is an outbreak that looks very different in the US than in the few countries, like South Korea and Taiwan, that have better contained Covid-19, the disease caused by the SARS-CoV-2 coronavirus.
This isn’t solely on Trump. Some of it comes down to chance — that the coronavirus is popping up now and is so deadly and contagious is obviously not under any president’s control. Konyndyk’s experience under Obama shows the previous administration wasn’t ready for a pandemic either. Experts and advocates argue that pandemic preparedness, along with public health more broadly, is notoriously underfunded not just in the US but around the world. Some local and state officials, such as in New York City and Florida, have also underreacted to the crisis, making it worse.
But Trump, perhaps more than any other president, had plenty of warning about what was to come. He squandered all the opportunities given to him to do better, leaving much of the aggressive action that has reduced the death toll — down from the millions the White House and experts say is possible without interventions — to local and state officials who simply don’t have the reach of the federal government.
So now 100,000 to 200,000 Americans are likely to die.
Trump failed to prepare, then downplayed the coronavirus outbreak
Every step of the way, the Trump administration failed to take the threat of a pandemic seriously.
The threat was long well-known, including to the federal government. Government simulations and exercises before the outbreak revealed that there were a lot of problems, from the lack of sufficient PPE to simple confusion between the cities, states, and many federal agencies about who’s in charge during a crisis.
Trump reacted to the risks by deprioritizing pandemic preparedness. In 2018, then–National Security Adviser John Bolton fired Tom Bossert, a homeland security adviser who, the Washington Post reported, “had called for a comprehensive biodefense strategy against pandemics and biological attacks.” Then Bolton let go the head of pandemic response, Rear Adm. Timothy Ziemer, and his global health security team. The team, the Directorate for Global Health Security and Biodefense, was the main group within the White House for pandemic preparedness — and it was never replaced.
At the time, the Trump administration and Bolton said the cuts were needed to streamline the National Security Council. But what it did, experts have told me, is leave the US unready for a crisis of the magnitude it’s facing now.
“The basic systems need to be in place for global, state, and local responses,” Jen Kates, director of global health and HIV policy at the Kaiser Family Foundation, previously told me. “When you don’t shore those up, you’re not starting from scratch, but you’re catching up every single time.”
Even once it became clear that the coronavirus pandemic was a real threat, Trump downplayed the outbreak. He compared the novel coronavirus to the seasonal flu, when the coronavirus is in fact much deadlier and more contagious than the flu. He called concerns about the virus a “hoax.” He said on national television that, based on nothing more than a self-admitted “hunch,” the death rate of the disease was much lower than public health officials projected. Even after his administration invoked social distancing guidelines, Trump talked up the idea of doing away with them by Easter to allow for “packed churches.”
Ashish Jha, director of the Harvard Global Health Institute, described the administration’s early messaging as “deeply disturbing,” adding that it’s “left the country far less prepared than it needs to be for what is a very substantial challenge ahead.”
Trump’s tone has changed in recent weeks. He ultimately extended his task force’s social distancing guidelines through April. On Tuesday, he went after the claim — that, again, he repeatedly made before — that coronavirus is like flu: “It’s not the flu. It’s vicious,” he said.
But however Trump may feel now, his administration’s failure to take this threat seriously early on left the country in a much worse place.
A recent investigation by the New York Times exposed how the Trump administration failed to scale up testing. The CDC developed its own test for coronavirus — seemingly to make a more accurate test than what was available from other places — but the test turned out to be faulty, and the CDC took weeks to provide a fix. Meanwhile, the administration put up all sorts of regulatory hurdles that prevented private labs from rolling out their own tests.
The result: The US was only testing about 100 samples a day by mid-February, according to the Times.
The Times concluded, “Across the government, [experts] said, three agencies responsible for detecting and combating threats like the coronavirus failed to prepare quickly enough. Even as scientists looked at China and sounded alarms, none of the agencies’ directors conveyed the urgency required to spur a no-holds-barred defense.”
This failure alone doomed the US to a much bigger outbreak, forcing Americans to rely far more on social distancing and suffer many more deaths. That’s because testing is crucial, especially in the early stages, to curtailing an outbreak: First, it lets public health officials identify sick people, isolate them, and trace their recent contacts to make sure those people aren’t sick and get them into quarantine as well. Second, testing lets officials detect which places are hardest hit and, therefore, require the most attention and help.
Yet, even today, testing remains a problem. Maryland Gov. Larry Hogan (R) said this week that Trump’s claim that testing is no longer a problem is “just not true” and states are still “flying blind” due to insufficient testing.
Testing is only one example among many. The country is also experiencing a shortage of PPE for health care workers and ventilators for treatment. Both problems were repeatedly raised in pandemic simulations, but the federal government failed to replenish its Strategic National Stockpile and failed to scale up domestic production and supply chains. Even now, Trump has refused to use the full powers of the Defense Production Act, which would allow the federal government to demand more domestic production of these goods (although it’d likely take at least weeks for this production to scale up).
The lack of medical supplies is one reason experts worry the US won’t have the health care capacity to deal with a flood of Covid-19 patients, leading to sickness, suffering, and death due to insufficient treatment.
Again, a lot of this goes back to poor preparation in the years before the Covid-19 pandemic — and, indeed, the years before Trump was in office — but Trump and his administration failed to prepare even once the threat of the coronavirus became clear.
There’s another way this could have gone
These outcomes weren’t inevitable. Other countries that were more aggressive earlier seemed to reduce their potential death tolls.
Just take a look at this chart comparing Covid-19 cases between different countries and places:
The US’s trajectory in this chart is exponential: The number of cases is clearly rising every single day. But while US cases seemed to explode about two weeks after the 100th case, a few places — like South Korea, Taiwan, and Hong Kong — managed to flatten their curves with early, aggressive action around the same time.
South Korea did this, as Max Fisher and Choe Sang-Hun reported at the New York Times, with a lot of testing. While the US was still doing at most 100 tests a day, South Korea was pumping them out in the thousands, if not tens of thousands, a day. This allowed officials in South Korea to detect where outbreaks were happening and contain them — particularly by getting people to isolate and quarantine, along with some restrictions on movement, travel, and socializing — before things got too out of control.
The US is obviously not South Korea. It’s much bigger, more sprawling, and more populous. But the South Korean experience shows that aggressive testing, as one example, could help contain coronavirus. The US, due largely to the Trump administration’s failures, just didn’t have the capabilities South Korea did here.
There’s plenty of other evidence that early, aggressive action can help contain epidemics. During the 1918 flu pandemic, some US cities took quick, decisive action while others didn’t. A 2007 study in PNAS exposed the different outcomes in St. Louis, which quickly imposed restrictions to force social distancing, and Philadelphia, which didn’t, in this telling chart:
The study concluded that “cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates ≈50% lower than those that did not and had less-steep epidemic curves. Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (≈20%) and less statistically significant than that for peak death rates.”
If Trump had acted sooner, the US could have had a better chance at replicating the results from St. Louis in 1918 or South Korea in 2020. But that moment has passed — and Americans are now facing the deaths of potentially hundreds of thousands of their friends, family, and peers as a result.


vox--2020-04-01--The stark differences in countries’ coronavirus death rates, explained

The race to track and slow the coronavirus pandemic has been very much a numbers game .
While we watch the number of cases — and deaths — climb , experts also are closely eyeing what they call the case fatality rate ( CFR ) .
This tells the proportion of people who get Covid-19 and ultimately die from the illness , and it ’ s a number that has been varying widely from country to country .
Some countries , such as Germany , have a fatality rate of approximately 1 percent of confirmed cases , whereas Italy ’ @ @ @ @ @ @ @ .
Even within the US , large differences are emerging : As of April 1 , Louisiana had reported a CFR of 4.2 percent , one of the highest in the nation , compared to California ’ s 2.1 percent .
Since scientists are pretty sure the virus isn ’ t mutating very quickly , the pathogen itself shouldn ’ t be more deadly in one place than another .
So why the variation ?
Figuring out what is driving these disparate numbers reveals differences not just in population demographics but also in @ @ @ @ @ @ @ Understanding CFRs might also help us slow deaths around the world — especially for the most vulnerable countries and individuals .
Why might fatality rates be so radically different ?
Before diving into the details from different countries , it ’ s worth looking at some of the broad reasons why death rates can look so starkly different from place to place .
First , we know that there are big differences in the risk the virus poses to different age groups .
For this coronavirus , SARS-CoV-2 , older individuals are far @ @ @ @ @ @ @ die from the disease .
In a new paper in The Lancet Infectious Diseases , researchers concluded , when looking at data from China and elsewhere , that people between the ages of 40 and 49 have an estimated CFR of about 0.4 percent ; for those 80 and older , it ’ s 13.4 percent .
This gulf of survivability is already playing out in some countries with older populations , such as Italy .
Additionally , Covid-19 has been demonstrably deadlier for those with existing health conditions , including lung disease @ @ @ @ @ @ @ cardiovascular disease , severe obesity , diabetes , kidney failure , and liver disease .
So countries — or regions — with less healthy populations might also be seeing big differences in the rates at which people are dying from the illness .
Beyond the varying impacts of the illness itself , there are lots of variables in how numbers are being gathered and reported .
Perhaps the biggest factor here is testing .
When experts calculate a basic fatality rate , it can be as simple as dividing the number of deaths @ @ @ @ @ @ @ although — and we ’ ll get to this later — it really shouldn ’ t be ) .
Since the international spread of the novel coronavirus , countries have varied widely in their ability and willingness to roll out testing .
So that means the denominator ( the number of cases ) can be closer or further from an accurate count of how many people actually have the virus .
The larger the percentage of a population that has been tested , the more complete picture we will get of the virus @ @ @ @ @ @ @ The other issue with the poor testing rates is sampling bias .
Tests that are available are usually saved for the sickest and riskiest cases .
This pushes the fatality rate higher than it actually is because the testing is more likely to omit mild or asymptomatic cases and instead overrepresents those who are more likely to die .
So , as testing finally becomes more widespread in various countries , their fatality rates will drop .
That is no reason for optimism , as the authors of the new study in The @ @ @ @ @ @ @ overall CFR for Covid-19 at 1.38 percent , which reflects their estimates for lack of testing and other factors , including potential censorship .
This number , they noted , is still “ substantially higher than for recent influenza pandemics ( e.g .
H1N1 influenza in 2009 ) ” — “ swine flu ” — which had a case fatality rate of 0.1 percent .
Their estimated CFR , “ combined with likely infection attack rates ( around 50-80 percent ) , show [ s ] that even the most advanced health-care systems @ @ @ @ @ @ @ is clear that this is far worse than the seasonal flu .
Another way to look at death rates — in the absence of widespread testing — is to compare the number of Covid-19 deaths to a country ’ s total population , which is what researchers have done here .
In another effort to make up for incomplete testing ( and possibly incomplete reporting ) , researchers are attempting to estimate what percentage of actual cases have been reported ( as of a couple weeks ago ) for each country .
The @ @ @ @ @ @ @ fatality rates include a country ’ s resources ( particularly its health care capacity ) , its organization ( such as how easily it can institute effective , widespread public health measures ) , and how forthcoming it is with data .
We will likely see other factors emerge as the pandemic rages on and more data comes in .
But here ’ s what we know so far about some of the key countries and their fatality rates for Covid-19 based on the number of confirmed cases .
For each country , @ @ @ @ @ @ @ the University of Oxford ’ s Center for Evidence-Based Medicine , which has been updating its statistics on dozens of countries ’ fatality rates daily .
You can find their full list of countries , which includes data on how confident they are in their estimates , here .
Early on in any pandemic of a potentially fatal infectious disease , the death rate is going to be high for numerous reasons , including : health workers are not looking for the new disease and will miss cases early in their progression ; @ @ @ @ @ @ @ for the illness ; and people don ’ t yet know how it is spread ( and , thus , how best to contain it ) .
In the first few dozen patients in China , all of whom were already hospitalized , the CFR was 15 percent , a recent paper in The Lancet noted .
Although the rate has pushed down over subsequent weeks , as the origin of the outbreak , China ’ s relatively high overall rate is not a surprise .
Even though the first reported Covid-19 death @ @ @ @ @ @ @ do not agree on what the country ’ s actual CFR should be .
One group of researchers reported in Nature Medicine that , as of the start of March , the fatality figure there should be 1.4 percent of symptomatic cases .
Another team , writing in The Lancet , estimated it should be 5.6 percent .
These sizable differences come from balancing considerations of estimating the capacity of health care systems to identify cases and deaths , determining the ability to approximate actual rates of infection ( including those not tested @ @ @ @ @ @ @ delay between onset of illness and death ( tabulating current deaths with current infections might be misleading because of the two- to eight-week lag from early symptoms to death ) , among other factors .
Clearly , finding the CFR is not as easy as an exercise in long division .
China ’ s governmental response , facilitated by being relatively centralized , likely played a large role in eventually slowing the outbreak — and lowering the fatality rate — there .
As more people were able to be tested and the hotspot @ @ @ @ @ @ @ fewer cases emerged , and those that did could be detected earlier .
New evidence , though , also reveals that China has underreported the number of cases and deaths from Covid-19 .
Italy currently has the highest fatality rate for Covid-19 of any country with a major outbreak .
Why ?
One factor in this , experts have suggested , is the relatively older population of the country .
The novel coronavirus is considerably more fatal with each passing decade of life .
As a March 23 viewpoint in JAMA noted , @ @ @ @ @ @ @ a 3.5 percent chance of dying if they get Covid-19 ; those 80 and up face a 20.2 percent chance .
And Italy has one of the oldest populations in the world .
According to the World Bank , nearly a quarter of the country ’ s population is 65 or older , a higher percentage than any other country except for Japan .
( There are also numerous other factors , including a cultural tradition of physical closeness , that could be contributing to Italy ’ s overwhelming number of cases and @ @ @ @ @ @ @ from The Conversation points out . )
But that doesn ’ t entirely explain the country ’ s high number .
( As we ’ ll see below , Germany , which also has a fairly old population , has one of the lowest Covid-19 fatality rates . )
Some of Italy ’ s dire death rate might be due to how slow it was to do widespread testing .
Italy has now performed a lot of tests — about 3,500 per million people as of March 20 ( compared to about 300 @ @ @ @ @ @ @ same time ) .
But it was , compared to countries like Germany and South Korea , relatively slow in the early stages of its outbreak to make large numbers of tests available , allowing the virus to spread undetected for crucial periods of days and weeks while people went about their daily lives , unaware that a crisis was looming .
Experts are not sure why Germany has managed to maintain such a low fatality rate for Covid-19 .
As HJ Mai reported in Vox , part of it does likely have @ @ @ @ @ @ @ : Another benefit of the widespread early testing is that they were able to locate a larger number of cases — adding to the denominator — many of which were milder and less likely to lead to a death .
As Mai wrote , “ The majority of cases in Germany have been detected in people between the ages of 35 and 59 .
That most coronavirus cases in Germany are being detected in an age demographic that is not considered part of the high-risk population could be a further contributing factor ” @ @ @ @ @ @ @ there is another question of timing that may be at play here , and that is when a country ’ s outbreak started .
Germany ’ s outbreak began later than Italy ’ s , with Italy topping 1,000 cases by March 1 , when Germany still was reporting just slightly over 100 .
And with the current estimates suggesting Covid-19 deaths occurring up to eight weeks after the onset of symptoms , as Mai notes , “ That means there ’ s a chance Germany and other nations in a similar stage @ @ @ @ @ @ @ spike in deaths.
” Indeed , their fatality rate has been climbing slowly over the past weeks .
Widespread and early testing , however , is not all that it takes to keep infection and death rates low .
The results of those tests also need to be swiftly acted upon to have the most benefit .
South Korea has been largely lauded for its rapid , robust , and coordinated response to its outbreak .
In addition to having conducted some 6,150 tests per million people by March 20 , they put @ @ @ @ @ @ @ right away , an article in Science explained .
Positive cases were isolated .
Additionally , that person ’ s contacts were traced , and they were themselves considered potential cases and asked to quarantine at home , as NPR reported .
New daily confirmed cases there spiked to their highest level March 1 — at 730 per day — and then dropped off , reaching an average of just 92 new cases per day by March 30 .
( By comparison , the US had about the same number of reported new @ @ @ @ @ @ @ March 15 — and , as of March 30 , had more than 18,000 new cases per day . )
To facilitate this massive undertaking , the country used GPS data from people ’ s phones ( because your phone is better at remembering where you were and who you were near than you are ) .
The approach raises privacy concerns , as Science pointed out , but it is also credited with helping to sharply curtail the country ’ s outbreak .
Japan , a country with more than 35.8 million @ @ @ @ @ @ @ global health experts worried .
The government has lagged on testing as well as on instituting strict social distancing guidelines .
As of late March , many shopping malls in Tokyo were still open and busy .
And as of March 19 , the country had performed just 117 tests per million people ( which pales in comparison to even the paltry efforts of the US ’ s 313 tests per million people by the same date ) .
As Eric Margolis reported for Vox , these facts do not bode well : @ @ @ @ @ @ @ ’ s relatively constant numbers of reported Covid-19-related deaths , despite rising case numbers .
( There have been some questions as to whether Japan is thoroughly testing those with pneumonia , a common outcome and cause of death for severe Covid-19 cases . )
Some attribute this to effective contact tracing that was done of cases early on in the outbreak or the country ’ s strong health care and elder care systems , Margolis noted .
Time — and increased testing — will tell whether Japan has efficiently controlled the virus @ @ @ @ @ @ @ to do .
Or if it was a case of delayed detection and containment leading to a much larger disease burden .
Where does the US stack up in all of this ?
Given that testing rates have been exceedingly low especially early on , as in Italy , undetected cases continued to spread the virus .
As Dylan Scott and Rani Molla of Vox have written , case numbers in the US were more in line with Italy and Iran in mid-March , and “ far outpaced places like Hong Kong and @ @ @ @ @ @ @ quickly.
” The US is now on an even sharper trajectory of new cases than Italy or Iran .
And that means a spike in deaths may well be coming next .
That is one of the other factors that can lead to a higher CFR : a sudden jump in the number of severe cases .
When that happens , it “ adds to the strain on the healthcare system and can overwhelm its medical resources , ” wrote a team of researchers March 27 in The Lancet .
That can result @ @ @ @ @ @ @ many lives .
( Hence the call to “ flatten the curve.
” ) The US might be looking at this scenario in many places .
New York City is already running out of hospital beds , with the projected peak outbreak there predicted to still be weeks away .
And other cities and towns might face similar fates .
Within the US , too , the rates of mortality are varying widely .
As of April 1 , Louisiana had a CFR of 4.2 percent — compared to California ’ s 2.1 @ @ @ @ @ @ @ regional disparities are yet to be determined , but they will likely end up including the same factors that lead to countries ’ different rates , such as the area ’ s healthcare resources and containment policies as well as the overall age and health of the population .
( Current counts for states ’ case and fatality numbers can be found here . )
What experts are looking out for next It will be some time before testing catches up and we have firmer numbers for countries ’ actual CFRs .
Even @ @ @ @ @ @ @ remain sharp contrasts among nations .
As researchers noted in a March 20 Science report , “ The patchwork reflects different phases of the epidemic , as well as differences in resources , cultures , governments and laws.
” As we learn more about the fatality rates for different populations of people , though , it will hopefully help governments make the best decisions about public health policies — as well as the best allocation of resources to protect and treat the most vulnerable .
A country ’ s response , so far @ @ @ @ @ @ @ impact on the severity of an outbreak and the subsequent number of deaths , as demonstrated by South Korea ’ s apparent success ( which was also achieved without broadly shuttering daily life ) .
One of the big questions that remains to be answered is how the overlapping factors of a country ’ s age demographics and its health care resources impact the fatality rate .
Going off of median age or the proportion of the population 65 or older may or may not end up being the next strongest predictor .
@ @ @ @ @ @ @ the whole , to be wealthier and healthier , with better health and social infrastructures to begin with ( for example , the notoriously rich country of Monaco boasts the highest media age : 55 ) .
Countries with younger populations , on the other hand , are often places where health care and other resources are scarcer and people are already not as likely to live to late adulthood ( see Niger as the country with the youngest median age , at 14 ; and consider that in Uganda , only 2 @ @ @ @ @ @ @ ) .
So , as the Covid-19 pandemic continues its global spread , experts will be closely watching not just countries with a large proportion of octogenarians but also those with higher poverty rates and already-stressed systems .
These countries might also be more likely to lag behind in test availability , logistics , and reporting , so it is possible that accurate data will be delayed or perhaps never be collected to know the true numbers of those infected or who perish from the illness .
But even in the US , @ @ @ @ @ @ @ never know the true number of deaths this coronavirus causes .
Because how we determine the ultimate cause of someone ’ s death is often not clear cut .
Will we ever know the pure case fatality rate of SARS-CoV-2 ?
Some scientists are looking to the natural experiment that took place aboard the Diamond Princess cruise ship , which was quarantined for more than a month .
During that time , about 19 percent of the ship ’ s passengers and crew fell ill and were confirmed to have Covid-19 .
Of @ @ @ @ @ @ @ seven died , providing a CFR in a well-tested group of people of 0.99 percent .
The cruise ship demographic did skew older , so , as researchers pointed out in The Lancet , “ the CFR in a healthy , younger population could be lower.
” Whatever they end up being , the numbers from this pandemic will doubtlessly be studied for decades to come .
As in a laboratory experiment where researchers set up different versions of the same test , changing this variable or that , the world ’ s @ @ @ @ @ @ @ test case .
With hindsight and thorough analysis , we will eventually be able to more carefully plot out steps and missteps and what combinations of factors from these experiments came to mean for different populations .
And hopefully , with that knowledge , we will be able to better head off the next pandemic threat , which could be even more virulent .

The race to track and slow the coronavirus pandemic has been very much a numbers game.
While we watch the number of cases — and deaths — climb, experts also are closely eyeing what they call the case fatality rate (CFR). This tells the proportion of people who have been confirmed as having Covid-19 and ultimately die from the illness, and it’s a number that has been varying widely from country to country.
Some countries, such as Germany, have a fatality rate of approximately 3 percent of confirmed cases, whereas Italy’s rate has climbed above 13 percent. Even within the US, large differences have emerged: As of April 20, Michigan had reported a CFR of 7.6 percent, compared to Oregon’s 3.8 percent.
Since scientists are pretty sure the virus isn’t mutating very quickly, the pathogen itself shouldn’t be more deadly in one place than another. So why the variation?
Figuring out what is driving these disparate numbers reveals differences not just in population demographics but also in health care capacity and government response. Understanding CFRs might also help us slow deaths around the world — especially for the most vulnerable countries and individuals.
Why might fatality rates be so radically different?
Before diving into the details from different countries, it’s worth looking at some of the broad reasons why death rates can look so starkly different from place to place.
First, we know that there are big differences in the risk the virus poses to different age groups. For this coronavirus, SARS-CoV-2, older individuals are far more likely to become critically ill or die from the disease. In a paper in The Lancet Infectious Diseases, researchers concluded, when looking at data from China and elsewhere, that people between the ages of 40 and 49 have an estimated CFR of about 0.4 percent; for those 80 and older, it’s 13.4 percent. This gulf of survivability is already playing out in some countries with older populations, such as Italy.
Additionally, Covid-19 has been demonstrably deadlier for those with existing health conditions, including lung disease (often caused by smoking), cardiovascular disease, severe obesity, diabetes, kidney failure, and liver disease. So countries — or regions — with less healthy populations might also be seeing big differences in the rates at which people are dying from the illness.
Beyond the varying impacts of the illness itself, there are lots of variables in how numbers are being gathered and reported. Perhaps the biggest factor here is testing. When experts calculate a basic fatality rate, it can be as simple as dividing the number of deaths by the number of confirmed cases (although — and we’ll get to this later — it really shouldn’t be).
Since the international spread of the novel coronavirus, countries have varied widely in their ability and willingness to roll out testing. So that means the denominator (the number of cases) can be closer or further from an accurate count of how many people actually have the virus. The larger the percentage of a population that has been tested, the more complete picture we will get of the virus’s actual fatality rate there.
The other issue with the poor testing rates is sampling bias. Tests that are available are usually saved for the sickest and riskiest cases. This pushes the fatality rate higher than it actually is because the testing is more likely to omit mild or asymptomatic cases and instead overrepresents those who are more likely to die. So, as testing becomes more widespread in various countries, their fatality rates will drop.
That is no reason for optimism, as the authors of the study in The Lancet note. The researchers offer an overall CFR for Covid-19 at 1.38 percent, which reflects their estimates for lack of testing and other factors, including potential censorship. This number, they noted, is still “substantially higher than for recent influenza pandemics (e.g. H1N1 influenza in 2009)” — “swine flu” — which had a case fatality rate of 0.1 percent. Their estimated CFR, “combined with likely infection attack rates (around 50-80 percent), show[s] that even the most advanced health-care systems are likely to become overwhelmed.” It is clear that this is far worse than the seasonal flu.
Another way to look at death rates — in the absence of widespread testing — is to compare the number of Covid-19 deaths to a country’s total population, which is what researchers have done here.
In another effort to make up for incomplete testing (and possibly incomplete reporting), researchers are attempting to estimate what percentage of actual cases have been reported (as of a couple weeks ago) for each country.
The other factors likely impacting the vastly different fatality rates include a country’s resources (particularly its health care capacity), its organization (such as how easily it can institute effective, widespread public health measures), and how forthcoming it is with data.
We will likely see other factors emerge as the pandemic rages on and more data comes in. But here’s what we know so far about some of the key countries and their fatality rates for Covid-19 based on the number of confirmed cases.
For each country, we are using April 20 data from the University of Oxford’s Center for Evidence-Based Medicine, which has been updating its statistics on dozens of countries’ fatality rates daily. You can find their full list of countries, which includes data on how confident they are in their estimates, here.
China
Estimated CFR: 5.6 percent
Early on in any pandemic of a potentially fatal infectious disease, the death rate is going to be high for numerous reasons, including: health workers are not looking for the new disease and will miss cases early in their progression; there aren’t established treatment protocols for the illness; and people don’t yet know how it is spread (and, thus, how best to contain it).
In the first few dozen patients in China, all of whom were already hospitalized, the CFR was 15 percent, a paper in The Lancet noted. Although the rate has pushed down over subsequent weeks, as the origin of the outbreak, China’s relatively high overall rate is not a surprise.
Even though the first reported Covid-19 death occurred there January 11, experts still do not agree on what the country’s actual CFR should be. One group of researchers reported in Nature Medicine that, as of the start of March, the fatality figure there should be 1.4 percent of symptomatic cases. Another team, writing in The Lancet, estimated it should be 5.6 percent.
These sizable differences come from balancing considerations of estimating the capacity of health care systems to identify cases and deaths, determining the ability to approximate actual rates of infection (including those not tested), and accounting for the time delay between onset of illness and death (tabulating current deaths with current infections might be misleading because of the two- to eight-week lag from early symptoms to death), among other factors. Clearly, finding the CFR is not as easy as an exercise in long division.
China’s governmental response, facilitated by being relatively centralized, likely played a large role in eventually slowing the outbreak — and lowering the fatality rate — there. As more people were able to be tested and the hotspot of Wuhan was put on lockdown, fewer cases emerged, and those that did could be detected earlier. New evidence, though, also reveals that China has underreported the number of cases and deaths from Covid-19.
Italy
Estimated CFR: 13.22 percent
Italy currently has the highest fatality rate for Covid-19 of any country with a major outbreak. Why? One factor in this, experts have suggested, is the relatively older population of the country. The novel coronavirus is considerably more fatal with each passing decade of life. As a March 23 viewpoint in JAMA noted, those 60 and older in Italy have a 3.5 percent chance of dying if they get Covid-19; those 80 and up face a 20.2 percent chance.
And Italy has one of the oldest populations in the world. According to the World Bank, nearly a quarter of the country’s population is 65 or older, a higher percentage than any other country except for Japan. (There are also numerous other factors, including a cultural tradition of physical closeness, that could be contributing to Italy’s overwhelming number of cases and high death rate, as this piece from The Conversation points out.)
But that doesn’t entirely explain the country’s high number. (As we’ll see below, Germany, which also has a fairly old population, has a relatively low Covid-19 fatality rate.) Some of Italy’s dire death rate might be due to how slow it was to do widespread testing.
Italy has now performed a lot of tests — about 22 per 1,000 people as of April 20 (compared to about 11 per 1,000 in the US). But it was, compared to countries like Germany and South Korea, relatively slow in the early stages of its outbreak to make large numbers of tests available, allowing the virus to spread undetected for crucial periods of days and weeks while people went about their daily lives, unaware that a crisis was looming.
Germany
Estimated CFR: 3.19 percent
Experts are not sure why Germany has managed to maintain a relatively low fatality rate for Covid-19.
As HJ Mai reported in Vox, part of it does likely have to do with their aggressive early testing:
The [country’s Robert Koch Institute] early on recommended broad testing to detect cases as soon as possible and to slow the outbreak. “This is probably why we started to see cases very early, also mild ones, which in other circumstances might have been missed,” RKI’s [deputy spokeswoman Marieke] Degen said. “If you start seeing deaths, it indicates that the virus has already been active in the community for some time.”
Another benefit of the widespread early testing is that they were able to locate a larger number of cases — adding to the denominator — many of which were milder and less likely to lead to a death. As Mai wrote, “The majority of cases in Germany have been detected in people between the ages of 35 and 59. That most coronavirus cases in Germany are being detected in an age demographic that is not considered part of the high-risk population could be a further contributing factor” to the low fatality rate.
But there is another question of timing here, and that is when a country’s outbreak started. Germany’s outbreak began later than Italy’s, with Italy topping 1,000 cases by March 1, when Germany still was reporting just slightly over 100. And with the current estimates suggesting Covid-19 deaths occurring up to eight weeks after the onset of symptoms, as Mai notes, “That means there’s a chance Germany and other nations in a similar stage of the outbreak could soon see a spike in deaths.” Indeed, their fatality rate has been climbing slowly over the past weeks, rising from about 1 percent at the beginning of April.
Related Why France has 4 times as many coronavirus deaths as Germany
South Korea
Estimated CFR: 2.21 percent
Widespread and early testing, however, is not all that it takes to keep infection and death rates low. The results of those tests also need to be swiftly acted upon to have the most benefit.
South Korea has been largely lauded for its rapid, robust, and coordinated response to its outbreak. In addition to having tested about 3 people per thousand by March 5 (which was days before the US even started testing anyone in the general population), they put the results of those tests to use right away, an article in Science explained. Positive cases were isolated. Additionally, that person’s contacts were traced, and they were themselves considered potential cases and asked to quarantine at home, as NPR reported.
New daily confirmed cases there spiked to their highest level March 1 — at 730 per day — and then dropped off, reaching an average of just 67 new cases per day by April 1. (By comparison, the US had 777 reported new cases per day on March 15 — and, as of April 15, had more than 26,500 new cases per day.)
To facilitate this massive undertaking, the country used GPS data from people’s phones (because your phone is better at remembering where you were and who you were near than you are). The approach raises privacy concerns, as Science pointed out, but it is also credited with helping to sharply curtail the country’s outbreak.
Japan
Estimated CFR: 2.19 percent
Japan, a country with more than 35.8 million people 65 or older, has many global health experts worried. The government has lagged on testing as well as on instituting strict social distancing guidelines. As of late March, many shopping malls in Tokyo were still open and busy. And as of April 15, the country had performed just about 1 test per thousand people (which pales in comparison to even the paltry efforts of the US’s 10 tests per thousand people by the same date).
As Eric Margolis reported for Vox, these facts do not bode well:
“Thus far, Japan has managed to escape exponential growth, but the worst may be yet to come. ‘This may be the tip of the iceberg,’ said John Ioannidis, professor of disease prevention at the Stanford School of Medicine. ‘If you don’t test, you find no cases and even no deaths.’”
What has people puzzled is the country’s relatively constant numbers of reported Covid-19-related deaths, despite rising case numbers. (There have been some questions as to whether Japan is thoroughly testing those with pneumonia, a common outcome and cause of death for severe Covid-19 cases.) Some attribute this to effective contact tracing that was done of cases early on in the outbreak or the country’s strong health care and elder care systems, Margolis noted.
Time — and increased testing — will tell whether Japan has efficiently controlled the virus and deaths as South Korea has managed to do. Or if it was a case of delayed detection and containment leading to a much larger disease burden.
United States
Estimated CFR: 5.31 percent
Where does the US stack up in all of this? Given that testing rates have been exceedingly low especially early on, as in Italy, undetected cases continued to spread the virus. As Dylan Scott and Rani Molla of Vox have written, case numbers in the US were more in line with Italy and Iran in mid-March, and “far outpaced places like Hong Kong and Singapore, where the governments mobilized more quickly.” The US is now on an even sharper trajectory of new cases than Italy or Iran. And that means a spike in deaths may well be coming next.
That is one of the other factors that can lead to a higher CFR: a sudden jump in the number of severe cases. When that happens, it “adds to the strain on the healthcare system and can overwhelm its medical resources,” wrote a team of researchers in The Lancet. That can result in not being able to save as many lives. (Hence the call to “flatten the curve.”) The US might be looking at this scenario in many places. New York City is already running out of hospital beds, with the projected peak outbreak there predicted to still be weeks away. And other cities and towns might face similar fates.
Risk map of #COVID19 in America? Here's mine: Any urban center with areas of high population density, esp those with #poverty/crowding where practicing social distancing can be challenging. So far it's been a good predictive map: NYC, Chicago, Detroit, NOLA, ATL, LA, SF, Seattle pic.twitter.com/WuQGMb7z1u — Prof Peter Hotez MD PhD (@PeterHotez) March 26, 2020
Within the US, too, the rates of mortality are varying widely. As of April 20, Michigan had a CFR of 7.6 percent — compared to Oregon’s 3.8 percent. The reasons for these emerging regional disparities are yet to be determined, but they will likely end up including the same factors that lead to countries’ different rates, such as the area’s healthcare resources and containment policies as well as the overall age and health of the population. (Current counts for states’ case and fatality numbers can be found here.)
What experts are looking out for next
It will be some time before testing catches up and we have firmer numbers for countries’ actual CFRs. Even when that happens, there will likely remain sharp contrasts among nations. As researchers noted in a March 20 Science report, “The patchwork reflects different phases of the epidemic, as well as differences in resources, cultures, governments and laws.”
As we learn more about the fatality rates for different populations of people, though, it will hopefully help governments make the best decisions about public health policies — as well as the best allocation of resources to protect and treat the most vulnerable.
A country’s response, so far, appears to have among the largest impact on the severity of an outbreak and the subsequent number of deaths, as demonstrated by South Korea’s apparent success (which was also achieved without broadly shuttering daily life). And as Vox’s Alex Ward writes: “Saving lives is ... about how quickly, thoroughly, and effectively the government responds to the brewing crisis. Any delay, it seems, is very costly.”
One of the big questions that remains to be answered is how the overlapping factors of a country’s age demographics and its health care resources impact the fatality rate. Going off of median age or the proportion of the population 65 or older may or may not end up being the next strongest predictor.
Countries with older populations tend, on the whole, to be wealthier and healthier, with better health and social infrastructures to begin with (for example, the notoriously rich country of Monaco boasts the highest media age: 55). Countries with younger populations, on the other hand, are often places where health care and other resources are scarcer and people are already not as likely to live to late adulthood (see Niger as the country with the youngest median age, at 14; and consider that in Uganda, only 2 percent of the population is over 65).
So, as the Covid-19 pandemic continues its global spread, experts will be closely watching not just countries with a large proportion of octogenarians but also those with higher poverty rates and already-stressed systems.
These countries might also be more likely to lag behind in test availability, logistics, and reporting, so it is possible that accurate data will be delayed or perhaps never be collected to know the true numbers of those infected or who perish from the illness. But even in the US, as the Atlantic reported, we might never know the true number of deaths this coronavirus causes. Because how we determine the ultimate cause of someone’s death is often not clear cut.
Will we ever know the pure case fatality rate of SARS-CoV-2? Some scientists are looking to the natural experiment that took place aboard the Diamond Princess cruise ship, which was quarantined for more than a month. During that time, about 19 percent of the ship’s passengers and crew fell ill and were confirmed to have Covid-19. Of those 705 people with the virus, seven died, providing a CFR in a well-tested group of people of 0.99 percent. The cruise ship demographic did skew older, so, as researchers pointed out in The Lancet, “the CFR in a healthy, younger population could be lower.”
Whatever they end up being, the numbers from this pandemic will doubtlessly be studied for decades to come. As in a laboratory experiment where researchers set up different versions of the same test, changing this variable or that, the world’s countries are now part of this global test case.
With hindsight and thorough analysis, we will eventually be able to more carefully plot out steps and missteps and what combinations of factors from these experiments came to mean for different populations. And hopefully, with that knowledge, we will be able to better head off the next pandemic threat, which could be even more virulent.