OSTERHOLM: I’m from rural Iowa where a lot of very commonsense, smart people live. I think to myself: if I were at the local café, how could I explain what’s going on to a group of people sitting at that table? I’d say to them, let’s just take the following simple numbers.
There are 320 million people in the United States. If half of them get infected in the next 6 to 18 months, that’s 160 million people. The 50% rate of infection over the course of the pandemic is at the low end of my colleagues’ consensus on what we can expect to see given the infectiousness of this virus.
Based on what we know from Asia, from the European Union and from the United States, about 80% of these cases will have asymptomatic, mild or moderate illness but won’t need professional medical care. About 20% of infected people will seek medical care. That’s 32 million people.
Of those, about half will be hospitalized. That’s 16 million people. Of those who are hospitalized, about half will actually require some form of critical care. That’s 8 million people. About 0.5 to 1% of the total number of 160 million infected people will die. So you have the possibility of at least 800,000 deaths in the US over the next 18 months. This is the number of deaths I’m expecting.
BERGEN: Is there a world in which we would all be issued nationally recognized status as immune that would allow us to go back to work? Relatedly, would that really work if there are faulty tests?
OSTERHOLM: I’ve seen this idea expressed by a number of people in the past few days. They believe that we just need to have a kind of system where we see if you have been infected using antibody tests. Right now, Covid-19 virus and antibody testing in this country and in some other parts of the world is nothing more than the Wild, Wild West.
Before we can launch on any kind of an immune status national program, we have to understand two things. One is what the test results really mean. Does a positive antibody test mean someone has immunity or not? I think that’s a big challenge. In a low prevalence area for previous Covid-19 infection, which is most of the country, a positive antibody result could be a true positive or a false negative.
These both are important moonshot issues and we need to do the work right now to clarify. We need to invest in developing critical manufacturing infrastructure for reagents and support testing in general. And then, second of all, we have to know what that testing means.
I think there have been a number of health care workers who have been infected or who suspect they’ve been infected, but were never tested at the time. There wasn’t adequate testing available. Today if they could know that they were antibody-positive and there was sufficient data to support that they likely were protected against becoming infected again, then, wow! Think how that would change the picture of health care if 20 or 30% of our current medical staff were already protected. That would give them an incredible peace of mind.
The problem is that we don’t have a national prioritization around this issue.
And there is the rub. There is no national prioritization of a mass-produced, accurate antibody test — why is that?