# The Math that Matters Most

Math and the coronavirus have one thing in common: they don’t give two poops about what you believe.

As discussions over the COVID-19 pandemic descend further into political extremism each day, math has become a weapon of choice for any viewpoint. One of the biggest targets is the mortality rate – how likely it is that an infected person will die. On the “wearing a mask makes me a freedom-despising sheep” side, the common practice is to find math that shows this new coronavirus is no different from the flu. The problem is, the lower estimates of coronavirus mortality rates generally seem to originate from that vast game of telephone that we call Facebook. A game I am admittedly playing myself with this blog post, but please carry on.

So let’s start with the flu, our affectionate name for influenza. Let’s also start with a website run by people who have been educated to, and are paid to, investigate the spread and impacts of diseases: the Centers for Disease Control (CDC). If you want to see these numbers for yourself, here is the link: https://www.cdc.gov/flu/about/burden/2018-2019.html. Summarizing the 2018-2019 flu season, the CDC estimated the mortality rate as deaths per 100,000 people in five age groups:

As you look at this table, one thing is clear: assigning a single number to the mortality rate hides some important information about how dramatically it varies by age group, with the elderly being most at risk as expected. But if you go ahead and count up all the infections and deaths from the 2018-2019 flu season, you get 35,500,000 ill and 34,200 deaths – leading to a mortality rate of 0.096% – or about one in a thousand.

A viral (yes I know) post on Facebook has stated the CDC “confirmed a 0.2% death rate for COVID19”. Let’s start with some more advanced math: that’s twice the rate of the 2018-2019 flu season. Let’s also look behind the number – what the CDC in fact said (in May 2020) was that their estimated mortality rate for those showing symptoms was between 0.2% and 1%, with a “best estimate” of 0.4% – or four times the mortality rate of the 2018-2019 flu. The CDC estimated (again, in May) that the mortality rate for those with and without symptoms was around 0.26% – a little over two and a half times the mortality rate of the 2018-2019 flu. In any case, every number in this paragraph says the new coronavirus is more lethal than the flu. Some people can’t even get conspiracies right.

The yearly estimates of mortality rate for the flu are usually based on the infection-fatality rate, which among other methods is explained in this National Geographic article: https://www.nationalgeographic.com/science/2020/07/coronavirus-deadlier-than-many-believed-infection-fatality-rate-cvd/. Epidemiologists (again, people who put a fair amount of effort into understanding diseases) have reviewed data from the New York City outbreak from March 1 to May 16, and their estimate of the COVID-19 mortality rate is 1.46%. That is nearly fifteen times more lethal than the most recent flu. The estimated mortality rate for those older than 75 is 13.83%. That’s about a one in seven chance of not surviving.

Despite all this conversation around mortality rates, it is my assertion that everybody is missing the point. There might be one piece of math that matters more than any other: how many people need to be hospitalized vs how many beds and respirators are available. Once the former becomes bigger than the latter, we become a society that tells some number of people we simply don’t have enough resources to keep them alive – whether they are suffering from COVID-19 or some other affliction. Think on that for a moment – and also think on what it would do to the mortality rates from just about anything.

If you go to this link: https://www.healthline.com/health-news/why-covid-19-isnt-the-flu#Hospitals-overwhelmed, you will find a comparison of hospitalization rates for the initial six weeks of the COVID-19 outbreak and the first six weeks of the 2017-2018 flu season. The overall rate for the flu was 1.3 people per 100,000. The overall rate for COVID-19 was 26.2. Both numbers go up by more than a factor of three for people 65 years and older. Just focusing on the 26.2 overall number: if you extrapolate that to the US population of around 330 million, that’s around 86,460 people requiring hospitalization, and that has typically not been a short stay for COVID-19, meaning there’s a lot of overlap. According to the American Hospital Association (https://www.aha.org/statistics/fast-facts-us-hospitals), there are 924,107 staffed beds in all US hospitals. That means at the infection rate of the first six weeks of the COVID-19 outbreak, something likely larger than 5% of the total beds in the US would have to be allocated to COVID-19 victims alone. The number of intensive care beds in community hospitals is a little over a hundred thousand, a number much more perilously close to the estimated number of people that would need hospitalization for COVID-19 – and those people tend to need fairly significant care – not just equipment, but the nurses who have to come in multiple times per hour for treatments. ICU beds, by the way, are typically configured for certain types of care (post-surgical, pediatric, etc).

Another view of available resources to combat the pandemic has been assembled by the Society of Critical Care Medicine (https://sccm.org/Blog/March-2020/United-States-Resource-Availability-for-COVID-19). There you will find a similar estimate of nearly a hundred thousand ICU beds. A smaller number of rooms are capable of negative pressure isolation, a means of containing pathogens and preventing their spread to the rest of the hospital. It is estimated that US acute care hospitals own 62,188 full-featured mechanical ventilators, with another 98,738 non-full-featured devices that can be used during a surge in need. The US Strategic National Stockpile has another 12,700 ventilators.

Let’s throw these numbers together again once more: 100,000 ICU beds, 170,000 ventilators, and 86,000 people needing hospitalization for COVID-19 alone based on data from early in the outbreak, and indications are that we are on our way up another spike in infections, with another wave expected in the fall, coincident with the new flu season, all against the backdrop of all the other reasons a person might need an ICU bed or a ventilator. This is the math that matters. This is the math that tells us how close we are to being a nation that has to choose who lives and who dies, for nothing other than lack of resources, human or otherwise. That should be the topic of a dystopian science fiction novel, not the consequence of our conscious decisions. You can refuse to wear a mask, but you can’t mask the math that goes with that decision. “Freedom” is teetering on the precipice of something far darker than masks and six feet of separation.