COVID-19 forecaster: ‘Unthinkable’ daily death counts coming

BOSTON — A few weeks ago, COVID-19 modeler Qi-Jun Hong forecasted 1,000 deaths per day in the United States by the end of the year. Monday, the Brown University research scientist ventured into what he called ‘unthinkable’ territory: upping his prediction to 1,500 deaths per day.

And that’s a “best-case scenario,” according to Hong.

“My model assumes people will take action when they see these scary numbers,” Hong said. “If we don’t take action, the number will just keep going up.”

While Hong has confidence Americans will, at some point, adopt protective public health habits, there is little evidence that’s happening now. His model incorporates human interactions in its attempt to forecast future COVID infections, a variable he calls ‘Encounter Densities.’

“Our encounter density is still very high,” Hong said. “So on the pre-pandemic level it’s 100%. Our current encounter density data is about 90%.”

By comparison, during the spring lockdowns, encounter densities hovered in the 30-50% range, Hong said.

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Without the public’s cooperation, Hong expects U.S. daily case counts to soar by 20% a week. That would mean numbers well above the nearly 100,000 cases per day seen in recent days, with a rise in deaths lagging by about two weeks.

By comparison, the toughest days during the summer wave brought about 70,000 cases, Hong said; and in spring, about half that.

“But this time the weather is against us,” Hong said. “We need to work even harder to flatten the curve and that’s big trouble.”

And this third wave is causing some very big trouble for the 20% of Americans who consider rural parts of the country home. Unlike the spring and summer waves, which heavily affected urban areas, the fall outbreak is hitting sparsely populated areas too.

“In rural communities all across the U.S. you have an elderly population with multiple chronic health issues,” said Alan Morgan, CEO of the National Rural Health Association in Washington, DC. “These small towns are the worst possible set-up for a COVID outbreak.”

Many lack hospitals. Morgan said that more than 130 rural hospitals have closed in the last 10 years – 16 so far in this year alone.

And even if communities do have hospitals, those small facilities were never equipped to handle a pandemic.

“The majority of them do not have dedicated ICU rooms,” Morgan said. “They simply are not set up for the type of patients they’re seeing now because of the COVID outbreak.”

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Severely ill COVID patients are thus usually transferred to large medical centers in the nearest city, but ‘nearest’ can mean ‘far away,’ and, Morgan pointed out, it can also mean an urban hospital already swamped with COVID-19 problems of its own.

So far, rural communities in the U.S. have seen about 1.2 million cases of COVID-19, Morgan said. And things have especially been tough lately.

“Over the last five weeks in particular, the mortality rate per population has been higher in rural areas,” he said. “This pandemic, quite literally, is more deadly in these small towns than in our urban communities.”

And at the present moment, Hong said, his model sees no end in sight to the latest wave.

“We are still moving up,” Hong said. “So the reproductive number is still increasing and there’s no sign of slowing down.”

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