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Disclosures: Adalja and Mokdad report no relevant financial disclosures.
November 03, 2020
3 min read

COVID-19 projections show health systems facing ‘extreme stress’


Press Conference

Disclosures: Adalja and Mokdad report no relevant financial disclosures.
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As COVID-19 resurges across the United States and many places globally, experts estimate there will be major increases in cases and deaths over the next 6 months.

“Europe is seeing a surge right now, and Europe is about a month ahead of the United States,” Ali Mokdad, PhD, chief strategy officer at the University of Washington’s Institute for Health Metrics and Evaluation (IHME), said during a recent press briefing hosted by the Infectious Diseases Society of America. “So basically, we are watching what would unfold here in the United States.”

Amesh Adalja

US projections

According to the IHME, the fall and winter surge has already begun in the U.S., with an accelerating increase in daily cases and deaths already in effect and even further acceleration expected in the next 2 to 3 weeks. The data show that daily cases in the past week increased to 60,000 a day, up from 50,000 a day the week before, which suggests an accelerating week-on-week increase.

Unfortunately, with the increase in cases comes an increase in deaths. The IHME expects the surge to cause a daily death toll approximately three times higher than the current rate by mid-January. The data show that daily deaths are up to 770 in the last week, a 9% increase from the week before. The IHME said that even at this early point in the fall and winter surge, COVID-19 is the second-leading cause of death in the U.S. Some states, including Montana, North Dakota, South Dakota, Kansas and Wisconsin, are facing high death rates of more than four deaths per million residents.

In terms of what is driving transmission in the U.S., the IHME determined that social distancing mandates have stayed the same despite the surge of cases and deaths, apart from Iowa lifting business restrictions. Only one mandate school restrictions remains in place in Florida, Idaho, Iowa, Missouri, Oklahoma and South Dakota. Additionally, the data showed that mask use is holding steady at 65%. The highest levels of mask use are on the West Coast and in the Southwest and Northeast and is lowest in Idaho, Wyoming, North Dakota and South Dakota. According to the IHME, scaling up mask wearing could delay the need for further social distancing mandates and save 62,000 lives by Feb. 1.

Moving forward, the IHME anticipates that hospital systems, particularly ICUs, will be under “extreme stress” in December and January in at least 18 states. The IHME projects that there could be 399,000 cumulative deaths by February, although it said added that “if states do not react to rising numbers by reimposing mandates, cumulative deaths could reach 514,000 by the same date.”

“Some voices are underplaying the virus or doubting the need for mask mandates in the United States,” Mokdad said. “We need a message that is scientific and that will help us spread the need for the public to be more vigilant.”

Global projections

Global cases of COVID-19 and deaths are rising steadily, according to the IHME. Experts expect that the Northern Hemisphere fall and winter surge will cause an increase in daily deaths reaching up to three times the current daily death toll by January, causing “severe to extreme stress” on hospitals.

Currently, IHME data show around 375,000 daily cases an increase of about 75,000 cases per day compared with the previous week. Daily deaths have also increased to 6,200 deaths per day, making COVID-19 the fifth leading cause of death globally.

Drivers of transmission are changing as social distancing mandates are being reimposed in some locations in Europe, with more planned for the coming weeks. According to the IHME data, mobility stayed relatively constant over the past few weeks about 20% below the pre-COVID-19 levels. Additionally, mask use remained relatively constant at the global level, with increases in the past week observed across Europe and North America, although decreases were seen in Brazil. The rate of diagnostic testing is also fairly constant at the global level, with the highest rates of testing seen in European countries, as well as many U.S. states and Canadian provinces.

Moving forward, the IHME anticipates daily deaths steadily rising in November and reaching nearly 18,000 a day in January and cumulative deaths reaching 2.5 million by February. Currently, more than 1.2 million people have died from COVID-19 globally, according to tracking by Johns Hopkins University.

“I think it's important to remember that models are kind of ‘if-then’ if things continue the way they are, [then] this is what's going to happen,” Amesh Adalja, MD, senior scholar at Johns Hopkins University Center for Health Security, said during the press briefing. “There are assumptions built into models that models will be a reflection of reality, but because we're living in that reality, we have the ability to change the trajectory of those models. And I think that's an important point about models.”


IHME. COVID-19 resources. Accessed on Nov. 3, 2020.

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