What could the final death toll for the coronavirus pandemic look like?

The predicted death toll for the coronavirus pandemic is the subject of much speculation, a matter not helped by initial attempts by some populist leaders like US President Donald Trump and the UK’s Prime Minister Boris Johnson to play down the potential number of infections.

Experts at Imperial College were able to bring about an infamous change of heart with their research showing millions could die without intervention.

“We estimate that in the absence of interventions, COVID-19 would have resulted in 7.0 billion infections and 40 million deaths globally this year,” a report by Imperial College academics said.

“Mitigation strategies focussing on shielding the elderly (60% reduction in social contacts) and slowing but not interrupting transmission (40% reduction in social contacts for wider population) could reduce this burden by half, saving 20 million lives,” the report estimated. 

The researchers warned that even with mitigation measures, hospitals could become overwhelmed with the surge of patients causing unnecessary and preventable deaths.

They estimate that with sufficient suppressive measures to combat the virus, 95 percent of those 40 million potential deaths can be avoided.

“If a suppression strategy is implemented early (at 0.2 deaths per 100,000 population per week) and sustained, then 38.7 million lives could be saved whilst if it is initiated when death numbers are higher (1.6 deaths per 100,000 population per week) then 30.7 million lives could be saved,” the report stated.

The UK and US were slow to act initially thanks to a prevailing sentiment among their leaders that the virus could sweep through the population without much disruption to lives or the economy.

Their folly in not acting sooner is now becoming clear.

The US now has the highest number of cases in the world with 200,000 confirmed infections, with 5,000 deaths resulting from the disease. 

In the UK, Johnson was himself infected with the virus, as were several of his ministers. The spread of the virus continues to gather steam in the country.

"Our research adds to the growing evidence that the COVID-19 pandemic poses a grave global public health threat. Countries need to act collectively to rapidly respond to this fast-growing epidemic,” said Neil Ferguson, an author on the Imperial College report.

After initially asserting that “We cannot let the cure be worse than the problem itself”, Trump has backtracked from his earlier stance. On February 26, the Republican falsely claimed that cases in the US will go “down to close to zero” in the near future. 

Now, the US president is stressing the importance of preventative action and mitigating deaths.

“So you’re talking about 2.2 million deaths, 2.2 million people from this. And so if we could hold that down, as we’re saying, to 100,000 — it’s a horrible number, maybe even less — but to 100,000. So we have between 100 and 200,000, and we all together have done a very good job," Trump said on March 30.

Experts, including Trump’s top medical advisor, Antony Fauci, believe that the virus could kill as many as 240,000 Americans. Fauci urged the government to keep lockdown measures on for a longer period. 

According to a scientific model developed for the US context, without any measures, 126.5 million people could contract the Covid-19 virus across the country between January and late October, with a peak of 37.8 million on June 5. 

“More than 1.3 million people would die under these conditions and 125 million people would recover,” the authors of the model said.

How suppression measures could save lives

A suppressive strategy allows governments and healthcare providers the time needed to better treat patients with the coronavirus and stop excessive strain on healthcare services.  

“Our analysis therefore suggests that healthcare demand can only be kept within manageable levels through the rapid adoption of public health measures (including testing and isolation of cases and wider social distancing measures) to suppress transmission, similar to those being adopted in many countries at the current time,” the Imperial College report said. 

The interventions will also help flatten the infection and death curve.

The efforts coincide with attempts to find a vaccine or cure for the illness, which could take up to a year and a half.

“We do not consider the wider social and economic costs of suppression, which will be high and may be disproportionately so in lower income settings. Moreover, suppression strategies will need to be maintained in some manner until vaccines or effective treatments become available to avoid the risk of later epidemics,” the report advised. 

The virus has spread to more than 200 countries, with cases nearing a million, and deaths approaching 50,000.

"Sharing both resources and best practice is critically important if the potentially catastrophic impacts of the pandemic are to be prevented at a global level," Ferguson concluded.