What the coronavirus teaches us about time and risk

How bad are the odds of dying from coronavirus?

That’s a question on many people’s minds these days. A lot of us are following the numbers closely and wondering, how safe am I?

To truly understand risks, you must account for the time period for which those risks are valid.

According to recent forecasts by the University of Washington’s predictive model the U.S. may lose up to 68,000 people to Covid-19 before the pandemic is over. That number looks low, since as of April 24, 2020, the US has already recorded more than 50,000 deaths, and well over 2,000 per day are added to the toll.

If this forecast is accurate, the risk of dying would be 1 in 4,853. Not great, but not alarming, either. At first glance. Those odds are lower than from dying in a pedestrian accident, which are 1 in 541.

What’s wrong with this picture? Why are extreme lockdown measures being taken at the national, state, and local levels to deal with Covid-19, but not to mitigate many other, often preventable causes of death?

Even if the U.S. were to lose 2.2 million people, based on an alarming early forecast (which did not take into account containment measures), the risk to any one individual would still be “just” 1 in 166. That is far lower than dying of heart disease (1 in 6), and still lower than the risk of dying in a car accident (1 in 106), or even, supposedly, just from falling (1 in 111). (These estimates come from the U.S.-based National Safety Council.) The fatality risk per person from base jumping (pictured above) is around 1 in 60 annually.

Here’s the rub: the seemingly low “risk of death” odds related to the coronavirus are misleading. Why? Because the they don’t account for the time span over which they play out.

Time is a key factor when computing odds of anything happening. You see, you may die in an accident over the next 40 years. But you may die of Covid-19 in the next 40 days.

That, in a nutshell, is why our response to dealing with Covid-19 is so urgent and extreme when compared to our response to dealing with heart disease, car crashes, and other fatalities.

The virus has exposed the fragility of our society

Covid-19 has revealed how fragile both our societies and economies are. This is true both at the local and the global level. It is a story of how a microscopic pathogen has wreaked global havoc. With a diameter of just 60-140 nanometers (laid end-to-end, about 600,000 would make an inch), Covid-19 is nature’s nano-weapon against humanity.

The odds of succumbing may appear fairly low, but Covid-19 is scary because it is an imminent threat. In this post I’m going to explain why.

The invisible weapon against humanity

Let’s review. The coronavirus is adept at homing in on the most vulnerable among us, to disable and even kill. However, there is no guarantee that those who appear fit and healthy have dodged a bullet, as they can succumb as well.  But unlike being hit by a “normal” weapon, in many cases people will never even know they have been “attacked.” In other cases, it will only become apparent days later.  

Worst of all, the virus has weaponized humans against each other. We, the most social of creatures, can’t come physically close to one another because we might accidentally cause each other to die.

And so, almost every government in the world has told its citizens to keep a distance of least six feet from each other. Entire countries are under stay-at-home orders of varying strictness. Businesses have been shut, economies are under massive strain and headed for collapse. It is as though the Great Depression is being resurrected like a zombie from the dead.

The odds of not making it

As bad as things are, in a way, things could be much, much worse. Only a small share of each country’s population shows symptoms of being infected, i.e. are reported as Covid-19 cases.

There is general agreement that these case numbers—tracked by Johns Hopkins and avidly followed by perhaps millions of people—are significantly under-counting the actual cases. The actual number of persons infected is not yet known, given the still unacceptably low testing rates in most countries. Even so, even if the rates of dying doubles, the chance of any single person succumbing would remain very low.

A study from the  Stanford Prevention Research Center estimated the absolute risk of dying among individuals younger than 65 without underlying diseases at just 1.7 per million in Germany (a country that so far has managed to keep death rates relatively low) to 79 per million in New York, the U.S. epicenter of the virus. That comes to a relatively minuscule risk of 1 person out of 588,000 in Germany, and a still very low risk of one person out of 12,658 in New York state.

These odds depend on age, gender and underlying health conditions, among other factors. Men, for example, are more at risk than women. And the risks are much greater for older adults than for the young.

In the U.S., the pandemic is taking a critical toll on African-American and Hispanic communities. This is due to the lethal combination of having worse underlying health conditions, and that they are generally less likely to have health insurance.

Let’s take demographics out of the equation for now, though, and consider the entire U.S. population of about 330 million people. That includes infected and non-infected, of course. And let’s remember that we don’t know the actual rate of infection, because not everyone is tested.

If U.S. fatalities from Covid-19 reach 68,000 before this is over, the absolute death rate for all ages would come to about one in 5,500. Looked at another way, if those are the odds of the average American dying of Covid-19, it means that 5,499 out of every 5,500 will survive this. 

I am not minimizing the importance of the measures taken to try and control the virus. In fact, the projection are fairly “low” largely because of all the social distancing measures being taken. This may be lost on the “liberate America” protesters

Healthcare and hospital systems are under strain in many areas. Clearly, they are not prepared to handle a surge in patients, just as morgues and cemeteries were not prepared to handle them. Doctors, nurses, and healthcare workers—the real heroes of this crisis—are putting their lives on the line while caring for patients. Often, they don’t have the equipment they need.

An outside observer might say, why all the fuss? Why the lockdowns if the risk of dying is so low, not much higher than a bad normal flu season?

Compare these numbers to the Black Death, which hit Europe in 1348. An astounding 30-60 percent of the population may have died. For those going through it, it must have been apocalyptic. Here’s a firsthand account from a chronicle kept by William de la Dene at the cathedral priory of Rochester 30 miles east of London, written in the year the plague arrived:

“A great mortality … destroyed more than a third of the men, women and children. As a result, there was such a shortage of servants, craftsmen, and workmen, and of agricultural workers and labourers, that a great many lords and people, although well-endowed with goods and possessions, were yet without service and attendance. Alas, this mortality devoured such a multitude of both sexes that no one could be found to carry the bodies of the dead to burial…”

We can count ourselves lucky that we’ve only got Covid-19. (But this does not mean we can afford complacency. The next virus to hit us could conceivably be much worse.)

Covid-19 and the other risks we face

To return to my initial argument, if you compare the odds of dying of Covid-19 with the odds of dying from other factors, it is essential to understand over what time period it plays out.

That is because there seem to be many other causes of death for which the odds of dying are much, much higher. They include cancer (1 in 7), suicide (1 in 86), car accident (1 in 106), or from a gun assault (1 in 298). Even the chances of dying from choking on food (1 in 2,618) or from being hit while bicycling (1 in 4,060) seem to be worse than dying from covid-19, at least if you’re under 65. 

The U.S.-based National Safety Council provides a long list of those odds:

Lifetime odds of death for selected causes, United States, 2018

The odds above show the risk in 2018 of someone in the U.S. dying of these various causes, but not dying in the year 2018 of any of those causes. (If that were the case, 47 million Americans would have died of cancer in 2018, not the estimated 609,000.)

Knowing that your chance of one day dying of cancer are one in seven may be unpleasant, and dying in a pedestrian accident 1 in 541. But these risks do not reflect the chance of dying within the next few months, but over the rest of your lifetime, which will extend for many more decades.

The average age of the U.S. population is 38.2 years, and average life expectancy is 78.5, so the odds in the table above really cover, on average, 40 years of a person’s life span.

At 50 years old, I still have, actuarially speaking, about 34 years left to live, and 34 years during which I could die as a pedestrian crossing the street. I don’t like to think about it, but I can handle it. But I could die of covid-19 in the next month. For proper comparison, it means that the risk of me getting hit by a car in the next month is 408 times (12 months times 34 years) lower than the 1 in 541 odds. The odds are now about 1 in 220,000 of me dying as a pedestrian next month.

Now look again at the odds of dying of coronavirus, of 1 in 5,500 in the very near future. Things look quite different.

To take the most extreme form, the risk of any one of us dying eventually is, unfortunately, 100%. As the Game of Thrones saying reminds us, valar morghulis (“all men must die” in High Valyrian). At the other end of the extreme, the risk of any one of us dying in the next 24 hours is close to zero.

There you have it. This is why there is, to put it mildly, a rather significant time dimension to risks.  And that is why Covid-19 is so brutal. It is not about the possibility of dying from it, one day, maybe in a few years, maybe far in the future. It is that you, your loved ones, your friends, your colleagues, may die of it tomorrow.

Be prudent, be safe, and treasure the life you have. Remember, the biggest risk in life is to die without having lived.

But let’s leave the last word to Game of Thrones author George R.R. Martin. As the inimitable Tyrion Lannister puts it, “Death is so terribly final, while life is full of possibilities.”