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September 25, 2020

Forgotten numbers: Non-fatal Covid-19 infections in the US

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This is a bad news–better news (but still not so good news) story. The virus known as Covid-19 has killed a tragically large number of Americans—at the time of writing, about 190,000 since the first recorded case on January 22, 2020. Better news is that the overwhelming majority of people who have been infected with the virus have not died. This still not so good news has been largely forgotten though. However, although the death rate is low, the number of infections is so large and the non-fatal infections are serious enough to deserve emphasis too. Here we summarize three aspects of our recent research in this area.  

Catching Covid-19 is very different from catching the conventional flu for non-fatal cases. There is psychological dread among the infected. Prominent US newspaper columnist Bill Plaschke described the personal dread he experienced during his own non-fatal case of Covid-19: “I know the overwhelming odds of survival. It doesn’t matter. You live in constant fear. You check your temperature 53 times a day and pray. You can’t call your doctor because he’s already told you that there’s nothing he can do.” 

Dr Henry Miller of the US Food and Drug Administration has noted that Covid-19 can bring with it non-respiratory complications, including cognitive impairments, ischemic strokes, kidney damage, and the transmission of pediatric inflammatory disease to an unborn child via the placenta. Unlike the conventional flu, recovered patients can have chronic fatigue syndrome that is debilitating for years. Suppression of Covid-19 infection spread is therefore about more than just reducing current medical care costs and ultimate fatalities.

US regulatory agencies evaluate the benefits of avoided fatalities by using revealed behavior which indicates people’s willingness to tolerate exposure to the risk of death from accidents or disease at work, when consuming goods and services, or from the health consequences of industrial pollution where someone lives. The Department of Transportation and the Environmental Protection Agency also use estimates of what people reveal they are willing to pay via their altered behavior to avoid non-fatal accidents or diseases like asthma. Medical professionals’ judgments are also used by regulatory agencies to help differentiate the benefits of harm avoidance by the severity of the harm, and implicitly for the issues of dread and quality of life effects. 

We calculate that the benefits of avoiding non-fatal Covid-19 range from about US$11,000 from avoiding a mild case to US$2.9 million from avoiding a severe case requiring mechanical ventilation to prevent death. The result is a weighted average of US$46,483 per non-fatal case avoided. Applying the US Centers for Disease Control adjustment factor for the undercount of actual infections, the total number of non-fatal cases has been over 47 million. The total estimated benefit of avoidance of harm to health is therefore about US$2.2 trillion. 

We should not let the non-fatal numbers be forgotten, because preventing the spread of Covid-19 is much more than a concern that an infection might be fatal. Most people do not die; but there are still medical and psychological consequences. Our calculations have important implications for benefit–cost calculations of stemming the pandemic. When evaluated in the manner by which economists and government regulatory agencies measure risks, the large numbers of non-fatal Covid-19 cases are as economically important in the US and probably elsewhere as Covid-19 related fatalities.

© Thomas J. Kniesner and Ryan S. Sullivan

Thomas J. Kniesner is a professor of economic sciences at the Claremont Graduate University, professor emeritus at Syracuse University, and a Research Fellow of IZA
Ryan S. Sullivan is an associate professor of financial management at the Naval Postgraduate School, USA

Views expressed here do not reflect official policy or position of the US Department of Defense or the US Federal government.

Find more IZA World of Labor coronavirus content on our curated topics pages: National responses to Covid-19 and Covid-19—Pandemics and the labor market.

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