LETTER: Death isn’t only COVID measure that matters

While differing opinions exist regarding how to manage the COVID pandemic, some facts are indisputable. This illness is serious, has major societal consequences, and should not be minimized. A recent IBJ column argued otherwise, triggering this rebuttal.

Let’s start where we agree. It is likely that, with significant intervention, schools can operate safely. This still doesn’t mean that the majority of Hoosiers are safe from the virus.

It’s a mistake to focus on death as the only outcome that matters. Many other consequences of infection matter too. Even people who don’t require hospitalization suffer, in numbers greater than other common infectious diseases. Some patients, dubbed “long-haulers,” suffer ongoing symptoms long after “recovery.”

In addition, even if young people who become infected fare mostly well, many of the people they come into contact with might not. These include teachers and staff at schools, others in the community who might have chronic conditions, or even loved ones at home.

Our biggest concern with the column, however, is with the math. In order to determine the true death rate, you need a reliable estimate of the number of infections (which is different than case counts). The only such calculation in the U.S. that we know of, ironically, comes from Indiana, and was coauthored by us in Annals of Internal Medicine.

We scientifically determined that, among people not living in nursing homes or other institutions, the fatality rate in Indiana was 0.26%, or one death for every 385 people infected. The risk was much lower for people under 40 (still, it was one in 10,000) but rose to one in 833 for those age 40-59; and was one in 58 for people over 60. For no group was it 1.7 in a million.

Indiana has more than 1 million people over age 65. In the catastrophic scenario where all of the senior citizens not in nursing homes got infected, 17,500 elderly Hoosiers would succumb to COVID. Besides the massive loss of life, losing these highly productive members of society would devastate the economy.

This disease is serious. We should treat it as such.


Dr. Aaron E. Carroll, IU School of Medicine

Nir Menachemi, professor, IU Fairbanks School of Public Health

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