It is difficult to estimate the number of cases in the initial stages of an outbreak but Acton's estimate does seem rather large. Estimates of actual case numbers for other places like Seattle are not that large and if there are 100,000 infections around 1,000 deaths would be expected.
It would be likely that Ohio would already see significant patient counts in ICU units if they had 100,000 infections.
Either that or the symptoms are so mild in most people that don't seek medical care or don't even know they have it.