Coronavirus infections are higher than ever, but COVID-19 deaths are not. Why?



COLTON, CA - JULY 8, 2020: Critical care nurse Lynda Tegan checks on COVID-19 patient Jose Mariscal, 66, who has been in intensive care for four days at Arrowhead Regional Medical Center on July 8, 2020 in Colton, California .  This intensive care unit only has 2 extra beds for Covid patients, but has the ability to expand to more beds if needed (Gina Ferazzi / Los Angeles Times)
ICU nurse Lynda Tegan is checking on COVID-19 patient Jose Mariscal at Arrowhead Regional Medical Center in Colton this summer. Deaths from the disease have not increased in line with the increase in the number of cases. (Gina Ferazzi / Los Angeles Times)

For months, epidemiologists have predicted a peak in COVID-19 cases as winter approaches. Now, it looks like those grim predictions were too precise.

Coronavirus infections are on the rise across much of the United States, with the number of daily new cases approaching 200,000 in the past few days. That’s about five times the number of daily new cases the United States was reporting as recently as September, according to the World Health Organization.

In California, the average number of new coronavirus cases has tripled in the past month alone. The virus now infects more Californians every day than at any other time during the COVID-19 pandemic, according to a Time analysis.

As the federal government continues to take a relatively hands-off approach, state and local governments have become more aggressive in the hopes of bending the curve on new cases.

In response to the growing number of cases, California has imposed a 10 p.m. statewide curfew to prevent people from gathering and drinking together late at night. New York City closed its public schools for in-person learning less than two months after they reopened. Even Iowa Governor Kim Reynolds, a longtime opponent of mask warrants, imposed one last week after 50% of Iowans who tested for the virus tested positive.

But while infections have reached unprecedented highs, the number of COVID-19 deaths per day has not kept pace.

In early April, the United States reported about 30,000 new infections and about 2,000 deaths a day, according to the WHO. That’s roughly the same number of deaths that are being reported right now – although new daily cases are more than six times higher.

What exactly is going on? The more coronavirus cases are reported, the more COVID-19 deaths we expect to see, right?

The answer is both yes and no, the experts said.

The general consensus is that the number of deaths will eventually follow infections in their upward trajectory, but the ratio of deaths to infection will remain significantly lower than it was in the spring.

There are several reasons for this. Some may seem obvious; others, more surprising.

But before you go through them, just remember that if you were hoping the virus was losing its bite, or that the lower death rate is a reason to ignore safety protocols, experts say it’s not the one. case.

“There is no evidence that this virus is less and less lethal,” said Jennifer nuzzo, epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Reason 1: Increased testing

In the early days of the pandemic, coronavirus testing was only available to people who had known exposure to the virus or were showing symptoms of COVID-19. (Although even when these two criteria were met, it could be difficult to get tested.) That means a large percentage of infected people were not counted, especially “silent spreaders” who were asymptomatic and those who had only mild symptoms, Nuzzo said.

As testing has intensified across the country and the bar for getting tested has dropped dramatically, more infections are being identified. However, since sicker COVID-19 patients were usually able to get tested throughout the process, improving testing capacity did not make as much of a difference in counting the number of people who died. of disease.

This dichotomy explains why the percentage of coronavirus cases severe enough to cause death has declined.

Reason 2: better treatments

Over the past several months, what started as a scattered and tried approach to treating people with severe cases of COVID-19 has evolved into a set of best practices that have allowed more of the sickest patients to survive, has declared Dr Robert J. Kim-Farley, medical epidemiologist at UCLA Fielding School of Public Health.

These improved treatment protocols include:

• Position patients on their stomachs rather than on their backs when they are having difficulty breathing.

• Be smarter in putting patients on mechanical ventilators and wait longer to do so.

• Administration of dexamethasone or other steroids to help suppress the overactive inflammatory response in critically ill patients.

• Using remdesivir, an antiviral medicine, originally developed to fight hepatitis C and respiratory syncytial virus, but has failed to fight either.

• In some cases, give patients anti-virus antibodies from people who have recovered from COVID-19 (convalescent plasma) or synthetic antibodies designed to attack the disease-causing coronavirus (monoclonal antibodies). Both are believed to help the immune system recognize and fight the virus more effectively.

“There is still no quick fix, but all of these little, incremental things are having a measurable impact on our ability to keep people from dying or having serious illness,” Kim-Farley said.

Reason 3: More young people are infected

“The most important thing that has changed since the spring is the age of those infected,” Nuzzo said.

This makes a difference, because the older the COVID-19 patient, the greater the risk of the disease being fatal.

At the start of the pandemic, older people accounted for a larger share of new cases reported daily. In May, for example, more than 27% of known infections were in people aged 60 and over; by August, that figure had fallen to 18%, according to data from the Centers for Disease Control and Prevention. Meanwhile, the proportion of cases among people in their 20s and 30s has increased from 32% to 38%.

This change in the age distribution of people infected with the coronavirus has reduced the overall death rate from COVID-19. During the pandemic, people between the ages of 18 and 39 made up just 1.8% of deaths in the United States, while people 65 and older made up 80%, according to the CDC.

Dr Mark Dworkin, an infectious disease specialist at the University of Illinois at Chicago, said it was not surprising that infections exploded in young adults, because as a rule, they tend to be less strict in with regard to public health measures. Epidemiologists have noted similar trends with HIV, he said: Infected youth are more likely to disregard drug protocols that are important in controlling this virus.

“You can definitely find a lot of young people doing what they need to do, but if you go to a bar it’s usually not crowded with old people,” Dworkin said. “It’s this invincibility of youth. They treat risk differently. “

However, as cases increase in young adults, there will be ripple effects for their elders, Nuzzo added.

“We have pretty good data that young people are not living in a bubble,” she said. “In the coming weeks, we should expect to see the virus spread to older populations as well.”

Reason 4: better prepared retirement homes

In the spring, nearly half of the deaths recorded by COVID-19 were in nursing homes, Nuzzo said.

Today, most long-term care facilities are much better prepared to fight and contain the virus if it passes through their doors.

“Many retirement homes have caught up by improving testing, [personal protection equipment] and other infection prevention measures, ”Dworkin said. As a result, we don’t hear as much about nursing home outbreaks as we used to. “

But as Nuzzo points out, these measures require resources and are not foolproof.

“As the prevalence of infection increases, it becomes more and more difficult to prevent the virus from entering nursing homes,” she said. “So we were able to see explosive outbreaks there again.”

Reason number 5: the lag

Most of us now know the trajectory of an epidemic. First, infections are increasing. Days later, there is an increase in hospitalizations, after the virus has had time to incubate and cause serious illness in its more unlucky victims. The increase in hospitalizations is in turn followed a few weeks later by an increase in deaths of those who do not survive their hospitalization.

New coronavirus infections began to increase in earnest in the United States in mid-October, so epidemiologists say we are just getting to the point where they would expect deaths to start increasing. And indeed, it is exactly what the data show.

“When I look at the data from mid-November to the end of November, I see the start of a rise,” Dworkin said. “I believe we will see the deaths increase. It won’t just be a flat line as cases continue to rise.

In other words: if you were hoping for a reason why more infections won’t necessarily mean more deaths, science just isn’t on your side. And even if deaths don’t increase over the next two months, we still see 2,000 Americans dying from COVID-19 every day.

“Why is it okay to have so many deaths when it’s preventable?” Dworkin asked.

This story originally appeared in the Los Angeles Times.


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