Why has there not been an increase in COVID-19 mortality such as coronavirus cases?

Epidemiologists have been predicting an increase in COVID-19 cases as winter approaches for months. Now, these dark predictions seem to have been too accurate.

Coronavirus infections are on the rise in much of the United States, with the number of new daily cases approaching 200,000 in recent days. That meant about five times the number of new daily cases reported by the United States back in September World Health Organization.

In California, the number of new cases of coronavirus has only tripled in the last month. The virus now infects more California daily than at any earlier point in the COVID-19 pandemic. Analysis of times.

While the federal government continues to take a relatively freehand approach, state and local governments have become more aggressive in the hopes of bending the curve to new cases.

In response to the growing number of cases, California has introduced a nationwide 22-hour curfew to keep people from gathering and drinking late at night. New York City closed its public schools for personal learning less than two months after reopening. Even Iowa Governor Kim Reynolds, a longtime opponent of mask mandates, imposed one last week. 50% of Iowans tested for the virus tested positive.

But because infections soared to unprecedented heights, the number of COVID-19 deaths per day did not follow this example.

In early April, the United States reported about 30,000 new infections and about 2,000 deaths a day, according to the WHO. About the same number of deaths are reported as now – although the number of new cases per day is more than six times higher.

What exactly is happening? The more coronavirus cases reported, the more COVID-19 deaths can be expected, right?

The answer is yes and no, the experts said.

There is general agreement that the number of deaths will eventually follow the infections in their upward trajectory, but the rate of deaths per infection will remain significantly lower than in the spring.

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

But before we go through them, keep in mind that if you hoped the virus had lost its bite, or that a drop in mortality was a reason to ignore security protocols, experts say that’s not the case.

“There is no evidence that this virus is less deadly,” he said Jennifer Nuzzo, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health.

Cause 1: Increased testing

In the early days of the pandemic, the coronavirus test was only available to those who were known to be exposed to the virus or had symptoms of COVID-19. (Although even if these two conditions are met, it can be difficult get a test.) This means that a large percentage of infected people were not counted, especially those with asymptomatic “silent distributors” and those who had only mild symptoms, Nuzzo said.

As testing has accelerated nationwide and the control band has been lowered, newer infections are being identified. However, because the most sick COVID-19 patients were generally able to test throughout, the improved testing capacity did not make much difference in the number of deaths from the disease.

This duality explains why the percentage of coronavirus cases has decreased to lead to death.

Cause 2: Better treatments

Over the past few months, a set of best practices has begun as a dispersed, testable approach to the treatment of patients with severe cases of COVID-19 that has enabled the survival of the most sick patients. Dr. Robert J. Kim-Farley, medical epidemiologist at UCLA High School of Public Health.

These advanced management protocols include:

• Place patients on their stomachs, not on their backs when they have difficulty breathing.

• You need to be more careful about placing patients in mechanical ventilators and wait longer.

• Administration of dexamethasone or other steroids to help suppress an excessive inflammatory response in severe patients.

• Remdesivir is an antiviral medicine that was originally developed to fight hepatitis C and the respiratory syncytial virus, but neither of them worked.

• In some cases, the administration of antibodies to the virus from patients who have recovered from COVID-19 (recovering plasma) or synthetic antibodies that are intended to attack the coronavirus that causes the disease (monoclonal antibodies). Both are thought to help the immune system recognize and fight the virus more effectively.

“There’s still no silver bullet, but all of these little incremental things have a measurable impact on our ability to prevent people from dying or suffering from a serious illness,” Kim-Farley said.

Cause 3: More young people become infected

“The biggest thing since spring is the age of those infected,” Nuzzo said.

This makes a difference because the older a patient with COVID-19, the greater the risk of death.

At the beginning of the pandemic, older people accounted for the majority of reported daily new cases. In May, for example, more than 27% of known infections were in people 60 years of age and older; by August, that number had dropped to 18%, according to data from the Center for Disease Prevention and Control. Meanwhile, the proportion of cases among 20-30 year olds has risen from 32% to 38%.

This change in the age distribution of those infected with the coronavirus reduced the overall mortality rate of COVID-19. During the pandemic, people between the ages of 18 and 39 accounted for 1.8% of deaths in the United States, while people 65 and older accounted for 80%, according to the CDC.

Dr. Mark Dworkin, a specialist in infectious diseases at the University of Illinois at Chicago, said it was not surprising that infections had exploded among young adults, as they were generally less stringent against public health measures. Epidemiologists have observed similar trends in HIV, he said: Infected youth are more likely to ignore drug protocols that are important in protecting against the virus.

“You can certainly find plenty of young people doing what they have to do, but if you go to a bar, it’s usually not full of older people,” Dworkin said. – This is the invincibility of youth. Risk is processed in different ways. “

However, as cases crawl among younger adults, there will be fluctuating effects in older age, Nuzzo added.

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

Reason 4: Homes for better prepared nursing homes

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

Today, most long-term care facilities are much better prepared to fight the virus and repel the virus if it arrives through their door.

“Many nursing homes have caught up to improve testing, [personal protection equipment] and other infection prevention measures, ”Dworkin said. “As a result, we don’t hear as many nursing home epidemics as before.”

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

“As the incidence of infection increases, it becomes increasingly difficult to keep the virus out of the nursing home,” he said. “So we saw explosive epidemics again.”

Cause 5: The lag

By now, most of us know the trajectory of the epidemic. First, the infections rise. A few days later, hospitalization increases after the virus has had time to incubate and cause serious illness in its most unfortunate victims. An increase in the number of hospitalizations a few weeks later is followed by deaths from those who do not survive their hospital stays.

New coronavirus infections began to multiply severely in the U.S. in mid-October, which is why epidemiologists say we’re just getting to the point where they would expect deaths to begin. And indeed, that is exactly the case what the data show.

“When I look at the data between mid and late November, I see the beginning of the rise,” Dworkin said. “I believe we will see the number of deaths. It won’t just be a flat line while cases keep rising.

In other words, if you hoped for the reason that multiple infections don’t necessarily mean more deaths, science simply isn’t on your side. And even if mortality doesn’t increase over the next few months, we still see two thousand Americans dying in COVID-19 every day.

“Why is so much death acceptable if it can be prevented?” Dworkin asked.