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

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

For several months, epidemiologists have been predicting an increase in COVID-19 cases as winter approaches. Now it seems that the dark forecasts were far too accurate.

Coronavirus infections are on the rise in large parts of the United States, with the number of new daily cases approaching 200,000 in the last few days. That’s about five times the number of new daily cases that the United States reported as recently as September, according to World Health Organization.

In California, the average number of new cases of coronavirus has tripled in the last month alone. The virus now infects more Californians every day than at any earlier time in the COVID-19 pandemic, according to a Analysis of times.

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

In response to growing numbers of cases, California imposed a curfew at 6 p.m. 22.00 to prevent people from gathering and drinking together late at night. New York City closed its public schools for personal learning less than two months after they reopened. Even Iowa Gov. Kim Reynolds, a longtime opponent of mask mandates, introduced a final week after 50% of Iowans tested for the virus had a positive result.

However, as infections rose to unprecedented heights, the number of COVID-19 deaths per day has not followed suit.

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

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

The answer is both yes and no, experts said.

The general consensus is that the number of deaths will ultimately follow infections in their upward trajectory, but the ratio of deaths per 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 we go through them, just remember that if you were hoping that the virus lost its bite, or that the fall in deaths is a reason to ignore security protocols, experts say that is not the case.

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

Cause 1: Increased test

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

As testing has increased across the country and the bar to be checked has come a long way down, several infections are identified. However, since the sickest COVID-19 patients were generally able to be tested all the time, improved test capacity did not make nearly as much difference in counting the number of people dying from the disease.

This dichotomy explains why the percentage of coronavirus cases that are severe enough to result in death has decreased.

Cause 2: Better treatments

Over the past few months, what began as a scattershot, try-something approach to treating people with severe cases of COVID-19, has evolved into a set of best practices that have enabled more of the sickest patients to survive, said Dr. Robert J. Kim-Farley, a medical epidemiologist at the UCLA Fielding School of Public Health.

These improved treatment protocols include:

Placing patients on their stomachs instead of their backs when they have difficulty breathing.

• To be more sensible in placing patients in mechanical fans and wait longer to do so.

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

• Use of the antiviral drug remdesivir, which was originally developed to fight hepatitis C and respiratory syncytial virus but which could not work against any of them.

• In some cases, patients are given antiviral antibodies from people who have recovered from COVID-19 (convalescent plasma) or synthetic antibodies designed 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 is still no silver ball, but all of these little incremental things have a measurable impact on our ability to prevent people from dying or having a serious illness,” Kim-Farley said.

Cause 3: More young people become infected

“The biggest thing that has changed since the spring is the age of the people who get infected,” Nuzzo said.

It makes a difference because the older the COVID-19 patient, the greater the risk that the disease will be fatal.

Early in the pandemic, the elderly accounted for a larger proportion of reported daily new cases. In May, for example, more than 27% of known infections in humans were 60 years and older; by August, the figure had dropped 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 rose from 32% to 38%.

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

Dr. Mark Dworkin, an infectious disease specialist at the University of Illinois, Chicago, said it is not surprising that infections have exploded among young adults because they generally tend to be less severe in terms of public health measures. Epidemiologists have noticed similar trends with HIV, he said: Young people who are infected are more likely to ignore the medication protocols that are important for controlling that virus.

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

However, when cases climb among younger adults, there will be ripple effects for their older ones, 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 the virus to spread to older populations as well.”

Cause 4: Better prepared nursing homes

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

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

“Lots of nursing homes have been able to improve testing, [personal protection equipment] and other infection prevention measures, “Dworkin said. As a result, we do not hear about as many disease outbreaks as before. “

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

“As the incidence of the infection grows, it becomes harder and harder to keep the virus out of nursing homes,” she said. “So we could see explosive eruptions there again.”

Reason number 5: The delay

Most of us now know the path to an outbreak. First, infections increase. Several days later, there is an increase in hospitalizations after the virus has had time to incubate and cause serious illness in its most unfortunate victims. The increase in admissions is again followed a few weeks later by an increase in deaths from those who do not survive their hospital stays.

New coronavirus infections started in earnest in the United States in mid-October, so epidemiologists say we are just about to reach the point where they expect to see deaths begin to rise. And it actually is what the data shows.

“When I look at data from mid to late November, I see the beginning of an uptick,” Dworkin said. “I think we will see the death toll increase. It will not just be a flat line as cases continue to rise. ”

In other words: If you were hoping for a reason why more infections doesn’t necessarily mean more deaths, science just isn’t on your side. And while deaths do not rise over the next few months, we still see 2,000 Americans dying of COVID-19 every day.

“Why is it acceptable to have so much death when it can be prevented?” Asked Dworkin.

This story originally appeared in the Los Angeles Times.

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