A Blog by Jonathan Low

 

Oct 20, 2020

Why As US Covid Hospitalizations Rise, Deaths Are Lagging. For Now.

Covid hospitalizations are rising - as predicted - due to the onset of fall and winter weather, as well as global weariness with safety precautions which has led to a rise in less cautious behavior. 

Deaths have not yet mirrored hospitalizations because many of the new infections are among young people who indulge in riskier behavior because the virus's impact on many of them is not as severe as it is for older people who appear more likely to follow safety guidelines - and because death is a lagging indicator. JL

Dylan Scott reports in Vox:

America is now averaging 54,000 new confirmed cases every day. More than 37,000 Americans are currently hospitalized with Covid-19 in the US. 700 new deaths are being reported on average every day. The US is now averaging 1 million tests every day. The positive test rate is 5%. Ideally, it would be 2% or less. "The problem is America never suppressed its Covid-19 cases to begin with.” More people developing severe symptoms will inevitably lead to more deaths.

A new wave of Covid-19 cases is rising across the United States, a harbinger of difficult winter months ahead.

America is now averaging about 54,000 new confirmed cases every day, the highest numbers since early August, according to the New York Times. More than 37,000 Americans are currently hospitalized with Covid-19 in the US, up from about 30,000 a week ago. Roughy 700 new deaths are being reported on average every day, too — and while that is down from August, when there were often more than 1,000 deaths a day, deaths are going to start increasing if cases and hospitalizations continue to rise. It’s a pattern we have seen before.

Public health experts have been warning for months that fall and winter could lead to a spike in Covid-19 cases. Why? Because the best way to slow down the coronavirus’s spread is to keep your distance from other people and, if you are going to be around others, to be outside as much as possible — and both become harder when the weather gets cold.

We may now be seeing those predictions start to come true, even as much of the country still has warm weather. The US already has nearly 8 million confirmed cases and 217,000 confirmed deaths. Both numbers will continue to climb.

Eight months into the pandemic, America’s failures to contain Covid-19, and states’ eagerness to reopen even if they haven’t gotten their outbreaks under control, is once again leading to a surge in cases and hospitalizations.

Covid-19 cases are rising everywhere across the country

Earlier in the year, there was limited value to discussing “waves” because some states would have a decline in cases while other states were experiencing surges. What distinguishes this autumn wave is that it seems to be happening everywhere.

Case numbers are up across every region: the Northeast, the South, the Midwest, and the West.

Chart showing recent rise in cases across regionsCovid Tracking Project

What’s so worrisome is that no one state or region can be blamed for this new wave. Just two states have seen their number of new Covid-19 cases drop over the last two weeks, as of October 15, according to Covid Exit Strategy. Cases are up in all the others.

Raw case numbers can, of course, obscure important differences in population; 100 new cases means something different for California than it does for Wyoming. Experts will use another metric — new cases per million people — to gauge how saturated a given state is with Covid-19.

The goal would be to have fewer than 40 new cases per million people. But just two states — Maine and Vermont — meet that threshold. Meanwhile, North Dakota (800 cases per million), South Dakota (743), Montana (569), and Wisconsin (531) are some of the states seeing very high levels of new infections.

As Vox’s German Lopez reported this week, just one state — Maine — meets all of the benchmarks indicated by experts for a state to consider its Covid-19 outbreak contained. And yet, most states have reopened many of the businesses that were closed in the spring: 40 or so states have reopened restaurants, bars, gyms, movie theaters, and nonessential retail.

“Part of the problem is America never really suppressed its Covid-19 cases to begin with,” Lopez wrote, explaining why experts were anticipating a new surge in cases. “Think of a disease epidemic like a forest fire: It’s going to be really difficult to contain the virus when there are still flames raging in parts of the forest and small embers practically everywhere. The country always risks a full blaze with each step toward reopening and with each failure to take precautions seriously.”

Too many Covid-19 tests are coming back positive right now

Another closely watched indicator for renewed Covid-19 spread is the percentage of coronavirus tests that come back positive. The number of tests being conducted doesn’t actually tell you all that much; if a high percentage of them are positive, that suggests that many others aren’t being caught at all and the virus could continue to spread unchecked.

So while the US is now averaging about 1 million tests every day, that is not quite the triumph it might sound like (or that President Donald Trump would like to believe it is). The country’s positive test rate is around 5 percent, right at the threshold experts say would reflect adequate testing. Ideally, it would be even lower, 2 percent or less.

But even with that passable national positivity rate, most states are still not conducting nearly enough testing. Here are the 10 states with the highest positive test rates, according to Covid Exit Strategy. (Mississippi’s test positivity rate appears to be very high, but large recent swings in reported tests currently make the rate hard to determine.)

  1. South Dakota (35.5 percent)
  2. Wisconsin (22.9 percent)
  3. Idaho (22.3 percent)
  4. Iowa (20.2 percent)
  5. Nevada (17.3 percent)
  6. Kansas (17.1 percent)
  7. Indiana (16.5 percent)
  8. Utah (15.2 percent)
  9. Nebraska (15.1 percent)
  10. Alabama (14.6 percent)

It’s really only a handful of better-performing states — namely, New York, with more than 115,000 tests conducted per day and a 1.1 percent positivity rate — that’s keeping the US’s overall positive test rate from looking a lot worse.

America has never had a cohesive Covid-19 testing strategy. Since February, there have been regular supply shortages delaying test results. States have been fighting each other for precious testing resources. Contact tracing has not been a priority for the federal government, and most states have still not hired nearly enough people to perform that work.

Wealthy countries like Germany and South Korea have used effective test-trace-isolate programs to keep their Covid-19 outbreaks in check. The US, meanwhile, is still struggling to perform enough tests or scale up its contact tracing capabilities. Just a handful of states, plus the District of Columbia, could realistically expect to perform adequate contact tracing, according to Covid Exit Strategy, considering their positivity rate.

Without improvement in both of those areas, it will continue to be difficult for the US to contain the coronavirus before a vaccine becomes available.

More Americans are being hospitalized with Covid-19, too

Both case numbers and the positive test rate can be a little deceptive, depending on how many tests are being performed. They suggest what’s happening on the ground — in this case, Covid-19 is spreading — but they do have their limitations. There is some truth to the president’s claim that more tests will mean more cases, though that is not a reason to stop testing.

Hospitalizations, on the other hand, are more concrete. If more people are developing symptoms severe enough to warrant being hospitalized, that is a strong indicator that the real number of people being infected with Covid-19 is growing, regardless of whether they are getting tested.

And after a dip in September, the number of Americans currently in the hospital with Covid-19 is higher than it’s been in a month. That trend has been seen across the country.

Chart showing current hospitalizationsCovid Tracking Project

The worry becomes that if hospitals take in too many patients, they’ll have to turn other people away, or that overwhelmed staff and facilities could lead to some patients receiving substandard care. According to Covid Exit Strategy, about 20 states currently have elevated ICU occupancy that puts them in a risk zone; and about 20 have an elevated occupancy rate of their regular hospital beds.

Wisconsin, where the number of hospitalized Covid-19 patients has risen over the last month from about 300 to more than 1,000 today, recently established a new field hospital on its state park fairgrounds over fears that the state’s hospitals wouldn’t have enough beds given the recent surge in cases.

Fortunately, hospitals have gotten much better at treating Covid-19. They have treatments with some supporting evidence, like remdesivir and dexamethasone, of reducing the length of hospital stays or mortality in patients with severe symptoms. They have learned techniques like putting patients on their stomach to improve breathing. Hospitals that have endured spikes of Covid-19 cases report patients in the later waves are spending less time in the hospital and dying less frequently.

Nevertheless, more people developing severe symptoms, as we are starting to see, will inevitably lead to more deaths. Over the summer, people wondered why deaths were falling while cases and hospitalizations rose — until deaths did start to increase. There is a long lag between cases rising and deaths rising, because it can take a month or more between when a person first contracts Covid-19 and, if they die, when their death is reported.

That’s why these new Covid-19 trends in the US are so worrisome. Cases are rising, as are hospitalizations. It could be only a matter of time before deaths start to spike as well.

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