By just about any measure, the coronavirus outbreak in the United States continues to worsen — without a peak in sight. But, interestingly, the nation’s death rate is declining. As of Friday evening, the rate of confirmed Covid-19 cases ending in death in the U.S. was 1.3%. At one point it was over 3%, and as recently as six days ago it was still over 2%.
The declining death rate isn’t surprising. Despite the World Health Organization’s research showing a 3.4% fatality rate worldwide, many health experts have said the number is lower than that — and the WHO has acknowledged that the number will ultimately come down. As I wrote earlier this week, the Diamond Princess cruise ship — an excellent case study for coronavirus researchers — had a 1% fatality rate, which is in line with what many health experts have opined is likely the actual death rate. And a new study out of China concluded that the death rate in Wuhan was 1.4%, substantially lower than initially thought.
It was always known that the death rate in the U.S. was too high because too many cases were going undiagnosed — and still are. We simply don’t have a handle on how many actual cases of coronavirus there are in the U.S. right now; there are far too few people being tested. And we will likely never know, since medical professionals throughout the country are advising people with mild symptoms who do not require treatment to simply stay at home and get well.
But what’s interesting is that while the death rate is declining in the U.S., which has the sixth-worst outbreak in the world in terms of sheer numbers, it’s rising in many other countries.
Here’s the current situation in the U.S.: As of Friday evening, there were 19,624 confirmed cases of Covid-19, and 260 deaths. That’s an effective death rate of 1.3%, a number that ticked up on Friday after several days of steady decline. It was at 1.2% on Thursday. The reason for the increase was a rash of fatalities added to the total late in the day on Friday; there had been only 216 confirmed fatalities in the U.S. around lunchtime on Friday.
It’s important to note that the actual number of coronavirus-related deaths isn’t dropping; it’s just that the number of diagnosed cases is out-pacing the number of deaths. In fact, if you’ve been following the chart that maps the growth of the outbreak in the U.S. against what happened in Italy, 11 days apart, an alarming thing happened today: the U.S. surpassed Italy in the overall number of cases today.
Exactly how alarmed we should be by that development will have to be determined by someone with a lot more expertise than myself. For one thing, the chart measures the sheer number of cases. Italy has less than one-fifth of the population of the U.S. (~61 million vs. ~327 million), so it stands to reason that the cumulative number of cases in the U.S. is going to surpass that seen in Italy, and that it can do so without overwhelming our health care system. The more interesting chart would be to compare the number of infections per capita, at least in the hardest-hit areas. If we surpass Italy in that regard, even a fool such as myself knows we should be alarmed.
At the very least, the trend doesn’t seem too promising. The number of cases in America is doubling every two days, and there were more than 6,000 new cases today alone — the largest single-day jump thus far. But that could be, and probably is, due to a lot of different factors, certainly not the least of which is a significant increase in testing this week which has led to a huge uptick in diagnoses. There have now been more than 103,000 tests conducted in the U.S. At the beginning of the week, there had only been around 25,000.
Take Tennessee, for example. The Volunteer State has gone from 52 cases on Monday to 228 today — an increase of more than 400% in just four days. And no one is surprised because those of us who live in Tennessee knew it was coming due to the increased testing. It isn’t that the virus is spreading that quickly here; it’s just that testing is finally catching up to it somewhat — even if there are still far too few people being tested. (I have a story about that, but that’s for another day…)
What’s interesting — or at least seems to be; we may still be too early in our outbreak to start making bold assumptions that are only going to be proven wrong in a day or two or three — is that the virus seems to be mild thus far here in the U.S. I’ll admit that I have no idea as to the accuracy of the numbers being reported by the Worldometers.info website, but it currently reports only 64 critical cases among 19,241 total active cases nationwide. If that’s true, that means only 0.3% of current patients are critically ill, which would be a number that’s quite astounding.
However, it would fit what seems to be happening in Tennessee so far. Nashville/Davidson County, the epicenter of the outbreak in the Volunteer State, has reported 110 confirmed cases. One man, a 73-year-old with underlying medical conditions, died today — the first fatality. But a Nashville TV station reports that all of the remaining patients are recovering at home with mild symptoms. The Metro Public Health Department in Nashville said this morning that only 2 patients “remained hospitalized,” but there was no indication on whether additional patients had been hospitalized at some point. Based on WSMV’s report, that would mean that only 0.9% of confirmed coronavirus cases in Nashville thus far resulted in anything more than mild illness.
Again, that has to come with a disclaimer: thus far, not many people in the most at-risk age demographic have been infected in Tennessee. According to the Tennessee Department of Health, only 7.4% of the state’s diagnosed patients are 70 or older; only 14% are 60 or older. These are the age groups most at-risk, particularly when age is coupled with underlying medical conditions.
In any event, the slight uptick in the U.S. death rate today may be a sign that the several days of declining fatality rate have ended. Just while I’ve been writing this, four more deaths have been added to the Worldometers tally. But we’ll see.
In the meantime, while the death rate in the U.S. has fallen from just over 2% to just over 1% in the past week, the death rate continues to climb in Italy. It’s now at 8.6% — a really astounding number for a pandemic that produces relatively mild symptoms in most patients. The death rate in Italy topped 7% earlier this week and just keeps going up. According to the John Hopkins University tally, there are now 47,021 cases of Covid-19 in Italy, and 4,032 deaths. The horror stories of overrun hospitals and helpless medical teams continue to pour out of the nation. And, 10 days into a lockdown, there’s no sign that the carnage is going to slow down. There were 572 fatalities reported today — the most in a single day thus far, beating the previous record of 475 that was set on Wednesday.
Most people are attributing the high death rate in Italy to the fact that the virus overwhelmed the nation’s health care system. Obviously that has to be part of it. But does it explain all of it? Probably not. One might think that Italy simply hasn’t tested enough people; there were some criticisms early on in the way the country was conducting its testing, and an analysis by The Guardian today claims that the nation could’ve stopped Covid-19 in its tracks with the proper amount of testing. So, perhaps, there are far more people in Italy with the virus than we know, which would mean the death rate is actually lower than it appears to be? But Italy has tested more than 200,000 people thus far. Only South Korea has tested more. So, clearly, that’s not the answer, either. (There are other factors, too, such as the age of Italy’s population — one of the oldest in the world.)
Then there’s South Korea. Their response to the coronavirus outbreak has been lauded as one of the best in the world. And, certainly, every indication is that they got on top of it in the beginning and have stayed on top of it. But, interestingly, the death rate keeps going up there, too. It was at 0.6% for a long time — a number that was mentioned over and over and over in news reports — but it’s been steadily climbing for several days. As the country reported its 100th death today (8,652 total cases), its death rate is 1.2%, double what it was just over a week ago.
One important thing to keep in mind with these death rates is that there is a delay between the onset of symptoms and death (obviously). In Italy, the average seems to be about 8 days between symptom onset and death. In Wuhan, the average time frame between symptom onset and death was measured at 14 days. So it could be that the U.S. — which is still relatively early in its outbreak compared to Italy and South Korea — has indeed seen the end of its declining death rate, and today was the start of a new trend that sees the death rate increase. The days ahead will tell us…