Covid-19 cases have recently skyrocketed in the southern half of the United States. Given the reopening of states that exposed more individuals to contagion, this trend is not surprising. The surprising thing is that the case fatality rate is so low, at least for now.
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SILVER SPRING, MARYLAND – MAY 11: Maryland Cremation Services transporter Morgan Dean-McMillan gently moves the remains of a coronavirus victim on a stretcher in the morgue at Adventist HealthCare White Oak Medical Center on May 11, 2020 in Silver Spring, Maryland. MCS carriers travel hundreds of miles per day throughout the Washington metropolitan area as they retrieve the remains of COVID-19 victims from hospitals and other care facilities to prepare them for cremation. The crematorium workload is beginning to return to normal, around nine cremations per day, but during the recent pandemic boom they processed 19 unprecedented cremations in one day. For Dean-McMillan, 30, working in the cremation and funeral business is both a calling and a career choice. She says that God tells her what to do when she comforts people who have lost a loved one. “I am where I am supposed to be,” he said. She will start funeral school in the fall. (Photo by Chip Somodevilla / Getty Images)
The hallmark of the Covid-19 debacle in the spring was the staggering number of deaths in places as distant as New York, Detroit, and New Orleans. Morgues and funeral homes were overwhelmed by the volume; Some New York hospitals required refrigerated trucks to store the bodies.
Although not now. The increase in cases has not been accompanied by an increase in deaths. There are many theories as to why: given a delay of two weeks or more from infection to death, it may be too early in the new wave for deaths to have increased (probably); This time younger people could become infected and have a much lower risk of death (definitely); current patients may have fewer comorbid conditions than March and April (I’m not so sure); Initially, due to limited resources, the tests were only performed on very sick people, while we can now do general tests, diagnosing thousands of healthy people with little risk of serious results (for sure).
Or maybe medical care has improved (not fake).
Or maybe the virus has weakened (not likely).
The list goes on and on.
Recent work, done not by the federal government but by reporters for The New York Times, has gathered data that could show a compelling “reason” for the change: nursing homes.
Using the collection of old-school leather information, Times reporters identified 54,000 Covid-19 deaths in long-term care facilities between patients and staff (no breakdown is given between the two groups). This represents a staggering 43% of all Covid-19 deaths in the U.S., a proportion similar to what was previously reported from France.
Additionally, the Times constructed a state-by-state chart showing that nearly half of these deaths (26,331) occurred in just five states that were part of the devastating March and April wave in the northern United States: New Jersey, New York, Massachusetts, Pennsylvania and Illinois. (Florida ranks tenth, with 1,748 nursing home deaths.)
Which means that a crucial problem affecting mortality is whether the epidemic in the southern states will cause the virus to spread further in nursing homes.
Because there are no mandatory nursing home case reports, as well as the suggestion that some states have yet to comment on their nursing home cases, the only way to estimate what lies ahead is to examine the cases and rates among people age 65 and older. . Of course, the majority of the approximately 50 million people in the US in this age group are not in chronic care centers, which provide care for approximately 1.3 million Americans, but the majority of those in centers chronic care are in this age group.
Overall, looking at the age group over 65 is extremely important when examining Covid-19 mortality: Although they represent only 16% of the U.S. population, More than 80% of Covid-19 deaths in USA They have occurred in this group.
Fortunately, the Centers for Disease Control and Prevention provides age-specific information on Covid-19 testing by geographic region. Every week, they update COVIDView, which includes both a high-level summary and a no-frills series of charts. Access to interactive information is also provided.
One caveat: the data presented is a sample, not a wall-to-wall surveillance. Data collection sites are strategically selected to provide a representative sample, as CDC does for all disease monitoring. With Covid-19, information from approximately 17 million tests (of more than 35 million completed in the US as of Thursday) is available, while Covid-Net hospitalization data includes information from more than 250 hospitals in 14 states.
The pdf tells the story better. On page 20, a weekly summary of test results for just under 12.4 million tests conducted by commercial laboratories, classified by age, is shown. Data from any additional tests do not provide age-specific information and are not included.
Data from the US tests were recorded as of March 29 (week 14 or 202014 in the table), when the tests were finally readily available in the US and jumped in early May (week 20 , 202020 in the table), when commercial testing was also made widely available. About 2.2 million tests have been performed on people over 65, approximately 649,000 early, when only the sick and dying were evaluated, and the remaining 1.5 million in the following six weeks.
In this latter interval, testing has slowly increased in the age group to approximately 300,000 per week (note that the most recent week’s information is always lagging, so the numbers currently appear). Nationwide there has been a decrease every week in the proportion of older people who are positive. More recently, the positive rate is 4.0% in this group versus 7.9% (and increasing) for the country as a whole.
This report then splits the data into 10 geographic regions. This perspective shows that the decrease in the national positive rate in older people is due to the fact that the northern states have positive test rates that sink deeply; in contrast, the positive rate in the southern states is actually going up.
The CDC document reports that in the last six weeks, in Region 4, with Florida, Alabama, Georgia, and five other southern states, test positivity among older adults has increased from 3.6% to 5.7%, while than the rate in Region 5 (Illinois, Michigan, and 4 northern states) from 5.2% to 1.9%, each consistent with the overall regional trend.
In other words, the southern US is only seeing an increase in people at increased risk for serious outcomes. At first, some areas, particularly Florida (with the tenth majority of Covid-19 nursing home deaths) experienced devastating outbreaks of Covid-19 in nursing homes, but this did not occur extensively in the southern U.S. .
Although Southern test positivity rates among older adults are increasing, there is perhaps a promising trend: a still low hospitalization rate. For example, Arizona is currently in the midst of a surge of more than 84,000 cases and has a clear and reliable Covid-19 control panel.
Overall, only 6% of Arizona cases have required hospitalization through Tuesday, but among people 65 and older, the hospitalization rate is 20%. Older people, who make up about 16% of the Arizona population, contribute 40% of Covid-19 related hospitalizations.
Alarmingly, the case fatality rate is 13% for people over 65, similar to that seen in other states and countries. The Times article identified 541 nursing home deaths in Arizona, representing about a third of the state total.
Protecting nursing home residents is critical to preventing the high case fatality rate seen in the previous outbreak in the northern states. Unfortunately, as CDC data shows, more infections are occurring in people 65 and older in affected regions, just as hospitals are already full and healthcare workers are worn out and demoralized.
Although the devastation seen in the spring is unlikely to repeat itself, we should prepare again for scenes of overwhelmed emergency rooms, morgues, and funeral homes, and a federal government that cannot be bothered to develop a meaningful strategy to protect our citizens more. vulnerable.
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