I’m reminded of old diseases like polio, that caused lung damage and in some a permanent limp.
Infections can be the gift that not only keeps on giving, but gives you life-changing gifts. /s
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I might be misunderstanding what you are trying to say. I am tired, exhausted and irritable.
But WTH?
That is what “flattening the curve” is all about.
That is not what a very large proportion of people think it means. This is what most people think “flatten the curve” means:
That graphics is basically wrong, or at least does not show what we should have been trying to do, and what a large number of other countries appear to have done so far…
A strong response would make the “peak” both lower and shorter, decreasing both the overall area and the amount of time that there is widespread infection. It would then be followed by a long period of very low steady state where we can’t eliminate the virus altogether because of abnormally long-lived carriers, asymptomatic transmission, and re-introduction from countries that are unable to control the spread.
Take a look at daily infection rates from countries like italy and spain that were initially considered examples of “bad” response. Their infectious pea" was both lower in height and shorter in duration that whatever the hell the US is doing now. Not like the graphic I posted above.
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That at least might be an exaggeration. A lot of coronaviruses don’t generate long lasting immunity but they do generate long lasting resistance so that subsequent infections are much less severe. But there is a lot we don’t know about SARS-COV-2 and we know almost nothing about it’s long term behavior.
Here is a brief summary that at least gets to the idea that immunology is more complicated that most people realize:
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- All the old people are dying off and we are inching closer to the world of Logan’s Run
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I read something that seemed to be suggesting that asymptomatic carriers might be, in an immunological sense, as if they’d never been exposed at all. Even if it’s true that they have less severe infections in the future (i.e. continue to be asymptomatic with future infections), they’re still going to be viral spreaders (and may be behaving as if immune and thus exposing themselves - and everyone around them - to the virus frequently). So even if it’s not bad for them…
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Yeah #1 is a favorite with the MAGA types, who also think herd immunity is just around the coroner. I don’t put much hope in that, and the rebuttals were pretty scathing. File it away with the Hydroxychloroquine.
eta: Also, Medium doesn’t fact check or review content.
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ISWDT… 
But seriously, this is not a real strategy, look at Sweden that just let 'er rip and they are still nowhere even close to the ballpark of herd immunity.
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There is another factor that I haven’t seen discussed anywhere, I don’t think. I am not an epidemiologist of course, but it seems sort of common sense to me.
Testing is more widespread now. Not perfect, but better. Certainly better than March/April and even May. We were not catching cases via testing as often earlier on, so death rates were actually lagging behind new infections that were being reported at the same time. Now they can identify illness earlier, because of increased testing capacity. We have only seen the real spikes in cases over the last 1-2 weeks. There could be more deaths coming, and we will just see them in the data “later” than we saw them earlier on, because there were essentially no tests earlier on, so actual early infections were missed entirely. Does that make sense?
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Yes, it makes sense to me. But I would expect that testing could only get about 1 or 2 weeks ‘earlier’ in the disease process, relative to a couple months ago. And that effect should be reduced by now, if testing has steadily gotten better, in the sense of catching cases earlier.
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We’re about 2 weeks behind the beginning of this recent spike, so we’ll know over the next week or two if the “apparent increased lag” between cases and deaths ends up being a factor.
I have to think better treatment protocols, cases shifting to younger people, and a number of the other factors all come into play. Complex things like pandemics are multifactorial by nature, it seems.
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I thought I had read that one reason the death rate is lower, is because now more people can get tested (where I live, this means anyone, with or without symptoms, willing to wait in line for a test). Previously, the sample set was the patients (for example) admitted to the ICU and then getting tested, by which time the illness is serious and, yes, the death rate among them would be higher. Meanwhile, those carrying the virus without getting sick, or only mildly so, and not dying were not getting tested.
But yeah, enough people getting the virus at any severity still means that we have (for example) the ICUs in Houston filling up.
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1The least likely explanation is that the virus is becoming less lethal.
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There is no evidence what so ever that the virus is less lethal. None. No reported mutations that have shown any change in viral behavior. the “experts” saying this must be the 10% of dentists who tell you to chew sugar filled gum.
2It’s also unlikely that hot weather and sunshine is causing the virus to decay. though some experts believe this is a reason.
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This makes no sense. It is almost word salad. How does a virus decay in sunshine, yet still infect people but not make them get as sick?
3Testing has increased in recent weeks, which likely accounts for part of the reason why fewer people are requiring ventilators. “More people are reported sick, many of them in a very mild state, which makes the percentage of those in critical condition drop.”
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The more people we know have infections, the more the ventilator need compared to total cases will fall. But testing will not change the total number of ventilators needed per population.
4Hospitals are starting to use treatments other than ventilators. “In some countries, the practice has now shifted considerably to no more early ventilating and efforts being made to avoid ventilators at almost any cost.”
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Yes, we are trying not to intubate people. It may be working, it may not be working. No one can be sure YET. But the evidence on dexamethasone alone doesn’t explain the smaller number of intubated patients. Nor does the early evidence on remdisivir. Giving people 50 LPM high flow nasal cannula oxyen might be keeping people off the vent. Might. We hope so. We’re also less afraid of bipap, and that could be a big driver in avoiding intubation (though in many hospitals (most? all?)) you are still put in the ICU on bipap, so it can change ventilator days, but not ICU volume.
5Younger people are getting sick. For example, in Florida, the median age for infected people is 37, but in March it was 65. Younger people are less likely to become seriously ill from coronavirus, and as a result, do not require ventilators.
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This is the best guess in this list of bad guesses. Less vulnerable populations are getting sick, and so far they are doing better. I’m in CO, where numbers are on an uptick, but are still doing better than all of our neighboring states. We’re still seeing virus patients every day in the ER. But we’re not intubating multiple people every day. We’re discharging many people every day, instead of admitting them to the ward. In that way, things here are looking up.
Some plausible explanations:
- it is possible that @rocketboy1971 has a great point - that the sickest have already gotten covid19, but… that’s only in some places, some cities, some states, etc.
- society is doing better at protecting the vulnerable at nursing homes and care facilities, and in their own homes. Nursing homes etc are wise to the virus and wise to prevention strategies in ways they were not, and are trying damn hard to be safe havens rather than hotbeds. When we look back, the people working at them may be the unsung heros of this pandemic.
- people with comorbidities are staying home even when other people have forgotten there’s a pandemic
- a higher percentage of younger patients, without comorbidities, are catching the virus, so the total population with covid19 is skewing away from the vulnerables
- people are arriving for care earlier in their disease course. this is a difficult thing, bc it could be a temporary skew in the numbers on ICU patients, rather than a permanent skew. It could be temporary, bc they could return to the hospital later, in worse shape, bc we don’t have any proven treatments (yet, I hope) for this virus that have been shown to help unless you are sick enough to need admission (and even then, they are small percentage improvements).
No, the treatment protocols have not really gotten much better. A little better, but not enough to explain the difference in ventilator need.
And the ventilator shortage was a potential shortage that was kept at bay through things like stay at home orders, lockdowns, social distancing, closing workplaces - things that slowed the spread, so that it slowed the sudden onslaught of patients needing ventilation, which solved the ventilator shortage before it became too real and too prevalent. But there were plenty of people on transport vents and OR aneasthesia machines for a short time, so the problem was real, it was just avoided and ameliorated enough to prevent tradegy. And here’s a thing with ventilators - if you Need to be intubated, and there’s no ventilator, you die. Sure, of the ICU intubated population the survival might be 50%, but without that ventilator, the survival is going to be a lot closer to Zero percent.
No, we didn’t. And no, we don’t put everyone on dexamethasone. But the treatments we do are probably decreasing ventilator need some, but not as much to totally explain the change in percentages.
Onset to symptoms is a mean of 5 days, with a tail to 12. Presentation to hospital was 7-10 days, and intubation was about 10 days post infection. Deaths were harder to track - many died in 3-5 days post intubation, but there are patients at day 30 and day 50 still on ventilators, so there’s no good “how long until they die” metric for intubated patients. With people getting tested earlier, since they can sometimes get tested before they are admitted, we’re speeding identification of disease.
So an earlier i.d. will lead to a quicker rise in case numbers. Assuming the same course of disease, deaths will not change, but will lag further behind the rise in case numbers, but not by much - there’s only so much earlier you can test positive. As treatments gets better, especially if science invents new treatments, earlier Dx can have an even greater improvement in mortality.
Hopefully we do a better job of treating patients as time goes on, and, coupled with the current crop of younger infections, we see a smaller mortality. But even those who live are, for the most part, miserable while they are sick, and at risk for long term complications and damage.
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“which makes the percentage of those in critical condition drop.” The percentage needing ventilators, yeah, it has no effect on the total needing them.
That’s the kind of a situation that leads to “Everyone will be vaccinated unless they can show very good medical reasons they can’t be. You can either take the vaccine, or take the vaccine and go to jail.”
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3 other factors…
#6. Viral Load is lower. Can’t recall where I read it, but testing using qPCR has shown that viral loads people are carrying now are much lower than earlier in the pandemic. This is possibly due to…
#7. Mask wearing has changed the primary site of infections. Back in March when folks were getting sneezed on and breathing it in, primary infection site was deep in the lungs, leading to a much bigger infection. Now with masking, it’s mostly nasopharyngeal infection, which is not so bad (not so far down the respiratory tract).
#8 Proning instead of ventilator use has improved outcomes for hospitalized patients. You’re just a lot less likely to die than you were in March, because we know more about treating it now.
TL/DR wear a mask MF’ers!
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Deaths will always lag behind cases, simply due to the fact that this is not a “catch it and keel over dead” illness, you tend to be 2-3 weeks in before you pass, so yeah, a distinct gap. A better number is percentage of positivity. If you are seeing increasing percentage of positive tests (as they are in FL right now) that indicates that you are falling behind the surge of cases and not testing nearly enough.
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I cannot say how horrifying this is to contemplate, for many reasons.
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I suppose it depends, what’s your time scale and frame of reference for that around the corner?
On a cosmic scale, it’s practically here.
This is the worst part. It’s not a hard problem to solve. But, it takes national leadership, federal money that can be “endless”, and a resolve to make it happen.
- Isolate a positive person.
- Trace all the people they’ve interacted with.
- Test all those people.
Repeat as long as there are positive results. Throw in a little random statistical population testing to catch gaps and do the same loops then.
Of course doing that means you need to have enough testing. And, the testing needs to be fast enough to complete the entire loop quickly. It’s a complete waste of time if it takes a week plus to get a test and another week to get the results. By then, there’s no way to do step 2, and the population is to big to manage.
We completely blew it in the beginning by not getting there while the count was small enough. But, again, part of the general lock down was supposed to drive the count small enough that this could be done. It’s a prerequisite to opening up, since it should let you contain the infection before it’s to large and you’re back at needing a general lock down. Unfortunately, we appear to have made zero progress and are opening up anyway. We’ll just repeat again, and again, and again.
The worst part is, there’s a large (enough) number of people that are just fine with this. 
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Only if it’s possible. You can’t get to herd immunity if too many people’s immunity expires before the percentage is high enough.
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