A: Timing, timing, timing. And some other factors too.
As this Vox article notes, “The sinking death rates reflect the state of the pandemic a month or more ago, experts say, when the original hot spots had been contained and other states had only just begun to open up restaurants and other businesses.”
We have to remember that it takes individuals who develop symptoms, an average of 5 days from the date they are infected to when they start to feel sick, but the range of time before individuals develop symptoms is more like 2-14 days. Once symptoms start, it may take individuals a few more days to weeks to develop symptoms severe enough to require hospitalization (and we are in fact seeing a rise in hospitalizations with hospitals reaching capacity in some parts of the U.S.). People may then be hospitalized for days to weeks before unfortunately dying from COVID-19. It can then take a week or two for deaths to be included in the official counts. So, the spikes in cases we are seeing now may still take a few more weeks to translate to a rise in deaths and if and when we do start to see spikes in deaths, this likely corresponds to infections that were acquired ~4-6 weeks ago.
A decreasing trend in deaths nationally also does not tell the whole story. While hospitalizations have trended down in the Northeast (which was of the first geographic areas to be hit hard and became the epicenter of the outbreak), they are on the rise in the South and West (now the epicenter) and are somewhat leveled off (for now) in the Midwest (see Figure below from The COVID Tracking Project included in article). We should therefore be on the look-out for rises in deaths on the horizon in regions, states and cities currently experiencing increased hospitalizations (especially those with maxed out hospital capacity) and also be on the look out for increased hospitalizations in places now experiencing a surge in cases.
In some states the mean age of new cases has also dropped significantly with people in their 20s and 30s now making up a substantial proportion of total cases to date. While, as highlighted in the linked article, younger individuals are not exempt from the possibility of dying from COVID-19 and the potential for long-term complications from the infection are plenty of reason to avoid infection even if you are young, it may be that we won’t see a spike in deaths until infection spreads from younger individuals to others who are more vulnerable to complications in their communities. In other words, the timeline between initial spike in cases to a related spike in deaths may be extended if the initial surge in cases is primarily among younger individuals.
Another consideration related to timing not mentioned in the article below is that as testing and contact tracing capacity is built up, we are able to test people earlier in their course of infection (at the beginning only the very ill were prioritized for testing and now some individuals might even be tested BEFORE their symptom onset). This produces something called “lead time bias” (see super helpful explainer by Dr. Eleanor Murray on Twitter here, which could also be playing a role in extending the time it is taking for cases (who are now detected relatively earlier in the course of their illness) to result in deaths from COVID-19.
The article does provide some cause for hope though. As time goes on, better treatments are becoming available which can potentially improve survival (see our recent post on the latest treatment advances). We can also proactively #StaySMART in our day to day interactions and work to protect those who are vulnerable to complications in our family and communities. This not only reduces our own risk of infection but helps slow the spread of COVID-19 overall and prevent unnecessary deaths.
