Coronavirus cases surge but deaths keep falling

MOBILE, Ala. (WALA) – New cases of the novel coronavirus set fresh records this week nationally and remain near all-time highs in Alabama.

The trend has been apparent for weeks, yet a new surge in deaths predicted by some has not materialized. Through Wednesday, an average of fewer than 600 people a day have died from COVID-19 over the past seven days, according to a database maintained by The New York Times. Those are levels not seen since March when the pandemic was just gaining a foothold in the United States.

Dr. David Rubin, a physician and researcher at Children’s Hospital of Philadelphia who has studied the coronavirus, has noticed.

“There’s a note of optimism there. Some of it, I think, is summer-related,” he told FOX10 News. “I don’t think we know for sure. But I think asking whether the fatality rate has changed in summer is a really important question. We suspect that respiratory droplets are not as big a component of transmission.”

The overall daily death numbers have fluctuated more dramatically up and down in Alabama as cases have shot upward. But a closer look at the statistics shows clearly that fewer Alabamians who contract the virus are dying. One way to measure this is to look at deaths during that past seven days as a percentage of recent cases – those diagnosed in the prior 14 days.

It is not perfect; some patients linger for weeks or longer before succumbing to disease.

But it offers a picture of the outcome of recent cases. The Alabama Department of Public Health generally presumes non-hospitalized patients are recovered if they don’t die after 14 days.

By that measure, the mortality rate – less than 1 percent – was running nearly 6 times as high in Alabama in the middle of May. Deaths have slowed in Mobile County, as well. Baldwin County on Thursday recorded its first coronavirus death since May 22 after having nine in about a one-month period before that.

One reason why fewer COVID-19 patients are dying might be that doctors and hospitals have gotten better at treating it, according to health care experts.

Dr. Karen Fagan, director of the Division of Pulmonary and Critical Care at USA Health in Mobile, pointed to drugs like remdesivir and dexamethasone – arrows health care providers did not have in their quivers four months ago.

“So, we’re learning how to ventilate the patients a little bit better or to avoid ventilating them, because we know once they go on a ventilator, their mortality rate is much higher than if they never get on a ventilator,” she said. “So we’re trying to do that. Every day, we’re learning about more and more management strategies for the critically ill.”

Fagan said doctors discovered that treatments deployed to fight other kinds of respiratory infections were not as effective against COVID-19.

“Over time, we’ve adapted those when we’ve learned that maybe those aren’t the best strategies in the COVID acute lung injury patients,” she said. “And so, I think one of the things is we’ve been very adaptable. We’re trying to learn, you know, on the fly like everyone else, but we’re trying to learn with the goal of improving outcomes for everyone.”

Along with better treatments, the profile of COVID-19 patients has changed in the past couple of months. Alabama residents younger than 25 have accounted for a quarter of coronavirus cases since June 1. That is nearly double the percentage prior to June. At the same time, people older than 65 have seen their share drop from 22 percent to 13 percent.

“More of these cases are occurring in younger people who we know, as I said, generally have not only milder cases of the disease, but certainly don’t experience the same kind of mortality rates,” said Dr. Jeanne Marrazzo, the director of infectious diseases at the University of Alabama at Birmingham.

Declining deaths also might be due, in part, to a better job by nursing homes of keeping the virus out of their facilities. Nationally, nursing home residents – highly vulnerable because of their age and health – have accounted for a large share of overall COVID-19 deaths. Long-term care workers and residents make up a lower share of cases than they did three months ago.

But John Matson, a spokesman for the Alabama Nursing Home Association, said he could not say if the facilities are doing a better job.

“The infection control protocols are the same,” he said. “They have not changed.’

Marrazzo, speaking at a recent Facebook session organized by Sen. Doug Jones (D-Mountain Brook), said she worries the decline in deaths will not last if Alabama does not get infections under control. She pointed to rising hospitalizations.

“You’re still seeing that increase in the number of cases, and the very substantial risk that those (younger) people who are infected are going to pass it on,” she said.

Jones said there is more to worry about than fatalities.

“Sometimes, I think we focus too much just strictly on the deaths,” he said. “This virus is a devastating virus for people. So many of the people that get it, they can’t work. They can’t do things. They can’t be around their families.”

Marrazzo agreed, noting the young and healthy are not immune to severe complications.

“I want to emphasize that the more cases you see, the more chance you have, or the higher chance you have, of seeing uncommon outcomes,” she said. “So we know that strokes, for example – devastating strokes – have been reported in young patients.”

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Novel coronavirus deaths have fallen to levels not seen March, while infections have been surging for more than a month.

Experts agree there is no single explanation for the diverging trends. Here are five likely possibilities:

Heat and humidity. Dr. David Rubin, director of the Children’s Hospital of Philadelphia PolicyLab, told FOX10 News that it is a “really important question” if the summer weather reduces respiratory droplets and makes infections less severe.
Younger patients. Many experts have noted that recent coronavirus cases have skewed toward a younger demographic. Dr. Anthony Fauci, director of the National Institutes of Allergy and Infectious Diseases, said during a Facebook appearance with Sen. Doug Jones (D-Mountain Brook) this week that the average age of people testing positive is about 15 years younger than it was few years ago.In Alabama, people younger than 25 have accounted for 26 percent of the state’s COVID-19 cases since June 1. That’s double what it was before June 1. Younger, healthier people are much less likely to die. Residents 65 and older make up almost 79 percent of Alabama’s COVID-19 deaths, while those younger than 50 account of less than 5 percent.
Better protections at nursing homes. John Matson, a spokesman for the Alabama Nursing Home Association, told FOX10 News he cannot say whether those facilities are having more success keeping the virus out. But state records show long-term care facilities are home to a smaller share of the sate’s cases. As of Thursday, workers and residents of those facilities made up less than 10 percent of all infections. By comparison, it was 15.5 percent through the end of May.
Better treatments. There is no cure for the novel coronavirus. But experts contend that doctors and physicians have gotten better at treating the illness. That includes better protocols the prevent the need for mechanical ventilators. Health care providers also point to drugs like remdesivir and dexamethasone.
More testing. Alabama registered 54,944 coronavirus tests last week. That is more than double what it was in the week ending May 2. Experts say the testing limits deaths in two ways. It captures more asymptomatic and lightly symptomatic people, which makes the death rate lower. More testing also might lead to an actual decline in mortality by identifying infections sooner and intervening with treatments earlier.