The percentage of those infected with the coronavirus who die of COVID-19 is falling in most states, a sign that the battle against the virus is entering a new phase.
Across the nation, that percentage — known as the case fatality rate — has been on the decline for weeks, and in some states for months. It is a hopeful indicator, but one that health experts caution is layered with uncertainty.
In Arizona, about 5 percent of those who tested positive for the coronavirus by the end of May died. The case fatality rate now is about half that figure. In California, the rate stood at 4 percent in late May, and is now 1.6 percent. In April, 7.5 percent of those who tested positive in Minnesota died, a rate that has fallen to 2.7 percent, according to The Hill’s analysis of state data.
Health experts pointed to several reasons for the decline: Doctors are learning about better methods of treating those who are ill. Those who contract the virus are now more likely to be younger, rather than older people who are most at risk of dying. And more widespread testing is identifying cases among those who show few or no symptoms.
In the early days of the pandemic, as hospital wards filled in places like New York and New Jersey, overwhelmed doctors and nurses put thousands of patients on ventilators. A huge percentage of those people never came off the ventilators.
Now, some doctors said, fewer patients are being intubated, and the sickest patients are being treated with drugs like remdesivir and dexamethasone, treatments that can help lower the risk of death.
Doctors are also using more basic methods like proning, in which patients lay on their stomachs. That method helps them access more of their lung capacity, preventing suffocation that comes with fluid buildup caused by pneumonia.
“I think we are getting better in treating COVID-19. The experience that’s been acquired over the past few months by those individuals who have been laboring with incredible determination and energy in ICUs have made it possible for the people who we were losing maybe back in March and April in the terrible outbreak in New York are now being saved,” Francis Collins, director of the National Institutes of Health, told The Hill in an interview. “There’s a better understanding now about how to keep people off of ventilators, unless you absolutely have to because of all the complications that ensue at that point.”
The virus’s main vectors of transmission have shifted, too. In March and April, outbreaks in assisted living facilities targeted older people who were more likely to have the underlying conditions that led to the worst outcomes.
But as states report a smaller number of cases among older people, the number of cases among younger people has risen dramatically. The average age of a coronavirus patient has been cut in half in some states.
“Younger people tend to handle this virus better, so that’s why we’re seeing death rates and hospitalization rates come down,” said Scott Lindquist, Washington’s state epidemiologist for communicable diseases. Still, he said, “It is concerning that we are seeing an increase in the younger age group.”
Health officials are concerned that a falling death rate will provide a false sense of security about a disease that can cause significant damage to the heart, lungs and other organs.
“We have focused a lot on mortality, and one of the things I have really seen going back on the wards over and over again is that morbidity, the disease from this, is pretty bad. Even if they survive, the number of people who have long-term health effects that can really be disabling is being ignored by the media,” said Celine Gounder, a clinical researcher at New York University’s Grossman School of Medicine who practices at Bellevue Hospital. “Even in elite athletes, we’ve seen long-term impacts on their breathing.”
The nation’s increased testing capacity is also partly responsible for a decline in the case fatality rate. Early in the pandemic, the lack of capacity meant only the sickest patients — and therefore the more likely to die — were being tested.
Now, hundreds of thousands of new tests are being conducted every day. While still not enough to allow health officials to contain the virus, those tests are picking up more cases among those with few symptoms, people who are most likely to survive.
But the case fatality rate has not fallen uniformly across the country. In Massachusetts, the rate remains just north of 7 percent. In New Jersey, the 8.4 percent fatality rate is still near its peak. Even in New Hampshire, which never saw a massive spike in cases, 6 percent of those who are confirmed to have contracted the virus have died.
The United States remains behind most of the rest of the world in the fight against the coronavirus. More than 170,000 people in the U.S. have died of COVID-19, a higher death toll than any other nation.
Even adjusting for population, the United States has lost more people than all but a handful of nations. Only Peru and Chile have lost greater percentages of their population, and Brazil’s toll is almost on par with the United States.
“I really am watching much more closely to what has happened to our mortality rate in the United States as a function of our overall population, and that is still quite troubling,” Collins said. “We are still losing 1,000 or more people a day, which is more than it was six weeks ago.”