A Second Coronavirus Death Surge Is Coming
By: The Atlantic
Tags: Health, Science, Coronavirus

In the United States, the rising severity of the current moment was obscured for several weeks by the downward drift of cases, hospitalizations, and deaths resulting from the spring outbreak in northeastern states. Even though deaths have been rising in the hardest-hit states of the Sun Belt surge, falling deaths in the Northeast disguised the trend.

It is true that the proportion of infections in younger people increased in June and July compared with March and April. And young people have a much lower risk of dying than people in their 60s and older. But, at least in Florida, where the best age data are available, early evidence suggests that the virus is already spreading to older people. Additionally, analysis of CDC data by The New York Times has found that younger Black and Latino people have a much higher risk of dying from COVID-19 than white people the same age. According to the racial data compiled by the COVID Tracking Project in concert with the Boston University Center for Antiracist Research, Latinos in Arizona, California, Florida, and Texas are 1.3 to 1.6 times more likely to be infected than their proportion of the population would suggest. It is telling that despite outbreaks all over Texas in recent weeks, the border region has been leading the state in deaths per capita.

Even with cases surging, if hospitalizations were not rising, that might suggest that this outbreak might be less deadly than the spring’s. But hospitalization data maintained by the COVID Tracking Project suggested otherwise as early as June 23. On that date, hospitalizations began to tick up across the South and West, and they have not stopped. It’s possible we’ll match the national peak number of hospitalizations from the spring outbreak over the next week.

Even if better knowledge of the disease and new treatments have improved outcomes by 25 or even 50 percent, so many people are now in the hospital that some of them will almost certainly die.

There was always a logical, simple explanation for why cases and hospitalizations rose through the end of June while deaths did not: It takes a while for people to die of COVID-19 and for those deaths to be reported to authorities.

So why has there been so much confusion about the COVID-19 death toll? The second surge is inconvenient for the Trump administration and the Republican governors who followed its lead, as well as for Mike Pence, the head of the coronavirus task force, who declared victory in a spectacularly incorrect Wall Street Journal op-ed titled, “There Isn’t a Coronavirus ‘Second Wave.’”

“Cases have stabilized over the past two weeks, with the daily average case rate across the U.S. dropping to 20,000 — down from 30,000 in April and 25,000 in May,” Pence wrote. In the month since Pence made this assertion, the seven-day average of cases has tripled. Several individual states have reported more than 10,000 cases in a day, and Florida alone reported 15,000 cases, more than any state had before, on an absolute or per capita basis.

But there’s another reason for some of the confusion about the severity of the outbreak right now. And that’s the perceived speed at which the outbreak initially landed on American shores and started killing people. The lack of testing let the virus run free in February and much of March. As my colleague Robinson Meyer and I put it at the time, “Without testing, there was only one way to know the severity of the outbreak: counting the dead.” And that is how we figured out how bad the outbreak was. Thousands began dying in the greater New York City area and a few other cities around the country in early April. The seven-day average for new cases peaked on April 10, followed by the peak of the seven-day average for daily deaths just 11 days later.

Everything seemed to happen at once: lots of cases, lots of hospitalizations, lots of deaths. But some of this is also the compression of memory. Most of us remember the deaths in March beginning as quickly as the cases, especially given the testing debacle. That’s not exactly what happened, however. The nation did, in fact, see cases rise weeks before the death toll shot up. There was a time in March when we had detected more than 100 cases for each death we recorded. This is a crucial metric because it gets at the perceived gap between cases and deaths. And it tells us that we did see a lag between rising cases and deaths back in the spring.

During the slow-decline phase in May, the case-to-deaths ratio fell to about 20. Then, this summer, the case-to-death ratio began to rise in early June. On July 6, the ratio hit 100 again, just like in the spring. But as in spring, this was not a good sign, but rather the leading indicator that a new round of outbreaks was taking hold in the country. And, indeed, a week ago, this ratio began to fall as deaths ramped up.

The U.S. came most of the way down the curve from the dark days of April, and now we’re watching the surge happen again. The testing delays, the emergency-room-nurse stories, the refrigerated morgue trucks — the first time as a tragedy, the second time as an even greater tragedy. One must ask, without really wanting to know the answer, How bad could this round get?