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| U.S. Coronavirus Cases Are Rising Sharply, but Deaths Are Still Down | U.S. Coronavirus Cases Are Rising Sharply, but Deaths Are Still Down |
| (about 4 hours later) | |
| After a minor late-spring lull, the number of confirmed coronavirus cases in the United States is once again on the rise. States like Arizona, Florida and Texas are seeing some of their highest numbers to date, and as the nation hurtles further into summer, the surge shows few signs of stopping. | After a minor late-spring lull, the number of confirmed coronavirus cases in the United States is once again on the rise. States like Arizona, Florida and Texas are seeing some of their highest numbers to date, and as the nation hurtles further into summer, the surge shows few signs of stopping. |
| And yet the virus appears to be killing fewer of the people it infects. In April and May, Covid-19, the disease caused by the coronavirus, led to as many as 3,000 deaths per day, and claimed the lives of roughly 7 to 8 percent of Americans known to have been infected. The number of daily deaths is now closer to 600, and the death rate is less than 5 percent. | And yet the virus appears to be killing fewer of the people it infects. In April and May, Covid-19, the disease caused by the coronavirus, led to as many as 3,000 deaths per day, and claimed the lives of roughly 7 to 8 percent of Americans known to have been infected. The number of daily deaths is now closer to 600, and the death rate is less than 5 percent. |
| In general, experts see three broad reasons for the downward trend in the rate of coronavirus deaths: testing, treatment and a shift in whom the virus is infecting. The relative contribution of these factors is not yet clear. And because death reports can lag diagnoses by weeks, the current rise in coronavirus cases could still portend increases in mortality in the days to come. | In general, experts see three broad reasons for the downward trend in the rate of coronavirus deaths: testing, treatment and a shift in whom the virus is infecting. The relative contribution of these factors is not yet clear. And because death reports can lag diagnoses by weeks, the current rise in coronavirus cases could still portend increases in mortality in the days to come. |
| Since mid-March, when the coronavirus was declared a national emergency, diagnostic testing for the coronavirus has risen significantly. More than 600,000 tests are administered each day in the United States, up from about 100,000 per day in early spring. Although the nation is still falling short of the millions of daily tests that experts have called for, the increased testing has identified many more infected individuals with mild or no symptoms, driving down the overall proportion of patients who die from Covid-19, said Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. | Since mid-March, when the coronavirus was declared a national emergency, diagnostic testing for the coronavirus has risen significantly. More than 600,000 tests are administered each day in the United States, up from about 100,000 per day in early spring. Although the nation is still falling short of the millions of daily tests that experts have called for, the increased testing has identified many more infected individuals with mild or no symptoms, driving down the overall proportion of patients who die from Covid-19, said Caitlin Rivers, a senior scholar at the Johns Hopkins Center for Health Security. |
| And with more tests available, infections are often identified earlier, “which allows us to intervene earlier,” said Saskia Popescu, a hospital epidemiologist and infectious disease expert in Arizona. Many treatments seem to work best when given well before people are at death’s door. | And with more tests available, infections are often identified earlier, “which allows us to intervene earlier,” said Saskia Popescu, a hospital epidemiologist and infectious disease expert in Arizona. Many treatments seem to work best when given well before people are at death’s door. |
| As the weeks have worn on, doctors and nurses have also gained a better handle on how to treat the coronavirus. In several states, emergency departments are no longer overflowing; between April and June, nationwide hospitalizations dropped to less than 30,000 from nearly 60,000, according to the Covid Tracking Project. That may have eased the strain on exhausted employees and limited medical supply chains, including those that keep lifesaving equipment like ventilators in stock, said Dr. Taison Bell, a physician specializing in infectious disease and pulmonary and critical care at the University of Virginia. Under less pressure, hospitals are now “better able to take care of critically ill patients,” he said. | As the weeks have worn on, doctors and nurses have also gained a better handle on how to treat the coronavirus. In several states, emergency departments are no longer overflowing; between April and June, nationwide hospitalizations dropped to less than 30,000 from nearly 60,000, according to the Covid Tracking Project. That may have eased the strain on exhausted employees and limited medical supply chains, including those that keep lifesaving equipment like ventilators in stock, said Dr. Taison Bell, a physician specializing in infectious disease and pulmonary and critical care at the University of Virginia. Under less pressure, hospitals are now “better able to take care of critically ill patients,” he said. |
| Health care workers have also become more knowledgeable about promising treatments and palliative care options to combat the coronavirus and its effects. For instance, prone positioning, in which patients are flipped onto their stomachs, can ease respiratory distress by opening up the lungs. Critically ill individuals are also now known to be vulnerable to excessive blood clotting, and may benefit from blood thinners. And the steroid dexamethasone appears to reduce deaths among patients with severe Covid-19, although the data demonstrating this emerged only recently. (Another drug, an antiviral called remdesivir, seems to speed recovery, but does not appear to have notable effects on mortality.) | Health care workers have also become more knowledgeable about promising treatments and palliative care options to combat the coronavirus and its effects. For instance, prone positioning, in which patients are flipped onto their stomachs, can ease respiratory distress by opening up the lungs. Critically ill individuals are also now known to be vulnerable to excessive blood clotting, and may benefit from blood thinners. And the steroid dexamethasone appears to reduce deaths among patients with severe Covid-19, although the data demonstrating this emerged only recently. (Another drug, an antiviral called remdesivir, seems to speed recovery, but does not appear to have notable effects on mortality.) |
| “Before, it felt like we were stumbling in the dark,” Dr. Bell said. “It feels a little bit better now.” | “Before, it felt like we were stumbling in the dark,” Dr. Bell said. “It feels a little bit better now.” |
| A shifting patient population is probably also altering the disease’s dynamics. Coronavirus-related hospitalizations increase with age, and elderly individuals remain some of those hardest hit by the coronavirus; patients over 65 account for eight out of 10 deaths from Covid-19, according to the Centers for Disease Control and Prevention. But younger people now make up a growing proportion of cases, and they are less likely to die from the disease. In Arizona, people ages 20 to 44 now account for nearly half of all cases. In Florida, which just recorded more than 10,000 new cases in a single day, the median age of residents testing positive has dropped to 35 from 65. And in Texas, more than half of those testing positive are under the age of 50. | A shifting patient population is probably also altering the disease’s dynamics. Coronavirus-related hospitalizations increase with age, and elderly individuals remain some of those hardest hit by the coronavirus; patients over 65 account for eight out of 10 deaths from Covid-19, according to the Centers for Disease Control and Prevention. But younger people now make up a growing proportion of cases, and they are less likely to die from the disease. In Arizona, people ages 20 to 44 now account for nearly half of all cases. In Florida, which just recorded more than 10,000 new cases in a single day, the median age of residents testing positive has dropped to 35 from 65. And in Texas, more than half of those testing positive are under the age of 50. |
| Numerous states recently began reopening their economies, which might be driving some of the youthful bias, said Natalie Dean, an infectious disease epidemiologist in Florida, where new cases are hitting record highs. People in their 20s and 30s have returned to bars and beaches; working-age employees have resumed jobs that cannot be done from home. | Numerous states recently began reopening their economies, which might be driving some of the youthful bias, said Natalie Dean, an infectious disease epidemiologist in Florida, where new cases are hitting record highs. People in their 20s and 30s have returned to bars and beaches; working-age employees have resumed jobs that cannot be done from home. |
| “We know that’s high-risk,” Dr. Dean said. “We’re hearing a lot of reports of clusters being linked to these places” as they open back up. | “We know that’s high-risk,” Dr. Dean said. “We’re hearing a lot of reports of clusters being linked to these places” as they open back up. |
| At the same time, elderly individuals, as well as those with underlying health conditions thought to exacerbate Covid-19, may be warier of exposure, said C. Brandon Ogbunu, a computational biologist and disease ecologist at Yale University. “Early on, this disease ripped through older populations with such aggression,” he said. “It’s possible that’s where the message was felt the most strongly.” | At the same time, elderly individuals, as well as those with underlying health conditions thought to exacerbate Covid-19, may be warier of exposure, said C. Brandon Ogbunu, a computational biologist and disease ecologist at Yale University. “Early on, this disease ripped through older populations with such aggression,” he said. “It’s possible that’s where the message was felt the most strongly.” |
| Moreover, nursing homes and other facilities that harbor vulnerable populations may be working harder to protect their residents, Dr. Dean said. In general, “We now have a better set of tools to keep our communities safer,” he said. “More people are wearing masks. We’re better at sanitizing things.” | Moreover, nursing homes and other facilities that harbor vulnerable populations may be working harder to protect their residents, Dr. Dean said. In general, “We now have a better set of tools to keep our communities safer,” he said. “More people are wearing masks. We’re better at sanitizing things.” |
| Of course, “Young people don’t live in isolation,” Dr. Bell said. They are still mingling with older members of the population — potentially seeding transmission events that have yet to appear. | Of course, “Young people don’t live in isolation,” Dr. Bell said. They are still mingling with older members of the population — potentially seeding transmission events that have yet to appear. |
| Experts can’t be sure, but behaviors like mask wearing, physical distancing and hygiene may also be reducing the dose of coronavirus that people encounter in the population at large, Dr. Dean said. The amount of virus that individuals carry may influence the severity of their symptoms. But so far, there is no evidence that this dynamic is contributing to the lower mortality rate in the United States. | Experts can’t be sure, but behaviors like mask wearing, physical distancing and hygiene may also be reducing the dose of coronavirus that people encounter in the population at large, Dr. Dean said. The amount of virus that individuals carry may influence the severity of their symptoms. But so far, there is no evidence that this dynamic is contributing to the lower mortality rate in the United States. |
| Updated July 7, 2020 | |
| The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization. | |
| Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days. | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | |
| Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks. | |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | |
| If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.) | |
| If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others. | |
| There is also no indication that the death rate is lower because the coronavirus itself has become less deadly, Dr. Ogbunu said. Mutation is a normal part of any virus’s evolutionary trajectory, but these genetic changes are often inconsequential. | There is also no indication that the death rate is lower because the coronavirus itself has become less deadly, Dr. Ogbunu said. Mutation is a normal part of any virus’s evolutionary trajectory, but these genetic changes are often inconsequential. |
| Given the recent rise in infections, the dip in coronavirus mortality will not necessarily last. As more people socialize, those with milder infections might end up ferrying the pathogen to vulnerable individuals. As states reopen, local leaders are urging residents to continue physical distancing and to wear masks. But even tempered by warnings, moves back toward normalcy could inadvertently signal to people that the worst is already over, Dr. Popescu said. | Given the recent rise in infections, the dip in coronavirus mortality will not necessarily last. As more people socialize, those with milder infections might end up ferrying the pathogen to vulnerable individuals. As states reopen, local leaders are urging residents to continue physical distancing and to wear masks. But even tempered by warnings, moves back toward normalcy could inadvertently signal to people that the worst is already over, Dr. Popescu said. |
| Experts are also reluctant to place too much emphasis on falling death rates. “We’re training a lot of attention on the idea of mortality,” said Dr. Jennifer Tsai, an emergency medicine physician at Yale University. Behind that picture, she added, there is a great deal of suffering. Reports from around the world have painted a sobering portrait of chronic Covid-19 syndromes, some of which last for months. Patients may be saddled with physical and emotional distress that persists long after the virus has left their bodies. | Experts are also reluctant to place too much emphasis on falling death rates. “We’re training a lot of attention on the idea of mortality,” said Dr. Jennifer Tsai, an emergency medicine physician at Yale University. Behind that picture, she added, there is a great deal of suffering. Reports from around the world have painted a sobering portrait of chronic Covid-19 syndromes, some of which last for months. Patients may be saddled with physical and emotional distress that persists long after the virus has left their bodies. |
| “Death is not the only outcome,” Dr. Dean said. And people marginalized by race, ethnicity and social standing will inevitably bear more of the disease burden than others, Dr. Tsai added. “The risk and the mortality is going to be passed on to the most vulnerable, no matter who gets infected first,” she said. | “Death is not the only outcome,” Dr. Dean said. And people marginalized by race, ethnicity and social standing will inevitably bear more of the disease burden than others, Dr. Tsai added. “The risk and the mortality is going to be passed on to the most vulnerable, no matter who gets infected first,” she said. |
| Recent upswings in coronavirus case numbers leave experts apprehensive of what’s to come. Death, when it occurs, tends to trail infection by about two to four weeks. Early on in the pandemic, when testing focused on patients with worrisome symptoms, the typical lag between case and death reporting was a week or two. Now that diagnostic testing is more widespread, that interval has widened. | Recent upswings in coronavirus case numbers leave experts apprehensive of what’s to come. Death, when it occurs, tends to trail infection by about two to four weeks. Early on in the pandemic, when testing focused on patients with worrisome symptoms, the typical lag between case and death reporting was a week or two. Now that diagnostic testing is more widespread, that interval has widened. |
| Two weeks into a new round of coronavirus cases, the United States may be verging on another wave of deaths. Already, hospitalizations have begun an alarming upsurge in several states. | Two weeks into a new round of coronavirus cases, the United States may be verging on another wave of deaths. Already, hospitalizations have begun an alarming upsurge in several states. |
| “I think the next two to three weeks will be very telling,” Dr. Popescu said. | “I think the next two to three weeks will be very telling,” Dr. Popescu said. |
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