The news is almost all bad, and it doesn't need to be that way.

in #covidlast month

The one bit of good news is that our CFR and IFR (Case and Infection Fatality Rates) have declined significantly, most likely a combination of improved treatment programs and the increase in infections happening mostly in younger cohorts since reopening. But even that improvement isn't enough to offset the huge increase in new cases, and our death toll is climbing again, fairly quickly.

tl;dr - It seems possible that our responses have been enough to stop the growth of the curve, and are surely far short of what we need to reverse it. And we lack the political will to do more. I expect the new case count to slow its growth or maybe flatline, and the hospital / death situation will get significantly worse over the coming weeks. Eventually, that news will drive changes in public behavior even in the absence of leadership.

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EVERYONE ELSE IS WINNING.

There's a popular sentiment in the US that "we're all going to get it" and "you can't stop this virus". Among large, rich democracies...we're the only ones that aren't winning. Most of the others are on track to keep more than 90% of their population safe, and because of that, they'll be able to open and recover more quickly than we will.

We had more lead time, but had a terribly high peak anyway because of our lack of testing. After that peak, we had a relatively ineffective lockdown, and it ended too early, causing our entirely self-inflicted second wave. Our new case rate is now FORTY TIMES HIGHER than the rates in comparable countries.

This thing can be beaten, it isn't difficult, and we continue to choose not to do it.


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This second wave is being driven by southern states, most of which never really had a decline in the first phase. Florida did make some progress in April and the start of May; Arizona and Texas were flat or slowly climbing through April and May.


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There's another popular but false belief in the US: that our apparent rise in cases is due to increased testing, not an expansion of the epidemic.

This is false.

In the states that are having the biggest outbreaks, confirmed case counts are rising FASTER than testing, resulting in an increase in the test positive percentage.

Expanded testing can increase case counts, but when that happens, you see the % positive decrease, as you have to do more and more tests to find each new case.

In Arizona in early May, they had to do 25 tests to find one positive. Today, they're getting one positive from 4 tests. Florida went from one in 40 to one in five. Texas, from one in 20 to one in six.

Testing is not producing a false increase.

In fact, the increased % positives means we're MISSING a higher percentage of true cases than before, and THE REAL INCREASE IS STEEPER than our official counts show.

That's an important point. As scary as the case growth has been, the real increase is actually quite a bit higher.

And that brings me to false belief #3: it's all OK because the death count is going down, right?


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The US death rate was declining rapidly until about mid June, then continued a slower decline into early July. (Ignore the week-long blips caused by state reporting changes.)

The US total is the sum of two different curves. Until recently, it was dominated by the huge death count declines in the northeast, as they made excellent progress in fighting the epidemic.

More recently, death rates in the south have been rising, and now the decline from the northeast is nearly complete. As a result, the US death rate is climbing.

This increase has lagged the increase in infections for several reasons. First, deaths lag case counts for the obvious reason that most positive cases come from living people. Symptom onset to death averages about two weeks, and can be much longer. But we've also had improvements in treatment, and the recent case count increase has skewed younger than the first wave.

Arizona's death rate has roughly tripled, Texas has more than doubled, and Florida has nearly doubled. There's also significant evidence that Texas and Florida are undercounting COVID deaths by 50-100% based on excess death measurements.

Overall, the huge increase in case counts has now overwhelmed the gains we got from improved treatments and a younger set of patients, and is now rising rapidly...up 30% in less than a week. I expect it to continue to rise for at least the next two to three weeks, possibly much longer than that.

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