The emerging face of COVID: Younger patients, more cases, but fewer deaths
For weeks, the headlines of the coronavirus have been getting worse. "Florida, Texas, and Arizona have all set records for most of the cases they reported in a single day," a typical New York Times warning said on Wednesday. Thursday's stories will likely sound worse.
But while the bad news about rising sunbelt infections is a real and worrying sign of increasing spread - and not a delusion caused by further testing, as President Trump and his allies have falsely claimed - some of them don't covert -bath news about the current contours of the US epidemic.
Yes, the number of cases is increasing in more than 20 countries. But the number of COVID 19 deaths has not increased.
Since the beginning of June, the seven-day moving average of new daily coronavirus cases in the United States has been around 20,000. At the same time, the 7-day average of daily coronavirus deaths fell 23 percent - from 952 on June 1 to 731 on June 16.
This distinction between cases and deaths is even more pronounced in countries where cases are on the rise and where deaths would be expected to follow.
For example, in Florida, the 7-day average of new daily cases has almost tripled since the beginning of the month, rising from 726 on June 1 to 2,015 on June 16. The daily average death rate has dropped from around 39 to around 33 per day.
Beachgoers in Miami Beach, Florida on Tuesday. (Eva Marie Uzcategui / AFP via Getty Images)
In Arizona, the daily case average tripled from 508 to 1,543, while the daily death average was 20.
The same is true for Texas, where the daily case average has increased from 1,272 to 2,279, but the average daily death rate has remained at or below 25.
At this point, it is clear that more people in Florida, Arizona and Texas are signing COVID-19. Why don't more people die there?
An obvious explanation is that the onset of the disease does not happen overnight. The number of cases after Memorial Day rose sharply in all three states, indicating an increasing prevalence associated with reopening businesses and disappointing residents.
But the commemoration day was only three weeks ago. Given that it can take a month or more for the disease to progress from infection to death, it may be too early to say whether many of these new cases will be fatal. Hospitalizations in Florida, Texas and Arizona are beginning to increase. Maybe their mortality numbers will follow.
As doctors learned more about the treatment during the pandemic, they may also be more successful in keeping patients alive.
But it is also worth considering another hypothesis: what if more of the people who now test positive for COVID-19 happen to be the kind of people - namely younger people - who are less likely to die from it?
Republican governors have put forward this argument in recent days. "One of the reasons [for the surge] we've seen from several reports in the state of Texas is that there are certain neighborhoods where the majority of people who test positive in this county are under 30 years of age," Texas Governor Greg Abbott said Tuesday.
"These are people in low-risk groups, so ... almost none of them are hospitalized," added Florida Governor Ron DeSantis. "For 25 to 45 year olds, the clinical consequences of a positive test are usually very, very modest."
There is some data to support this theory. In March, the average age of all Floridians who tested positive for COVID-19 was approximately 60 years; Since then, the average age has dropped to around 35 years. Three quarters of Florida's COVID-19 residents are now under 50 years old.
In Arizona, residents under 45 years ago made up about 40 percent of all COVID-19 cases two months ago. Today, they make up more than 56 percent of the state's cases.
Similar trend lines are emerging in Texas, Georgia, California and other countries. In Georgia, 53 percent of new cases on June 16 affected people under the age of 40, compared with 34.5 percent on June 2. In California, the percentage of people under 35 with COVID-19 increased 15 percentage points (to 44 percent) last month, while the percentage of cases over 50 decreased by the same amount (to 30 percent). And in the emerging hotspot of Hays County, Texas, southwest of Austin, people in their 20s account for 52 percent of all local COVID-19 cases - an increase of 10 percentage points in less than a week.
To a certain extent, this shift reflects the changing demographics of coronavirus testing. Early on when the tests were scarce, the only people who could get a test were either vulnerable (read: older) or clearly sick. If all 50 states are reopening today and the U.S. is testing nearly half a million people a day, anyone who believes they should be tested can do so - including many more younger people with no obvious symptoms who still fear exposure to the virus . This will make positive tests younger.
While it is true that tests with COVID-19 are now more likely to catch younger people, it is also likely that younger people are more likely to contract the virus than older people.
An employee sprays disinfectant on the hands of incoming customers at a bar in Austin, Texas on May 23. (Alex Scott / Bloomberg via Getty Images)
"Of those who are positive, they are overrepresented by young people," said Dr. Philip Keizer, the local health authority in Galveston, Texas, recently told the Texas Tribune.
That makes a lot of intuitive sense. Every older person in America is now aware that the corona virus could kill them, and they are more likely than any other group to take the necessary precautions to avoid this: stay at home whenever possible, then put on a mask wear and keep your distance and try to avoid interiors when leaving the house. (A recent poll by Yahoo News / YouGov confirmed this: 79 percent of Americans 65 years and older said they would continue to stay 6 feet from others after being blocked, and 72 percent said they continued to wear cloth masks in public percentages higher than any other age group.) In states like New York that were hit hard early on, most younger people probably understood the message as well.
But in countries that didn't initially suffer, younger people aren't as scared. When companies reopen - bars, restaurants, etc. - they are the first to go. Sometimes they are maskless. Sometimes they are inside. Sometimes they are close to each other. And most of the time they have "jobs that leave their homes to work," as Texas MP Erin Zwiener from Hays County said recently.
"They are less likely to just be able to afford not to work and are more likely to have jobs that have not paid sick leave," Zwiener continued. "These are all factors that help make young people one of the most important transport companies."
Several recently reopened bars in Florida and Texas were closed after employees and customers tested positive for COVID-19. On a Friday night in Scottsdale, Arizona, “the dance floors were clogged. Lines stretched for blocks. And almost no one wore masks or gloves. "
"If you are at risk or are old or sick, you have to stay at home," a young man who identified himself as a hedge fund manager told the Los Angeles Times. "If you're healthy and young, you have to spend money out here to help the economy."
It is not difficult to imagine what will happen next. Erika Crisp, a 40-year-old healthcare worker, spent the night of June 6 drinking and hanging out with friends in Lynch's Irish pub in Jacksonville Beach, Florida. Soon she felt breathless. Last week, she tested positive for COVID-19 - and 15 of her friends, too.
"We've all been stuck in the house for months, careful, socially distant, and doing everything right," Crisp said recently to a local news channel. "And then, on the first night, we go out, Murphy's law, I think. The only thing we have in common is that one night in that one bar."
Crisp recovers after more than a week of illness. It is encouraging. Statistically speaking, it is much less likely that people their age will end up in a hospital than their parents, which is a drain on healthcare resources, and they are far less likely to die, although 850 US COVID-19 patients under 35 have been so far Years have passed away Many more could have ongoing health problems.
But even if younger residents drive the current increase in some cases, it would be short-sighted to assume that nothing will change. Once the prevalence of COVID-19 infections in a particular community exceeds a certain threshold, it is difficult to limit the spread of the disease to lower-risk demographics. Mark Settles of the University of Florida, a horticultural professor who has followed the state's data on his Facebook page, recently predicted: "Hospitalizations and deaths should increase more slowly than people infected in March / April due to the displacement of people." - but COVID-19 is "still growing" in all age groups, "and deaths will increase in a few weeks. "
"Slowing down the spread of the virus is becoming more difficult," continued Settles. “The spread in April and May was much larger in group institutions. The spread in the community is now increasing. "
A "Right to Work" rally outside Elbo Room Bar in Fort Lauderdale, Florida on Tuesday. The state bars reopened in early June, with the exception of bars in three counties. (Lynne Sladky / AP)
The security of vulnerable populations can be particularly difficult in places like Florida, Texas, and Arizona, where governors refuse to allow residents to wear masks in public and insist that they not be closed again.
"We will not shutdown, we will continue," DeSantis told reporters recently. "You have to have a social function."
For her part, Erika Crisp regrets having to go out after months of quarantine to celebrate.
"I think we were careless and went to a public place we shouldn't have been," said Crisp earlier this week. "And we didn't wear masks. I think we had a whole mentality that was out of sight and mind. The state reopened and said everyone was fine, so we took advantage of that. "
The lesson for younger people according to Crisp?
"We should wear masks. We should distance ourselves socially. It was too early to open everything again. "
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