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I understand what you are describing and generally agree with it, except perhaps for your ultimately prediction. The death rate may ultimately increase, but it
by zaroth 6y ago
I understand what you are describing and generally agree with it, except perhaps for your ultimately prediction. The death rate may ultimately increase, but it would not be simply because the current population of non-recovered cases haven't run their course.
The total case count in theory is a factor of test capacity * positivity rate (ignoring distortions from "probable" cases). Death count also theoretically requires a positive test, so that curve could similarly be impacted by limited testing, but certainly the death part is getting measured in any case. The positivity rate itself can be impacted by limiting testing criteria based on symptoms (but, e.g. perhaps not if you were limiting based on just demographics).
Presuming we were heavily test constrained in March/April, and were limiting testing based on symptoms, so you would have an increase in positivity rate but a lower test count. COVID death count could be low depending on how limited testing was for autopsy purposes, and whether deaths could be ruled being as due to COVID without a positive test.
As testing capacity increases, and testing criteria is loosened, you would expect a lower positivity rate (for the same actual community disease burden) and a greater percentage of actual COVID deaths to be correctly diagnosed (perhaps a lower number of mis-attributed COVID deaths)... there's too many variables here to say for sure, but I would still expect the curves to have the same shape, even if the IFR ultimately goes down because you are catching more cases. The curves are clearly going in different directions.
At first I attributed the divergence to new cases being limited to a younger demographic. If case count is increasing, but it is infecting a demographic with an order of magnitude lower IFR, then death count still decreases over time. But I'm beginning to think this doesn't fully explain it. There are clearly multiple forces at play, and the situation resists simplistic explanations.
And all that is even ignoring the changes in medical protocols, like avoiding ventilators, and more recently, administering dexamethasone. Anecdotally, the majority of cases today come in as a young adult with mild symptoms (someone who probably wouldn't have even been tested in April, let alone admitted), they get a course of dex and antibiotics, are monitored for a couple days, and sent home.
I think if the current active cases were to largely resolve without spreading, or if they spread mainly within their current demographic, then we will not see a major spike in COVID deaths. If the current surge in young adult infections ultimately results in a second wave of elderly infections then it's a different story. But I don't see an inevitable surge in deaths due to the current case count spike. And to the extent that the surge in cases are "probable" and not even confirmed, we could be looking at a lot of smoke without any fire.
- slg 6y agoMany places are counting suspected COVID-19 deaths in the total which doesn't require a positive test. It is much easier to get an accurate picture of suspected deaths than suspected cases so the lack of testing has a much bigger impact on cases. Beyond that, I agree with you that there are too many variable involved to know exactly what is going on. I simply think the lack of adequate testing means the curve of the new cases plot from early in the pandemic is actively misleading. Your analysis/predictions are more optimistic than mine so hopefully you are right and I'm wrong.