Changing Demographics and Death Lags, What We Know
I addressed the question of death lags yesterday in When Will the Exploding Number of Cases Lead to More Deaths?
My analysis shows that states have vastly different lag times. Many people averaged these lags to suggest we are out of the woods.
On top of that mistake, others believe that more testing is behind most of the rise. That has been widely disproved but people will believe what they want.
It's Not Just Testing
For discussion, please see It's Not Just Testing
The starkest example, Florida, has actually slowed testing almost 10 percent, week over week, while seeing a 65 percent jump in the cases in the same time span. Florida’s rising cases, we can conclude, have nothing to do with expanded testing. South Carolina and Kentucky have followed the same pattern as Florida, with testing increases slowing while cases rise.
Given the high percent-positive rates and the degree to which case counts have outpaced tests in Arizona, Florida, and Texas, we interpret the case counts as indicators of sharply worsening outbreaks. In California and Georgia, where percent-positive rates remain relatively steady, the numbers are more difficult to interpret, but we’ll be watching them closely over the coming weeks.
What About Median Age and Demographics?
I came across a new article yesterday evening that sheds more light on the matter.
Death Trends Hard to Understand
On June 18, new daily COVID-19 cases in the US exceeded 27,000 for the first time since May 8, and stayed over 27,000 for the next four days. This was the first five-day run of new cases above that number since April 22-26. The 32,325 new cases reported on June 20 were the most since May 1, when just over 33,000 cases were reported. After plateauing in May, the trend is heading in the wrong direction.
Deaths, on the other hand, continue to decline: from June 18-22, fewer than 700 people in the US died each day, a first for a five-day period since March. The disconnect between case and death trends is striking; in Brazil and India, the two other large countries reporting a rapid increase in infections, in recent weeks as well.
Some anecdotal and statistical evidence suggests that the average age of people with COVID-19 is declining, which complicates expectations that deaths will increase in step with new cases.
In a Twitter thread, University of Florida biostatistics professor Dr. Natalie Dean offers three possible explanations for why the median age of cases might be falling, and what data signals we should look for.
Natalie Dean - Three Explanations of Rising Cases
- If it’s simply a matter of More Testing, hospitalizations should not increase, and test positivity should decline or hold steady. In the South and West, positivity rates appear to be rising, but regional numbers can mask very different state trends. In Texas, Florida, and Arizona, test positivity and cases are both rising; in California, by contrast, new cases are way up but the positivity rate has remained at five percent in June, and in Georgia the positivity rate is up just two percentage points while testing is up.
- If “elderly people are More Cautious,” then cases, test positivity, and hospitalizations should decline. In the Northeast, tests are way up, positivity is way down, and new cases are flat. In New Jersey, new daily cases are down to 10% of April peaks, and hospitalizations have dropped precipitously. New daily cases in Connecticut have been in the double digits for the past couple weeks, and hospitalizations are down to 124 as of June 23 from over a thousand in mid-May.
- If younger people are —or if they’re more exposed as young service workers return to their jobs—cases, test positivity, and hospitalizations should rise. This is happening in Texas and Arizona. Cases and test positivity are up in Florida; statewide hospital data was only available for a few days in May before the state removed it from public view, but in Miami-Dade County, hospitalizations increased from 601 to 776 from June 9 to June 22.
Dean ultimately concludes that it’s slightly too early to tell, but the real answer is likely a combination of all three, and that better age-stratified data is needed. High-quality samples exist for the country as a whole, but as we’ve seen, trends vary greatly from state to state and even city to city. The United States is a big country that needs a lot of detailed data.
Here is Dean's 10-Point Twitter Thread
Three Points I Made
- Regional numbers mask trends.
- Hospital cases are rising and ICU beds are at capacity in Houston.
- We do not have Florida data because governor DeSantis blocked it, I believe on purpose, but feel free to make your own conclusions.
In regards to point 3, please recall that on June 2, Trump says he is ‘forced’ to move Republican National Convention out of North Carolina.
- President Donald Trump announced late Tuesday that the GOP is now “forced” to look for another state to host the Republican National Convention due to social distancing guidelines that would limit event capacity.
- While Trump did not specify in his tweet to where the convention will be moved, multiple governors and GOP officials from places such as Texas and Georgia immediately offered up their states as potential hosts when the saga over the location of the convention first broke out.
On June 11, Trump announced the Convention Would Move to Jacksonville.
Now isn't that move special?
Florida just happens to be the key swing state in the election, and Governor DeSantis in a totally unrelated move suppressed Covid totals.
And I am the Tooth Fairy.
Death Rate Will Rise
The reasonable conclusion is the death rate will rise, the key point I made.
In retrospect, I asked the wrong question: When Will the Exploding Number of Cases Lead to More Deaths?
"How fast?" is a better question.
I do not know, nor does anyone else.
One thing we do know (should know) is that it is foolish to conclude this is behind us, a position I am bombarded with daily from those who repeatedly deny there is a problem at all.