Case Fatality: A case of mistaken significance

When COVID-19 initially began its spread throughout the United States, there was much talk and anticipation of a “second wave”. It was easy enough to understand that communities and, eventually, the country as a whole would flatten the curve to the point where it was safe to reopen public spaces. Many argued that the second wave of coronavirus cases would arrive at some point in the late fall or early winter. In addition to cold weather being the ideal environment for the virus to spread, flu season would mean more instances of immunocompromisation. What many experts and public officials failed to realize, what the potential for COVID to spread in hotter, more states in the summer months of June and July (i.e. Florida, Texas). Rather than spending the majority of their time outdoors, where virus transmission rates are lower, folks in these regions of the country tend to spend a great portion of their time indoors during the summer. This, coupled with a rush to reopen, has led to a surge in cases all across the Sun Belt. States like Arizona and Florida that initially boasted low quantities of cases and deaths in comparison to their neighbors in the Northeast, now find themselves struggling. The increased number of cases in these states has brought the United States to experience single-day case records throughout the month of July, including over 67,400 on the 14th. 

In response to this changing dynamic, the Trump administration has lasered in its focus on one statistic that, on its face, makes the situation appear less grim. “We’re seeing the fatality rate in this country come down. That is a very good thing”, said White House Press Secretary, Kayleigh McEnany, in a recent briefing. In theory, mortality rate is a coherent, easy-to-understand concept that speaks volumes about the threat posed diseases, or anything really. There’s just one problem.

The mortality rate of COVID-19 cannot be understood in constant terms. Though the number of cases may rise quickly, death numbers will always lag behind several weeks given the nature of how the virus impacts immune systems. This is especially true now, as the average age of those directly affected by COVID is decreasing all throughout the country. As Dr. Anthony Fauci appropriately pointed out, “the average age of people getting infected is now a decade and a half younger than it was a few months ago”. In fact, in the state of Florida, the median age of positive cases in March was 65; it’s now 39.5. This is significant because it entails that symptoms of the virus will tend to take longer to kick in for symptomatic carriers. Contrary to the narrative that only older people become severely sick from COVID, more than 40% of virus-related hospitalizations during the last week of June involved patients between the ages of 18 and 49.

While it appears that younger people are less likely to die or face severe health complications from COVID-19, medical experts are indicating it's simply too soon to be sure. According to David Relman, a microbiologist at the Stanford University School of Medicine, focusing solely on case mortality rate means overlooking other COVID-related complications. For example, 20% of people who get sick are faced with long-term side effects, even after they recover from the virus. While pointing out a low death rate in the immediate term might prove politically beneficial to President Trump, it does little to address genuine risks in the near future.

Presently, hospitals in the Sun Belt are becoming increasingly overwhelmed and pushed to the brink of their capacities for patients; not to mention having to face shortages in ICUs, PPE, and other medical equipment. The crises in these regions are severely exacerbated by the fact that many young carriers of COVID-19 are asymptomatic. While it’s certainly a good thing that fewer young people on aggregate grow severely sick as a result of the virus, it also means they are less likely to take it seriously. This might manifest itself in the form, for instance, of COVID-infected people refusing to wear masks and/or practice social distancing. Some public officials, like Florida’s Governor Ron DeSantis, have mirrored this attitude by refusing to mandate the wearing of masks in their states and communities.

The reality is, so long as more young people contract the Coronavirus, there will be a greater number of COVID patients that are actually asymptomatic. Not displaying signs of the virus, however, is by no means an excuse to not wear masks in public, to disobey social distancing guidelines, etc. Even if a specific demographic or subset of the population is less likely to be hospitalized as a result of the virus, every person must do what is necessary to keep those around them safe. As the threat of COVID-19 molds into different forms over time, it remains important to consider the wellbeing of those around us, just as we would our own.

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