Sept. 22, 2020 — Just over 6 months after the World Health Organization declared COVID-19 a pandemic, the United States has reached a grim milestone: the novel coronavirus death toll has climbed to a staggering 200,000.
“It’s sobering. It’s a large number, and clearly it tells us that everything we’re doing right now to contain it needs to continue,” says Erica Shenoy, MD, associate chief of the Infection Control Unit at Massachusetts General Hospital. “Especially heading into the fall, where we don’t know if there will be a second surge, or if this will be compounded by other respiratory illnesses.”
Doctors and scientists say the number sends a clear message: Although people are itching to return to pre-pandemic life, Americans should continue to wear masks, practice hand-washing hygiene, and keep physical
distance from others.
While the high death toll is a bleak glimpse into how severe the illness is, there are two silver linings: The numbers seem to be trending in the right direction, and researchers have had time to discover more about a virus that at first baffled even the world’s leading scientists.
According to Shenoy, the best way to gauge whether mortality is dropping is the CDC’s report of “excess deaths” — the bulk of deaths above historically normal levels. About 246,600 more people died than usual from March 15 to Aug. 22. That number continues to decline, Shenoy says, which is promising.
“That might be a sign that it’s going in the right direction,” she says.
New cases and deaths are slowing. For example, New York saw a sharp rise before reaching more than 170,000 total cases in April. But new cases are down from 10,000 per day to under 600 per day. The dip could be related to several things. More young people are contacting the virus now, and they are less vulnerable to severe illness than older adults. Doctors and caregivers are also learning more about how to treat and manage the illness, leading to better outcomes.
The buildup of knowledge over the last several months has shed light on which patients are most vulnerable. An August study in Lancet Oncology found that blood cancer patients are especially high-risk, with 57% higher odds of severe symptoms than people who have other types of cancer.
The things that most determine risk have consistently been age and underlying conditions. A study out this month in the journal Infection Control & Hospital Epidemiology examined COVID-19 patients admitted to the hospital with non-critical illness. It found that the biggest drivers for deadly outcomes were age and diabetes.
“Age is one of the most important risk factors for severe disease. There is increasing morbidity and mortality, highest in patients over the age of 85,” Shenoy says. “There is also a subset of underlying medical conditions that lead to worse outcomes, including COPD, obesity, heart disease, sickle cell disease, and diabetes.”
Despite the growing body of information on COVID-19, attempting to predict what the flu season will be like is often considered “a fool’s errand,” Shenoy says. With schools opening this fall and states easing up on regulations, the numbers of COVID-19 cases, and other respiratory viruses, the numbers could begin to trend in the wrong direction, depending the practices of U.S. residents in the coming months.
As of August, COVID-19 was on track to be the third leading cause of death in the United States. Thomas Frieden, MD, former director of the CDC, said the novel coronavirus only lagged behind heart disease and cancer. The virus is now on par with death rates from Alzheimer’s and dementia, Shenoy says.
The biggest question mark — and perhaps the main factor in how the rest of the year plays out — is how severe this flu season will be, she says. There could either be a perfect storm of deadly respiratory illness that leads to another spike in cases, or a mild flu season and a decrease in COVID-19 deaths.
Shenoy says it’s important to get the flu vaccine as soon as it’s available. Aside from that, she says, wearing masks, thorough hand-washing, and social distancing remain crucial to decreasing infection. She also encourages people to stay home if they don’t feel well.
“Some things we can’t control, but some things are within our control,” she says. “We need to continue to do what we can to curb this.”