Why is the death rate so much lower now?

If you look at the death rate now verses mid-April, it’s much better now. Even though the number of cases is going through the roof, the death rate seems to have stabilized at around 1K/day.
Why is that? Better treatments? More diffused infections (less stress on the hospital infrastructure)? Something else?

WAG that most of the increase in infections is in the younger age groups which tend to have much lower mortality rates. Rates closer to the seasonal flu for their age brackets.

More WAGs:

It could be that, because of mask-wearing, people are getting milder cases.

It could be that we have better knowledge now of how to treat it.

It could be that the virus that many people are getting now is a less deadly form.

I vote for this. Doctors have figured out better ways to treat COVID just because exposure to so many patients. They’re learning what works and what is helpful. Like positioning people face down to assist with breathing instead of automatically putting them on ventilators. Also discovering the usefulness of steroids in treatment. In the beginning no one knew exactly what to do.

I imagine nursing homes are doing a much better job of protecting the most likely to be killed by the virus from infection now than they were at the start of this pandemic.

Or, you know the second wave hasn’t really hit yet.
Don’t look at base numbers. In March and April, you could only get a test if you were coughing out your organs or were exposed to someone who was, nowadays pretty much anyone can get it.
Look at hospitalization rates. If those have gone down then you know that the death rate hasn’t either and the larger numbers are due to a massive increase in testing. Which means we are soon to be properly fucked.

Deaths lag cases, by a lot. In late June and July, cases were rising here, but it was okay because death rates were dropping. After mid August, deaths were real bad but it was okay because case counts were dropping.

It’s been a pretty stable case fatality rate (notably very different than true Infection Fatality Rate) since late June, ranging from a low of just over 1% and 2.3% during that time. The high numbers were at a time both when it was running rampant through nursing home populations (staff without PPE, without training on proper use when they did have it, and many staff members having close contact with many residents across multiple facilities), AND when case counts were most undercounted, as reflected by positivity rates that peaked over 20%. (Positivity rates got to under 10% by early May and are currently running under 6%.)

In short the high CFR in mid-April was a reflection of both the most extremely vulnerable population getting sick most (as @Elmer_J.Fudd opines) and the case count representing a much smaller fraction of true infections.

As to the suspicion that better treatment and/or less stressed systems are major portions of that - depends on your definition of “major”. We can get hospitalization rates at the CDC’s COVID-net and there were 2.72 times more hospitalizations at the peak than there are now (more infected but only a fraction as many getting sick enough to get hospitalized). The death rate then though was 3.24 times as high. So most is due to fewer getting as sick in the first place even as more get infections, but those ill enough to be hospitalized are less likely to die there than at peak. One also though has to factor in that the case mix of who is in the hospital has changed. At peak 47.5% of hospitalizations were 65+ and now it’s 41.2%. Fewer are in the hospital and they are more often of the age groups more likely to recover. So not sure how much better care explains it.

That also answers @AK84 - hospitalization rates have gone down. Hit a low point in June, came back up to a peak in July, and back down to the low now.

Do you think we will see a fresh peak in late fall/winter?

People that will gather together no matter what will tend to gather indoors instead of outdoors in the winter, so I imagine the rate will rise.

No one knows for sure how much seasonality SARS-CoV-2 will have, this year and moving forward in future seasons, but having none would be shocking. My great fear from very early on has been over this. Areas with the fewest cases to date are at the greatest risk with the potential to have placed the surge at a worst possible time of year, when influenza might be making demands on hospital capacity as well, and seasonal forcing could drive up both. My HOPE is that enough people do reasonable (and sustainable) levels of mitigation, and that state governments move forward in the sustainably cautious ways, that the entire winter is an infectious disease non-event … I don’t bet on those things happening though.

I am not a physician, but I’d wager it’s a combination of:

  1. More general understanding of COVID signs, symptoms, and disease progression. This obviously leads into better treatment (which I’ll get into), but it’s important in and of itself. Victims and their families recognize COVID and take it seriously. They’re more likely to visit a hospital and not assume it’s just a bad cold. Similarly, medical staff have much better knowledge of the stages of the infection when they arrive.

  2. Better treatment options: Medical staff know what treatments to use and when to use them - at least much more so now than they did back in February.

  3. People are masking up and social distancing - not everyone obviously, but enough to make a difference. As someone said earlier, even when people get it, it’s probably a weaker dose.

  4. The virus itself may in fact be getting less lethal, albeit gradually. Evolution favors viruses that don’t scare people into staying away from each other, so perhaps this is what’s going on with COVID-19.

  5. Also said earlier, the hospitalization rate has been kept under control. We’re not seeing what we saw in New York in early spring, when ICUs were overflowing – not yet, but winter hasn’t started yet.

I don’t think it is correct to say “Areas with the fewest cases to date are at the greatest risk.”

Areas that don’t mask up or otherwise take covid seriously are at the greatest risk. Seattle had or at least noticed the first outbreak, the governor locked down early, all the big employers are still work from home, and folks follow the indoor mask laws.

Smaller states in say the midwest that don’t have mask laws and worry about their freedom to be drunk drivers are at risk, regardless if they’ve had a peak or just an outbreak waiting to happen. Case in point, Wuhan China.

What does Wuhan demonstrate?

To answer the OP directly, it’s not, at least not universally. I have no idea if Florida is lying about case numbers or just shitty at treating the coronavirus, but their CFR (which is all we really have for a death rate at the moment) appears to be moving in the wrong direction.

I used data from the NYT Github repo, applied a 7 day moving average, and offset new cases against deaths by 3 weeks, as that seems to be a common lag time. As you can see, it shows clearly that the early days had a higher CFR (which is what we expect to see) and after a while it seemed that they were getting a handle on it and losing fewer people (which is what we expect). Over the past couple of months, they appear to be actually doing worse than they were during the early days and abysmal compared to how they were doing 3 or 4 months ago.

The OP is asking broadly comparing to early in the U.S. curve and now. But it in fact is true for Florida as well. I am sure there are some places in which it is not but Florida? It is.

Florida in early May peaked its 1 week CFR at over 8%. It dropped way low by July (as case numbers surged) and then came back up relatively moderately in comparison (as case numbers dropped back down), ranging between about 2.7 to 4.6% since. Per 91-divoc’s graphs the 1 week CFR peaked at 4.65% 9/15, was 4.1% on 10/13 and has dropped to 3.3% on the most recent 10/16 report, pretty much the same as it was in August.

The U.S. overall had a curve with a huge initial peak in CFR, dropping to a low in July (with the rise in case numbers), and then rising back up some (as case numbers dropped).

No definitely not worse than at peak early days. Like the U.S. overall: not as low of a CFR as in July with the surge in cases driven by younger adults, and not as bad as at its early peak.

Florida has 20.9% of its population over 65. Not sure if that is the highest but it is for sure up there. United States overall is 16.5%. And they have had spread, real numbers. Frankly I am surprised that their CFR is not significantly worse and rising.

I wonder if ventilators are more available, now. There was a push to buy more, and I suspect there are more available per COVID patient than earlier in the pandemic.

Well, when you do analysis with unreliable input, I guess unreliable output is what you get.

In mid April we were mostly testing sick people. Not only was there no attempt to test anyone who wanted it, you had to meet certain strict criteria to be eligible for free testing. We didn’t surpass 500K tests in a day until early June, which is also around the time our positivity rates appeared to somewhat normalize.

Most of the deaths that made April look horrible were concentrated in New York, which we know was hit early, hard, and fast.

The number of new cases is indeed rising, but other than the last two weeks, it’s still well below what we were seeing in July. The last two weeks are a problem, but it’s too soon to see their impact on the death numbers.

Until a few days ago, I would have made the same guesses as you on the cause. Then I started noticing weirdness in Florida’s chart here at worldometers.info. If you look at the new cases, they are about a third of what they were when they were peaking. If you look at new deaths (offset by a few weeks), they are about half of what they were at peak. That’s not a sign that we have a handle on this, so I put together the chart I posted above.

I wanted to dive a bit deeper, but my Excel skills make things like variable lag death rates tricky, so I loaded the data into a database (my SQL skills are far superior to my Excel skills). I was able to test different lag settings, and while they varied by state a bit (some appeared to be more consistent at 2 weeks, some at 3), overall 3 weeks appeared to show strong correlation with peaks and valleys for the US as a whole, so I chose it for my new report. This one allows you to change date ranges, pick any combination of states and shows the offset CFR directly. Interestingly, but also disturbing, the country had its lowest CFR the week of July 12th, which was a long time ago. It’s actually been trending upwards with the exception of the last two weeks that could easily be caused by delayed reporting. My guess is that the early high CFR numbers were from biased testing, but only the IFR can prove that. IFR is tricky, but some people are trying to nail it down. If I come across an IFR source with what is widely considered valid data, I’ll happily revisit this.

With all of the people who are actually doing this stuff for a living, I knew I couldn’t be the first one to notice. I wasn’t:

There are also many papers citing the issues with CFR vs. IFR, but noting the fact that we have shitty IFR data over time:

So in summary, we don’t know if it is much lower now.

Those articles were not really all that helpful. Mainly it seems to be people not wanting to go on record.

Basically there a lot we don’t know about April, a lot we don’t know today. Hopefully less we don’t know today. But ask if there’s a difference between April and today? “We can’t prove it.” Even though April is murkier than today, that is treated as some sort of baseline, because it happened first. So April is set in stone, and “proving” it’s different today is subject to scientific rigor that we’ll likely never get.

Me, as a plebe, I look at overall deaths. April was the worst, even though it was prominent in far fewer parts of the country. I find it hard to believe that total number of infected was actually higher in April than since then. So it’s either we’re protecting seniors better, or fewer infected are dying for some reason. Since I live today, I guess I have to go forward with beliefs, instead of the scientific certainty that will never happen.