Another foreboding sign is how bad conditions are across the country. From the beginning of November through yesterday, there were more than 100 COVID-19 deaths per 1 million people in the Northeast, the South, and the Midwest (which, at 267 deaths per million, had the highest rate in that period), according to COVID Tracking Project data. The West had 94 deaths per million people. In April, during the first surge, only two regions, the Northeast (602 deaths per million) and the Midwest (138 deaths per million), were above that 100-deaths-per-million line; the West was at just 50 deaths per million. In July, only the South exceeded 100 deaths per million.
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In this surge, then, the share of deaths is more evenly distributed across the country. In the same period, starting in November, the Midwest represented 37 percent of U.S. deaths; the South, 35 percent; the West, 15 percent; the Northeast, 14 percent. In April, 60 percent of deaths occurred in the Northeast; no other region accounted for more than 17 percent. Since then, no region has seen anything like the conditions once seen in the Northeast, but seven months later, the picture in the country as a whole could be worse.
The seven-day average of deaths is crucially important because the daily death toll is a noisy number. We know from experience that the daily toll falls, substantially, after weekends and holidays because the people counting get a merciful break. Any high daily death toll is worrisome—no matter what, it represents a lot of recent deaths—but the average gives a better indication of the rise and fall of the toll across the country.
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While this new record is chilling, and perhaps boosted by numbers coming in after the Thanksgiving delay, it’s not unexpected. The unprecedented hospitalization numbers, which doubled over the course of November, made it all but inevitable. The proportion of cases that end in deaths—the case-fatality rate—is much lower now than it was in the spring, but progress on lowering that number stalled in August, as the epidemiologist Trevor Bedford found last month.
Worse yet, the country could lose what progress it has made on the case-fatality rate since the spring and see it increase, which would mean that people could die who, under other circumstances, might not have. Improvements in the outcomes of COVID-19 cases came in part from doctors and nurses learning how better to identify and treat the disease’s most serious symptoms, which can vary widely from patient to patient. Health-care workers cannot provide that level of care when hospitals are overwhelmed by the most serious COVID-19 cases.
As Robinson Meyer and Alexis Madrigal have reported, hospitals have now hit a breaking point at which they no longer have the capacity to treat COVID-19 patients that, not long ago, might have been hospitalized. One indication, observed by Ashish Jha, the dean of the Brown University School of Public Health, is that in recent weeks, about 3.5 percent of cases translated into hospitalizations a week later. But that number has started falling. The University of Nebraska Medical Center—which started preparing for such a scenario in 2003, making it perhaps the nation’s best-prepared hospital—was nearing its breaking point at the end of November, Ed Yong found.