COVID-19 cases and deaths are falling: what that means for you

Coronavirus cases at colleges might be exploding, but in the United States as a whole, the COVID case counts are actually falling. That’s right. We bring you (tentatively) good news for perhaps the first time since this pandemic began.

After a massive resurgence in June and July, the majority of American states and the United States as a whole have shown a sustained downward trend in COVID-19 cases and deaths for over thirty days now, with no firm sign of letting up. This is great news. Here’s what it means for you:

• Local transmission is the name of the game. While most of the United States is looking a little better, it’s very important to watch case counts in your area. Not every county or city is following this trend.
• If cases are low around you, now could be a good time to do some shopping, go to the doctor, or do home repairs.
• It’s still vitally important to wear a mask when in public or around people you don’t live with. Cases might be falling now, but that trend could quickly reverse if we let our guard down, and this will be true until the pandemic is over.

All the numbers that were going up are now going down

As of this writing, the 7-day moving average of new confirmed cases in the USA as a whole has been falling for 33 days. New cases have declined by over 35% from their July peak. Over the same period, test positivity has dropped from 8.5% to 6.1% amid slowly falling testing volumes. The actual new cases could be seeing an even more significant decline.

Daily deaths have been declining, too, albeit a little more slowly. Daily deaths from COVID-19 have declined by only 15% so far. Deaths hit a high of 1139 dead per day in the first days of August. Now we’re seeing a little under a thousand deaths per day.

As we predicted in June, the CFR (case fatality rate) of COVID-19 has declined significantly from the March peak to the summer resurgence. In addition to increased ascertainment, we’re catching cases earlier and we have better treatment options than we did back then.

Now that the resurgence has crested, we can approximately quantify this effect: CFR dropped fourfold. Despite twofold higher peak new cases, the resurgence saw a peak death rate half as high. Decomposing this into treatment and ascertainment effects is difficult, but it’s almost certainly a mixture, and researchers will doubtless form a new appraisal based on serostudies and other methods before too long.

There are a few unfortunate holdouts

Not every state is experiencing the same thing right now. But the numbers show that most states are seeing a decline in overall cases. Right now, state specific R values from rt.live show over 30 states with R below 1, and only seven with R values above 1.1:

• Hawaii
• North and South Dakota
• Iowa
• North Carolina
• Utah
• Wisconsin

Of these, only North Carolina is showing over 1000 cases a day, and none is in or near a Level 4 situation.

At the county level, only 69 US counties show both a crude R value over 1.1 (by simple case numbers over the last two weeks, not adjusted, and assuming a 7-day serial interval), and a current moving average over 25 cases a day. To put that number in perspective, the United States counts over 3,000 counties. The following states have four or more counties each experiencing case growth like that:

• Texas
• California
• Georgia
• Illinois
• Missouri
• Mississipi
• Kansas
• Iowa
• North Carolina

Of this group, perhaps the most worrisome individually are places like Fresno and San Bernardino, California, which are seeing many cases and steady growth.

There are also some smaller counties seeing explosive growth from a low level, possibly because of local superspreader events. Take these counties, for example:

• Orange, NC
• Pinal, AZ
• Mclean, IL
• Comanche, OK
• Grand Forks, ND
• Guam

What does this mean for you? For the pandemic?

The changing numbers have a lot of implications for the future of the pandemic in the USA:

1. For now, success just means perpetuating an existing accomplishment, rather than qualitatively improving our response.
2. Many areas can begin thinking about “opening up” to some extent (though in a measured manner carefully designed not to allow R to slip back above 1).
3. Any new improvements in containment will just allow more opening. We have a better shot at keeping things under control than we did a month ago.

It’s far from certain whether the USA will avoid a second resurgence, as we’re currently looking at a host of recent and upcoming risky activities, from school openings to growing protests to the recent Sturgis rally. In addition, fall is looming, with (still) little certainty about how seasonal SARS-CoV-2 is. But the declines are good news.

In terms of your own life, if you don’t live in one of the states or counties with rising numbers, now may be a good time to do things you’ve been putting off, like home repairs, larger shopping, medical and dental appointments, etc. While we would never encourage risky or irresponsible behaviors, if there are any activities you need to get done outside the home that you’ve been putting off, including preparation activities, the period of time while cases are falling is probably the best time. We don’t know how long the numbers will keep dropping, but we know they’re dropping now.