Question: If you remove March and April from the death counts/percentages, can you please tell us the rate of death in America? Doctors and hospitals have learned a lot about how to prevent death since the early days of COVID infections and so it would be interesting to know what someone’s chance of death would be in today’s healthcare system vs early in infections.

Answer: Case fatality rates have been declining over time in the United States, which is fantastic news! Part of this decline is due to demographic shifts in the cases — especially changing age distribution of cases. With more and more cases among young people who are less likely to have severe outcomes, we’d expect to see a declining case fatality rate. Part of the decline is also due to increases in testing, which allow us to capture more mild and moderate cases than ever before. And part of the decline is surely due to improvements in treatment, enhanced provider experience, and health systems resilience (as discussed in previous Q&As, most recently Q&A of 7/30 #Mortality). I’ve got a side project going with a couple of colleagues on case fatality trends and hopefully I can share more on this in the coming days! In the meantime, I ran a very simple (overly simple) analysis of monthly case fatality rates using data from covidtracking.com (Table 1).

As you can see, in March we were not widely testing and most all cases identified were serious cases that resulted in hospitalizations and oftentimes death. Because of so much missing case data, the case fatality rate in March is nowhere close to “real”. As the months have progressed, case fatality rates have fallen even as the monthly number of deaths has increased. Note: because deaths lag cases, I compared monthly deaths to mid-month cases — ex: deaths in August are cumulative from August 1–31 while cases in August are cumulative from July 16-August 15.

Table 1. Case Fatality Rates Have Declined Each Month in the United States