What follows surge in cases? More deaths
Data show increase in numbers as more people gather indoors for holidays
The short history of the coronavirus suggests that California will soon see a marked rise in COVID-19 deaths that traditionally follows a surge in cases — but when and how severe will it be this time?
Experts, who now have a better understanding of the disease and the data, point to later this month or in early December. And some forecast the number of cases, hospitalizations and, ulti
mately, deaths is likely to continue to rise through the new year.
“It’s getting easier to make these kinds of prognostications because that’s what we’ve seen,” said John Swartzberg, clinical professor emeritus of infectious diseases and vaccinology at UC Berkeley, pointing to the summer surge that swept both California and the U.S. in late June and July.
While the latest dire prediction for the Golden State follows a rough pattern playing out across the U.S., the overall number of cases here relative to the population is much lower than in the Midwest and other parts of the country. And experts are optimistic that the death toll won’t be as severe this time around in California, as younger and healthier people make up a higher proportion of cases, and doctors and hospitals are better prepared to treat the virus.
Here’s where we are: California is seeing a sevenday average of more than 8,000 new daily cases, up from just slightly more than 4,000 at the end of October. Hospitalizations are also starting to tick up, to more than 4,500 from fewer than 4,000 a week ago. But death rates in California have held steady throughout the month at about 1 per million residents each day, although they too are soon expected to rise.
“We know a few things today that we didn’t know early on,” California Health and Human Services Secretary Mark Ghaly said at a Monday update. “Tracking the data over many, many months shows us that cases today will end up in our hospital beds in two to three weeks.”
People now generally get sick around five or six days after they pick up the disease, and then some need inpatient care a week or so after they first show symptoms. Deaths usually occur a week or so after that, and then reporting of deaths can take another week, so deaths from the rise in cases the state saw at the beginning of November will likely start to show up in the data toward the end of the month.
That was the pattern in most of the country in June and July, when the summer surge was beginning: Case rates in the U. S. rose, followed by hospitalizations and then by deaths. In California, somewhat unusually, hospitalizations actually tracked fairly closely with new cases, rising and falling at roughly the same time, with deaths lagging as expected. Now, all three data categories appear to be following more of the traditional pattern.
UC San Francisco infectious disease expert Monica Gandhi thinks case counts started to tick up earlier this month in part because of the cold weather, pointing to evidence that the virus does well in colder temperatures, especially as more people gather indoors.
She agrees with the timeline that hospitalizations and deaths will grow, but she doesn’t see any signs that the surge will overwhelm the Bay Area’s hospitals.
“I genuinely think this is not going to go crazy,” she said of the toll on medical
facilities. “This isn’t a mysterious, secret, radioactive alien virus.”
Doctors now know a lot about how to handle the virus, and, especially in California, people have widely adopted masking and other practices to help slow the spread.
But unlike in the spring and summer when case rates in California sank to relatively low, manageable levels after the spring and summer peaks, Swartzberg does not expect that to happen so quickly this time.
“The numbers are going to get a lot higher in December and January and probably reach their peak my guess would be sometime in late January, early February, and then remain really high through February and start to drop by the end of February,” he said.
Why? A whole range of factors, including people gathering for the holidays — despite pleas from public health officials to stay apart — through the end of the year.
Travel is another problem, with people flying or driving in from hot spot areas or college students returning home and bringing the virus with them. Add in the ongoing flu season, and the ingredients are there for things to get a lot worse.
Think of the virus as fire in need of fuel, Swartzberg said. “Is there plenty of fuel in California? Yes. Are there embers flying to California? Yes. Are Californians different than anybody else? No.”
The data does point to a few differences between what’s happening in California and what’s going on in the rest of the country, however.
The state’s surge is not nearly as bad as the country’s overall and is happening slightly later, Gandhi thinks, in part because California officials have implemented a fairly clear, widespread system — those different colored tiers now familiar to residents all over the state.
The residents getting infected are also younger than in the past, when the virus ravaged nursing homes, a reason we should expect fewer deaths but a wider spread of cases, experts say. For example, in the last two weeks, nearly half of the state’s coronavirus cases were among people younger than 35, according to infectious disease epidemiologist George Lemp, who has calculated the trends using state data. Young people are far, far less likely to die of the coronavirus.
“They are also more frequently asymptomatic and capable of spreading the virus silently while it’s undetected,” Lemp said.
One good sign: In California, the current sevenday average case rate per 100,000 people is around 20. In the rest of the U. S., it’s more than double that — roughly 49. In some states, such as Iowa and North Dakota, the rates are much higher — north of 100. Why? Aggressive public health policies and a population generally willing to follow them. Swartzberg attributes some of that mentality to the AIDS epidemic that hit San Francisco in the early ’80s, which helped regional public health officials learn to work with activists and, ultimately, the public.
“We’re reaping the fruits of that here,” he said.