Since it was first reported by the Wuhan Municipal Health Commission on December 31, 2019, the novel coronavirus known as COVID-19 has spread worldwide to reach pandemic level. It has killed more than 575,000 people and there have been more than 13 million confirmed cases as of July 14. The United States accounted for around one-quarter of all confirmed cases and deaths worldwide as of this point, with weekly cases rising throughout June and July as states continued to reopen. On July 12 the World Health Organization (WHO) reported a daily record of 66,281 new cases in the US.

Despite the rising number of confirmed cases, total deaths per day in the US was down substantially in July from peak levels in April. There are several metrics and potential explanations to explore to better understand the COVID-19 death rate in the US.

High Death Rate in May

While determining the true mortality rate of COVID-19 is a challenging prospect, researchers at the University of Washington estimated in May that the rate of death among those who displayed symptoms was 1.3 percent. (In contrast, the seasonal flu death rate is 0.1 percent.)

Researchers arrived at this figure by examining COVID-19 data from 116 counties in 33 states. One of the authors of the study, Anirban Basu, extrapolated the data available at the time and suggested that if the virus infects the same amount of people this year as the influenza virus did in 2018-19 (35.5 million) then between 350,000 and 1.2 million Americans could die of COVID-19. 

Weekly Average Death Count Down Substantially in June and July

Despite new daily confirmed cases in the US regularly exceeding 60,000 in early July, average daily deaths were down as much as 75 percent from April. The country had a record of 4,928 deaths on April 16 but was below 1,300 every day between June 27 and July 14. In fact, 391 deaths were reported on July 13, according to the European CDC. So how does one explain the drastic rise in new cases and decline in deaths?

Higher Rates in Long-Term Care

One possible reason for the decline in deaths is that state governments now know more about the virus and how to protect those who are high-risk. While New York Governor Andrew Cuomo has been lauded by some for his leadership during the pandemic, he has also been criticized for his initial strategy that involved sending recovering patients into nursing homes housing high-risk individuals. New York was an early hot spot for the virus due in part to this strategy, which, as of July 7, had resulted in 6,457 deaths at nursing homes in the state. This was second only to New Jersey.

While nursing homes account for just 10 percent of all confirmed COVID-19 cases, they account for 42 percent of all deaths in the US (as of July 7). This adds credence to a recent CDC report that suggests the majority of those who have died from the virus were people older than 65 with underlying medical conditions.

Increased Testing

Another reason for the declining death is the fact that testing is now more accessible to most Americans. Generally speaking, tests were scarce in March and April, which meant they were often only limited to patients exhibiting symptoms. Now, because tests are more readily available, positive cases of individuals with mild symptoms or those who are asymptomatic are being recorded.

The increase in testing means younger people who are less at risk of dying are being included among the confirmed cases. For instance, the median age of individuals who tested positive in Florida was 65 in March but 35 in June. While some see this "youth surge" as a positive, it's important to note they can still pass the disease along to high-risk populations. Moreover, even if there isn't a significant risk of death for young people, they can still experience serious complications: "We see people in their 20s and 30s in our ICUs gasping for air because they have COVID-19," notes Baylor College of Medicine dean of clinical affairs James McDeavitt.

Doctors Better Prepared

At the outbreak of the virus, doctors worldwide were ill-prepared to treat patients, and many were shocked at some of the symptoms brought about by what they believed was just a respiratory disease. Medical professionals now have millions of case examples to study and, despite the absence of a cure, have made some breakthrough discoveries.

The steroid dexamethasone, for instance, has been shown to help control harsh immune responses. As of July 1, hospitalizations were rising throughout the US while reported deaths in hospitals were declining. Similarly, hospitals in the United Kingdom reported declines in hospital mortality rates every month since April, while a hospital in Milan, Italy, noticed a decline from 24 percent to 2 percent from March to May.

Cause for Concern: Deaths Lag Cases

The rising number of confirmed cases still presents a very real problem for hospitals in the US, even with current trends showing a decline in deaths. This is because reported deaths often lag confirmed cases. According to the COVID Tracking Project, official reporting of death can take up to one month from the time of COVID-19 exposure.