There are likely several things happening to reduce mortality: a) earlier diagnosis and self-admission to hospitals - at the outset of the pandemic, I believe many may have confused COVID-19 symptoms with other, less serious respiratory illnesses....this likely caused them to delay seeking care, so by the time they were admitted, the disease had progressed further. b) improved knowledge of the natural history of the virus & its disease - at the outset, we didn't know much about this virus & were struggling to even test effectively. We now have much improved testing, which helps diagnostics. c) improvements in medical treatment - in addition to the much-feared ventilators, the Brits have shown that CPAP machines are effective for maintaining oxygenation (I believe PM Boris Johnson was treated in this manner). Other recent improvements include steroids to counter-act the cytokine storm, plasma transfusion and remdesivir, although I don't think the last has been proved to reduce death. d) younger patients - as DJ points out, the newest wave seems to be younger patients than what we have seen at the outset of the pandemic. Pandemic fatigue seems to be taking place across the globe, so more young patients are surfacing. Other factors could include a slight attenuation of the lethality of the virus due to natural forces such as mutation and genetic drift. This is a very good, although deep, paper that discusses how COVID-19 and SARS-CoV2 may become endemic upon humanity: https://theconversation.com/covid-19-will-probably-become-endemic-heres-what-that-means-146435 - https://theconversation.com/covid-19-will-probably-become-endemic-heres-what-that-means-146435 This one is also enlightening, for true virus geeks only!! https://science.sciencemag.org/content/early/2020/10/13/science.abe5960 - https://science.sciencemag.org/content/early/2020/10/13/science.abe5960
------------- CRS, DrPH
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