A state official working on COVID asked this week: given the number of deaths per 100 cases seem be lower than March, is the needed government response now similar to that which we need for a particularly strong strain of flu? Answer: definitely not, and here's why... 1/x

Yes COVID clinical case fatality rate has been moving lower as compared to early on in the pandemic. @WHO has noted that this past week and attributed it largely to improving medical response. 2/x https://www.urdupoint.com/en/world/covid-19-mortality-declines-as-world-gets-bet-1050657.html

The improved care seems a combination of dexamethasone (perhaps to small extent remdesivir, though new trial results suggest effect is small if at all) and better medical care in general as clinical world figured out how to deal w/ disease better (e.g. prone positioning) 3/x

And for all of this we should be deeply grateful to the health care workers and to the researchers who have been identifying and implementing these improvements in care. 4/x

Also in many places, the lower CFR reflects higher numbers of young people (kids and young adults) than earlier in the pandemic, and when you include them in the new case numbers every day, that will decrease overll mortality statistics. 5/x

If there is a rising fall and winter wave, the number of deaths per every 100 cases will be lower that it was earlier in the pandemic. But for the country, the overall number of deaths would still be very high. 6/x

In addition to those who die from COVID, there are more who were hospitalized and survive, possibly critically ill and intubated, and those who get Long COVID. If we get a new wave or even if we just stay where we are, unable to lower the numbers, the impact will be grim. 7/x

There are about 700 COVID deaths a day on average in the country, and we know that when there is a rise in new cases, as the country is experiencing now, the impact of the rise in cases isn’t reflected in rising death tolls for many weeks after that rise starts. 8/x

The response to COVID we continue to need is far more urgent and intense than what we need for a strong flu season. See last column of this table for the number of people who get sick and who die in normal flu season. 9/x https://www.cdc.gov/flu/about/burden/index.html#:~:text=CDC%20estimates%20that%20influenza%20has,61%2C000%20deaths%20annually%20since%202010

We have had 10X the numbers of COVID deaths as compared to influenza last year, and that is with huge social distancing, masking and restrictive policies in place. Without those things in place, the numbers of COVID deaths would have been many, many times higher. 10/x

Unlike flu, there is no off season for COVID. The cumulative impact of COVID that we see now has come about even before it has become winter, with a country that will be shifting to more indoor living. 11/x

Given the average of 700 people dying a day from COVID this week, only 31 days of COVID deaths at this rate would equal the number of all Americans who died of flu for the 2019-2020 flu year. 12/x

Even now, before any additional surge, COVID is the second leading weekly cause of death in the US, after heart disease and ahead of lung cancer. 13/x

Hospital crises can happen even when the number of deaths per 100 cases remains at this new lower baseline. Wisconsin is experiencing health care crisis even though the number of deaths per new case has been less than the national average. 14/x

And the great stress on hospitals is already quite serious in many other places (e.g. Dakotas, Utah, Idaho, Oklahoma, Montana et al) and could become much worse there or in other places if epidemic curves in those states are not turned around soon 15/x

So back to the answer to the opening question – is COVID now just like a strong flu? Not at all. COVID has far higher mortality. Most are still susceptible to it. It’s year round. We have no vaccine, and only dex as a highly valuable treatment. 16/x

Even with masking and physical distancing in place, people are still dying of COVID in large numbers. Countries around the world have seen what happens when society lets up against COVID – its comes surging back hard and is not forgiving. 17/x

The good news is that we know what slows COVID down: Masking, physical distancing, telecommuting, outdoors > indoors, increase ventilation inside buildings, handwashing, testing, tracing, isolation, quarantine. And leaders who tell people the truth about what is happening. 18/x

Our best chances for restoring life more toward normal before we get a vaccine is to broadly adopt the strategies that we know have worked. /end