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Survival rates among people hospitalized with COVID-19 have improved, but rising case numbers are causing the total number of deaths to increase. Westend61/Getty Images
  • Experts say the mortality rate for people with COVID-19 has declined since the pandemic began, but the total number of deaths is rising.
  • They attribute the drop in the mortality rate to healthcare professionals being able to provide better care and a decrease in the average age of people with the disease.
  • They add that the number of deaths is increasing because of the recent surge in cases across the United States.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

The percentages are lower, but the total number of COVID-19 deaths continue to rise as cases surge across the United States.

The death rate among people hospitalized with COVID-19 dropped dramatically from the beginning of the pandemic to the summer, according to recent peer-reviewed studies.

The data suggests that physicians and other healthcare workers are getting better at helping people survive COVID-19.

But the surge in COVID-19 cases in the United States since October — with no signs of abating — threatens to derail that progress.

Daily deaths are now on a clear upward trajectory across the country, with many states shattering records set earlier in the year.

On Nov. 11, deaths topped 2,000 nationwide, the first time since early May that the country passed that mark. On Nov. 17, another 1,707 deaths were recorded.

Right now, North Dakota has the highest death rate per capita in the world. South Dakota is third.

Since the pandemic began, nearly 250,000 people in the United States have died from the disease. Last week, the Centers for Disease Control and Prevention (CDC) estimated there will be as many as 282,000 COVID-19 deaths nationwide by Dec. 5.

A recent estimate by the Institute for Health Metrics and Evaluation suggests the total death count could reach 438,000 by March 1.

If an effective vaccine is approved before then, it could put a dent in this rise, but experts don’t expect a vaccine to be widely available until at least April.

One of the recent studies looked at more than 5,100 people hospitalized with COVID-19 at NYU Langone Health system in New York City between March and August.

Researchers found that mortality among these patients dropped by 18 percent during that time. In March, patients had a 25 percent chance of dying. By August, it was 7 percent.

The study was published Oct. 23 in the Journal of Hospital Medicine.

In another study, U.K. researchers found a similar drop in mortality among people hospitalized with COVID-19. This study included more than 21,000 critical care patients.

Mortality among severe COVID-19 patients who weren’t in the intensive care unit (ICU) decreased from 28 percent in late March to 7 percent at the end of June.

Among those in the ICU, mortality decreased from 42 percent to 19 percent during that time.

The study was published Oct. 26 in the journal Critical Care Medicine.

So did the mortality rates drop because of improvements in how patients were treated? Or was there a shift in who ended up in the hospital?

At the beginning of the pandemic, many older people in the United States contracted the novel coronavirus, SARS-CoV-2. This group has a higher risk of severe illness and is more likely to end up in the hospital and die from COVID-19.

From May to April, the average age of people who developed COVID-19 and those visiting emergency rooms due to the disease dropped as more young people came down with the illness, CDC data shows. After that, the average age shifted upward again.

Over the summer, many health systems also reported an increase in younger people hospitalized with COVID-19.

To find out if these kinds of shifts were behind the drop in mortality seen in their study, NYU Langone Health researchers adjusted for other factors that can affect a person’s survival — age, sex, smoking history, and other health conditions such as heart disease and diabetes.

Even after taking these into account, they saw a drop in mortality over the 6 months of their study — which suggests that indeed physicians and other healthcare staff are getting better at treating COVID-19 patients.

After adjusting for similar factors, the U.K. researchers came to the same conclusion. They also saw an improvement in survival rates across all age groups as the pandemic continued, as did the NYU researchers.

Dr. Barry J. Make, a pulmonologist and critical care specialist at National Jewish Health, thinks that some of the decline in mortality among hospitalized patients is still due to less sick people ending up in the hospital, something that the authors of the two studies couldn’t entirely rule out.

So part of the decline in mortality may be due to our ability to better protect people most at risk.

“If you think about the initial outbreaks, a lot of them were in nursing homes, the most chronically ill and frail patients in our society,” Make told Healthline.

“We are now trying to protect them better,” he said. “We understand the disease better and how to prevent it from spreading through an institution like a skilled nursing facility.”

Many people at risk are also taking more steps to reduce the chances of being exposed to SARS-CoV-2.

“Patients who are older and have more underlying medical conditions, at least in my clinical practices, are more consistently doing social distancing, handwashing, and other measures to protect themselves,” said Make.

New medications — most notably the antiviral remdesivir and the steroid dexamethasone — may have also helped, but probably aren’t the main drivers of the increase in survival rates.

“I think it would be a mistake to attribute the decrease in mortality to us having these fancy new therapeutics that get a lot of press coverage,” said Dr. Patrick E. Jackson, an infectious diseases and international health specialist at UVAHealth.

“These drugs are probably not making a lot of difference for most of our patients,” he told Healthline.

Also, remdesivir and dexamethasone weren’t widely used during the time period of the two studies.

Jackson thinks the drop in mortality has been more due to supportive therapies rather than specific treatments.

This includes using masks and high-flow oxygen to provide patients with higher concentrations of oxygen. And using nonmechanical ventilation instead of putting them on a ventilator.

“We can provide them with ventilation without putting a tube in their throat, by putting a mask over the nose and mouth,” said Make.

Physicians also understand COVID-19 better now.

“COVID-19 patients in the hospital often get sick very rapidly,” said Jackson. “So just the clinical familiarity with the disease has allowed us to intervene more rapidly, and know when patients are going to do OK and know when they need more aggressive intervention.”

And after more than 8 months of the pandemic, hospitals have much more experience with treating seriously ill people.

“Many medical centers in the United States were overwhelmed with COVID-19 patients initially, and they may not have seen patients who were that sick before, especially in small communities,” said Make.

“Not only had they not seen COVID-19,” he added, “but they hadn’t seen patients with the severity of illness or the kind of illness that COVID-19 presents with.”

Even with better survival rates among people hospitalized with COVID-19, the ongoing surge in cases in the United States means that more deaths will follow.

“There are still a lot of people dying,” said Make. “Even if the percentage of patients that die is smaller, as hospitalizations rise you’re still going to have an increase in the total number who die.”

There’s also a risk that hospitals will become overwhelmed, which can impact the quality of care they can provide.

We’re already seeing many hospitals reaching their capacity.

“In the very early days of the pandemic, a large part of the increased mortality was due to hospital systems being overwhelmed,” said Jackson.

This stress on the healthcare system would impact not just COVID-19 patients, but also people coming to the hospital because of a heart attack, car accident, or other severe illness or injury.

Also concerning is that COVID-19 will overlap with the flu season.

“Hospitals usually get a little more stressed as influenza cases rise, especially if it’s a bad season,” said Jackson. “So our margin for error generally decreases in the fall and winter.”