It’s time to celebrate a COVID-19 milestone … with caution

On Jan. 23, 2020, the same day that Donald Trump’s first impeachment trial began, Daily Kos diverted from following that story to cover what was then referred to as the “Wuhan virus,” after the city in China where the first outbreak of the highly infectious disease was reported. At the time of that report, there had been 17 deaths connected to the virus, but with 21 million people under lockdown in China and scientists already working to sequence the virus, that report ended with reassurance that “Restricting the spread of an emerging disease remains a near-impossible task, but health officials around the world are giving it a really extraordinary try.”

That report was the first of more than 500 that would follow. Daily Kos’ coverage included Trump’s promotion of increasingly unlikely outlandish “cures” and Dr. Anthony Fauci becoming a hero to Americans as well as a villain to conspiracy theorists. Seemingly overnight this became a world in which everyone was all too familiar with overflowing hospitals, cheering weary healthcare workers at the end of their shift, and terms like “spike protein” or “variant.”

Since then, there have been another 6,899,724 deaths. Of those, 1,134,710 happened in the United States. At its worst, the level of excess mortalities in the United States rose to an astounding 46%, including not just deaths directly attributed to COVID-19, but those who died because they couldn’t get adequate treatment in a pandemic-driven world.

However, over the first half of this year, the level of excess deaths has hit another very important number. That number is 0%. As far as deaths are concerned, the pandemic may be over.

Right now, a quick look at the CDC data shows that Puerto Rico still attributes 4.5% of deaths to infection by COVID-19. No other state or territory currently has a value above 1.5% and several states are reporting numbers so low that they easily round to 0%.

However, the CDC values also show that many states have quit breaking out COVID-19 deaths into a separate category. That’s a trend that started two years ago, when some Republican governors found it highly inconvenient to admit that people were dying from COVID-19 in their states. But even for those states where COVID deaths are shuffled in among deaths due to “respiratory failure” or “cardiac arrest,” the damage being caused by COVID-19 should show up in the form of excess deaths.

But in the first half of 2023, that signal disappeared.

The chart of excess deaths in the U.S. clearly shows the spike of initial deaths largely centered in the Northeast, where many medical facilities were overrun and life-saving equipment like ventilators became a huge topic of concern. Additional spikes appear as the disease spreads across the country, peaking at the end of 2020 when most states had lowered any restrictions and people traveled to see their families around the holidays. There’s a sharp drop in the rate of deaths in spring of 2021, as vaccines begin a widespread rollout. However, more spikes come in the fall of 2021 with the arrival of the 200% more infectious delta variant, and at the end of the year with still more travel and more family get-togethers. Then rates drop off again before the arrival of the still more infectious omicron variant, which drives a prolonged period of elevated deaths that peaks … with family travel and get-togethers at the end of the year.

Then the rates drop again at the beginning of 2023. And they have stayed down.

However, there’s another way of looking at this, with just a little annotation, that adds a cautionary note to the current celebration.

Looked at this way, it’s easy to see that every year of the pandemic has ended in much the same way, with that travel-related spike in which millions of Americans ran around the country stirring the mix and making sure that the latest variant was spread far and wide. When that spike subsides, each year has seen a big decline in excess deaths. There are two reasons for this. One is probably that following the spike more people have a level of exposure to the latest variant and have gained at least partial immunity. The other factor is that many of the most susceptible died during that holiday spike.

In each of the previous years, that low level of post-holiday deaths continued for some time, but only until a new variant that was either more contagious or more evasive of past infection became dominant. Then the number of deaths rose again.

It’s easy to read into those declining humps the idea that each variant has become weaker than the one before. That’s not the case. Untreated delta in a person with no immunity is actually 3.45 times more likely to be deadly than early variants up to alpha, and untreated omicron is about the same. Contrary to popular belief, there is no evolutionary pressure on viruses to become less deadly. In fact, since the same factors that make a disease more infectious can also make it more likely to result in the death of the host, diseases can easily move from mild to more deadly over time.

What’s different about 2023 so far is that no new variant has appeared that is significantly more contagious, or more evasive, than omicron. Also, the CDC estimates that 96% of Americans have antibodies to at least one variant of COVID-19 through either vaccination or exposure. Put that all together, and you get a season where COVID deaths have just stayed down.

The other big factor is treatment. In 2020, medical workers were in the dark on how to handle a COVID-19 infection. Now, in addition to over 75% of the population being vaccinated at least once, the steps to more effectively treat COVID-19 are better understood. Plus there are new tools like Paxlovid, which can reduce the rate of death even if it doesn’t necessarily help people get over symptoms more quickly. Improved treatment over time is a big factor in why each of those peaks in mortality tends to be smaller than the previous.

That’s fantastic. But it’s also not a guarantee of peachy keen sailing from here on out.

Scientists around the world are still tracking variants of concern, two of which are thought to be more contagious than baseline omicron while maintaining about the same level of severity. Those variants, or others with similar statistics, could become dominant in the United States in coming weeks, creating a new crest in mortality. All of these variants are descended from omicron. Right now, alpha, delta, and all the other variants and subvariants are either essentially extinct or found only at very low levels in the population. Omicron has won the evolution game by simply being more infectious than all the rest—including by being the variant most likely to infect people who have already been infected by past variants.

The good news is that the relative level of change in infectiousness between these latest variants is much lower than the two-times, or even five-times jumps seen earlier. The SARS-CoV-2 virus underwent a period in which the billions of people infected, pouring out quadrillions of new viruses, created a high-speed evolutionary showdown for most infectious virus ever. But having obtained a measles-like rate of contagiousness, the structure of the virus may not offer any other opportunities for big jumps that don’t involve a whole series of changes to the genetic sequence.

So the next big wave may never come—or it may begin next week. But even if the threat still looms out there, the level of deaths at this moment deserves real celebration.

Yes, things could get worse again quickly. Yes, levels of hospitalization haven’t dropped nearly as sharply as deaths, so COVID-19 is still making thousands of people a day very, very sick. Yes, long COVID remains a poorly understood problem that is affecting the lives of millions and will affect both the economy and the stability of health care programs. Yes, COVID-19 probably has more nasty sequelae waiting in the wings that we don’t understand at the moment.

But right now, the number of people dying from COVID-19 in the United States has dropped to a level that is pretty much lost in statistical noise. Numbers that were once going up by thousands a day are now going up by single digits. This is all much better than I expected.

That’s worth celebrating. Just please don’t blow the candles out while they’re on the cake. Because … germs.