New disease needs time to figure out how to actually treat critical patients with it.

Doctors see it more -> Doctors get experience treating it -> Death rate goes down

Some things off top of my mind, I’m sure there are more I’ll keep thinking

-March/April a lot of people were being intubated early, unconventionally, due to prevailing thought they MIGHT decompensate and die rapidly. When you intubate a patient they go to ICU and automatically have a prolonged hospital course. The more time u spend in the hospital, the worse
-March/April numbers also involved hospital systems that were genuinely overwhelmed. NYC and Detroit being key examples, regardless of what u hear on the news many people died due to lack of ventilator and hospital access. People were dying in waiting rooms in some hospitals because they came to the hospital just too late
-by looking at some serum inflammatory markers we can quasi predict which patients are at higher risk for decompensation, and keep a closer eye on them on a more acute floor
-as you said , steroids. In March April we were still throwing hydroxychloroquine and azithromycin at patients :/

Experience would have led to a change or evolution in treatments that get the mortality rate down, which is what I asked about.

I think patients are admitted to the hospital more early in the course of the disease than back in March/April, since it was found that it's better to treat symptoms while they're still mild than to wait until someone requires a ventilator.
This approach should reduce the mortality rate two-fold, by providing better treatment to those patients who needed hospitalization, and by admitting a certain share of less sick patients who might otherwise have recovered without hospitalization.

Nice one, very interesting.

Hospital systems are still overwhelmed in localised COVID outbreaks, but if these are in less populated cities the effect wouldn't be as drastic. I wonder how much of the improvement can be put down to hospital systems not being overwhelmed and having more resources thrown at it and how much is due to genuine improvement in medical treatments.

I know we were trying to mitigate the impact on overflowing hospitals as much as possible, but this seemed like the obvious path from the word go. Look at any other illness, we never want people to wait until they're absolutely dying to come to the hospital. If you waited til your tumor is short circuiting your brain its already too damn late.

Kinda sorta

Earlier on the same patients that would have been admitted still were. If you need any oxygen, even pre covid, you’re gonna he spending the night in the hospital and that hasn’t changed. If you aren’t requiring oxygen but you’re one of those higher risk people...well A LOT of patients fall into this category and you can’t admit all of them. Something specifically our hospital system does is send people home with pulse oximeters with directions on how to check their oxygen level and if it declines to a certain point to come back. Whereas you’re correct in March April when we didn’t know much about that decompensation phase a lot of people not on oxygen were sent home and just died before they could get back. The decompensation timeframe occurs violently fast. Steroids def seems to help this

I think it’s all about the former and resource management. Identifying who needs to stay and who can go home. It will be even more important as Flu starts to take off. Medicine has come so long that with supportive care and even without novel therapeutics we can keep people alive for a long time. Few people get so sick where they are severely hypoxic even while intubated. I mean 10 months later we haven’t made very much progress in therapeutics. only abcxyz does not work or minimally works, with exception to steroids (which everyone was thinking about earlier but we listened to their goddamn French guidance which says it worsened outcomes).

As I’ve said before the issue isn’t just mortality rate though. American healthcare is just not setup for a good chunk of the population to require medical care, from a financial standpoint. Clearly a huge flaw in our system given how much money we spend on healthcare and still the lack of affordable widespread access. Staying 2 nights in the hospital requiring only 2L of oxygen shouldn’t cost a person thousands of dollars out of pocket (with insurance). The reasons people should take appropriate precautions mask/distance isn’t to prevent your neighbor from dying, it’s more to prevent your neighbor from losing his house

seeing so much of this, hospitals flooded here and people needing care are being filtered into emergency rooms and then charged a lot more from what i hear. OR sent home with oxygen because the beds are all full.

family friend and his wife were super anti precaution, literally daily facebook posts saying its a hoax and just a flu, etc. well, he got it, and the next day it shifted to asking for prayers because he was hospitalized via emergency room, then sent home because beds were full with oxygen. still not doing well. funny how we have to pray for just a flu and a hoax huh? they've got savings im sure, but its not gonna be a fun bill.

Seasonal variability in vitamin D levels rises in the summer: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4512566/



This study states that there is a 54% increase in Covid19 infections amongst people with vitamin D levels that fall below 20ng/ml (deficient): https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0239252



That's my story and I'm sticking to it.