With daily reports of coronavirus cases in the United States surging to previously unseen heights, averaging more than 75,000 a day over the last week, the country on Thursday crossed the threshold of nine million known infections since the pandemic began.
More total cases have been identified in the United States than in any other country, though some nations have had more cases in proportion to their populations.
“There is no way to sugarcoat it: We are facing an urgent crisis, and there is an imminent risk to you, your family members, your friends, your neighbors,” said Gov. Tony Evers of Wisconsin.
More than 200 coronavirus deaths have been announced over the last week in Wisconsin, and as case numbers explode, hospitals have been under increasing strain.
Wisconsin, home to eight of the country’s 15 metro areas with the highest rates of recent cases, was among the first states to lose control of the virus this fall. But the surge that started in the Upper Midwest and rural West has now spread far beyond, sending infection levels soaring in places as disparate as El Paso, Chicago and Rexburg, Idaho.
Idaho’s governor, Brad Little, this week imposed new restrictions on businesses and gatherings. “Hospitals throughout the state are quickly filling up or are already full with Covid-19 patients and other patients, and way too many health care workers are out sick with Covid-19,” Mr. Little said.
Twenty-one states added more cases in the seven-day period ending Wednesday than in any other seven-day stretch of the pandemic against a backdrop of a bitter presidential contest.
President Trump, in the closing days of his campaign, has assured voters that the virus is vanishing, brushing aside the devastation it has wrought and even mocking people who take precautions — including measures his own health advisers recommend — to slow the spread of the disease.
Daily reports of deaths from the virus remain far below their spring peaks, averaging around 780 a day. But those, too, have started to tick upward.
There are not many hopeful signs in the recent data.
Reports of new cases are increasing in 42 states. Northeastern states, including New Jersey and Rhode Island, are seeing infection numbers rise after months of stability. And in North Dakota, where more than 5 percent of the population has now tested positive — the biggest share of any state — as reports of new cases continue to soar.
Covid-19 death rates have fallen as understanding of the disease improved, researchers say.
Callaghan O'Hare/Reuters In April, the coronavirus killed more than 10,000 people in New York City. By early May, nearly 50,000 nursing home residents and their caregivers across the United States had died.
But as the virus continued its rampage over the summer and fall, infecting nearly 8.5 million Americans, survival rates, even for seriously ill patients, appeared to be improving. At a New York hospital system where 30 percent of coronavirus patients died in March, the death rate had dropped to 3 percent by the end of June.
Doctors in England observed a similar trend. “In late March, four in 10 people in intensive care were dying.” said John M. Dennis, a University of Exeter Medical School researcher. “By the end of June, survival was over 80 percent.”
Though the virus has been changing slowly as it spreads, most scientists say there is no solid evidence that it has become either less virulent or more virulent.
As older people took greater precautions to avoid infection, however, more of the hospitalized patients were younger adults, who are generally healthier and more resilient. By the end of August, the average patient was under 40.
Were the lower death rates simply a function of the demographic changes, or a reflection of advances in treatment that blunted the impact of the new pathogen?
Researchers at NYU Langone Health zeroed in on this question, analyzing the outcomes of more than 5,000 patients hospitalized at the system’s three hospitals from March through August. They concluded the improvement was real, not just the result of a younger patient pool.
Even when they controlled for differences in the patients’ age, sex, race, underlying health problems and severity of Covid symptoms — like blood-oxygen levels at admission — they found that death rates had dropped significantly, to 7.6 percent in August from 25.6 percent in March.
A combination of factors contributed to the improved outcomes of hospital patients, experts said. As clinicians gained more experience with the disease, they became better able to manage it, incorporating the use of steroid drugs and non-drug interventions.
Researchers have also credited heightened community awareness. Patients are seeking care earlier in the course of their illness. And outcomes may also have improved as the load on hospitals lightened and there was less pressure on the medical staff.
“We don’t have a magic bullet cure, but we have a lot, a lot of little things, that add up,” said Dr. Leora Horwitz, director of NYU Langone’s Center for Healthcare Innovation & Delivery Science. “We understand better when people need to be on ventilators and when they don’t, and what complications to watch for, like blood clots and kidney failure.”
Once doctors became aware of the clotting risk, they began to quickly put patients on blood thinners when necessary.
Another problem in the spring was that as hospitals in hard-hit areas like New York City became overwhelmed, doctors who hadn’t worked in critical care for many years were being drafted to care for seriously ill patients. Nursing departments, meanwhile, were short-staffed, and equipment was in short supply.
Medical experts worry that the surges in cases around the country could roll back the improvements in mortality rates. The number of hospitalized Covid patients has increased by 40 percent over the last month, and more than 41,000 patients are now hospitalized in the United States.
Remdesivir, still unproven, is turning out to be a proven moneymaker for its manufacturer.
Mike Blake/Reuters The United States reached a milestone, of sorts, when last week the Food and Drug Administration approved the first treatment for Covid-19: Veklury, better known by its scientific name, remdesivir.
But the F.D.A.’s decision to grant the drug full approval — which means its manufacturer, Gilead Sciences, can begin marketing it broadly to doctors and patients — has puzzled several outside experts. They say that it may not deserve the agency’s stamp of approval because it is, at best, a mediocre treatment for the disease caused by the coronavirus.
One large, government-run trial found that the drug shortens patients’ recovery times, but the two other studies the F.D.A. used to justify its approval — sponsored by Gilead — did not compare the treatments with a placebo, the gold standard for evaluating a drug. No studies have shown that it significantly lowers death rates. And a large study sponsored by the World Health Organization found that remdesivir provided no benefit to hospitalized patients.
Experts have also questioned whether Gilead deserves to pocket potential billions from the drug when the government has played a significant role in its development. On Wednesday, the company said that remdesivir, which has been authorized for emergency use since the spring, had brought in $873 million in revenue so far this year.
“The F.D.A. doesn’t exist to give monetary prizes to drug companies,” said Dr. Peter B. Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan Kettering Cancer Center. “The F.D.A. exists to help inform doctors as to what drugs they should give patients in front of them today.”
