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Since the COVID-19 pandemic first reached the United States, the case fatality (CFR) rate has fallen considerably. Between the first peak in mid-April and the second peak in mid-July, the case fatality rate fell from 7.9% to the 0.7%--2.3% range, where it has since remained despite cases rising again into an (ongoing) third wave:
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Since July, our team at CMU DELPHI has been tracking the drop in case fatality rates, driven by the question: **_"What explains the movement (and apparent overall decline) in case fatality rate over the course of the COVID-19 pandemic?"_** Last month, we released a [manuscript](https://arxiv.org/abs/2012.04825) analyzing the data through Thanksgiving. This blog post provides a vignette of our work on unpacking the drop in CFR, with newly updated data released on December 31st.
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In both the FDOH and the CDC datasets, one can discern three waves of COVID-19 cases. The first wave peaks around mid-April, the second wave peaks around mid-July, and the surge of cases leading up to December indicates an ongoing third wave:
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**Testing:** While the FDOH and CDC datasets do not contain data for negative test results, it is informative to have the level of testing in mind when interpreting the above plots.
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Using data from the [COVID Tracking Project](https://covidtracking.com/data), we observe that between April 1st and December 1st, testing has increased significantly, by approximately 964% in Florida and 1080% in the country (Figure 3).
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Note that in Florida, the second peak is larger than the first, whereas nationally the second peak is smaller than the first.
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Leading up to December, positive test rates in Florida are similar to those seen nationally. For Florida, this already places the ongoing third wave at almost the same level as the first peak, and nationally it has already surpassed the second peak.
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**Cases:** Across all age strata, as measured by cases, Florida's second wave is the most severe out of the three waves. In aggregate, it has approximately 1153% more cases than in the first peak and 46% more cases than in the ongoing third wave (Figure 2a, left panel).
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In contrast, at a national level the ongoing third wave
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Come December 1st, the Florida median age remains at 40 but the national median age group rises to 40-49.
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Additionally, we note that older individuals comprise a disproportionate share of the hospitalization and death counts (see Figure 4 below):
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<spanstyle="color:blue"><b>Key takeaway #2:</b> Since age distributions shifted substantially between the first and second waves (and continue to fluctuate), age must be accounted for in order to separate out the effects of treatment from age shift.</span>
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While we focus on the two peaks and the endpoints of the study time range, we also include plots of HFR estimates with uncertainty for all dates between April 1st and December 1st:
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Consistent with our point estimates, the overall HFR in Florida appears relatively flat until August, in which the HFR decreases greatly across all age groups (Figure 5a). In the national data, there appears to be an almost monotonic decline in HFR across all age groups for the entire time range, with the decrease slowing down in August, but slightly picking up again in December (Figure 5b).
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