COVID-19 Cases Are Rising, So Why Are Deaths Flatlining?为什么新冠病毒感染案例在上升，它的死亡率却趋于平缓？

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The gap between soaring cases and falling deaths is being weaponized by the right to claim a hollow victory in the face of shameless failure. What’s really going on?
在无耻失败的情况下，要求中立胜利的权利正为高涨的感染案例与死亡人数下降之间的鸿沟提供了武器。这到底是怎么回事？

For the past few weeks, I have been obsessed with a mystery emerging in the national COVID-19 data.
在过去的几周，我一直疑惑于全国新冠数据呈现的一个谜。

Cases have soared to terrifying levels since June. Yesterday, the U.S. had 62,000 confirmed cases, an all-time high — and about five times more than the entire continent of Europe. Several U.S. states, including Arizona and Florida, currently have more confirmed cases per capita than any other country in the world.
自六月来，感染案例飙升地恐怖。前几天，美国有62000例的确诊病例——大约是整个欧洲新增感染病例的五倍。目前，包括亚利桑那和佛罗里达在内的美国几个州的人均确诊病例比世界上任何其他国家都多。

But average daily deaths are down 75 percent from their April peak. Despite higher death counts on Tuesday and Wednesday, the weekly average has largely plateaued in the past two weeks.
但平均每日死亡人数较四月的峰值下降了75%，尽管周二和周三的死亡人数有所增加，但过去两周的死亡人数平均水平基本稳定。
The gap between spiking cases and falling-then-flatlining deaths has become the latest partisan flashpoint. President Donald Trump has brushed off the coronavirus surge by emphasizing the lower death rate, saying that “99 percent of [COVID-19 cases] are totally harmless.” On Tuesday, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warned Americans against “[taking] comfort in the lower rate of death” just hours before Trump tweeted triumphantly: “Death Rate from Coronavirus is down tenfold!”
突发感染案例与死亡人数下降之间的差距已成为最新的党派观点。川普通过强调降低死亡率来避免冠状病毒的激增，他说：“ 99％的新冠病毒病例完全无害。” 周二，美国国家过敏和传染病研究所所长安东尼·福西（Anthony Fauci）警告美国人，不要看到川普发的Twitter“冠状病毒的死亡率下降了十倍！” 就以较低的死亡率来自我安慰。

In the fog of pandemic, every statistic tells a story, but no one statistic tells the whole truth. Conservatives seeking refuge in today’s death counts may find, in a matter of days, that deaths are clearly resurging and their narrative is rapidly deteriorating. But liberals, too, should avoid the temptation to flatly reject any remotely positive finding, for fear that it will give succor to the president.
疫情期间，每项数据都说明了一个故事，但没有一个统计数据可以说明整个事实。今天寻求庇护的保守派可能会在几天之内发现，死亡人数正在明显复苏，其叙述正在迅速恶化。但是，自由主义者也应该避免诱惑，断然拒绝任何遥不可及的积极发现，担心这会侧面验证总统的话。

What follows are five possible explanations for the case-death gap. Take them as complementary, rather than competing, theories.
以下是5种死亡率下降的可能解释。它们之间互为补充而不对立。

1.Deaths lag cases — and that might explain almost everything. 死亡滞后于感染案例——这可能解释了所有情况。

You can’t have a serious discussion about case and death numbers without noting that people die of diseases after they get sick. It follows that there should be a lag between a surge in cases and a surge in deaths. More subtly, there can also be a lag between the date a person dies and the date the death certificate is issued, and another lag before that death is reported to the state and the federal government. As this chart from the COVID Tracking Project shows, the official reporting of a COVID-19 death can lag COVID-19 exposure by up to a month. This suggests that the surge in deaths is coming.
你不能只讨论感染案例和死亡人数，而不注意人们生病后会死于疾病。因此，案件激增与死亡激增之间应有一定的滞后。更微妙的是，在一个人死亡当日与颁发死亡证明的日子之间可能还会有一个滞后，而在向州和联邦政府报告死亡之前又有一个滞后。正如新冠病毒跟踪项目中的这张图表所示，新冠病毒死亡的官方报告最多可使感染新冠病毒滞后一个月。这表明死亡人数正在增加。

In Arizona, Florida, and Texas, the death surge is already happening. Since June 7, the seven-day average of deaths in those hot-spot states has increased 69 percent, according to the COVID Tracking Project.
在亚利桑那，佛罗里达和德克萨斯，死亡人数的激增已经发生。根据新冠病毒追踪项目，自6月7日以来，这些感染人数多的州的7天平均死亡人数增加了69％。

The death lag is probably the most important thing to understand in evaluating the case-death gap. But it doesn’t explain everything. Even where deaths are rising, corresponding cases are rising notably faster.
在评估病死率差距时，了解死亡滞后可能是最重要的。但这并不能解释一切。在那些感染案例明显上升的地方，死亡人数也在上升 。

2.Expanded testing is finding more cases, milder cases, and earlier cases. 拓展测试正发现更多的感染案例，症状较轻的病例和早期发现的病例。

There is a bad way to talk about testing, and a nuanced way to talk about it.
谈论测试是一种糟糕的方式，也是一件微妙的事。

The simplistic version, which we often hear from the president, is that cases are surging only because the number of tests is rising. That’s just wrong. Since the beginning of June, the share of COVID-19 tests that have come back positive has increased from 4.5 percent to 8 percent. Hospitalizations are skyrocketing across the South and West. Those are clear signs of an underlying outbreak.
我们经常从总统那里听到的简单说法是，感染案例激增是因为测试数量在增加。那是错误的。自6月初以来， 新冠病毒的测试比例已从4.5％增加到8％。南部和西部的住院人数在激增，这些都是潜在爆发的明显迹象。

Something subtler is happening. The huge increase in testing is an unalloyed good, but it might be tricking us with some confusing weeks of data.
微妙的事情正在发生。测试的大量增加是其中一个原因，它可能会在几周都展现一些令人困惑的数据。

In March and April, tests were scarce, and medical providers had to ration tests for the sickest patients. Now that testing has expanded into communities across the U.S., the results might be picking up milder, or even asymptomatic, cases of COVID-19.
三月和四月，测试很少，医疗工作者不得不对病情最严重的患者进行定量测试。现在，测试已扩展到美国各地的社区，结果可能是出现了更温和甚至无症状的新冠病毒感染病例。

The whole point of testing is to find cases, trace the patients’ close contacts, and isolate the sick. But our superior testing capacity makes it difficult to do apples-to-apples comparisons with the initial surge; it’s like trying to compare the height of two mountains when one of the peaks is obscured by clouds. The epidemiologist Ellie Murray has also cautioned that identifying new fatal cases of COVID-19 earlier in the victims’ disease process could mean a longer lag between detection and death. This phenomenon, known as “lead time bias,” might be telling us that a big death surge is coming.
测试的重点是查找病例、追踪患者亲密接触的对象并隔离病患。但是，我们的测试能力与最初的病患进行比较。这就像在其中一座山峰被云遮挡时试图比较两座山的高度。流行病学家埃莉·穆雷（Ellie Murray ）也警告说，在受害者患病过程中尽早发现新的感染新冠病毒的人可能意味着从发现病毒到因病毒死亡之间的时间更长。这种现象被称为“提前期偏差”，可能告诉我们死亡人数正在激增。

And maybe it is. Maybe this is all as simple as nationwide deaths are about to soar, again.
这也许像全国死亡人数再次飙升一样简单。

But there are still three reasons to think that any forthcoming death surge could be materially different from the one that brutalized the Northeast in March and April: younger patients, better hospital outcomes, and summer effects.
但是，还有三个理由认为即将到来的死亡激增可能与在3月和4月给东北造成惨重死亡的事件有实质性不同：年轻的患者，更好的医院治疗效果和夏天的效果。

3.The typical COVID-19 patient is getting younger. 新冠病毒的患病者正越来越年轻。

The most important COVID-19 story right now may be the age shift.
目前新冠病毒最重要的变化可能是年龄变化。

In Florida, the median age of new COVID-19 cases fell from 65 in March to 35 in June. Then it fell again, to just 21 in July. In Arizona, Texas, and California, young adults getting sick have been driving the surge.
在佛罗里达，新冠病毒新增病例的中位年龄从3月份的65岁下降到6月份的35岁。然后在7月，又下降到21岁。在亚利桑那，得克萨斯和加利福尼亚州，越来越多的年轻人感染病毒，一直在推动这一数据的增长。

If the latest surge is concentrated among younger Americans, that would partly explain the declining death count. Young people are much less likely to die from this disease, even if they face other health risks. International data from South Korea, Spain, China, and Italy suggest that the COVID-19 case-fatality rate for people older than 70 is more than 100 times greater than for those younger than 40.
如果增长一直在年轻美国人聚集，这能部分解释死亡人数的下降。即使年轻人面临其他的健康风险，他们死于疾病的可能性也要小得多。来自韩国，西班牙，中国和意大利的数据表明，年龄在70岁以上的新冠病毒患病者的病死率比40岁以下的患病者高100倍以上。

The youth shift seems very real, but what’s behind it is harder to say. Maybe older Americans are being more cautious about avoiding crowded indoor spaces. Maybe news reports of young people packing themselves into bars explain the youth spike, since indoor bars are exquisitely designed to spread the virus. Or maybe state and local governments that rushed to reopen the economy pushed young people into work environments that got them sick. “The people in the service economy and the retail industry, they tend to be young, and they can’t work remotely,” says Natalie Dean, an assistant professor at the University of Florida. Texas Governor Greg Abbott blamed reckless young people for driving the spike, but the true locus of recklessness might be the governor’s mansion.
患病年龄向青年转变似乎很直观，但背后的原因却很难说。也许年龄较大的美国人在避免在拥挤的室内环境方面更谨慎。也许因为室内酒吧设计精巧，有利于这种病毒的传播，而年轻人沉迷酒吧，这可以解释新冠病毒感染案例的年轻化。也许是急于重新开放经济的州和地方政府将年轻人带入了使他们感到不适的工作环境。佛罗里达大学助理教授纳塔莉·迪恩（Natalie Dean）说：“服务经济和零售业中的人们往往很年轻，他们不能远程工作。” 得克萨斯州长格雷格·阿伯特（Greg Abbott）指责轻率的年轻人推动了飙升，但真正的轻率之处可能是州长的公馆。

No matter the cause, interpreting the “youth surge” as good news would be a mistake. Young people infected with COVID-19 still face extreme dangers — and present real danger to their close contacts and their community. “We see people in their 20s and 30s in our ICUs gasping for air because they have COVID-19,” James McDeavitt, the dean of clinical affairs at Baylor College of Medicine, told The Wall Street Journal. Young people who feel fine can still contract long-term organ damage, particularly to their lungs. They can pass the disease to more vulnerable people, who end up in the hospital; a youth surge could easily translate into a broader uptick some weeks from now. And the sheer breadth of the youth surge could force businesses to shut down, throwing millions more people into limbo or outright unemployment.
无论原因如何，将“年轻人患病人数激增”解释为好消息都是错误的。感染了新冠病毒的年轻人仍然面临危险-对他们的亲密接触者和社区构成真正的危险。贝勒医学院临床事务主任詹姆斯·麦克戴维特（James McDeavitt）告诉 《华尔街日报》：“我们看到20多岁和30多岁的人在我们的ICU里喘着气，因为他们感染了新冠病毒 。”年轻病患中感觉良好的那些人仍会遭受长期的器官损害，尤其是肺部损害。他们会将疾病传给更脆弱的人，这些人最终会在医院去世。从现在开始的几周内，年轻人感染新冠病毒人数的增加很容易在更大范围内造成影响，它可能会使企业倒闭，使数以百万计的人陷入困境或彻底失业。

4.Hospitalized patients are dying less frequently, even without a home-run treatment. 即使没有家庭治疗，住院患者的死亡率也在降低

So far, we’ve focused on the gap between cases and deaths. But there’s another gap that deserves our attention. Hospitalizations and deaths moved up and down in tandem before June. After June, they’ve diverged. National hospitalizations are rising, but deaths aren’t.
目前为止，我们聚焦在患病案例与死亡人数之间。但还有另外一点值得我们关注，6月前，住院和死亡人数前后波动。6月之后，他们有所不同，全国的住院人数在上升，但死亡人数没有。

The hospitalization and death data that we have aren’t good enough or timely enough to say anything definitive. But the chart suggests some good news (finally): Patients at hospitals are dying less.
我们提供的住院人数和死亡人数还不够好或无法及时说出确切的话，但图表数据能显示一些好消息：医院的患者死亡人数变少了。

Indeed, other countries have seen the same. One study from a hospital in Milan found that from March to May, the mortality rate of its COVID-19 patients declined from 24 percent to 2 percent — “without significant changes in patients’ age.” British hospitals found that their hospital mortality rate has declined every month since April.
确实，其他国家也看到了同样的情况。米兰一家医院的研究发现，从三月到五月，其新冠病毒患者的死亡率从24％降至2％而“患者的年龄没有明显变化”。英国医院发现，自4月以来，他们的医院死亡率每月都在下降。

So what’s going on? Maybe doctors are just getting smarter about the disease.
所以，发生了什么？也许是医生正变得更加聪明来处理这种疾病。

In early 2020, the novelty of the coronavirus meant that doctors had no idea what to expect. Health-care professionals were initially shocked that what they assumed to be a respiratory disease was causing blood clots, microvascular thrombosis, and organ damage. But millions of cases and hundreds of white papers later, we know more. That’s how, for example, doctors know to prescribe the steroid dexamethasone to rein in out-of-control immune responses that destroy patients’ organs.
在2020年初，冠状病毒的新颖性意味着医生不知道会发生什么。最初，医护人员对他们认为的呼吸系统疾病感到震惊，它能导致血液凝块，形成微血管血栓和损伤器官。但是，在有了数万的感染案例和数百本的白皮书之后，我们了解更多。例如，医生知道要开出类固醇地塞米松的处方，以抑制会破坏患者器官的失控免疫反应。

Finally, it’s notable that mortality declined in Italian and British hospitals when they weren’t overrun with patients. This is another reason why flattening the curve isn’t just a buzzy slogan, but a matter of life and death. As hospitals across Texas and Arizona start to fill up, we’ll see whether hospital mortality increases again.
最后，值得注意的是，当意大利和英国的医院没有患者超标时，它们的死亡率也下降了。这是曲线平缓的另一个原因，这是生死攸关的问题，而不仅仅是个口号。随着得克萨斯州和亚利桑那州的医院开始满员，我们将看看医院的死亡率是否会再次增加。

5.Summer might be helping — but probably only a little bit. 夏天可能会有点帮助——但应该只有一点点

Several remaining theories about the case-death gap are more speculative, mostly falling under the category of “summer is just different.”
关于感染案例和死亡人数之间差距的其余几个理论更有推测性，大多都和“只是夏天会有所不同”有关。

The transition to summer may have stamped out other illnesses that were weakening our immune systems. People in the Northern Hemisphere may absorb more Vitamin D in the summer, which might mitigate COVID-19 mortality. The virus might have mutated to become more contagious, but not more deadly, which might — in combination with other factors, like superior hospital treatment of the disease — exacerbate an outbreak in cases that doesn’t correspond with an increase in deaths.
往夏天过渡可能会消除会削弱我们免疫系统的其他疾病。北半球的人在夏天会吸收更多的维生素D，这可能会降低新冠病毒的死亡率。该病毒可能已经突变，变得更具传染性，但不会更致命，这可能与其他因素（如医院对疾病的高级治疗）结合起来，加剧了与死亡人数增加不相符病例的爆发。

Finally, as more people wear masks and move their activities outside in the summer, they might come into contact with smaller infecting doses of COVID-19. Some epidemiologists have claimed that there is a relationship between viral load and severity. With more masks and more outdoor interactions, it’s possible that the recent surge is partly buoyed by an increase in these low-dosage cases.
最后，随着越来越多的人在夏天戴着口罩进行户外活动，他们可能会接触小剂量的传染性新冠病毒。一些流行病学家声称病毒载量和严重程度之间存在联系。随着越来越多的人戴口罩和在户外互动，这些轻微感染者案例的增加有可能部分推动了近期的变化。

The case-death gap remains a bonfire of unknowns. And, as we’ve seen, uncertainty is a cavity where propaganda can breed. So let’s conclude with what we know for sure: The surge in cases represents a vast and tragic American failure — even if it doesn’t lead to a correspondingly dramatic spike in deaths.
感染案例和死亡人数之间的联系仍然是未知数。而且，正如我们已看到的那样，不确定性是宣传信息可以钻的漏洞。让我们对已经知道的信息进行总结：感染病例的增加是美国一次巨大且悲惨的失败——即使这没有导致
而且，正如我们已经看到的那样，不确定性是宣传可以滋生的空洞。因此，让我们以我们可以肯定的结论做一个总结：案件的激增代表着美国的一次巨大而悲惨的失败，即使它没有导致相应的死亡人数激增。

This virus is a cryptic devil. It can brutalize people’s bodies for weeks or months, even if it doesn’t kill them. It can savage the lungs of young people, even when it doesn’t produce other symptoms. Those who are infected can transmit it to more vulnerable people. Those who contract severe cases can be sent to the hospital for weeks and live for months — which may turn into years — with aftershocks from the illness. Outbreaks might make school openings implausible, sports improbable, and ordinary life impossible.
该病毒是个隐秘的恶魔，它即使不杀死人的身体，也可能在数周或数月折磨人的身体。即使不会产生其他症状，它也可以损伤年轻人的肺。那些被感染的人可以传染给更脆弱的人。那些严重的患者会被送进医院待上数周，活上几个月（可能会长达数年），并患上后遗症。疫情暴发使学校开工难以执行，体育运动难以实现，日常生活的正常运转也变得不可能。

When President Trump and others point exclusively to lagging death figures during a surge, they are trying to tell you that America is, secretly, winning the war on COVID-19. But we’re not. The summer surge is an exceptionally American failure, born of absent leadership and terrible public-health communication.
当川普总统和其他人专门指出患病案例激增期间的滞后死亡人数时，他们正试图告诉你，美国正在悄悄地赢得与新冠病毒的斗争。但我们不是，夏季患病人数的激增是美国的一次失败，源于领导力的缺乏和糟糕的公共卫生沟通。

After all the graphs, statistics, science, and interpretations, we’re left with a simple fact: Hundreds of Americans are dying every day of a disease that is infecting several hundred thousand of them every week. If that’s success, let’s pray we never see failure.
从所有的图表，统计数据，科学和解释中，我们得到了一个简单的事实：成百上千的美国人因为一种每周会感染数百人的疾病濒临死亡。如果这成功了，让我们祈祷永远不会看到它失败。