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I had two interesting responses to my blog about the “third Peak.”
From C. Goller: It would be interesting to see the rate of hospitalization over the same time period. That rate might be a good intermediary between reported tests and reported deaths. If the hospitalization rate closely follows the death rate, then the increased testing would appear to be uncovering more less severe or even asymptomatic cases. If the hospitalization rate more closely follows the positive test rate, then it would indicate a real increase in cases, wouldn’t it?
From Chris Godwin: I mentioned this before, but I think it bears repeating: I know this sounds cold, but do you think that perhaps with regard to the stabilization of the death rate, we also may be seeing an effect due to the most vulnerable members of the “herd” be “culled” by previous waves of infection, especially the first wave? This would track with what we see in other species vis-a-vis these types of phenomena in the context of evolutionary biology, and I have no reason to believe that humans are any different in this way than are, e.g., reindeer. Thoughts on this?
These two comments point out an interesting conundrum when one examines COVID-19 data from different states.
First, the national data, which shows the third peak of infections, but a much different pattern of deaths.
Now look at three states in the news: Florida, Wisconsin, and Ohio.
In Florida, deaths and hospitalizations never dropped after the second peak in infections. In contrast, deaths have only recently increased in Wisconsin. In Ohio, deaths have never increased. Hospitalization rates actually parallel deaths, so the Goller comment reinforces the disconnect between cases and significant illness/deaths. But why the difference between states, especially since they are now all doing about the same testing per capita?
I don’t think these differences are because elderly individuals are inherently more fit in Ohio than Florida (actually many Midwesterners live in Florida half the year!). I also don’t think the “herd has already been culled” in Ohio vs. Wisconsin and Florida. There may be something unique with Florida’s population, but both deaths and hospitalizations are higher there. Ohioans just don’t seem to get as sick from this disease?!
I have no answer for this, but my guess is this relates to differences in the way the various states are reporting their statistics. Importantly, these are the types of questions that need to be addressed by the CDC to allow us to better manage the pandemic in the U.S. Otherwise, we are driven mainly by misinformation and fear.
Pandemic Pondering 
Do we have any data comparing deaths & insurance coverage? Also difference in death rate at Univ vs non Univ Hosp. Not for profit vs For profit hospitals etc. Just a guess, maybe FL has a higher death rate due to less commercial insurance & a smaller number Univ Hospitals & larger # of Medicare & VA patients ?
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A very good question. Huge medicare population. Certainly given the military facilities in Florida there is a large VA footprint. But would need to analyze exact rates in the different facilities.
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A minor but important correction for you: I didn’t say that the herd has “already” been culled; far from it since the infection has yet to move through the anywhere near the entire ~330 million people in the U.S. Rather, what I was trying to convey is that 1) the process is ongoing, and 2) it may be one of several/many factors contributing to what we’re aeeing vis-a-vis death rates. I personally belive that point #2 is especially important, i.e., the multi-factorial causes for observed death rates among different population groups. Certainly differences in the way we measure the variables is really important – we see that in, e.g., historical surface tempertures for the earth’s climate ove the last ~1.5 centuries – so I have no reason to believe that we’re not seeing this here.
I just wanted to clear that up because it’s especially important to note that I think we’re still in the “culling the herd” phase. IMHO it will be 2 – 3 years before will we have a better idea re. how big, if any, effect this had on observed death rates.
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