Here's some additional reading material that concerns the situation, even pertaining to Florida, yet doesn't cover the most recent increase in cases they are seeing.
From the CovdTrackingProject.com blog:
What we only sort of know: the changing demographics of the disease
Some anecdotal and statistical evidence suggests that the average age of people with COVID-19 is declining, which complicates expectations that deaths will increase in step with new cases. On June 16, for instance, Texas Gov. Greg Abbott said that a majority of people testing positive in three counties were under 30, which he said “typically results from people going to bars”; Dr. David Persse, public health authority of the Houston Health Department,
told The Texas Tribune that “it is my current theory that elder persons have become more vigilant in taking precaution.” Florida Gov. Ron DeSantis
has also said that infections are starting to skew younger.
In the Dallas-Fort Worth region of Abbott’s state, the University of Texas Southwestern
reports that the age distribution of positive COVID-19 tests has shifted dramatically from March to June, with a peak under 30 years old. Hospitalizations and ICU admissions in the DFW region have also shifted younger if less dramatically; 50% of hospitalized patients are under 50, as are 30% of ICU patients.
In California in mid-May, three-quarters of all COVID-19 cases were split evenly between residents 18-34, 35-49, and 50-64, at almost exactly 25% for each group.
By June 13, the 18-34 group represented a third of cases, while those 50-64 fell to 19%. Over a similar timeframe in Florida, the median age of people testing positive for COVID-19
fell from 54 to 35.
Untangling this shift in age groups from increased testing is a challenge. With additional testing available, more people in lower-risk populations are likely being tested now than
when tests were being strictly rationed to severe cases. As businesses reopen across the country,
workplace testing may also increase case numbers for the working-age population, and perhaps particularly younger-skewing service workers. Testing, however, is not universally adequate; local and regional spikes in cases are putting pressure on testing infrastructure. The Upshot reports that
the testing capacity situation is “acute” in Arizona. In Florida, The COVID Tracking Project’s data indicates testing has actually
slowed by 10% in the last two weeks.
In a Twitter thread, University of Florida biostatistics professor Dr. Natalie Dean offers three possible explanations for why the median age of cases might be falling, and what data signals we should look for.
- If it’s simply a matter of more testing, hospitalizations should not increase, and test positivity should decline or hold steady. In the South and West, positivity rates appear to be rising, but regional numbers can mask very different state trends. In Texas, Florida, and Arizona, test positivity and cases are both rising; in California, by contrast, new cases are way up but the positivity rate has remained at five percent in June, and in Georgia the positivity rate is up just two percentage points while testing is up.
- If “elderly people are more cautious,” then cases, test positivity, and hospitalizations should decline. In the Northeast, tests are way up, positivity is way down, and new cases are flat. In New Jersey, new daily cases are down to 10% of April peaks, and hospitalizations have dropped precipitously. New daily cases in Connecticut have been in the double digits for the past couple weeks, and hospitalizations are down to 124 as of June 23 from over a thousand in mid-May.
- If younger people are less cautious—or if they’re more exposed as young service workers return to their jobs—cases, test positivity, and hospitalizations should rise. This is happening in Texas and Arizona. Cases and test positivity are up in Florida; statewide hospital data was only available for a few days in May before the state removed it from public view, but in Miami-Dade County, hospitalizations increased from 601 to 776 from June 9 to June 22.
Dean ultimately concludes that it’s slightly too early to tell, but the real answer is likely
a combination of all three, and that better age-stratified data is needed. High-quality samples exist for the country as a whole, but as we’ve seen, trends vary greatly from state to state and even city to city. The United States is a big country that needs a lot of detailed data.
The best source for nationwide data on testing and positivity by age is the
CDC’s COVID-NET, a hospital surveillance network that serves as a sample—the data is very detailed, but it’s from only
250 hospitals spread across 14 states. COVID-NET data is best summarized in the CDC’s
weekly COVIDView reports. Looking at that data, Dr. Trevor Bedford of the Fred Hutchinson Cancer Research Center
finds hints of Dean’s explanations: a substantial decline in positivity among tests in the 50-plus age group from early April to early June, and a slower decline among younger age groups, with signs of a plateau. He also found a
very small increase in cases in the below-50 age group in that same time. (Disclosure: Both Dean and Bedford are members of The COVID Tracking Project’s
advisory board.)
What changing age demographics have to do with deaths
In areas where younger adults are driving new infections, we might not see deaths spike until infections overflow into more vulnerable populations. “If what is happening are outbreaks in young people, it seems likely that these young people will go on to transmit to others in their communities,” Dean writes in an email. “This spillover would cause a subsequent rise in cases among older people, followed by a lagged rise in deaths.” She points to a pattern in Florida in which new cases in the 0-44 age group began climbing gradually in early-mid May, echoed by a smaller climb in the 45+ age group in late May-early June. Cases in the first age group began increasing rapidly around the beginning of June, a worrisome portent for the more vulnerable 45+ age group.
Graphic copyright Ben Toh of the University of Florida School of Natural Resources and Environment, used with permission
[
Ed. note: Dr. Dean was also
interviewed on the Brian Lehrer show today about the changing demographics of COVID-19 infections and other aspects of the pandemic and the US public health response.]