Southern California right now is in an interesting pattern. Hospitalizations have been trending up rather quickly, not as steep as the initial stage in late March, early April, but pretty steep. Meanwhile ICU usage has been trending up as well, but not nearly as steeply.
I think this reflects three things, to differing degrees 1) the virus is now spreading in the community, but that community is different than the initial pandemic. The more vulnerable are probably being more careful with distancing and masks than the younger, healthier, less vulnerable. Nursing homes and hospitals have better systems in place to check spread amongst the most vulnerable (though how long PPE will last in a broader pandemic is a real open question to me). So while some people are getting sick enough to require admission, less are the type of patient that will need intensive care or a ventilator. 2) We are just at an early stage of the next outbreak, and not enough people are hitting that second week where many covid patients really go downhill. 3) We have gotten better at treating patients, perhaps with more broad usage of remdesivir or steroids. I think 3 is less likely. My understanding is remdesivir isn't going to many patients who aren't already in the ICU, and lots of patients were already getting steroids even before the dexamethasone study results were publicized (and only showed a mild improvement in any case.)
The idea the virus has mutated to be less lethal is possible but I think the least likely explanation.
I think this reflects three things, to differing degrees 1) the virus is now spreading in the community, but that community is different than the initial pandemic. The more vulnerable are probably being more careful with distancing and masks than the younger, healthier, less vulnerable. Nursing homes and hospitals have better systems in place to check spread amongst the most vulnerable (though how long PPE will last in a broader pandemic is a real open question to me). So while some people are getting sick enough to require admission, less are the type of patient that will need intensive care or a ventilator. 2) We are just at an early stage of the next outbreak, and not enough people are hitting that second week where many covid patients really go downhill. 3) We have gotten better at treating patients, perhaps with more broad usage of remdesivir or steroids. I think 3 is less likely. My understanding is remdesivir isn't going to many patients who aren't already in the ICU, and lots of patients were already getting steroids even before the dexamethasone study results were publicized (and only showed a mild improvement in any case.)
The idea the virus has mutated to be less lethal is possible but I think the least likely explanation.