COVID-19 is now the third-leading cause of death in Travis County, despite improvements in care

COVID-19 has overtaken accidents as the third-leading cause of death in Travis County, despite improvements in testing and treatment since March.

"When we hit 517 (COVID deaths), it will surpass accidental death as the third-leading cause," Austin-Travis County Interim Health Authority Dr. Mark Escott said Monday.

As of Monday, 522 people have died of the disease locally, according to Austin Public Health data.

Nationally, COVID is the leading cause of death, killing more Americans than cancer, heart disease or drug overdoses—with a daily death toll equivalent to the 9/11 attack, which killed 2,988 people, according to a Dec. 17 article published in the Journal of the American Medical Association.

The disease is also spreading more quickly than ever in Austin, with more active infections than at any other time during this pandemic.

At the beginning of the pandemic, inadequate testing resources meant that the COVID case-fatality rate—defined as reported deaths per confirmed cases—was likely significantly higher than the official record. But nine months into the pandemic there have been improvements.

"Our case data and death data are a lot more reliable," said Dr. Mark Hayward, a sociology professor at the University of Texas at Austin who studies morbidity and mortality. "The testing, especially in Travis County, has really ramped up."

As a result, the reporting—of the number of confirmed cases as well as of COVID-related deaths—is much better than it was at the beginning of the crisis.

There have also been improvements in how local doctors treat COVID patients, both because they are more familiar with the disease and because they have more treatment options—including convalescent plasma, monoclonal antibodies and antiviral drugs such as remdesivir—in their arsenal.

Despite this progress, community spread is picking up—and holiday gatherings have prompted local, state and national health officials to worry that the current surge could be the pandemic's worst.

"All in all the news is not good, even though we have these improvements in the case-fatality rate," Hayward said.

Other concerns include the indirect and long-term consequences of COVID, as well as how the disease has exacerbated existing inequities.

"All health is political," Hayward said, pointing to North and South Dakota, which have recently led the country in COVID deaths and where Republican lawmakers have waited to impose—or avoided entirely—a mask mandate and stay-at-home orders.

Hayward expects the disease to be responsible for many deaths indirectly, such as in cases where a person avoided the hospital for fear of contracting the disease and instead died at home of a heart attack. He also worries about the more than 17 million people in the U.S., including more than 40,000 in Travis County, who have recovered from COVID.

"It's kind of like adding a frailty component," he said. "You've been through a war, so to speak."

What this means for other conditions—such as dementia and cardiovascular disease—remains to be seen, but Hayward believes it will be one of the first questions doctors ask patients when it comes to their health history.

"It's going to be a big risk factor for a variety of disease outcomes," he said.