Here we are for our 7th edition of All Things Covid, the FanPost that just won't go away. This post will be two parts. The first will look at the trends for the states that got hit early versus the states that are getting hit hard now. The states hit early were in the Northeast, from Maine to DC. There were 3 states not hit hard - Vermont, New Hampshire, and Maine - but their overall effect on the numbers is marginal. I chose the noted four states getting hit hard now - Arizona, California, Florida, and Texas (aka "the Four States"). I should note that there are several other states getting crushed now. States like Nevada, Idaho, Kansas, Arkansas, Alabama, Mississippi, South Carolina, and Georgia all have positive test rates >10%.
The second part will look at some of the broader issues that were raised in Part Six and what they mean for the US going forward.
The Numbers
To look at the numbers, I looked at testing, cases, and deaths. Unfortunately, it is not easy to get hospitalization data and much harder to get longitudinal data. All I can report is what I have read which is that the states getting hit hard now are running out of beds. As a result, they are taking the route used by states like NY and NJ - canceling elective surgeries, converting regular beds into ER beds, using alternate facilities, ordering refrigerated trucks, nd making hard choices about who they admit and treat.
Testing
Tests Per Million |
||||
May 23 |
June 19 |
July 16 |
CDGR |
|
Northeast |
62,239 |
117,351 |
175,489 |
1.9% |
AZ/CA/FL/TX |
35,987 |
70,368 |
130,349 |
2.4% |
US Average |
43,377 |
82,590 |
138,056 |
2.2% |
1) Began capturing testing data on 5/23
As you can see, the Northeast continues to be testing ahead of the national average. Some of that was forced by circumstances. The more people who present with symptoms the more you need to test. These states, with the exception of PA, have also been building their capacity and expanding eligibility criteria. I note PA as it only average 76k tests per million. By contrast, NY averages 253k. The Four States have really been playing catch up with their testing and that is driving some of the increase in cases. Together though they still haven't reached the national average with only CA exceeding that average. In fact, only 19 states exceed the national average.
Another testing metric is the cumulative positive test rate. That is, the total cases/total tests. This gives another view into the trend in cases and the robustness of the testing regime. If the rate is going down it generally means that testing is extensive enough to catch the majority of infected people. And if the rate is going up then it means that you probably are not testing enough and you need to keep expanding testing to get to a level where you are testing more healthy people.
Cumulative Positive Rate |
|||
May 23 |
June 19 |
July 16 |
|
Northeast |
20.4% |
12.4% |
9.0% |
AZ/CA/FL/TX |
6.1% |
6.1% |
8.9% |
US Average |
11.6% |
8.4% |
8.1% |
This is a tale of two cities. The Northeast was slammed early on and was not sufficiently testing to capture all who were infected. However, these states have driven the rate way down through aggressive, mandated measures and expanded testing. On 5/23, 8 of the 12 Northeast states had rates >15% with both NY and NJ >20%. NY is now <9% and NJ is at 10.4%. The Four States, on the other hand, were not testing a lot earlier and seemed to be lulled into complacency. They should not have been because a rate >6% is not sustainable. What I have read advises that a rate <5% suggests the spread is manageable and <1% suggests the spread is contained.
Positive Rate (7-Day Avg) |
|||
May 30 |
June 23 |
July 16 |
|
Northeast |
4.3% |
1.9% |
2.1% |
AZ/CA/FL/TX |
4.5% |
9.1% |
13.0% |
US Average |
5.2% |
5.7% |
8.5% |
Breaking down testing further, you can see the rapid increase in the positive rate for the Four States. Simply put, it's out of control. On the other hand, the Northeast states have seen their testing rate drop to very manageable levels. There are currently 12 states with testing rates >10% with 6 with rates >15%. No states are >20%, unlike what occurred in the Northeast earlier. This is most likely due to more testing now. Seven of those states are in the Southeast. The worst rate in the Northeast is PA at 6% while 6 states are <2%.
Cases
Cases Per Million |
||||||
March 27 |
April 24 |
May 22 |
June 19 |
July 16 |
CDGR |
|
Northeast |
825 |
8,295 |
12,630 |
14,575 |
15,791 |
2.7% |
AZ/CA/FL/TX |
88 |
1,034 |
2,162 |
4,259 |
11,597 |
4.5% |
US Average |
258 |
2,795 |
4,996 |
6,940 |
11,163 |
3.5% |
1) Began capturing case data on 3/27
2) CDGR - Compound Daily Growth Rate
Case levels are informative but the differences in growth rates don't highlight the real gap in the groups. Looked at another way, on 3/27 the Northeast had cases about 9.3x that of the Four States. By 7/16 that gap had been reduced to 1.4x. And while the Four States were at one time about 1/3 of the national average they have now passed the country's rate as a whole.
New Cases (7-Day Avg) |
||||||
April 2 |
April 29 |
May 25 |
June 20 |
July 16 |
CDGR |
|
Northeast |
12,742 |
15,176 |
6,307 |
2,437 |
3,237 |
-1.2% |
AZ/CA/FL/TX |
2,532 |
3,384 |
4,266 |
11,965 |
33,352 |
2.3% |
US Average |
22,427 |
29,974 |
22,325 |
26,745 |
66,856 |
1.0% |
Looking at current case levels relative to early April highlights the changes in fortunes between the two groups. While the Northeast has seen a significant decrease in new case levels the Four States have increased at a higher rate. The Northeast went from having daily cases 5x that of the Four States to having new cases almost 11x lower.
Deaths
The ultimate measure, deaths typically lag 4-6 weeks after diagnosis.
Deaths Per Million |
||||||
March 27 |
April 24 |
May 22 |
June 19 |
July 16 |
CDGR |
|
Northeast |
10 |
539 |
923 |
1,067 |
1,163 |
4.4% |
AZ/CA/FL/TX |
1 |
36 |
84 |
124 |
189 |
4.5% |
US Average |
4 |
158 |
295 |
367 |
426 |
4.3% |
Not much here to differentiate the two groups of states. What is most interesting to note is that the Northeast is still experiencing a high level of growth in deaths. This most likely reflects the older demographic and a higher level of infection per patient.
What Does It All Mean
I've been thinking about 9/11 a lot recently. I think about how the country banded together to care for one another, to make sacrifices to battle a common enemy, and to understand that an attack on one of us is an attack on all of us.
With the pandemic, this sense of shared sacrifice and common good has eroded. Is this a reflection of the level of tribalism in our society, the notion that if you haven't been exposed to the savagery of Covid it doesn't resonate with you, or something else? Everyone saw damage brought upon us by Al Qaeda in the leveled World Trade Center buildings, the damaged Pentagon, and the remains of the plane in PA. That is not so easy to see from an invisible enemy like a virus.
My question is what happens when there is another tangible enemy? Do we "rally round the flag" to fight that enemy or do we remain in our corners, pointing fingers at others and saying, "this isn't my problem, it's theirs"?
And lastly, our management of this pandemic might be the low mark of leadership in the history of our country. As a result, I believe we have lost our place in the world as the leader of the free world. Will we ever get back to that place or will other countries, perhaps some not so free, fill that void? And what will that mean for us?
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