Wednesday, July 8, 2020

Coronavirus Testing and the Rising Number of Cases


The week of June 28 to July 4 was particularly brutal with total new cases rising by 34.1% nationwide over the number from the week before. This followed a weekly rise of 42.4% for a combined 91.0% over two weeks. 

A month ago, for the week ending June 6, Maryland was in first place among states with 904.3 new cases per million population. For the week ending July 4, this same figure would rank 17th. 

Prior to the past two weeks, the week ending April 11th held the record with 215,901 new cases nationwide. For the week ending July 4th, there were 341,926 new cases nationwide. A comparison of the top three states with the highest new case rates for April 11th and July 4th.

New cases of COVID-19 Virus: Two Weeks Compared.

week ending
July 4
Arizona 3366.1
Florida 2677.5
S. Carolina 2507.0
week ending
April 11
New York 3426.8
New Jersey 2705.1
Conn. 1786.2

April 11th represented New York State cases at their peak. New York State has done a remarkable job of recovering. For the week ending July 4, they had 267.7 new cases per million, ranking 44th out 51 states (and Washington DC). 

Test Numbers.

When I refer to testing in this post, I am referring to PCR, molecular testing which confirms active COVID-19 infection and not antibody testing. Not that many states report antibody results. Some states are likely mixing antibody and molecular testing results.

The number of viral tests being performed is going up. For the week ending July 4, testing had increased by 17.9% over the previous week which followed a 9.7% rise. For the past two weeks tests have risen 29.4%. (Note: a 29.4% rise in total tests led to a 91% increase in positive tests.)

Several states performed fewer tests over the past week. Since minor changes might be considered expected for states maintaining the same amount of testing, I chose a 10% decrease for cutoff.

The table below presents those states that decreased their testing by at least 10% over the past week and the concurrent change in new cases. (Change week ending June 27th compared to week ending July 4th):
New Tests   New Cases
 % decline    % change
Indiana
-12.70% +22.80%
N. Hampshire -18.01%  -19.60%
N. Dakota
-18.50% +55.10%
Ohio -15.45% +29.56%
S. Dakota
-12.90%    -0.50%
Wyoming 
-15.90%   +0.50%

Which States Test the Most?

These are the top 10 states which perform the most PCR tests per population for both of the past two weeks. The cases rank column represents their ranking for how many new cases per million population.

week June 27   Tests  Cases week July 4   Tests   Cases
State   per mill.  rank State   per mill.   rank
1  Alaska 23964.5 46   New York 24634.2 44
2  New York 21649.8 40   N. Mexico 23525.9 21
3  Dist Col 19285.8 37   Alaska 23446.3 35
4  Louisiana 17691.2  Louisiana 22853.0 4
5  New Jersey 16705.0 41   Conn. 22224.5 47
6  New Mexico 16368.8 18   Nevada 20004.2 7
7  R. Island 16358.9 37   Tennessee 19036.1 11
8  California 16098.1 12   R. Island 18904.8 40
9  N. Dakota 15141.1 39   California 18310.2 12
10  Illinois 14537.6 30   Dist Col 18224.5 37

Several (New York, Connecticut, DC, Rhode Island, Illinois, New Jersey) had among the highest infection rates back in April and May and are now among the lowest in terms of new infection rates. Louisiana, Nevada, California, and Tennessee are among the highest in terms of new infection rates. New Mexico and Alaska have consistently promoted aggressive testing while maintaining a moderate to low infection rate.

Which States Test the Least?

These are the bottom 10 states for performing PCR tests per million population. 

week June 27   Tests  Cases week July 4   Tests  Cases
State per mill.   rank State per mill.   rank
42  Mass. 7643.5 43   Ohio 8541.0 22
43  N. Hampshire 7519.3 47   Kansas 8341.1 18
44  Idaho 7424.9 16   Indiana 7603.3 29
45  Missouri 7197.7 27   Mass. 7204.1 46
46  Kansas 7108.8 19   Penns. 6639.4 36
47  Oregon 6801.8 35   Oregon 6496.9 31
48  S. Dakota 6632.4 28   Colorado 6255.6 41
49  Penns. 6412.9 38   Hawaii 6248.3 50
50  Colorado 6373.1 36   N. Hampshire 6165.3 49
51  Hawaii 6175.6 51   S. Dakota 5776.6 32

Here, the narrative is more complex. It is quite possible that states like Hawaii (50th and 51st in case rates for the two weeks) need fewer tests. Massachusetts and Pennsylvania are among those who once led in the nation in new cases. Now they are in the bottom ten of testing rates and the bottom third of new case rankings. (Contrast to New York and Connecticut mentioned above.) Some states are in the bottom ten of testing and have unnerving numbers of new cases (Idaho for June 27, and Kansas for both weeks).  Other states are middle of the pack in terms of new cases and low in testing (Indiana, Oregon, and South Dakota). 

The Most New Cases Versus Testing.

How do the states which rank in the highest case rates for the week ending July 4th do in terms of testing?

week July. 4 Cases      Test
State per mill.      rank
1   Arizona 3366.1 22
2   Florida 2677.5 18
3   S. Carolina 2507.0 19
4   Louisiana 1883.5 4
5   Georgia 1726.8 23
6   Mississippi 1704.9 32
7   Nevada 1699.9 6
8   Texas 1669.9 25
9   Alabama 1586.627
10   Arkansas 1480.9 11
 
Louisiana, Nevada, and Arkansas are among the highest rates for testing and for cases. All of the other states are middle of the pack. 

For the week ending May 30th, before the June escalation in cases, Arizona ranked 46th in testing, Florida 36th, South Carolina 32nd, Georgia 51st, Alabama 38th, and Arkansas 28th. Among the top 10, only Louisiana, Mississippi, and Nevada had robust testing rates. 

All of the States, Testing Rate Ranked.

Note: on June 20th, Washington State ranked 51st. This was due to the reclassification of several thousand tests. 

rank  week  rank  week  rank      week 
order June. 20 order June. 27 order     July. 4
1 New York 23683.0  Alaska 23964.5   New York 24634.2
2 Louisiana 21604.1  New York 21649.8   New Mexico 23525.9
3 DC 21244.2  Dist Col 19285.8   Alaska 23446.3
4 R. Island 20252.8  Louisiana 17691.2   Louisiana 22853.0
5 Alaska 19691.1  New Jersey 16705.0   Connecticut 22224.5
6 Arkansas 18297.1  New Mexico 16368.8   Nevada 20004.2
7 New Jersey 15835.9  R. Island 16358.9  Tennessee 19036.1
8 Minnesota 15365.1  California 16098.1   R. Island 18904.8
9 New Mexico 14137.3  N. Dakota 15141.1   California 18310.2
10 Delaware 13541.8  Illinois 14537.6   Dist Col 18224.5
11 Connecticut 13434.2  Minnesota 14372.3   Arkansas 18201.3
12 Illinois 13259.4  Arkansas 13828.3   Delaware 18068.4
13 California 13078.3   Iowa 12549.5   Illinois 16831.0
14 Nevada 12784.6   Florida 12489.8   Montana 16497.0
15 Wisconsin 11710.8   Arizona 12342.2   New Jersey 15908.0
16 N. Carolina 11408.3  Wyoming 12167.3   Minnesota 15710.0
17 Vermont 11370.4   N. Carolina 11802.9   N. Carolina 15557.2
18 Tennessee 10827.0   Delaware 11678.0   Florida 14843.4
19 Montana 10713.0   Montana 11337.0   S. Carolina 13785.2
20 Arizona 10554.1   S. Carolina 11084.0  Utah 13697.4
21 West Virginia 10539.0   Oklahoma 11044.0   Michigan 13015.2
22 Michigan 9578.0   Wisconsin 10976.1   Arizona 12954.1
23 Nebraska 9438.1   Connecticut 10739.4  Georgia 12860.6
24 Indiana 9436.6   Tennessee 10708.1   Iowa 12555.5
25 Utah 9387.1   Michigan 10696.7   Texas 12354.8
26 S. Carolina 9233.2   Maine 10324.4   N. Dakota 12346.2
27 Iowa 8951.2   Mississippi 10266.1   Alabama 11739.6
28 Florida 8886.4   Ohio 10101.2   Wisconsin 11624.6
29 Maryland 8852.9   Virginia 9975.1   Washington 11371.3
30 Mississippi 8805.8   Georgia 9533.9   Oklahoma 11241.3
31 S. Dakota 8712.4   Nebraska 9441.7   W. Virginia 10939.7
32 Virginia 8691.5   Utah 9334.1  Mississippi 10772.2
33 Alabama 8571.3  Kentucky 9209.2   Vermont 10695.7
34 Oklahoma 8452.4   W. Virginia 9206.5   Maine 10695.6
35 Georgia 8373.8   Alabama 9163.0   Idaho 10324.0
36 Texas 7939.0   Vermont 9126.8   Wyoming 10236.8
37 Maine 7562.9   Nevada 8744.9  Maryland 9846.0
38 Mass. 7522.1  Indiana 8706.7   Virginia 9492.9
39 Ohio 7517.0   Texas 8588.8   Missouri 9282.6
40 Wyoming 7022.1   Maryland 8524.4   Nebraska 8970.7
41 N.Hampshire 6960.4   Washington 8336.9  Kentucky 8657.3
42 Oregon 6747.0   Mass. 7643.5   Ohio 8541.0
43 Missouri 6732.3   NHampshire 7519.3   Kansas 8341.1
44 North Dakota 6701.2   Idaho 7424.9   Indiana 7603.3
45 Kansas 6298.4   Missouri 7197.7   Mass. 7204.1
46 Colorado 5826.8  Kansas 7108.8   Penns. 6639.4
47 Penns. 5676.9  Oregon 6801.8   Oregon 6496.9
48 Idaho 5542.5   S. Dakota 6632.4   Colorado 6255.6
49 Hawaii 5223.5  Penns. 6412.9   Hawaii 6248.3
50 Kentucky 5040.4   Colorado 6373.1   N.Hampshire 6165.3
51 Washington 2222.4   Hawaii 6175.6   S. Dakota 5776.6

While visiting so many state websites, I was surprised to find that most governors, in the portraits that they present, seem so much like the Hollywood stock character of the public's imagination. 

And then there's the official portrait of the grinning governor of Nebraska, Pete Ricketts.

Latest News | Office of Governor Pete Ricketts
I've just eaten a Tweety Bird and now I will eat you.

Martin Hill Ortiz is a Professor of Pharmacology at Ponce Health Sciences University and has researched HIV for over thirty years.


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