Continuing to Break Records: the Fall Wave of COVID-19

 

The mid-summer peak in COVID-19 cases did not represent a true second wave: the spread of the virus could be clearly traced to those places where the first wave had only begun to crash. In mid- to late-July numbers of infections in the United States peaked, mostly due to very high infection rates in two of the most populous states, Florida and Texas, and a moderately high rate in the most populous state, California.

Seventeen states have had increases of at least 100% in their case rates over the past 4 weeks, since September 26 (as shown in the table below). The current peak in cases includes alarming rates in states that had until recently had the virus relatively under control, including New Mexico, Rhode Island, Connecticut, Michigan and New Hampshire. Although Vermont had the highest rate of increase, they still maintain their place as having the least number of new infections over this past week: they had started incredibly low. Their new cases are no longer in the single digits per day.

Also in the table are several states that had very high case rates and then more than doubled them, including North and South Dakota, Montana, Idaho, and Wyoming.

Only four states have had drops in their case rates over the past 4 weeks. These are, alphabetically, California, Hawaii, South Carolina and Texas.

Here are the states ranked from lowest to highest case rates for the week ending October 24th.

 

The week ending July 25th had the previous peak. Presented below is a graph for the states of that week on the scale presented above (with the Y axis continuing to 8000 cases per million).

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

https://mdhillortiz.com/

The Zombie March of COVID-19: A Report for the Week Ending October 17

 

The principles of my COVID-19 virus analyses have been these:

1) Numbers per population are more important than total numbers. Total numbers dazzle but the population of a state is more significant in its capacity to deal with cases. Population correlates to numbers of hospitals, contact tracing, and tests. Some less populated states receive little publicity. This week North Dakota has had a rate of new cases per million population that is over 80% higher than New York state at its peak. It frustrates me to see depictions like this from NBC news (the map toward the bottom) that provide total numbers versus shouting out where the infection rates are at crisis level. 

2) Numbers of new cases, tests and deaths per population are more important than total numbers. Total historical numbers from previous weeks and months will not change. The new cases need to be addressed. 

3) Weekly numbers are better than daily numbers in determining trends. Illinois, for example, updates its probable cases and deaths on Fridays and will always have a jump on that day. Connecticut, Rhode Island, and Kansas don't report on weekends. Weekly numbers overcome such daily variances. 

4) Numbers 1, 2, and 3 taken together mean that the number of new cases per population per week are the optimal form of reporting the current state of the infection. 

5) The states, are in a sense, in competition with one another. State government decisions, in part, determine the number of infections. By ranking the states according to their weekly new cases, tests, and death rates, a picture forms of which states are doing better and which are doing worse. 

Performance Beyond Replacement

Statistical geeks invented a metric for ranking baseball players that takes into account multiple aspects of player performance and compares those to how much better (or worse) that player would be compared to an average replacement performer. Finally, they extrapolate this into the number of likely additional wins that the player delivers. This is called Wins Above Replacement or WAR. 

I propose looking at performance of states compared to the numbers from a median state for any given week, performance above (or below) replacement. For the week ending October 17, the number of new cases in the median state was in Colorado, 6481 cases for 1188 per million with 25 states (or DC) performing better and 25 performing worse. 

Vermont performed best among states with 69 cases for a weekly new case rate of 111 per million. Vermont bested Colorado by 1077 cases per million population. 

On the other extreme, North Dakota had 6184 new cases per million for the week ending October 17. North Dakota performed 4996 cases per million worse than Colorado.

A different way of looking at this is by extrapolating the numbers of infections for a given state to what those numbers would look like if the state had the population of California (2019 US Census estimate 39,551,223). If California had the rate of infections per million that North Dakota had this past week, California would be experiencing 34,954 new cases per day. (This past week California averaged 2,963 daily new cases. That may seem like a lot but, because of their population, they ranked 6th best in new infection rate per million people.)

Legend: Performance compared to median is derived by subtracting the weekly case rate for a given state from the rate for Colorado, the median state this past week. The numbers refer to the number of cases by which a state is doing worse (adjusted for population) than the median (negative numbers, the top portion of the list) or the number of cases by which a state is doing better (positive numbers, the bottom of the list). Cases per day if the state had a population of California is obtained by taking the case rate per million and multiplying it 39.551 for California's 39,551,000 people. I adjusted this to per average day even though most of my other figures are per week.

The Week Ending October 17.

I began this project in early May. Sometimes I feel as though I'm watching a zombie movie. The zombies keep marching on relentlessly and those places you once believed were safe, eventually fall prey. Very few states can say they have never had an out-of-control infection, most notably Vermont, New Hampshire and Maine. Continuous vigilance is necessary to prevent out-of-control numbers.

Several states that maintained very low levels for a long time are currently among the worse in infection rates including Montana and Wyoming. In May the number of new cases per week in Hawaii was below ten. In August, it peaked at 1783. This past week it registered 574. 

The dominant story for the last three months has been the surge in cases in Republican-leaning states. Although states that Trump won in 2016 still account for the top 14 spots, they have been joined in the top 20 by resurgences in Democratic-leaning states, notably Rhode Island, Minnesota, and Illinois, with New Mexico at 21. New Mexico had maintained a reasonable rate of new infections even while bordering states surged, especially Arizona and Texas. New Mexico can no longer make that claim. 

New Jersey, New York, and Massachusetts all went from very high levels to being among the best in the country. Although they still have among the lowest new infection rates in recent weeks those rates have more than doubled. Each was below 250 new cases per million per week; each is now above 500. 

Overall the total number of states doing poorly has increased with the median rising to a new height. North and South Dakota have spent seven weeks in the top two positions with their numbers growing ever higher. Their numbers are likely even higher than what is presented. North Dakota has advised positive patients to do their own contact tracing. By my count, 40.9% of North Dakota's PCR tests were positive this past week.

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

https://mdhillortiz.com/

It's Getting Bad Again: A Report for COVID-19 Cases for the Week Ending October 10th

 The story thus far, abridged. Abridged, because you know much of the story thus far. 

In early March of 2020, at a time when few tests were available and all positive tests had to be confirmed through the Centers of Disease Control and Prevention, the SARS-CoV-2 seeded itself throughout the United States. (From hereon, I'm going to call the virus by its commonly used name, coronavirus.)

At first, individual cases were reported by states in their Department of Health Twitter accounts. The alarm was downplayed. Texas pointed out that, when it had its first case, there was only one case statewide and there was no great danger (the tweets are at the end of this post). Over the course of the month of March, each state put together its own website with its own style of reporting or not reporting essential information (with Texas being among the last to put together a dedicated web-page). West Virginia was the last to report a case: March 17th.

 

Since March, coronavirus has been responsible for over 10% of all deaths in the United States. (Derived from Table I, CDC) 

From mid- to late-March each state initiated its own flavor of lockdown. Deriving these numbers from state reports, I found the cases went from an median weekly rate of 31.8* per million population per state for the week ending March 21st, to an early peak of 459.3 for the week ending May 2nd. The infections and mortality in the initial hotspots greatly declined. For the week ending May 9th, (when testing was much more available) Montana registered 3 new cases statewide. (Spoiler alert: for the week ending October 10th they would have 1808 new cases.)

*The March numbers were mostly likely underestimated due to limited testing. 

The Trump administration and many state governments were chomping to reopen businesses. There was a desperation to return to normal. The president suggested reopening for Easter (April 11). This date came and passed. April into May and the pressure to reopen built. 

Number geeks put together a series of statistical benchmarks for reopening. Yay, thought the geeks. We can help fight this virus. Among these was a guideline that the local area should have a 5% or lower positivity rate. 

State governments looked at their numbers and freaked out. I have to tell this urban county they can reopen and not this rural one? Won't people just cross the county borders to go shopping? What if the number is 6%? Or 10%. Iowa's governor later put out a guideline that schools can request closing if the local numbers were over 20%. 

And so many states ignored the stop signals. With positivity rates of over 10%, Florida allowed the reopening of Disneyworld. The numbers rose. These are the median number of cases per week per million for the fifty states and the District of Columbia starting the week ending May 30th. The median number were derived by ranking the states each week and noting the number of the state in the middle spot: twenty-five states with more cases, twenty-five with fewer. I also included the rate of cases for the state that had the peak number. 

For the week ending June 6th, Maryland led the nation with 904.3 new cases per million population. In the past two weeks this number was well below the median. Having crunched a lot of these numbers, 1000 new cases per week per million was my line for dividing out those states with out-of-control infection rates. Now it is the norm. 

In the first days, a select number of states had high infection rates, while others were nearly virus-free. During July, as more and more states "reopened," the infections shifted to high-population states, most especially Florida and Texas. California had a moderately high rate and with its population added to the total. This gave a peak in total cases in new cases per week climbed over 500,000.

As the most populous states lowered their rates, the new cases per week fell to near 240,000. This week it passed 300,000.

The current rise in the median number of cases indicates that most states are experiencing high rates. This is especially true of a number of low-populated state. Before October, Florida set the record high in new cases per week with 3867.2 per million. This past week, North Dakota shattered that record, nearing 5000. (South Dakota also broke Florida's record.)

I have written about the Sturgis, South Dakota motorcycle rally being a super-spreader event. This past week, South Dakota and those states sharing a border ranked 1st, 2nd, 3rd, 6th, 9th, 13th and 17th in most new cases per million people. 

Here is a graphic for all fifty states and the District of Columbia for new cases per million for the week ending October 10th. Although Vermont had the fewest new cases, they have had a blip or possibly significant increase of four-fold over the past two weeks. Other states that have been doing well, such as New York, have also had a disturbing jump. 

Appendix: Texas Tweets. These three tweets were from March 4th Texas Department of Public Health Twitter feed.

First Texas COVID19 Case, Travel Related

Texas DSHS confirms a presumptive positive case in a person infected with COVID-19 when traveling abroad. This does not mean there is community spread of COVID-19 in Texas.

---

“Having a COVID-19 case in Texas is a significant development in this outbreak, but it doesn’t change the fact that the immediate risk to most Texans is low,” said Dr. John Hellerstedt, DSHS commissioner.

---

“Over the past month, the state of Texas has been preparing for this moment, and we are confident in the steps we have taken to safeguard our communities against the coronavirus,” said 

@GovAbbott

9:16 PM · Mar 4, 2020

By March 6th, Texas had identified 6 cases, all from travel. On March 13th, Texas Governor Abbott declared a state of disaster for all Texas counties. There would be over 2000 cases by March 28, 6000 cases by April 4th, 12500 cases by April 11th, and over 800000 cases by October 14th.

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

https://mdhillortiz.com/

Report for the Rates of Infection for the week ending September 26

Washington, DC, includes all its historical COVID-19 reports on its main page, a long column of information. As of late, they have been handling their viral outbreaks well. When compared to the states, they have the eighth best record of having the fewest new cases per million population for the week ending September 26th and perform the second-highest testing when adjusted for population. 

Sorry, I am always a week late with these updates. Some states do not report their weekend figures until Tuesday. Still, that doesn't mean I can't look up the latest data. Between October 1st and 2nd, they had 50 new positive tests. It is likely that the outbreak that has infected Donald Trump will cause a measurable bump in their total cases. 

North and South Dakota again dominate the case rates for this past week, making it four straight weeks that they are numbers one and two. What's more remarkable is that they have continued to rise. This past week North Dakota, adjusted for population - and it is not a populous state - has had the second worse rate of new cases of any state since the beginning of the outbreak. Only Florida at its peak was worse.

In fact all of the states that border South Dakota (North Dakota, Montana, Wyoming, Nebraska, Iowa and Minnesota) have had remarkable increases in the number of new infections over the past month and a half.

As I've mentioned before, here, and in subsequent posts, the Sturgis, South Dakota cycle rally which ended August 16th, was a superinfection event. 

Here are the weekly rates of new cases per million in South Dakota and its bordering states for the weeks ending August 15 and September 26.

Here are the new case rates in 49 states and the District of Colombia for the week ending September 26th, adjusted for population. Texas made some corrections to its case numbers this week and is left off. 

Here is the rate of testing, from Pennsylvania with the lowest rate to Rhode Island with the highest rate. Kentucky and New Hampshire made adjustments and are left out. 

Here are the death rates. Death rates are stubborn, slow to go down. Some states that haven't had high case rates for months, still maintain a high rate of deaths. Vermont hasn't had a COVID-19 death since August.

Finally, here are the positivity rates. Left off are those adjusting either tests or cases (Texas, New Hampshire and Kentucky). Maine edged out Vermont due to the high testing rate of the former.

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

https://mdhillortiz.com/