Sunday, October 3, 2021

Where Has COVID-19 Had Its Highest Death Rates Since The Delta Variant Appeared?


The COVID-19 Fatality Rates in the Time of the Delta Variant and Vaccine Availability

The COVID-19 infection has passed over the United States in several waves. The death rates before and since the appearance of the Delta variant and the general availability of the vaccine tell a dramatic story. 

So, before and after. What date to choose? For this analysis, I chose February 23, 2021 as the dividing point. This was the date when the highly contagious delta variant of the coronavirus first appeared in the United States. Delta variant infections now account for 99% of infections in the U.S.  By this date, the massive wave that began in November was well in decline. America COVID-19 deaths had peaked on January 12th, 2021 with 4490 in a single day. 

Cumulative US Deaths, from Worldometers .info

Death Rates Before and After February 23, 2021.

Which states have fared better or worse, before and since February 23, 2021? Below is table with the states ranked in order according to the numbers of COVID-19 deaths per 100,000 (100,000 being the standard epidemiological number) from before and after February 23, 2021. The end date for this analysis was October 1st, 2021. The phase one numbers are universally higher: 72.7% of all deaths occurred before 2/23/21.

Table 1.

The above numbers are taken from They are in 99% in agreement with the gold standard data maintained by Johns Hopkins, but worldometers is easier to navigate to a specific date for a specific state. (Note: the totals in worldometers appear a bit higher because they include Puerto Rico, U.S. territories. They seem to double count veterans. This analysis is the fifty states and District of Columbia.) 

I have been critical of Florida's response to COVID before this, but I was surprised that with all the competition they managed to rank the worst over the past seven-plus months. 

Vaccination Rates Versus Biden Vote

It is hard to look at the list and not notice that most of the states that have performed poorly recently are Republican-led. Trump won the state election in 12 out of the top 14 in the 2020 election, the exceptions being the hotly contested elections in Georgia and Nevada. (Twenty-five states went for Trump and twenty-five for Biden. DC, included in this analysis, went for Biden.)

So, what's going on in the Trump states? Do the states where Trump won have lower vaccination rates? The table below includes vaccination rates, state ranking of vaccination, percentage of votes that went to Biden in each state, and the ranking of those states. The vaccination rates came from Johns Hopkins and were current for October 1st. The voting percentages for Biden came from Wikipedia.

Table 2.

The correspondence is fairly remarkable. The eighteen states with the lowest vaccination rates all swung for Trump. The eighteen states with the highest vaccination rates all swung for Biden. Florida, ranked a modest 33rd, has the highest rate of vaccination among states that went to Trump. 

A fairly tight correlation between state vote for Biden and percent vaccinated. District of Columbia is on the far right.

Vaccination rates correspond to death rates after 2/23/21. (Going too much before February, the vaccine was not generally available)

Table 3.

Table 3 tells some fascinating stories. First of all is the big picture: states with death rates that correspond to their vaccination rate. Among the 20 who are doing most poorly in death rates are 14 states which are also in the bottom for vaccination rates. Among the 20 who have the lowest death rates are 13 who have the highest percentage vaccination.

Dividing this data up in another way, 31 states and the District of Columbia performed roughly as expected with death rate rankings corresponding to vaccination rates (plus or minus 10). This included states with high vaccination rates and low death rates (e.g., Vermont, ranked 3rd in vaccination and 1st in fewest deaths) or those with low vaccination rates and high deaths (e.g. Mississippi 49th in vaccination and 50th in death). 

*Worse and better were defined as having 10 or less in difference between rankings.

Nine states performed markedly worse in deaths compared to their rankings in vaccinations. Most notably was Florida (32), New Jersey (21), New Mexico (20), Virginia (20), Massachusetts (14), Kentucky (13), New York (13), Texas (12), and Nevada (12). With the high number for Florida, it suggests that the state is making poor decisions beyond the question of vaccinations.

Ten states performed markedly better in their rankings of deaths versus ranking of vaccinations. These were most notably North Dakota (44 ranks higher!), Alaska (22), Nebraska (21), Wisconsin (19), Wyoming (19), South Dakota (17), Utah (17), Iowa (16), Indiana (13), and Ohio (11). Out of the top eight of these, seven were contiguous.

(Note: these numbers were updated on October 6 due to a miscalculation)

Is There a Herd Immunity?

There are two ways to be vaccinated against COVID-19: by a prepared vaccine or by getting the disease. States that have outperformed their official vaccination rates in recent months are often those which have had the highest infection per population. 

An explosion of infections occurred in the upper Midwest beginning in October 2020, with over 1% of the population becoming infected per week. And this can only reflect what was measured at a time when health care services were saturated. "Silent" infections were likely not tested. Going back to the beginning of infection, North Dakota is ranked 2nd in infections per population. South Dakota is 6th, Utah 11th, and Wyoming 12th. With the exception of New Hampshire, all states that outperformed their vaccination rates (by having fewer deaths) are in the top 25 of infection rates.

Herd immunity, better phrased as vaccination by infection, carries a huge price. Although this analysis has focused on the ultimate price, death, hospitalization, economic destruction, short-term suffering and long term impairment are all possible with COVID-19 infection.

Martin Hill Ortiz is a professor of Pharmacology at the Ponce Health Sciences University. He teaches vaccinations and has researched viruses for over 30 years. 


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