It’s been a few weeks since West Virginia became the last state to confirm its residents had contracted the novel coronavirus at the heart of the pandemic. It’s been more than a week since Deborah Birx, a leading figure on the White House coronavirus task force, said nearly 40 percent of the country had “a low level of cases.” That figure derived from her estimate that 19 states had fewer than 200 confirmed cases — and ignored that those 19 states made up only 8 percent of the country’s population.
Only two states, Wyoming and Alaska, still have fewer than 200 cases.
Nonetheless, the coronavirus task force’s briefings continue to include assurances that most of the country isn’t at risk of being overwhelmed by the virus. On Friday, President Trump indicated he wasn’t concerned about states that hadn’t implemented restrictions on travel.
“I leave it up to the governors. The governors know what they’re doing,” Trump said. “They’ve been doing a great job. I guess we’re close to 90 percent anyway. And the states that we’re talking about are not in jeopardy.”
Five states still have no stay-at-home orders: the Dakotas, Arkansas, Iowa and Nebraska. To say that they are “not in jeopardy,” though, is quite wrong.
Birx, speaking on Sunday, put it differently. She unveiled revised versions of graphs that appeared Tuesday when the White House first announced projections that more than 100,000 Americans were likely to die of the virus. One showed the number of confirmed coronavirus cases in each state relative to the state’s population.
It looked something like this: New York and New Jersey continue to be the most-affected states, with Louisiana surging behind them. The District of Columbia was distinguishable from the pack, Birx noted, which it hadn’t been last week.
Birx pointed to the cluster of lines at the bottom of the graph.
“All of the states here, those are 38 of the states, 38 of our states have less than 50 cases” per hundred thousand, she said. “They are testing. Their laboratory results are consistent with that. Their zero positivity rate for their laboratories are less than 5 percent.”
The issue of testing is important, and Birx went on to describe how testing had evolved in states over time (including the good news that New York’s rate of positive tests had declined). The number of confirmed cases is dependent on how many tests have been completed, of course, and a surge in tests can yield a surge in new positives that doesn’t necessarily correlate with a surge in new infections. But these are the data Birx used to evaluate how the country was faring, so let’s consider them.
First of all, Birx’s numbers are wrong, according to tallies compiled by Johns Hopkins University. There are only 28 states with infection rates lower than 50 in 100,000. There are 38 states with infection rates lower than 70 in 100,000. On a separate slide, Birx broke out the 12 areas with the most infections, 11 states plus the District. The chart above, though, is only sort of useful at evaluating how those 12 states compare with the rest of the country.
New York’s surge in infections is problematic, deadly and certainly exceptional. But it also began there before it did in a lot of other states, such as West Virginia. If we shift the starting position of each line to the same point — the day on which the state first passed 10 confirmed infections per 100,000 residents — things look a bit different.
Here, you can better see how alarming the situation in Louisiana has been, with the number of cases per resident there quickly surging past that of other states about 10 days after it passed the 10-infections-per-100,000-residents mark. You also can see that several of the states with the most cases per population — shown in orange — are included in that group only because they’ve had cases over a longer period of time.
If we zoom in, you’ll see what we mean.
Here are the figures for each state on a more compressed scale. Orange lines indicate the 12 states with the most infections per resident. Blue lines are the other 38. You can see that Washington is one of the states with the most infections as a function of population — but only because it had cases long before other states. The growth of cases there has been much slower, and that’s a central consideration when evaluating how well a state will handle the virus.
Three states — Idaho, Indiana and Maryland — are seeing new infections accrue at a faster pace than states which rank among the 12 worst. That suggests those states will soon be among the top 12 in density of infections.
If we look at the first week after each state passed the 10-cases-per-100,000 mark, there are seven states that saw more rapid growth than states that rank in the top 12 overall. One week after it passed the 10-cases-per-100,000 mark, Colorado had 40.1 cases per 100,000 residents, eighth among the top 12 states. One week after they passed the same mark, Florida, Georgia, Idaho, Indiana, Maryland, Nevada and Vermont all had more cases than Colorado.
The projections of the number of deaths that would result from the pandemic unveiled by the White House last week included data from the Institute for Health Metrics and Evaluation at the University of Washington. At that point, the institute’s model estimates more total deaths by the end of the summer than it does currently, which is good news. Its most recent state-level estimates, though, show how the density of deaths per state is expected to evolve by the end of May.
Remember: These are just estimates and are subject to change as data from the states are compiled. What’s interesting is the comparison between states in terms of the possible long-term effects of the virus.
Notice that the states with the most infections per 100,000 people right now aren’t necessarily those expected to be the ones with the greatest density of deaths per 100,000 people. North Dakota, for example, is projected to have between 111 and 2,530 deaths by the end of May — or between 15 and 332 deaths per 100,000 residents. The most likely outcome, according to the model, is 663 deaths, about 87 deaths per 100,000 residents.
That ranks fifth among the states. In fact, only seven of the 22 states with the most per capita projected deaths by the end of May in the institute’s model are among the 12 with the most cases per capita.
Ideally, the measures being undertaken to contain the virus will help push those estimates for every state downward. Birx’s focus on the 12 states with the most cases — or, really, her downplaying the states that aren’t among that group — nonetheless neglects the distinct threat that remains in much of the country.
Trump’s description that some places aren’t in jeopardy is incorrect in its entirety. The question is how much jeopardy they’re in.