Global Comparison

A quick update on the diverging paths of the US & Brazil versus Europe.

Lets look at fatalities – comparing US with a basket of European countries that in total have a similar population to that of the US. See chart below.

To keep the time axis equivalent to the different starting points of the virus in each county, the clock starts for each country on the day of the 100th death.

Europe has been below 50 deaths per day for the last 2 weeks. The US is over 500 (even ignoring the NJ adjustment noted below). Brazil has been over 1,000 deaths per day for the past week.

The point where Europe starts to diverge from the US is around day 55. From this point you see the European covid deaths decline sustainably. The big message here is simply that US deaths have not fallen to the same level as those of Europe. We never reached those low levels. Essentially – Europe kept the focus – but the US seemingly lost its focus.

Declining death rates for most of the curve – but is the US bending up?

Lets look at the case data to illustrate the problem further. The US is now at over 50,000 new cases per day. That’s higher than the numbers recorded in March or April.

Europe has been well below 1,000 per day for the past week – and for the past few days has been below 300 per day.

Brazil daily new case aveage is around 37,000 (Brazil has a population of 208m – so prorating that for the US would give around 57,000 daily cases).

So – there we have it – the US has more than 50x the daily case load as the European Countries in this group – and more than 10x the average daily deaths.

Notes on the data:

1) – European cases spike negative around day 107 due to UK decision to change COVID methodology and remove about 20,000 fatalities and cases from their data set.

2) The large spike in the US curve around day 100 – is due to NJ adding 1877 deaths as part of a methodology adjustment. Ignore that spike and look at the trend. It has been declining – but we are now starting to see it uptick around day 115.

States setting new fatality records so far in July

So much for the hot weather preventing covid. That theory has been fully disproven. Here are the states setting new records for COVID average deaths per day in July.

StateMax Daily Av DeathsDateFPM

FPM stands for fatalities per million of population based off these new numbers.

Cumulatively these numbers are still a long way of the NY, NJ tristate areas however. NY (state) has since inception 1,683 deaths per million residents, NJ has 1715 per million residents. Since inception Arizona has 292, Florida has 185, Texas 107, Mississippi has 403.

There’s still time for the South to avoid the death tolls experienced by the Tristate – but not much time. The recent Arizona governors executive order to limit restaurants to 50% capacity doesn’t seem at all sufficient to halt the growth of cases there. The uptick in fatalities at almost 6 people per million per day is on an upward trend and does not indicate positively for that. Arizona’s record daily case load of 4,797 reported on June 30th hasn’t yet fully influenced fatality rates. Expect higher fatalities in short order.

Memorial Day Madness – the point of US divergence

I think it can all be traced back to Memorial Day. Prior to that time – the US was enjoying a declining trend in cases and fatalities. It wasn’t moving as quickly as some of the European countries – but it did not experience the same peak wave that affected those countries.

Now, those European countries continue to keep things largely on track – whereas the US has spiked, almost as though it is in a perverse race with Brazil. Check out these charts.

The US is managing to keep fatalities down ( at a level of 1.5 per million per day) . Whether the theory that this new wave of infections is amoung younger, healthier people who are better able to fight it off without hospital care and fatalies is true remains to be seen. Some states (like Arizona) have dangerously high level of hospital ICU utilization according to media reports. We’ll report back on that in subsequent posts. Already fatalties are much higher in the worst affected states.

For now though, here are the top 20 countries with the current highest rate of new fatalities per million (rolling 7 day average of recently reported daily deaths). Note some of these countries may have very small populations and the data can therefore be quite volatile – but for larger countries – the data is more stable. Also take the data with a pinch of salt in 3rd world countries.

Worst Large Counties 7-9-2020

The list of large counties (>100,000 population) which high levels of new cases diagnosed (>200 per million per day) continues to grow. 157 counties now meet those criteria. Since that list is too large to present easily on this website – here’s a link to the documents in pdf and excel.

The top counties for new cases, per million per day are:

StateCounty New Cases per million per day 
South CarolinaCharleston710

The top 10 for fatalities (per million per day are)

StateCounty New Fatalities per million 
New YorkNew York City11

Here’s a selection of some charts of the worst counties in the US for current spike in cases – my home county included.

Worst Counties in America 7-5-2020

Here is the list of worst counties based on new cases per million. The criteria is all counties with population greater than 100,000 people. In the list below – all counties have over 400 new cases per day, per million of population. Arizona is not relinquishing it’s spot as the new COVID epicenter of the US.

StateCounty New Cases per million  New Fatalities per million 
South CarolinaCharleston7885
South CarolinaHorry6024
South CarolinaDorchester4182

The fatality data lags cases, but as you can see Arizona cases have spiked for so long that in the case of Yuma, the fatalities are now growing significantly.

Here’s the full list of all counties with population greater than 100,000 and more than 200 new cases per day, per million of people. In total 141 counties meet those criteria. The list is organized by state for easy reference.

Notice the Flu Ratio column – this shows total fatalities for the county – expressed as a percentage of a typical flu level of deaths. Navajo, Arizona for example has a level of deaths 7 times greater than typical flu levels.

StateCounty New Cases per million  New Fatalities per million County PopulationFlu Ratio
AlabamaMontgomery3406        226,486272.94%
AlabamaJefferson3344        658,573137.65%
AlabamaTuscaloosa3014        209,355123.53%
AlabamaLee2802        164,542135.88%
AlabamaEtowah264         102,26874.71%
AlabamaMobile2271        413,210196.47%
AlabamaMorgan2262        119,67924.71%
AlabamaShelby216         217,70262.35%
AlabamaMadison201         372,90912.35%
ArizonaYuma103419        213,787313.53%
ArizonaMaricopa5524     4,485,414115.88%
ArizonaNavajo44212        110,924705.29%
ArizonaCoconino3424        143,476393.53%
ArizonaPinal3204        462,78995.29%
ArizonaPima2862     1,047,279158.24%
ArizonaCochise2709        125,92265.29%
ArizonaMohave2542        212,181244.12%
ArkansasWashington4351        239,18778.82%
ArkansasPulaski2041        391,91190.00%
CaliforniaImperial78426        181,215367.06%
CaliforniaMarin3631        258,82642.94%
CaliforniaStanislaus3431        550,66048.24%
CaliforniaSan Joaquin3201        762,14842.35%
CaliforniaRiverside3062     2,470,546114.12%
CaliforniaTulare3024        466,195171.76%
CaliforniaKings3018        152,940127.06%
CaliforniaOrange2832     3,175,69267.06%
CaliforniaLos Angeles2433   10,039,107204.12%
CaliforniaFresno2331        999,10145.29%
CaliforniaMerced230         277,68023.53%
CaliforniaSan Bernardino2241     2,180,08572.35%
CaliforniaSanta Barbara219         446,49938.24%
FloridaMiami-Dade6995     2,716,940225.88%
FloridaDuval5301        957,75541.76%
FloridaEscambia5151        318,31687.06%
FloridaBroward4842     1,952,778124.12%
FloridaOrange447      1,393,45224.71%
FloridaHillsborough4292     1,471,96860.00%
FloridaLee4282        770,577125.88%
FloridaOsceola4281        375,75142.35%
FloridaLeon412         293,58215.88%
FloridaPinellas3686        974,996119.41%
FloridaMartin3603        161,000102.35%
FloridaCollier3465        384,902130.00%
FloridaManatee345         403,253191.18%
FloridaPolk3352        724,77785.29%
FloridaPalm Beach3294     1,496,770212.94%
FloridaBay3151        174,70517.06%
FloridaSanta Rosa309         184,31328.82%
FloridaSeminole2951        471,82624.71%
FloridaSt. Johns2611        264,67217.65%
FloridaLake253         367,11837.06%
FloridaPasco2512        553,94725.29%
FloridaSarasota2491        433,742132.94%
FloridaIndian River2441        159,92362.35%
FloridaAlachua238         269,04326.47%
FloridaSt. Lucie2282        328,29789.41%
FloridaClay214         219,25291.18%
FloridaBrevard211         601,94218.82%
FloridaOkaloosa2041        210,73822.35%
GeorgiaMuscogee4507        195,769156.47%
GeorgiaBibb4443        153,159157.65%
GeorgiaWhitfield4404        104,62872.94%
GeorgiaChatham363         289,43075.29%
GeorgiaLowndes3494        117,40660.00%
GeorgiaRichmond3014        202,518157.06%
GeorgiaGwinnett2991        936,250108.82%
GeorgiaFulton274      1,063,937173.53%
GeorgiaDeKalb274         759,297134.12%
GeorgiaClarke249         128,33168.82%
GeorgiaClayton222         292,256158.82%
GeorgiaCobb2161        760,141190.59%
GeorgiaDouglas212         146,343144.71%
GeorgiaHall2011        204,441172.35%
GeorgiaCarroll2001        119,992195.88%
IdahoCanyon405         229,84915.29%
IdahoAda295         481,58728.24%
IndianaElkhart2133        206,341142.35%
IowaBlack Hawk2511        131,228260.00%
IowaJohnson245         151,14031.18%
KansasWyandotte3264        165,429302.35%
LouisianaCalcasieu6643        203,436170.59%
LouisianaLafayette4834        244,390115.29%
LouisianaOuachita3727        153,279307.06%
LouisianaLivingston3131        140,789158.82%
LouisianaTerrebonne308         110,461324.71%
LouisianaEast Baton Rouge2952        440,059366.47%
LouisianaCaddo2917        240,204595.29%
LouisianaTangipahoa252         134,758187.65%
LouisianaJefferson2241        432,493662.35%
LouisianaAscension205         126,604269.41%
LouisianaBossier2057        127,039162.35%
MississippiHinds3322        231,840101.76%
MississippiDeSoto2811        184,94551.18%
MississippiMadison2073        106,272188.24%
MissouriJasper256         121,3284.71%
NevadaClark2852     2,266,715114.12%
North CarolinaMecklenburg2851     1,110,35682.35%
North CarolinaDurham2402        321,488122.35%
North CarolinaJohnston2203        209,33992.94%
North CarolinaGaston200         224,52928.82%
South CarolinaCharleston7885        411,40651.76%
South CarolinaHorry6024        354,08190.00%
South CarolinaDorchester4182        162,80918.24%
South CarolinaBerkeley3692        227,90761.76%
South CarolinaGreenville3062        523,54297.65%
South CarolinaRichland2892        415,759122.94%
South CarolinaFlorence2537        138,293238.24%
South CarolinaSumter2533        106,721137.65%
South CarolinaBeaufort2504        192,12267.65%
South CarolinaLexington2344        298,750112.35%
South CarolinaPickens2211        126,88422.94%
TennesseeDavidson4972        694,144103.53%
TennesseeShelby4103        937,166125.29%
TennesseeBradley342         108,11016.47%
TennesseeRutherford268         332,28561.76%
TennesseeWilliamson2181        238,41237.06%
TennesseeSumner2141        191,283160.00%
TennesseeWilson2071        144,65769.41%
TexasNueces7403        362,29422.94%
TexasJefferson6202        251,56581.76%
TexasMcLennan4953        256,62325.29%
TexasGalveston4443        342,13978.82%
TexasBrazos4103        229,21187.06%
TexasTravis3602     1,273,95463.53%
TexasBexar3281     2,003,55438.24%
TexasWebb3112        276,65259.41%
TexasHays3081        230,19117.65%
TexasDallas3072     2,635,51688.24%
TexasComal2822        156,20934.12%
TexasEl Paso2721        839,23894.71%
TexasLubbock264         310,56998.24%
TexasEllis254         184,82660.59%
TexasHidalgo2504        868,70739.41%
TexasKaufman2501        136,15421.76%
TexasEctor2412        166,22331.76%
TexasHarris2221     4,713,32550.00%
TexasBrazoria211         374,26434.71%
TexasCameron2014        423,16392.94%
UtahSalt Lake2351     1,160,43757.06%
WashingtonYakima3475        250,873375.29%
Yuma: 18.2 fatalities per million per day is very very high

Arizona cases & deaths surge….. and says no to contact tracing app from Apple & Google

At this point, what has Arizona got to lose?

Its really hard to see what’s happening in the USA – and in particular states like Arizona. As widely reported – Arizona has been shooting up the league table for new cases of Covid – since early June. By the end of June, also the end of Q2 – it could hardly have been in a worse position imaginable. While during Q1 – all eyes were on the North East states in particular, many other states enacted lock downs and kept their numbers in check.

At the end of Q1 Arizona had about 50 cases per million per day, by the end of Q2 that number was 427 – over 8x higher

Here’s the data in league table format. Arizona is the #1 state for new cases per capita – and is moving ever higher on fatalities per capita also.

Note – the recent spike in NJ fatalities is due to a recent decision to add those people who died of presumed COVID but were not tested at the time into their stats. 1,877 deaths were added into their population of numbers on June 25th. Expect the NJ ‘new fatalities’ number to fall back in line with their trend in about a week.

Across the US – we have a sea of RED – showing many states with case levels far too high to support an acceptably low level of fatalties.

The result in aggregate for the US – is a very disappointing level of cases – that exceeded those recorded earlier in the crisis. Granted that much more testing is being done now, than was the case in early April – but lets not forget that prior to Memorial Day – the case trend was definitely downwards.

If growth in COVID cases can be constrained; fatalities should not reach the levels seen in Apri.

Whatever we were all doing, prior to Memorial Day, we need to return to that. There’s no cause for complacency here.

So that brings me back to apps that enable users to sign up for contact tracing. The latest updates from IOS provides the operating system support to enable apps to support contact tracing, without violating privacy data. Some states like Alabama, North Dakota, South Carolina have signed up to use these features. Many states have not – including ARIZONA. Read about this here.

Now – why would the state with the largest growth in COVID cases, say no to technology solutions to help people understand if they may have been exposed? It defies belief.

Florida Spikes Across Many Counties

Almost 10,000 newly diagnosed cases of COVID in a single day.

Now that is saying something. Only NY has recorded more cases in a single day – 12,274 cases recorded on April 4th 2020. Think about that – NY cases peaked almost 3 months before Florida’s own record setting day. But Florida may not have peaked yet.

As I looked into the data, I realized this isn’t limited to a few counties. Its across the board. Take a look at the table below. Its shows those counties in Florida with populations greater than 100,000 – that have the highest rate of new case creation. These are 7 day average cases – to eliminate one off spikes and focus on the sustained trends.

1 week increase represents the change in weekly average over a 1 week period. In Pasco for example the weekly average is up 257% over that a week ago.

Contagious is the sum of all of the new cases over the last 2 weeks. In Miami-Dade, population 2.7m – there are at least 9,645 contagious people. Likely many more – as asymptomatic people either may not be tested, or others may not have been tested yet.

County  New Cases per million  1 week increasePopulationContagious
Orange437161%1,393,452          5,707
Hillsborough370110%1,471,968          5,517
Martin34220%161,000             680
Miami-Dade34188%2,716,940          9,645
Pinellas33371%974,996          3,478
Collier32232%384,902          1,440
Duval321195%957,755          2,858
Seminole305112%471,826          1,443
Manatee303100%403,253          1,265
Lee26053%770,577          2,120
Osceola242225%375,751             811
Polk239119%724,777          1,716
Broward23563%1,952,778          5,118
Palm Beach23118%1,496,770          4,095
Pasco226257%553,947          1,109
Indian River21946%159,923             415
Highlands207267%106,221             202
Escambia198117%318,316             626
Alachua190155%269,043             492
St. Lucie17721%328,297             693
St. Johns174142%264,672             449
Brevard173167%601,942          1,002
Lake16697%367,118             634
Volusia148128%553,284             817
Sarasota136127%433,742             574
Okaloosa109109%210,738             231
Leon106138%293,582             306
Hernando103300%193,920             172
Worst affected counties in Florida (those with >100,000 people)

The only relatively good news in Florida is that total fatalities per million since the begining of the COVID crisis are about 156, and for NY, the number is 1,637. So total deaths per million are still 10x greater than in Florida.

Expect an increase in fatalities in Florida – possibly to above 8 fatalities per million per day by end of July – if past fatality trends hold.

The award for most contagious goes to…

Starting with an assumption that all cases in the last 2 weeks are contagious – we get these startling stats on which states have the most contagious populations. We hope this population (after all they have been tested postive), are self isolating – but there is also an unknown population of untested, asymptomatic people. Anyhow – knowing what we know, which is the number of new positive COVID tests over the last 2 weeks here’s what we get.

Now, some states have bigger populations than others; after all California is home to 40 million people. So lets adjust for that and look at all states on a per capita basis. Here’s what we get:

Arizona is the #1 state – per million of residents with the number of known cases, assumed to be contagious. South Carolina is #2, Arkansas #3, Alabama #4, Florida #5.

Lets expand this a bit – to identify the people who we assume to be ‘coping with covid’ – those who may, at some point, be in need of hospital care. If we assume that coping window to be approximately 1 month, we get the following CASELOAD stats – per million.

For states in the top of this leage table, the potential stress on the health care system are going to be very significant.

Recall my earlier post on the high bar set by Vermont. Vermont is using a caseload measurement to determine who is allowed to visit. A sensible measure to prevent Vermont’s numbers from skewing higher. Take a look at where Vermont sits, basically 49 out of 51 states (including Washington DC – which I know is not a state).

How did Arizona, and many of these states get so bad, so quickly? The answer has to be some very poor decisions by individuals and leaders. COVID is making us realize that we cannot assume our fellow citizens will act sensibly and rationally. That’s so disappointing.

In a few weeks time we’ll see how today’s caseload numbers translate into fatalities. If past trends hold, then expect very significant fatalities. I would not at all be surprised with possibly around 8 – 12 fatalities per person per day in the next few weeks in Arizona.

Up until Memorial day, Arizona was trending at about 45 new cases per day per million people – with a fatality rate of about 1.7 fatalities per day per million people and improving steadily.

In a little less than 1 month, new cases are now 8x higher at 360 per day, per million people. Fatality levels have already increased again to 3 fatalities per million per day and are on the rise.

We have to unpick the decisions taken in Arizona around Memorial Day and learn these lessons to apply to the next crisis.

Complacency Kills: Eye off the Prize

Although the US has the highest number of COVID deaths there are often some very uneven comparisons. Like comparing the US to Spain, or Italy. The fact is the US is 5 times bigger than those countries so we would expect our numbers to be higher.

We can make a more even comparison by comparing the numbers in aggregate for a group of European countries – such as UK; Italy; France; Spain and Germany. Taken together these have a population of 345 million – almost in line with the US at 326m.

Here’s what we see on the fatalities. The measurement here is from the date of the 100th death. This allows us to compare each measurement at an equiavlent point of time – since we know that Italy and Spain started COVID earlier than in the US.

US deserves a lot of credit for avoiding the peak that Europe experienced. The US did flatten the curve. However starting in May – European countries started to reduce average daily deaths faster than the US.

By this current point – the US is running at a daily average number of deaths approximately 3x that of the European counties I mentioned earlier.


We can really see the driver for this in cases. Although the US is testing more than ever (over 400,000 tests per day) – the surge in cases can’t be explained simply by more testing. The fact that US deaths remain higher and are not flattening as quickly reinforces the fact more needed to be done.

US cases bottomed out at about 20,000 per day on average. Unfortunately they are now on the upswing again – driven by the surge in cases in the South.

The media images of people not practicing social distancing and not wearing face masks demonstrate that complaceny is at large. We need to be more vigilant at this point. The early US lead, effective at avoiding the peak of fatalities, has been squandered. While the US states hit hardest by the virus initially have kept their focus – many others are learning the lesson the hard way.

What happened to Test, Trace, Isolate – and the apps that can help us understand if we have been in proximity to someone who tested positive?

Worst COVID Counties

By now we know that to get the best view of the COVID data we have to identify the specific locations that are creating the excess number of cases that together are keeping the overall US case count too high.

This post focuses on the 35 worst counties in America – those with populations of over 100,000 – and with a current new case daily average in excess of 100 cases per million of population. The reason for only looking at counties greater than 100,000 population is that anything smaller can be skewed very easily. Data as of June 18th.

With those criteria in mind, here are the worst counties for current levels of fatalities and current rate of case creation.

Lets go through some of the numbers. First daily new cases. The US average case to fatality rate is about 3.5% – so any county today experiencing 100 new cases per day – could likely experience about 3.5 deaths in a few weeks. See my earlier post for the case to fatality rate in the US. That seems far too high to be acceptable (and is higher than the US average today of 2 fatalities per million per day.

I’ve taken the view that the only long term acceptable fatality rate is about 1 person per million per day (that’s broadly equivalent to seasonal flu over a 6 month period) – so if COVID stays at these levels for a whole year – that’s about double the seasonal flu level.

Secondly, daily fatalies. I’ve filtered this data set on those counties currently exceeding 3 fatalities per million per day. So that’s 3x what I would expect to be acceptable in the long term.

The combination of some of these stats gives some very dire projections. Take Yuma Arizona, currently 18 fatalities per million per day – and daily new cases of 861 per million per day. That means future fatalities (taking the 3.5% trend above) in this county could be closer to 30 fatalities per million per day. See my earlier post on Arizona – and the potential link between poverty and those counties with high caseloads.

Now – I’ll be the first to admit that Yuma only has a population of about 214,000 so – in real numbers (not per million) – the results will appear smaller. But expressing data per million of population is the only fair way of comparing very uneven data sets.

Many of these counties tend to have a picture like the one below. Basically at no point was COVID successfully brought under control. Now with the ending of restrictions in many states – we see an upsurge in cases and fatalities.

I welcome thoughts, comments on this article as well as suggestions for future analysis.

Be careful out there. Especially in the counties mentioned here.