Oh No Rhode Island

I’m very puzzled by Rhode Island. This is ranked #5 on the scale of COVID fatalities per million people. Recently it has advanced significantly up the league tables – and as the chart shows – the pace of fatalities continues to grow – even though new cases don’t seem to be growing as rapidly.

If anyone has any insights to share on this – please let me know.

Rhode Island is a small state with a population of just over 1 million – but that’s significant enough – and equivalent to many cities in the US.

400,000 COVID Tests Per Day!

I found a great resource on COVID testing stats today. https://ourworldindata.org/grapher/daily-covid-19-tests-per-thousand-rolling-3-day-average?country=ITA~USA~GBR~KOR

This resource analyses the number of COVID tests performed per 1000 people – enabling a comparison across countries. It shows that the in each of the last 4 days of May the US performed over 400,000 tests. That’s amazing! The US testing is about 1.2 tests per thousand per day. South Korea (a country often associated with high rates of testing) is currently testing 0.2 people per thousand (although the incidence of new COVID cases in that country is very low).

Only Australia, with a population of 25 million people, is testing more people per capita than the US. I’m make the point that testing 25 million people has to be easier than testing over 300 million people. So I think the US deserves a pat on the back for reaching this significant scale quickly.

US is leading the way in COVID testing per capita

Now, in the interests of full disclosure – some countries are testing more individuals PER confirmed case than the US. If you like – some countries are doing a wider canvassing of people each time they find a positive case. The US does do that in some populations i.e. testing all of the people in a prison, if there is a confirmed case – or in Meat Processing facilities (see my other blog post on that). So there is some further room for improvement – but that shouldn’t stop us from celebrating what has been achieved.

400,000 tests per day is a great milestone.

New US cases per day re not falling as rapidly as some other countries – but putting this in the context of more testing – simply means the US is catching more cases that would otherwise be undiagnosed. Even with that caveat – the US is showing sustained progress even as States emerge from lockdown.

US total COVID stats are improving, even as testing has increased to over 400,000 tests per day.

COVID and Public Transport

NY State has a population of 19 million people, Florida has a population of 21 million. According to PRB.ORG 20.5% of Floridian’s are elderly – versus 16.5% in NY. Florida is ranked #2 by this percentage – whereas NY is number 26.

We might expect Florida, with a higher elderly population to have a worst COVID outcome than NY – but that’s not even close to being the case. Florida as 2,258 deaths from COVID and NY has over 29,000 – that’s more than 10x worse.

Here’s the public transport connection. Consider this, the NY public transport system has the most passenger trips per day of any system in the US ( and probably very high compared to many cities globally). It has over 9 million passenger trips per day. Florida has a public transport system in Miami (the Metrorail) – with average weekday ridership of 62,000.

Looking at the public transport systems in the US – here’s what we see:

There’s a clear correlation between average daily ridership and COVID deaths per million. Its not a perfect correlation because other factors have a big influence – like hospital capacity etc.

I’m convinced public transport was a big reason for the spread of COVID in NY.

Crowded subway trains are likely a major transmission source of COVID
Photo by Caio Christofoli on Pexels.com

How does the NY transit system stack up in worldwide comparions? According to the source below – in 2015 NYC was the worlds largest system – as measured by number of station. Bigger even than those in China, or Singapore.

In terms of passengers per year – the Asian countries carry more passengers i.e. Beijing carries 3.4bn per year (2014 data) and Tokyo at 3.2bn – but NYC still carries a colossal 1.8bn passengers per year. Add to this the observation that use of face masks seems a lot higher in Asian countries (even pre COVID) than in the American or European cities and we have one of the biggest reasons, in my view, for the rapid spread of COVID in NY.


Lessons for public policy makers:

Shut Down Public Transport much earlier in the crisis. In NYC there was not an official shut down.

Facemask must be mandatory for all passengers. The NY Governor issued a mandatory face mask order on April 15th. Not bad – especially given conflicting and delayed advice from the CDC on the use of face masks. On April 15th there were a cumulative 217,000 confirmed cases of COVID and almost 15,000 deaths. Interesting point – April 14th marked the peak in average daily deaths in NY at 1055 deaths per day.

Cleaning: Don’t wait until May 6th to do the first officialhttps://abcnews.go.com/US/historic-york-city-subway-shutdown-cleaning-deemed-successful/story?id=70536276 cleaning of the NY subway system.

By May 6th – NY had already had 329,000 confirmed COVID cases; and 25,000 deaths.

I can’t help but think the subway linkage was obvious from the get go. Our slow response – and delayed acknowledgement of the importance of face masks (compared to Asian cities) was a major contributor to rapid spread of COVID in NY.

Beware of Micro Clusters

The main stream media is geared to reporting on specific outbreaks of COVID as they appear but don’t seem to be doing a lot of reporting several weeks later. The message is typically combined with other broadcasts that reinforce the dangers of COVID. I think its important to go back and check to see what’s happened in these areas of small outbreaks, and that’s what I’ll do here.

Consider the case of meat processing plants in South Dakota. Here’s the headline from the NY Times on April 15th – it’s attention grabbing.

“South Dakota Meat Plant Is Now Country‚Äôs Biggest Coronavirus Hot Spot” https://www.nytimes.com/2020/04/15/us/coronavirus-south-dakota-meat-plant-refugees.html

6 weeks later – what’s happening? Check out the chart below. It clearly shows a large peak of cases – leading up to 119 confirmed cases per day around the date of this story. It also shows another peak around 1 month later.

Let’s ask the question – are the implied fears on the reporting of Micro Clusters founded? Answer – largely not. Fatalities in Minnehaha county rarely exceed an average of about 2 per day – at the peak – and currently are at a level of about 0.4 per day. In total 43 people out of a county population of 190,000 have died from COVID. That’s about 233 per million – and about 30% higher than the typical US rate of seasonal flu.

I’ve noticed that when the media reports these micro clusters – they don’t usually say “and 1% of these cases may result in fatalities“. I could be wrong – but in my view – they reporting seems to leave to the imagination a much worse outcome than 1 or 2%.

South Dakota is doing well with regard to COVID. It is ranked #40 in terms of fatalities per million of population – and overall COVID deaths are about 34% of the typical seasonal flu level. The peak in average daily deaths occurred 20 days ago – and the current daily level of fatalities is about 26% of the peak. You can see all of this data in the document below.

If there’s interest in this reporting I can share this output for all states. Let me know.

Footnote 1): The methodology used for all charts is to show 7 day moving averages. This strips out any random spikes caused by, for example, lack of full reporting over weekends etc.

Where is the COVID Risk Today?

Short answer – South America, UK and Sweden. US not quite out of the woods yet but the wide divergence in case load by state means that #onesizedoesnotfitall.

What’s the best way to represent the COVID risk we face today. While there is regular reporting of total COVID cases, and total COVID fatalities, at this point this data is backward looking.

We need to look at how many cases are being created today, and the best way to do that in a way that supports an even comparison across countries of different sizes is to do this in ‘per million’ of residents. The results show that South America is rapidly accelerating in its COVID burden.

New cases today are likely to result in future fatalities. How many depends on the capacity of the health care systems of the respective countries to take care of the sick. Once the health care system becomes overwhelmed the fatality rate increases.

The much higher rate of case creation particularly in Peru, Brazil, Chile will shift the global league tables several weeks from now.

The next table shows the current rate of fatalities per million – showing the top 20 countries in my dataset

Sweden and the UK both lead the league table for the number of daily fatalities per million of population. These countries were also the early proponents of the herd immunity theory. Several months later the data shows that the fatality rates in these countries have failed to come down as much as those in Spain, France and Germany etc.

Re the US – although the US is not low on this league table – the US did not experience the peak wave of fatalities that most European countries faced (to be covered in another post).

100,000 Deaths

It took 71 days since the 100th death for the US to reach 100,000 fatalities. That’s devastating outcome that none of us would have predicted or expected as we started the new year. Our daily lives have been changed significantly.

However grim that milestone of deaths is, the daily data is getting better. The stock markets are expecting a quick return to normalcy. Disney is making plans to reopen its theme parks. Consider the Nasdaq – on 2nd Jan it was at 9,092. At its low point around Mar 23rd it was at 6,631. Yesterday it closed at 9,412. Positive for the year.

S&P not quite as good a story – from 3200 at the beginning of the year, to 2200 at the low, to a current level of 3,036.

DJIA 28,868 on 2nd Jan – to 18,591 (down 36%) on March 23rd to 25,548 (down 12% from start of the year).

Lets look at Disney – opened the year at 148 – had a low point of 85 on Mar 23rd – and yesterday closed at 121. The stock price indicates it won’t be a complete return to normalcy – but equally so – it won’t be a continuation of the feeling of despair and doom we felt in March.

Question – was the depth of our despair on March 23rd – or do we feel it today – when the milestone number of 100,000 deaths has been reached?

Here’s some other context… If the US had followed the Italian curve – the 100,000 death would have come on Day 39 – around April 26th – a full month earlier. Following the Spanish curve the milestone would have hit April 14th. Its further evidence that the US curve was flatter.

I’m feeling optimistic today that we have this thing moving in the right direction…. how are you feeling?