April 5, 2020—The largest number of Americans have been suffering from the COVID-19 virus in eight states and the District of Columbia. As of April 4, the states were, in order of death rates: New York, New Jersey, Louisiana, Michigan, Connecticut, Washington, Vermont, Massachusetts. Their death rates all exceed the national average death rate to date of 2.6 per 100,000 population. The list of the worst-hit states underscores the role of social interaction in spreading the disease. New York City was the first big U.S. city to suffer from the pandemic, and its hospitals have quickly been overwhelmed by its spread. Governor Andrew Cuomo provides a daily briefing on his handling of the public health crisis.
Confirmed Cases and Deaths
Two main measures are being used to gauge the progress of the disease: confirmed cases and deaths. Both measures have built-in problems.
Confirmed cases provide an earlier estimate of the extent of the spread of the disease than deaths. It can take a week or more for symptoms to appear, and then it may take another week or more for recovery. Patients can be hospitalized for weeks before recovering or succumbing to the disease.
However, confirmed cases depend on the availability of testing equipment and personnel, and in the early days of the pandemic in the United States tests were in short supply.
For this reason, a low rate of cases to population may simply mean that fewer people are being tested in a state rather than that the disease is not spreading in a state. For the same reason, the case fatality rate is a less reliable number than deaths relative to population.
Deaths by cause would seem to be a simple enough number to keep track of. In a democracy it is hard to hide a dead body for long. Deaths are closely observed and recorded and whistleblowers historically have not been, as in dictatorships, punished for speaking out. A cause of death must be listed. The course of the COVID-19 disease is easy enough to spot. There are in fact some problems with the data, but let's look first at the reported numbers.
New Jersey and Louisiana both have half the severity of New York State, about 9 per 100,000. Michigan and Connecticut are 5 per 100,000. These numbers are rising daily.
As a comparison, the average number of deaths in the United States from traffic fatalities in a year is 12.4 per 100,000. (Note that the traffic fatalities number is the sum of events happening over a year's time, whereas we have only three months of pandemic data.)
The overall U.S. death rate to date from the coronavirus is 2.6 per 100,000 population.
Issues with Cause of Death Data
Two kinds of issues with the data on death rates are emerging:
- Underreporting of COVID-19 deaths. Some jurisdictions require that a test for the presence of the virus have been conducted in order to list it as a cause of death. So the absence of testing kits both lowers the number of cases and the number of deaths.
- Lack of data about victims. Even when the deaths are properly recorded, the hospitals or doctors signing the death certificates may be so pressed for time or staff that they are not recording demographic data about the victims. Ibram X. Kendi, in “Why Don’t We Know Who the Coronavirus Victims Are?” The Atlantic, April 1, 2020, suggests that African Americans are disproportionately the victims, but in many states we don't know. He asks why other states don't report this information—the problems including multiple illnesses and the lack of a test to prove that the victim had the virus; the coroner may be insisting on such proof (here is the Suffolk County, NY procedure for reporting a death).
Who Are the Victims?
The evidence so far is that more blacks are victims than their proportion of the population, and men are much more likely to be victims than women.
Kendi cites data showing that African Americans are 14.6 percentof the Illinois population, but are 28 percent of confirmed cases of the coronavirus (Latinos, however, are a smaller percentage of deaths than in the population). An even more striking disparity has occurred in Milwaukee, where blacks account for 26 percent of the population but are half of the reported cases and 81 percent of deaths. In Michigan, blacks are 14 percent of the population but 41 percent of the victims.
Support for Masks, Shutdown
Support has been growing for closing meeting places like restaurants and wearing face masks in public. The support for these actions has bubbled up from the states rather than having been led from Washington. The White House at first did not give credence to the pandemic's arrival in the United States and then expressed concern about interfering with economic activity to slow the progress of the disease.
Among the top nine victims of the virus, blue states predominate. Some of the governors of these states have clashed with the President on getting support in the form of supplies, equipment or a national shutdown or mask-wearing policy.
Democratic New York City and State, with more than 18 deaths per 100,000 population in the state, have supported closing public meeting places. Four other states and D.C. have Democratic leadership. These leaders of these states were early in supporting closing public places until the apex of the disease has passed and in calling for an immediate end to tariffs on medical supplies from China.
The other three states (Louisiana, Vermont and Massachusetts) are purple. Two have Republican governors and one has a Republican senator. Among the next nine states, ranked by death rates, three are red states and two are purple (Colorado and Pennsylvania).
In states with Republican or mixed party leadership, leaders have often appeared to wait for direction from the White House. This has sometimes led to disagreement between Republican Governors and Democratic Mayors over delays in locking down or advice on social distancing.
Note on Data: Confirmed cases and deaths by state are as of April 4, 2020 from the Johns Hopkins University Coronavirus website. A convenient tabular form of the JHU data was posted by The Guardian later on the same day. Total number of U.S. cases and deaths added by JT Marlin. Population data are from the U.S.Census Bureau, Population Division, Table 1. Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2019 (NST-EST2019-01), December 2019. The Census Bureau documents its estimation methods. Calculations of cases/population, deaths per 100,000 population and case fatality rates by JT Marlin.
