...THURSDAY APRIL 30 2020 2:30 PM EDT...
This is an update to my previous article on the COVID-19 outbreak in the United States (link to previous article here). Yesterday April 29 marked 100 days since the United States declared its first case of COVID-19 in Washington state on January 21. Even though the United States has long since become the nation with the most number of cases, because it is such a large nation with several million peopele it had not become the record holder for the % of its population infected. However as Figure 1 shows (in the section titled updated data for the United States), the United States will soon also lead in this metric as it has not seen an appreciable slow down in the number of new cases per day as European nations like Italy have been seeing.
About 7 days go as noted in Figure 2, there was an upward spike nationally in the new number of cases per day in the United States, which directly coincided with a sudden increase in the total number of COVID-19 tests being ran daily in the United States. This increased testing rate has been maintained in the United States over the last 7 days, and Figure 2 suggests that the number of new daily cases in the United States maybe decreasing even with the higher testing rate, we will have to see if this continues to know if this is a trend for sure. The updated mapping in Figure 3 shows the western coast of the United States has seen an improvement with all states along the coast now in the less severe "yellow zone," while problem areas persist in the central and eastern United States. Multiple states in the most severe "purple zone" in the northeastern United States are showing decreases in number of new daily cases over the last 7 days. The increased testing and recent decrease in new number of cases have made the national percentage of daily tests positive down from the 17% to 22% it was from April 20 to 22 to now 10% to 13% over the last 3 days (April 27 to 29). The World Health Organization suggests for a pandemic that this percentage needs to be 10% or less in order to declare that sufficient testing is occurring, sufficient meaning knowing who really does and does not have the virus (https://www.vice.com/en_us/article/v74wjd/the-us-doesnt-have-nearly-enough-coronavirus-tests-to-open-the-economy).
I continue to monitor each state's COVID-19 metrics as well, and it continues to appear some state governments are following politics rather than the data within their own state. For example I found states where the daily rate of infections was too high and/or testing was not sufficient and yet are going ahead with lifting some restrictions. I also found states that are doing quiet well with testing and had low daily infection rates, and yet restrictions remain in place. However their remains some good news in that there were plenty of states whose decisions on keeping or lifting restrictions seem to align with the latest data. I divided the states into multiplie tiers depending on these findings, to see which tier your state falls into, see section below titled "updated data for the United States." Here is my advice based on which tier your state belongs: Tiers 2 and 5: 1) Even though your state or city may not be under strict stay at home orders, because of a lack of testing and/or a high enough number of new COVID-19 cases per day, try to stay at home as much as possible and socially distance (maintain a physical distance) from others in public when going out for necessities. 2) Don't forget about sanitation habits such as keeping your hands clean by frequent old fashioned washing with soap and water or using disinfectant gels or wipes. Have a holding area in your home to temporarily place items ordered online or picked up from any store where you can disinfect their packaging (bags, boxes, cans, etc.). You can also use this holding area to give time for any bacteria to dissipate on the packaging before storing bought items in your home. Tier 4: 1) Continue following your state's stay at home order, your state either has a lack of testing and/or a high enough number of new COVID-19 cases per day. This means trying to stay at home as much as possible and socially distance (maintain a physical distance) from others in public when going out for necessities. 2) Don't forget about sanitation habits such as keeping your hands clean by frequent old fashioned washing with soap and water or using disinfectant gels or wipes. Have a holding area in your home to temporarily place items ordered online or picked up from any store where you can disinfect their packaging (bags, boxes, cans, etc.). You can also use this holding area to give time for any bacteria to dissipate on the packaging before storing bought items in your home. Tier 3: 1) Your state has a lower number of new cases per day and has sufficient testing, and the state government has already or is planning to lift some restrictions in the coming days. Even reduced restrictions does not mean a complete return to normal as some restrictions may still be in place. So please check your local news and local/state government websites for the latest rules. Tier 1: 1) Continue to follow your state's stay at home order. Perhaps there should be a discussion encouraged about reducing restrictions as your state has a lower concentration of new cases per day and sufficient testing activity. Tier 6: 1) There are currently a low number of new COVID-19 cases per day in your state and there is sufficient testing, and your state does not have a blanket stay at home order. However the lack of a blanket order may not mean there are no restrictions, check your local news and local/state government websites for the latest rules.
...WHAT AREAS I COLLECTED DATA FOR...
1) China, where COVID-19 originated 2) Italy, one of the first nations outside of China where the number of cases of COVID-19 increased rapidly 3) South Korea, where COVID-19 was quickly contained 4) Nations where I have family and friends, the United States, United Arab Emirates, and Egypt 5) Within the United States, I have recently expanded my data collection to now include all 50 states
...SOURCES FOR DATA... 1) For global COVID-19 case count, as well as the total number of tests in each nation, https://www.worldometers.info/coronavirus/ 2) For a state by state breakdown in the United States, including the total number of tests each state has ran, https://www.worldometers.info/coronavirus/country/us/
...CALCULATIONS TO NORMALIZE DATA....
Warning! Note that while the percentages described below have been of low numbers, it only has taken a very small percentage of the population getting infected to overwhelm the medical system, which forces hopsitals to make priorities as to who will or will not get COVID-19 treatments as well as other treatments for other serious diseases such as cancer. For example Italy on 3/11/2020 with only 0.021% of the national population infected with COVID-19 had hospitals reaching capacity (https://www.theatlantic.com/ideas/archive/2020/03/who-gets-hospital-bed/607807/).
Comparing nations or regions (state, county, city, province, etc.) simply by looking at the total number of cases may not provide a fair comparison as larger population areas naturally will have a higher number of cases. Therefore I converted the data by dividing by population to give a normalizing percentage, for instance:
% infected, nation = (total cases nationwide/total population of nation)*100
% infected, state = (total cases statewide/total population of state)*100
% infected, county = (total cases countywide/total population of county)*100
% infected, city = (total cases citywide/total population of city)*100
I also did the a similar normalization for the number of new cases per day, in a metric I called "percent chance of getting infected." For example in a population of 100, if you are getting 1 new case each day that the percent chance of the remaining uninfected 99 getting infected is (1/99)*100 = 1.01%. On the next day when another 1 case happens the chance of the uninfected 98 getting infected becomes (1/98)*100 = 1.02%. Then lets say on the third day the population is now getting 3 new cases per day, so now 95 are uninfected and the chances go up to (3/95)*100 = 3.15%. As such I calculated:
Number of Uninfected = Total Population - Total Number of Cases
% chance of becoming infected = (New Cases Today/Number of Uninfected)*100
Although I think this metric is proportional to the likelihood of getting infected, the small resulting values should not be interpreted as literal or to minimize the seriousness of the situation, because this is based on the number of new confirmed cases, so if testing supplies in a region are not adequate or a large number of people with flu-like symptoms decide not to get themselves tested, then the true number of COVID-19 cases in reality is larger and this percentage could actually be higher than what has been calculated thus far. And if you venture to certain hospitals, streets, buildings, etc. where the virus is present or in high concentration, the chances of becoming infected go up and is likely higher than reflected by the calculation. Rather, I use this calculation to understand if the number of new cases per day is increasing, staying the same, or decreasing, and this metric is normalized by population to be able to compare one region with less population to another region with more population more fairly.
I calculate the mortality rate as:
mortality rate % = (Total Deaths/Total Number of Cases)*100
And finally I calculate the daily positive test rate as:
% of daily tests positive = (New Cases Today/Total Tests Ran Today)*100
Some states or nations do not update the total number of tests ran each day. So if this value is updated every four days for example, a four-day average is calculated by summing the total number of new cases over the last four days, and dividing by the number of tests ran over the last four days.
...UPDATED DATA FOR THE UNITED STATES...
Figure 1 - Percent of population infected with COVID-19 in the United States versus a sample of other nations.
Figure 2 - Approximation of percent chance of becoming infected in the United States as well as a sample of other nations. I made this approximation by taking the number of new cases per day and dividing by the uninfected population. See disclaimer within this figure about the limitations of this approximation, this metric should not be solely used in assessing your risk or decision making about COVID-19.
Figure 3 - Approximation of percent chance of becoming infected in all 50 states in the United States. I made this approximation by taking the number of new cases per day and dividing by the uninfected population. See disclaimer within this figure about the limitations of this approximation, this metric should not be solely used in assessing your risk or decision making about COVID-19.
Figure 4 - Current state of COVID-19 testing in the United States.
I judged that if states were yellow or green in BOTH Figures 3 and 4, i.e. a state has sufficient testing AND has a low enough number of new cases per day, then that state would be safe to loosen restrictions. Unfortunately the loosening of restrictions seems to have some political motivations rather than simple objective motiviations driven by data. Thus I divided states into the following six tiers as follows:
Tier 1, States that I think are safe to reduce restrictions on by May 1 but are not going to have reduced restrictions: *Oregon, low concenration of new cases per day, sufficient testing, but no plans to lift restrictions *Vermont, low concentration of new cases per day, sufficent testing, current stay at home order ends May 15 *West Virginia, low concenration of new cases per day, sufficient testing. It apperas an updated bulletin has been released by the governor about potentially allowing some non-essential businesses to reopen by "Week 2," or May 7, if current trends continue (https://governor.wv.gov/News/press-releases/2020/Pages/COVID-19-UPDATE-Gov.-Justice-unveils-plan-to-reopen-state-%E2%80%9CWest-Virginia-Strong-%E2%80%93-The-Comeback%E2%80%9D.aspx)
Tier 2, States that I think are unsafe to reduce restrictions but have already or will have reduced restrictions by May 1: *Alabama, high concentration of new cases per day and insufficient testing, stay at home order expires April 30 *Arizona, even though concentration of new cases per day is on the low side, there is insufficient testing, stay at home order expires April 30 *Colorado, high concentration of new cases per day and insufficient testing, some non-essential businesses were allowed to reopen on April 26 *Georgia, even though testing is now sufficient per Figure 4, there remains a high concentration of new cases per day, some non-essential businesses were allowed to reopen on April 24. *Indiana, high concentration of new cases per day and insufficient testing, current stay at home order still expires April 30 (https://www.wane.com/news/indiana/indiana-governor-explains-how-state-can-reopen-with-virus-cases-still-rising/). *Maine, even though there is a low concentration of new cases per day, there is a lack of testing. Current stay at home order expires April 30. *Minnesota, even though there is now sufficient testing, new cases per day have been increasing and now the state is in the "red zone" per Figure 3. Outdoor recreational activities were allowed on April 17, with additional restrictions expiring May 4. *Mississippi, high concentration of new cases per day and insufficient testing, some non-essential business were allowed to reopen on April 27. *Nevada, even though new cases per day have dropped enough to put Nevada in the safer "yellow zone" in both Figures 3 and 4, the state is hovering just below the threshold of being "red" in Figure 3. Current order set to expire on April 30 with some non-essential businesses allowed to operate, although under some restrictions (https://www.fox5vegas.com/coronavirus/gov-sisolak-to-extend-stay-at-home-order-through-may-15-easing-restrictions-on-may/article_6e25dfca-8a7d-11ea-af98-2ba8c5d519a6.html). *Ohio, there remains insufficient testing, and even though there has been a slow drop in new number of cases per day to now put the state in the "yellow zone" in Figure 3, the state is hovering just below the threshold of being "red." Current order set to expire on May 1. *South Carolina, even though there is a lower concentration of new cases per day, there is insufficient testing, some non-essential businesses were allowed to reopen on April 27. *Tennessee, even though there is sufficient testing, there remains a higher concentration of new cases per day, current order set to expire on April 30.
Tier 3, States that I agree with reduced restrictions by May 1: *Alaska, sufficient testing with a low concentration of new cases per day, some non-essential business was allowed on April 24 *Hawaii, low concentration of new cases per day and sufficient testing, stay at home order expires April 30 *Florida, sufficient testing, and new cases per day have recently decreased to put the state in the "yellow zone" in Figure 3. Beaches were reopened on April 17 with other restrictions expiring April 30. *Idaho, low concentration of new cases per day and sufficient testing, stay at home order expires April 30 *Montana, low concentration of new cases per day and sufficient testing, stay at home order expired April 26 *Texas, low concentration of new cases per day and sufficient testing, state parks were allowed to reopen on April 20 and some non-essential businesses were allowed to offer retail-to-go on April 24
Tier 4, States that I agree keeping restrictions through May 1 or later: *California, sufficient testing, and the number of new cases per day has recently drifted to a low enough level to now make the state "yellow" in Figure 3. However the state hovers just below the threshold to make it "red" again should there be a spike. Still no dates put on lifting restritions as of now (https://www.nytimes.com/2020/04/29/us/california-reopen-coronavirus.html). *Connecticut, very high concentration of new cases per day and insufficient testing, current order expries May 20. *Illinois, very high concentration of new cases per day and insufficient testing, stay at home order recently extended to May 30. *Delaware, high concentration of new cases per day and insufficient testing, stay at home order expires May 15. *Kansas, high concentration of new cases per day and insufficient testing, stay at home order expires May 3. *Kentucky, higher concentration of cases per day and there is insufficient testing to re-open, current stay at home order now set to expire May 11 (https://www.wlky.com/article/kentuckys-phased-reopening-of-businesses-begins-may-11-heres-the-general-plan/32320920#). *Louisiana, high concentration of new cases per day and insufficient testing, current stay at home order was recently extended to May 15 (https://apnews.com/f2de894b86b7112393651d4d65f2b007). *Maryland, high concentration of new cases per day and insufficient testing, no end date to current stay at home order at this time. *Massachusetts, high concentration of new cases per day and insufficient testing, stay at home order recently extended to May 18 (https://www.nbcboston.com/news/local/gov-baker-to-provide-update-on-coronavirus-in-mass-3/2114910/) *Michigan, recent drop in new cases per day now makes testing sufficient per Figure 4, and now allows the state to be in the "red zone" instead of "purple" in Figure 3. However "red" is still too high as medical systems in the state will remain at capacity. Stay at home order expires May 15 *Missouri, even though there is a lower concentration of new cases per day and there is now sufficient testing, this progress has only been very recent, and so I agree with holding on to the stay at home order a little longer, to May 3. *New Hampshire, even though there is sufficient testing, a high concentration of new cases per day is currently present, stay at home order to expire May 4. *New Jersey, very high concentration of new cases per day and insufficient testing, there remains no end date to stay at home order at this time (https://www.fox5ny.com/news/nj-stay-at-home-order-continued-indefinitely). *New Mexico, even though testing is now sufficient, there remains a high concentration of new cases per day. Stay at home order to expire May 15. *New York, very high concentration of new cases per day and insufficient testing, stay at home order to expire May 15. *North Carolina, testing has now reached insufficient levels given the state's current caseload, and the state continues to hover too close to the border between "yellow" and "red" in Figure 3. Stay at home order expires May 8. *Pennsylvania, high concentration of new cases per day and insufficient testing, current stay at home order expires on May 8. *Rhode Island, very high concentration of new cases per day and insufficient testing, stay at home order to expire May 8. *Virginia, high concentration of new cases per day and insufficient testing, current stay at home order expires June 10. *Washington, sufficient levels of testing, and the state has seen a downward drift in new cases per day to move away from the border between "red" and "yellow" in Figure 3. This progress has only been very recent, and so I agree with holding on to the stay at home order a little longer, to May 4. *Wisconsin, even though there is now sufficient testing, the state hovers just below the border between "red" and "yellow" criteria in Figure 3 (right now the state is yellow, but could easily be red again). Stay at home order to expire May 26.
Tier 5, States that never had blanket strict stay at home order that I think should be under one: *Arkansas, although there is sufficient testing, the state has only just recently met the criteria to be "yellow" instead of "red" in Figure 3. Will have to see if this continues in order to remove this state from Tier 5. *Iowa, insufficient testing and increased concenration of new cases per day *Nebraska, insufficient testing and increased concenration of new cases per day *North Dakota, even though there is sufficient testing, there remains an elevated concentration of new cases per day *South Dakota, insufficient testing and elevated concentration of new cases per day *Utah, even though there is sufficient testing and the state just recently turned "yellow" per the latest mapping in Figure 3, the state remains just below the border between "yellow" and "red" and could easily go back to "red" with any spike in cases. There has been a stay at home recommendation without force of law. Tier 6, States that never had blanket strict stay at home order that I think are okay: *Oklahoma, low concentration of new cases per day and sufficient testing *Wyoming, sufficient testing, there was a spike in new cases on April 26 that put the state in "red" instead of "yellow" in the latest mapping in Figure 3. However as of April 29, the state is notably lower from the spike. However if another spike like this occurs, will consider moving this state to Tier 5 in my next update.
...A LOOK AT APRIL 25 FORECAST PERFORMANCE...
In my previous update (link here), I posted a forecast I created on April 25 which assumed the United States would through May 1st remain at an elevated pleateau of new confirmed cases per day caused by increased but necessary testing. As seen in Table 1, this forecast appears to have overpredicted the number of cases, because the number of new cases per day has been below this plateau as seen in Figure 2. Because testing capacity has NOT reduced and yet the number of new cases has become less, this maybe good news that cases in the United States are finally beginning to decline. Will have to see if this trend continues to know for sure.
Table 1 - Tabular view of USA experimental forecast for COVID-19 cases I generated on April 25
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