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Population-Adjusted Comparison of Deaths, Cases & Hospitalizations for All 50 U.S. States-

Decontextualized case numbers are being used to fan hysteria and as justification for keeping children out of schools, and businesses closed. A 55% increase in testing since September 15, 2020 has lead to a significant increase in observed U.S. COVID-19 cases, making apples to apples comparisons of prior case numbers challenging, and resulting in doomsday predictions of a third wave of U.S. COVID-19 infections and deaths. It is imperative to try and put these numbers into a useful context that will help the public and public officials make wise, not rash decisions. If we normalize observed cases for changes in testing, we find that as of mid-May, cases track almost exactly with hospitalizations (which is what one would expect). This exercise makes several things quite clear, which ought to have been clear from other pieces of data, such as hospitalizations and deaths. First, we are not at an unprecedented level of cases--we've been here 3 times before. Not surprisingly, the real peak case level was in April, when we saw our peak levels of deaths. Deaths and hospitalizations are far more reliable metrics than cases, given how dramatically testing has changed since the beginning of the epidemic. Second, the actual rate of case increase is not rising nearly as quickly as it was in late June, and nowhere near the level that it was in march. This is clear by not just from the testing-equalized case numbers, but by looking at hospitalizations and deaths, again, far better indicators of the actual level of spread in the community.


Figure 1

Source: National data from The COVID tracking project. Testing-equalized cases, calculated using: (7-day average observed cases on date)/(7-day average daily tests on date/7-day average of tests on reference date). In this case, reference date was 9/15/20. Visualization, Emily Burns


The panic around our rising case numbers arises largely from a fear that we too will soon be seeing a surge in deaths like that currently being seen in Europe. I have argued at length in this post that I do not believe that to be the case. Europe's rising case numbers were particularly concerning because, during the summer, European nations such as France and Spain were catching nearly every single case. This can be inferred from the fact that during the summer, the observed week over week CFR (1 week of deaths/prior week's cases) for both of these countries was close to 0.2%, lower than the IFR of 0.23%, currently in use by the WHO. If they were missing any cases, then it means that the IFR is even closer to that of flu. Thus, when cases started spiking in Europe, it was a cause for concern, because their contact tracing efforts, while doing little to slow the spread of the disease, were in fact catching nearly every single new case. This is in contrast to the U.S., where while we have been able to reduce our week over week CFR significantly due to increased testing, it is still around 1.4%. No doubt with this new surge in testing, we will be able to get it down even further. The other reason it is unlikely that most states will likely see a significant jump in deaths, is that in the U.S. our lockdown was not such as to completely suppress cases, as was the case in Europe. Coronavirus has been circulating much more widely in the U.S. These different surges aren't so much additional waves, as each state's or locale's first wave.


What is most important though is to understand just how different the "second" and "third" "waves" are from the first. If the rest of the country had had a first wave like NY, we would have had 320K hospital beds occupied at the peak (vs. 60K, as you see above), 565,000 total dead, and 13,000 daily deaths at the peak, vs. 2100. That is simply not where we are headed. Figure 1 above shows that had we had consistent testing, the real number of cases (whatever that actually is) in April was 3x what we are seeing now. This makes sense, given that the number of deaths was also nearly 3x what we are seeing now. That hospitalizations were not as high suggests that many hospitals were overwhelmed in the 7 early-peaking states of NY, NJ, CT, MA, RI, LA & MI, and not able to take people who might have benefited from care. In many of the graphs below, it is also clear that currently many, many more people are being hospitalized relative to the number of deaths than was the case early on in the epidemic. This may indicate that treatment is much better, and far fewer people are dying, or it may be that there is some level of "prophylactic hospitalization."


For instance, in El Paso, Texas, one of the current "hot spots" there are over 900 people in the hospital, 40% of the hospital's capacity. This is a record for coronavirus hospitalizations there, and on a population-adjusted basis, similar to the 10,000 or so that were hospitalized in NYC during their peak (NYC is 8.5 million people, to El Paso's 1-ish million). However, the difference in deaths is stark. When NYC hit its peak hospitalizations (appx 10k and 40% of all hospital capacity) on 3/30, they also saw 330 deaths--half their peak of 700-ish that they reached 1 week later. El Paso yesterday saw 3. Adjusting for population, if you are generous and say that NYC is 10x more (it's not, more like 8x), that would be the same as seeing 30 deaths in NYC--10-fold less on a population-adjusted basis (100-fold on a real basis). We are beginning to see a de-coupling now of hospitalizations and mortality. Which is a good thing, but may also be inflaming fears. Figure 2 below shows El Paso's deaths and hospitalizations. Back in July, when they peaked at 300 or so hospitalizations, the peak deaths were 7 deaths/day. Deaths lag hospitalizations by 7-10 days, depending on the severity of the outbreak, with more severe outbreaks (like in NYC) compressing down to 7 days, presumably because only the sickest are hospitalized. El Paso passed 400 people hospitalized on 10/15. If this spike were really a seriously deadly spike, we would as of yesterday expected to have seen an average of at least 10 deaths/day, based on the July figures. Instead, deaths have been in the 1-3 range for the last several days, suggesting that more people who are less sick are being hospitalized. Again, this is a good thing because it means everyone is getting the care they need, but it also may mean that hospitalization numbers are causing greater alarm than they ought to be causing us. Indeed, that ICU admissions are less than 1/4 of COVID cases, when they were 1/3 in July is one further indication of this. Now, 10 deaths were reported two days ago in El Paso, but when when you read the article, you see that those 10 deaths occurred over the past 2 weeks. Indeed, according to Texas's data (which has an A rating for data quality according to the COVID tracking project), there have been no new recorded deaths in El Paso since 10/25--a full week. Will there be? Yes, of course. But are we seeing a mini-New York in El Paso? Absolutely not.


Figure 2

Source: https://dshs.texas.gov/coronavirus/additionaldata.aspx

As promised in the title, I have analyzed deaths, cases, and hospitalizations for all 50 states, and done so on a population-adjusted basis, in order to facilitate easy comparison across states. I have also included in each graph, the data for New York state and Massachusetts, in order to put each individual state into relief. I have done this for two reasons. First, so that it is clear that no state (except New Jersey) has come near to New York in terms of daily deaths/capita, nor in hospital capacity used. I have included Massachusetts, because former FDA director Dr. Scott Gottlieb, who has been one of the most strident in sounding the alarm about this "third wave," is one of the architects of Massachusetts' coronavirus "response". And while Massachusetts is not NY, its deaths/million are still twice that of the U.S. at large, and its hospital utilization exceeded those of most subsequent "hot spots" by a factor of 2 or 3. Thus, if the Massachusetts approach is the "model" that is being proposed by leading public health figures, I think it is important that each state be able to compare themselves to that model. As you will see below, Massachusetts, like New York remains a cautionary tale, not a model. Other than New Jersey and New York, there is not a single state that has performed worse.


There are a few general trends to notice in the graphs below. First, in many of the "second wave" states, like Alabama immediately below, we see a very steep increase in cases prior to much more modest hospitalization and death surges. That is likely some of what we are seeing with our current surge in recorded cases. Our testing is up 70% since those second waves, so it is not surprising that third-wave states are seeing even higher case peaks ahead of hospital surges. Second, you will notice repeatedly in the third-wave sates, the phenomenon seen in El Paso of high-ish hospitalization rates, but low death rates.


Without further ado....



Alabama: 4.9 Million

594 Deaths/Million (30th), 6.6% Unemployment (24th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: While hospitalizations peaked at just shy of half that of MA, and 1/3 that of NY, daily deaths/million peaked at 5, 20% that of Massachusetts' 25, and 8x lower than NY's 40 deaths/million. Cumulative deaths/million are less than half that of MA, and 1/3 that of NY. Note also how far recorded cases outstrip hospitalizations, and especially deaths during the summer peak. Note also that, despite having 2x Massachusetts' hospitalizations and observed cases on 10/22/20, Alabama has roughly the same number of people dying (per capita) over the last several weeks.




Alaska: 0.73 Million

97 Deaths/Million (2nd), 7.2% Unemployment (28th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Alaska is seeing a large spike in observed cases, as we saw in Alabama. But like Alabama (a 2nd wave state) it is seeing only a very mild increase in hospitalizations. Despite having 3x the number of recorded cases as Massachusetts, deaths are substantially lower even as of today, and hospitalizations only just exceeded Massachusetts' current rate. The rest of the graph speaks for itself. Alaska's success (not unexpected given its size) relative to Massachusetts and New York renders it hard to even present the data on the same scale.




Arizona: 7.3 Million

813 Deaths/Million (43), 6.7% Unemployment (25th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)

Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Arizona, one of the most maligned "second wavers" has a death rate 60% that of Massachusetts, and less than 1/2 that of New York. At it's peak, Arizona's hospital utilization was 50% that of NYC, and about 80% that of Massachusetts. However, the substantially lower number of daily deaths indicates that they were likely able to hospitalize more at-risk people. At it's peak, Arizona had 11 people/day/million dying, only 40% that of Massachusetts, and 25% that of NY. Currently, Arizona has fewer than half the people dying per day as Massachusetts, despite slightly more people in the hospital and theoretically, the same rate of new cases.




Arkansas: 3 Million

621 Deaths/Million (31st), 7.3% Unemployment (30th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Arkansas has just over 40% the death rate of Massachusetts, and just over 1/3 that of New York. It has managed to keep hospitalizations relatively flat throughout, currently just kissing 200 people hospitalized/million--less than 1/3 that of Massachusetts at its height, and 20% of New York's peak. Currently hospitalizations and deaths are diverging, with deaths sinking, while hospitalizations grow slightly. Despite having ostensibly 3x the number of cases as Massachusetts as of 10/22, Arkansas has only 2x the number of deaths, at just over 5 deaths/million/day to Massachusetts' 2.5/million/day.




California: 39.5 Million

444 Deaths/Million (22nd), 11% Unemployment (49th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: California has fewer than 1/3 the death rate of Massachusetts, and fewer than 1/4 that of NY. Like Arkansas, it boasts a low hospital utilization rate, only just exceeding 200 people/million at its peak--1/3 that of MA, and 1/5 that of NY. It is currently in line with Massachusetts in terms of daily people hospitalized, but has fewer than 1/2 Massachusetts' daily deaths. However, this low death rate comes with a very steep unemployment rate--11%, 49th out of 51. Colorado, with slightly fewer deaths/million, and an unemployment rate that is half that of California ought perhaps to give California heart that it can safely open up more of its economy without a drastic increases in deaths.




Colorado: 5.8 Million

391 Deaths/Million (18th), 6.4% Unemployment (22nd)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)

Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Colorado has fewer than 1/3 the death rate of Massachusetts, and fewer than 1/4 that of NY. It never exceeded 200 people hospitalized per million, and despite being largely open has never seen a significant resurgence in hospitalizations or deaths. Colorado supposedly has twice the number of cases as Massachusetts as of this printing, but it's death rate remains significantly lower than that of Massachusetts, almost inline in with New York's. This gives some credence to the idea that Massachusetts is either finding fewer cases, or the infection is predominantly circulating amongst those at significantly higher risk of death. Colorado ought to be a model to blue states like New York, Massachusetts and California who are loath to look to red states for models, but which need desperately to open their economies for the well being of their populations.




Connecticut: 3.6 Million

1291 Deaths/Million (48th), 7.8% Unemployment (33rd)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Connecticut and Massachusetts look almost identical in terms of death rates, with Connecticut slightly lower than Massachusetts. Like all other northeastern states, Connecticut enjoys extremely low levels of hospitalizations, deaths, and cases now. The prevailing narrative is that this is due to incredible compliance with social distancing protocols. Likely it has far more to do with the virulence of the initial outbreak and some levels of immunity within this population. Connecticut enjoys the second lowest unemployment rate (after NJ) of all of the early-peaking northeast states. It ought to give some courage to these other governors that they can further open their economies without seeing a resurgence.




Delaware: 1 Million

707 Deaths/Million (37th), 8.2% Unemployment (38th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Delaware stands at 1/2 the death rate of Massachusetts, and about 35% that of NY. It's hospitals likewise experienced 1/2 to 1/3 the pressure of those in Massachusetts and NY. Currently, Delaware has higher hospitalizations and cases than MA, but about half the deaths.




D.C: 0.7 Million

914 Deaths/Million (44th), 8.7% Unemployment (43rd)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: D.C., like Connecticut finds itself in between NY and Massachusetts, in terms of hospital utilization. It is still about 50% of the death rate of NY, and 70% that of Massachusetts. But it's hospitals experienced greater strain that those of Massachusetts. Currently, like so many states, it has higher hospitalizations than Massachusetts, but lower deaths/million/day--in-line actually with NY. Like other early-peaking areas, I believe current flatness is due to earlier virulence that is currently serving to protect the population.




Florida: 21.5 Million

776 Deaths/Million (41st), 7.6% Unemployment (32nd)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Florida remains one of the most maligned second-wavers, this despite having roughly half the death rate of Massachusetts, and 65% lower than that of New York. In terms of hospitalizations, Florida stands at around 20% lower utilization @peak than Massachusetts, and 45% lower than that of NY. However, the daily deaths/million were far lower than both, with Florida averaging 9 deaths/day/million, 60% fewer than Massachusetts' 22, and 75% lower than NY's 40. Florida, like Arizona, offers an example of the poor linkage between case increases, hospitalizations and deaths, particular, once a "surge" is declared, and the populace becomes hyper-vigilant about testing. Notice the increase in cases is nearly asymptotic, though the increase in deaths remains quite gradual. On September 28th, Florida's governor, Ron DeSantis, lifted all statewide COVID restrictions. We are now one month beyond that. Florida is registering similar hospital utilization as Massachusetts, and lower daily deaths/million (as of 10/28, the 7 day average for Florida was 2.4 deaths/million, and 2.8/million for Massachusetts).




Georgia: 10.6 Million

742 Deaths/Million (38th), 6.4% Unemployment (22nd)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Georgia, like Florida, clocks in just above half the deaths/million of Massachusetts, and 40% of New York's. Georgia has had a relatively flat curve throughout in terms of hospital utilization, topping out at 50% of Massachusetts, and 30% of New York. Daily deaths/million never went above 7, again, 30% of Massachusetts 22, and fewer than 20% of New York's 40 deaths/million/day. Currently, Georgia is seeing the same deaths/day/million as Massachusetts, despite warnings of "experiments in human sacrifice" when it opened up in April. It also has an unemployment rate that is 33% lower than both states, and has schools largely open for in-person instruction.




Hawaii: 1.4 Million

150 Deaths/Million (5th), 15% Unemployment (51st)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Hawaii has managed to limit deaths significantly, with deaths/million at 1/10th those of Massachusetts, and 1/12th those of New York. Presumably they will be able to maintain this so long as they keep themselves cut off from the mainland, and keep incredibly strict social controls in place. But the price in unemployment has been astronomical, leaving Hawaii with the highest unemployment in the nation at 15%. Nor has this saved Hawaii's hospital system from strain. During Hawaii's summer "peak" Hawaii saw 200 people hospitalized/million, the same as many other states who are doubtless further along their epidemic curve. While Hawaii's cases remain low, the slow but consistent increase in deaths makes me think that things will continue to edge upwards.




Idaho: 1.8 Million

335 Deaths/Million (15th), 6.1% Unemployment (16th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)

Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Idaho is one of the states that for some inexplicable reason is always on the watch list, being flagged as about to spiral out of control. The data paints a very different picture. Idaho boasts less than 1/4 the death rate of Massachusetts, and less than 1/5th that of New York. Hospitalizations have never exceeded 150 people/million (lower than Hawaii's). While cases are "soaring," they did so in July as well, and never registered a concerning level of hospitalizations or deaths. In fact, they are almost completely decoupled from hospitalizations and deaths. While Idaho's cases are in theory almost 5x those of Massachusetts, Idaho's mortality (daily deaths/million) remains lower than that of Massachusetts. Idaho, like many other large, Western red states appears to be being punished for doing an exceptional job at finding asymptomatic cases and keeping hospitalizations and deaths low, all this with just a 6.1% unemployment rate.




Illinois: 10.2 Million

780 Deaths/Million (42nd), 10.2 Unemployment (47th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Illinois finds itself a little more than 50% of Massachusetts' deaths/million, and about 40% of New York's. It's hospitalizations @ peak track roughly the same. Since the spring, Illinois' deaths and hospitalizations have remained largely de-coupled from case increases. Illinois has maintained a baseline of around 125 people/million in hospital, and has recently gone up, getting close to 200, but nowhere near the increase that it has seen in cases. Illinois has remained largely locked down, and as such, has an unemployment rate that is 47th worst in the nation, 10.2%. This long, hard lockdown has done little to prevent deaths, as Illinois, while having a better record than Massachusetts or New York is slightly worst than states such as Georgia and Florida--both of which have been largely open since April, where Illinois' being largely closed.




Indiana: 6.7 Million

633 Deaths/Million (33rd), 6.2% Unemployment (19th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Indiana registers fewer 45% the death rate of Massachusetts, and approximately 1/3 that of New York. In terms of managing hospital resources, Indiana has done even better than those numbers. During Indiana's spring peak, it had approximately 1/3 the hospital utilization of Massachusetts, and 1/5 that of New York. Like Hawaii, it has only barely exceeded 200 people hospitalized per million. Unlike Hawaii, it has an unemployment rate that is just over 6.2%, 2.5x lower than Hawaii's. Like so many states, Indiana is seeing its cases go up, but its deaths and hospitalization rates lag far behind, indicating that this surge in cases will be like many of the summer surges, generating a hump, but not a spike. Currently, Indiana's death rate is just a tick higher than that of Massachusetts, despite having approximately 2x the hospitalizations, and 3x the cases.




Iowa: 3.2 million

536 Deaths/Million (28th), 4.7% Unemployment (5th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Iowa is another one whose recent case increase is generating significant media coverage that obscures its exemplary handling of the pandemic. Iowa has a death rate that is just over 1/3 that of Massachusetts' and about 3.5x lower than that of NY. Iowa has only just recently exceeded, for the first time in the pandemic, 150 people hospitalized/million. Iowa's daily deaths/million is exceedingly low, having peaked at 5 deaths/day/million in the spring. Since that low peak (78% lower than Massachusetts'), it has stayed lower than Massachusetts' daily deaths/million, except for a few short periods where it exceeded it by maybe one or 2 deaths/day/million. Iowa has managed this flat curve at the same time that it has kept its economy open to such a degree that it has only a 4.7% unemployment rate, giving it the 5th lowest unemployment in the nation. Yet the governor is under fire for not imposing mask mandates, because of rising cases that are only weakly coupled to hospitalizations or deaths.




Kansas: 2.9 million

346 Deaths/Million (16th), 5.9% Unemployment (13th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Kansas, like Iowa has done an exemplary job keeping both hospitalizations and deaths low, as well as unemployment. With a death rate that is lower than 1/4 that of Massachusetts, and almost 1/6 that of NY, and hospitalizations barely more than 150/million, Kansas has kept its curve flat. Kansas has recently reached 5 deaths/day/million, but hospitalizations look to be relatively flat if not declining--despite consistently rising cases since June.




Kentucky: 4.5 million

323 Deaths/Million (11th), 5.6% Unemployment (12th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Kentucky, like many of its neighbors is a marvel of flatness, with a death rate less than 1/4 that of Massachusetts, and 1/6th that of NY. Kentucky has literally never even had a peak of deaths, and even now has a lower daily death rate than Massachusetts, as it has throughout the entire pandemic. Hospitalizations have likewise stayed between 100 and 150/million, looking now like they may creep towards 200. While there is, and has been a steady increase in cases since early July, there has been no such increase in deaths or only a slight increase in hospitalizations. At the same time, Kentucky enjoys the 12th best unemployment at 5.6%.




Louisiana: 4.6 million

1267 Deaths/Million (47th), 8.1% Unemployment (36th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Louisiana really was given a raw deal. Hosting Mardi Gras at the beginning of this before the scope was known set Louisiana up for what ought to have been a catastrophic failure. And yet, in many ways, Louisiana has performed quite well. Louisiana's death rate remains below that of Massachusetts, and 1/3 lower than that of New York. Louisiana's hospitalizations during its first peak were lower than those of Massachusetts by about 25%, and lower than New York's by 55%. Daily deaths/million lower by almost 40% (13/day/million vs. 23). During Louisiana's second wave, we again see how case counts are linked to deaths and hospitalizations in an almost logarithmic fashion. Given that, despite what must have looked like the sky falling, during their second wave, deaths never exceeded 8/day/million (66% lower than Massachusetts' peak, and 85% lower than New York's. Since that second peak, Louisiana has stayed relatively flat, with deaths/day/million now lower than Massachusetts, and trending lower yet--despite case increases. Louisiana, like most of the early-peaking states remains partially shutdown, particularly in New Orleans, accounting for its 8.1% unemployment rate.




Maine: 1.3 million

109 Deaths/Million (3rd), 6.1% Unemployment (16th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)

Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Main unquestionably crushed the curve, so much so that Maine has fewer COVID deaths than they would experience flu deaths in a given season. My general sense of this kind of curve-crushing is that this is the kind of state that still has a reasonable way to go. perhaps they will be able to keep it down until a vaccine. It looks like it, and their unemployment at 6.1% remains low, so hard to fault them if it works. To me it looks a little like suppressing forest fires completely, and not clearing underbrush, subsequently resulting in a conflagration. Only time will tell.




Maryland: 6 million

683 Deaths/Million (35th), 7.2% Unemployment (28th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Maryland is another state that has done an all around good job managing the pandemic--not no spread, but nothing overwhelming. Maryland has fewer than half the deaths/million of Massachusetts, and 1/3 that of New York, this despite having very similar make-up particularly to Massachusetts in terms of population, and population density and dispersion. At its peak, Maryland had approximately 270 people hospitalized/million--less than half of Massachusetts' and 1/4 New York. At the same time, their peak deaths/day/million stands at 8, just a hair over 1/3 that of Massachusett's peak, and 80% lower than New York's. Since that time, despite a slight hump in hospitalizations in the summer, deaths have remained extremely low, lower than Massachusetts for the entire time, even when Maryland supposedly had a summer case spike that brought its cases to more than 5x the number of cases in Massachusetts. Currently, Maryland's deaths/day/million are in line with New York, at 1death/day/million, about 1/3 that of Massachusetts, despite nominally having the same case numbers (proportionally). Oh, and Maryland's unemployment rate is also lower at 7.2% and is classed as "opened" to Massachusetts' and New York's "reversing" course.




Massachusetts: 6.9 million

1440 Deaths/Million (49th), 9.5% Unemployment (45th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Ah, my home state. What can I say? We are one of the healthiest, wealthiest, youngest, whitest states, with the best medical care in the country. And yet we have the 3rd highest death rate in the country. Worse than Louisiana, by about 15%, Louisiana which is either 49th or 50th for poorest, least educated, least healthy, states in the country. Sure, we had the Biogen conference, what did Louisiana have? Oh yeah, Mardi gras. At the peak, we were using 560 hospital beds/million, where nationally only 180/million were in use (the vast majority of which were driven by the northeast states, following the Gottlieb protocol). And then there's our unemployment, 45th worst at 9.5%--for months it was the worst at 16.1%--and public schools in Boston are not open at all. And now we find ourselves in a social deep freeze, waiting for a vaccine while we gut the remaining portion of the middle class that lives in this states--which was already being pushed south and west by our high taxes. Thank you Dr. Gottlieb, you killed it--I mean them.




Michigan: 10 million

762 Deaths/Million (40th), 8.5% Unemployment (41st)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Michigan, has a death rate that is just over half that of Massachusetts, and about 2.5x less than that of NY. At its peak, its hospitalizations were 400/million about 20% lower than Massachusetts, and 60% lower than those in NY. Peak daily deaths/million reached 15, about 33% lower than Massachusetts, and 60% lower than New York. Since that time, Michigan has remained largely flat, despite being nominally open. Michigan, like Maryland has never exceeded Massachusetts' daily death rate--at many points being 1/3 the level--despite having nominally higher case counts. The same is true now where Michigan is supposedly "spiking" but hospitalizations remain at just over 100 people/million--well within the manageable range, and 10% New York's peak rate (25% of Michigan's peak rate). The unemployment rate remains uncomfortably high at 8.5%, suggesting that open is not really all that open.




Minnesota: 5.6 Million

438 Deaths/Million (21st), 6% Unemployment (14th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)

Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Another of these supposedly "cautionary tales" in the upper midwest. Minnesota has a death rate that is 1/2 that of Massachusetts, and 1/4 that of New York. At no point have they exceeded even 120 hospitalizations/million, that is 1/5 Massachusetts' rate, and 1/9th New York's. Minnesota's daily/deaths/million have never exceeded 5/day, and never at any point exceeded those of Massachusetts. Currently, Minnesota has ostensibly 2.5 x the cases of Massachusetts, yet a lower daily death rate, and similar hospitalizations. All of this with a 6% unemployment rate, and an "open" rating for their economy.




Mississippi: 3 Million

1112 Deaths/Million (45th), 7.1% Unemployment (27th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: At first blush, 1112 deaths/million, all mostly during the second wave seems like a pretty bad deal, but when you dive into the numbers, Mississippi has done far better than might at first seem to be the case. First of all, this is one of the few metrics where Mississippi has ever left Massachusetts in the dust. I say this as someone who is married to a Louisianian. Louisianians have a saying, "thank god for Mississippi", because if Louisiana is 49th, Mississippi is often 50th. This is of course cold comfort, when when you are beating not just Louisiana, but MASSACHUSETTS, and trouncing New York, there is perhaps some cause for congratulations. Because Mississippi is significantly poorer and more unhealthy than Massachusetts, so performing better on a health index, tells you something went deeply wrong--in Massachusetts. Digging in further, Mississippi has a 23% lower death rate than Massachusetts. They have a 40% lower death rate than New York. At the peak of Mississipppi's epidemic, they had 400 people hospitalized/million, roughty 30% fewer than Massachusetts had, and 60% fewer than NY. Deaths/day/million peaked at 12, for about 2 days, 50% fewer than Massachusetts, and almost 75% fewer than NY's peak. Deaths in Mississippi have been declining steadily since mid-August. So much so that Massachusetts is set to surpass them within the next week. While deaths in Mississippi have been going down, hospitalizations have been edging up, though largely flat in what is likely a muted recapitulation of the "El Paso effect." And in Mississippi, once again, we see the more logarithmic interaction between case increases and hospitalizations, and both remain relatively flat, with deaths declining. Like so many other states, Mississippi ostensibly has more cases than Massachusetts, but similar or fewer deaths. In Mississippi's case, they have 2.5 fewer cases, yet somehow has the same number of deaths as Massachusetts, with Mississippi trending in the right direction, while Massachusetts goes in the wrong direction. As the song says, "there's something happening here..."




Missouri: 6.1 Million

489 Deaths/Million (27th), 4.9% Unemployment (6th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Like so many other states that have flattened both their death curves, and their hospitalization curves, Missouri comes in only for abuse. And once again, the facts tell a different story. Missouri has less than 1/3 the death rate of Massachusetts, and less than 1/4 that of New York. In fact, deaths have stayed relatively flat throughout, jumping from 1.5/day/million to just above 5, but mostly around 3. Compare this to Massachusetts peak, which was 4 times higher than Missouri's highest day, and New York that was 8 times higher. Hospitalizations have also remained very static, staying in a range of 120 - 220 patients per million, compared to Massachusetts which is 3-4 times higher, and New York 5-10 times higher. Then there's the matter of Missouri's unemployment number which is roughly half that of both NY and Massachusetts, at 4.9%. And in Missouri's case, we once again see that cases are nominally 3-3.5x that of Massachusetts, while death rates are only a fraction higher.




Montana: 1.1 Million

304 Deaths/Million (9th), 5.3% Unemployment (9th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Another poster child being mis-categorized as a pariah. Montana has just over 20% the death rate that Massachusetts has, and roughly 15% that of NY. During what is now Montana's "peak," Montana has just surpassed 5 deaths/day/million, 78% lower than Massachusetts' peak, and 88% lower than New York's peak death rate of 40 deaths/day/million. At the same time, we do see an "alarming" increase in hospitalizations. But it is necessary to put these into context. Montana currently has 300 hospitalizations/million people--half that of Massachusetts at its peak, and 70% lower than that of New York. However, at the same point, Massachusetts had not 5 deaths/day million, but 14, nearly 5x that number. At the same time, Montana looks to be cresting its hospital curve, despite the near asymptotic rises in case. Again, ostensibly Montana has 7x the number of cases as Massachusetts, but somehow has only 2x the number of deaths.



Nebraska: 1.9 Million

329 Deaths/Million (11th), 3.5% Unemployment (1st)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)


Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: By the numbers, it's pretty hard to argue with Nebraska's handling of COVID. Nebraska has fewer than 1/4 the deaths/million of Massachusetts, and 1/6th that of New York, It has only in the last week reached a "peak" that slightly exceeded 3 deaths/day/million--just barely above Massachusetts now. A second "wave" of cases in July saw no increase in deaths or hospitalizations. Currently, Nebraska's hospitalizations have inched up, getting close to 200/million, but still 1/3 those of Massachusetts' at its peak, and 1/5 that of New York, and of course the deaths/capita/day are 85% lower than Massachusetts, and 95% lower than New York. All of this with the nation's lowest unemployment. Now, Nebraska is a large state with a small population, thus, this is not to indicate that this is a model for the rest of the country, but I am equally sure that their case "spike" is getting them some grief in some media somewhere, and this is clearly not deserved. Nebraska, like so many U.S. states has done an admirable job flattening the curve, without flattening its citizens.




Nevada: 3 Million

574 Deaths/Million (29th), 12.6% Unemployment (50th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)

Source: The COVID Tracking Project, Data extracted on 10/22/20


Commentary: Nevada clocks in at roughly 1/2 the death rate of Massachusetts, and 1/3 that of New York. During its summer surge, while hospitalizations reached 2/3's those of Massachusetts, and 40% those of New York, deaths remained mercifully low, with daily deaths/million only 7--66% lower than Massachusetts at its peak, and 1/6 New York's peak. Now, despite seeing a case "surge, hospitalizations are all but flat, while deaths are declining. With an unemployment rate that is 50th in the nation, behind only Hawaii, there is hardly a state that has greater need of being able to embrace some kind or relaxation of social distancing--and given how well Nevadans have flattened the curve, it seems cruel not to allow a state that thrives on risk to provide guidance and allow people to make their own choices. Given the economy's almost complete reliance on travel and entertainment, if forced to continue through mid-year with restrictions, which even if people can travel, make them not want to, it is hard to see how Nevada will not end up seeing higher deaths due to other causes than coronavirus, most particularly amongst the young.




New Hampshire: 1.4 Million

354 Deaths/Million (17th), 6% Unemployment (14th)


New York, 1728 Deaths/million (50th), 9.7% Unemployment (46th)

Massachusetts, 1440 Deaths/Million (49th), 9.5% unemployment (45th)