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How Dangerous is the Covid-19 Outbreak in Your State?

The national Covid-19 epidemic in the USA continues. The daily new cases in the US are still higher than most developed nations, and the country recently exceeded 248,000 deaths from the disease.

Things can look worse at the state level than at the national level.

Public health experts examine a few markers to determine how bad things are in each state: the number of new cases every day; the infection rate, which can show how likely the virus is to spread; and the percentage of tests that return positive and should be low in a condition with adequate testing.

A weekly updated Vox analysis shows the vast majority of states are reporting alarming trends in all three benchmarks for coronavirus outbreaks. Most states are still reporting a high – sometimes very high – number of new Covid-19 cases every day. Most still have high rates of infection. And most have positive test rates that are too high, which indicates they don't have enough testing to track and contain the size of their outbreaks.

Across these benchmarks, zero states do well on all three metrics, suggesting that no state is currently in control of its outbreak. In fact, no country fulfills two out of three benchmarks.

America's outbreaks, which stretch from California to Florida, are the result of the public and leaders who never take the virus seriously enough, and to the extent that they have given up their guard prematurely. With the support of President Donald Trump, states reopened – often before seeing sizeable declines in the daily new Covid-19 cases, and sometimes ran out of time so quickly to see if each stage of their reopening resulted in a reopening many more cases.

The public welcomed the reopenings, went out and often failed to adhere to recommended precautions such as physical distancing and wearing a mask.

Even as the cases began to fall later that summer, the total number of cases in America remained very high. Yet many states have decided to reopen, with much of the public accepting the looser restrictions and then walking out.

It's this mixture of government withdrawal and public complacency that experts have cited to explain why states continue to struggle to get the coronavirus under control.

"It's a situation that didn't have to be," Jaime Slaughter-Acey, an epidemiologist at the University of Minnesota, told me. “For almost three months, you have had the opportunity to proactively address the Covid-19 pandemic and normalize the culture to adopt practices that will curb the spate of transmissions and the development of Covid-19 complications. … It was not prioritized over the economy. "

Not only is the impact felt in the form of more infections, critical illnesses, new chronic illnesses, and deaths, but in terms of the long-term financial impact of the economic troubles, many people are still refusing to go out and companies are resisting reopening while a pandemic.

"The dead don't shop. They don't spend money. They don't invest in things," said Jade Pagkas-Bather, an infectious disease expert and doctor at the University of Chicago. "If you don't invest in the health of your people, there is longitudinal downstream effects. "

The benchmarks followed by Vox here do not cover all important facets of the pandemic. Hospital capacity was previously included in Vox's metrics but was removed due to inconsistent data reporting. The data for contact tracing when "disease detectives" track down potentially infected people and quarantine them is also poor. Some measures that are helpful in assessing whether a state can safely reopen, such as the total number of tests and whether cases have decreased in the past two weeks, are excluded in order to focus more closely on the status of the current Covid-19 Focus on outbreak of each state.

Together, however, these three benchmarks give an idea of ​​how each state is doing in the fight against Covid-19. It is pretty dark nationwide.

1) All 50 states have too many new Covid-19 infections every day

A map of Covid-19 case rates in each state.

What is the goal? Less than four new coronavirus cases per 100,000 people per day, based on data from the New York Times and the Census Bureau.

Which states achieve the goal? None.

Why is that important? The easiest way to measure if a location has a major coronavirus outbreak is to look at the number of new Covid-19 cases every day.

There is no generally accepted metric for how many cases are exactly too many. However, experts told me that, in general, it is a good idea to target fewer than four new cases per 100,000 per day – a level so low that a state can say it is gradually gaining significant control over the virus.

One major limitation of this metric: it is only as good as a state's tests. Cases can only be picked up when states actually test people for the virus. If a state doesn't have enough testing, many cases are likely to be missed and the reported cases don't tell the full story. For this reason, it is important not to use this benchmark on its own, but to use it in conjunction with metrics such as the positive test rate.

With that in mind, the number of new cases every day can provide a delayed snapshot of a Covid-19 outbreak. If it takes a week for test results to be reported to the state, the number of new cases each day reflects the condition of the previous week's outbreak.

However, if the tests in a state are sufficient, the number of new cases every day may be the best way of seeing how big the Covid-19 outbreak is in a state.

2) The coronavirus is spreading too quickly in most states

A card of the Rt in each state.

What is the goal? An effective reproduction number (Rt) below 1, based on data from, a website created by two Instagram founders and a data analyst.

Which states achieve the goal? Mississippi – a state.

Why is that important? The RT measures how many people of each person are infected with Covid-19. If the Rt is 1, on average, one infected person is spreading the coronavirus to another person. If it's 2, an infected person will split it into two on average. And so on.

So it's an attempt to measure how quickly a virus is spreading. One way to think about it: As opposed to the number of new cases every day, here's an overview of a state's Covid-19 outbreak today, but of where the outbreak will lead in the near future.

The goal is to get the Rt below 1. Unless every infection leads to a different one, it would lead to zero new Covid-19 cases over time.

The estimated Rt can be very imprecise, with margins of error making it difficult to know for sure whether it is really above or below 1 in any condition. Different modelers can also produce different estimates. Unfortunately, this is just the reality of using limited data to get a rough estimate of the overall spread of a disease.

The Rt also reflects an average. If 10 people are infected with Covid-19, nine will not spread it to anyone and one in 10, giving an RT of 1. However, it masks the fact that, for whatever reason, individuals can still cause over-spread events – which seem to be of particular concern with the coronavirus.

Still, the Rt is one of the better ways to track the spread of a pathogen through the entire population. Combined with the other metrics on this list, we can get a sense of the outbreak of each state now and in the future.

3) Most states have too high positive test rates

A map of the positive Covid-19 rates in each state.

What is the goal? Based on data from the Covid Tracking Project, less than 5 percent of coronavirus tests were positive in the past week.

Which states achieve the goal? Hawaii, Maine, Massachusetts, New Hampshire, New York, and Vermont – six states. Washington, DC, did too. (Wyoming is excluded from its reviews this week due to recent issues.)

Why is that important? In order to properly track and contain coronavirus outbreaks, states must have adequate testing in place. There are all sorts of suggestions as to how many tests it would take in the US, up to ten million.

One way to tell if a state is doing enough testing to match its outbreak is by the rate of tests that come back positive. An area with adequate testing should test many, many people, many of whom do not have the disease or have severe symptoms. High positive rates suggest that only people with obvious symptoms will be tested. As a result, there aren't enough tests to reach the scope of an outbreak.

The goal for the positive rate is zero percent in an ideal world, as that would suggest that Covid-19 is completely defeated. More realistically, in a pandemic-hit world, the positive rate should be below 5 percent. But even if a state hits 5 percent, experts should keep trying to push that number down further to match nations like Germany, New Zealand, and South Korea whose positive rates are below 3 percent and even 1 percent around their outbreaks really in the To get a grip.

As long as a state is above 5 percent, a significant number of Covid-19 cases are likely still missing. And the higher that number is, the more cases are very likely to be missed.

Even if your state reports only a small number of new cases each day, a high positive rate should be a cause for concern – a sign that there is an outbreak that is only hidden due to a lack of testing. And if your state reports a high number of new cases every day and a high positive rate, this is all the more cause for concern, suggesting that the epidemic is worse than the total number of cases indicates.

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