NedNotes (not blog): COVID data sweep week-ending 25sep20

B.L.U.F.: Improvements are seen across the board.

CONCLUSION: Ongoing vigilance of the more populated states keeps new mortality rates low. This suppression of new cases, led by New York Metro, outweighs the increases in deaths in rural states. Projected death toll by election day of 240,000 and by the end of the first year (i.e., 28feb21) of the American epidemic of 315,000.

REVIEW
Rural Spread. As noted in red font on the study of the thirty-three states and six territories, the increases in positivity rates -- particularly substantial ones in Arkansas, Idaho, Iowa, Nevada, and South Dakota -- indicate the likely spread of infections into more rural states. 

The second wave may have started but appears to be low thus far. For example, the five states mentioned with deteriorating positivity rates have mortality run rates between 1-2% versus 2.9% for the United States; they account for 3.8% of the population and 2.3% of the deaths.

Mortality Rates. The mortality run rates for the bellwether states have levelled out at 2.0% for the last month while the national rate has trickled down marginally to 2.9% over that time. These data imply a first-guess mortality run-rate for the first year of 2.5-2.7%, well below the base case of 3.6% that I projected for the first year almost six months ago. 

Again, the primary driver of the ultimate outcome will be penetration rates plus the timing of a vaccine. The penetration rate of confirmed cases remains an open question since many asymptomatic cases (i.e., up to 5x the confirmed cases) may not have been reported; the current known penetration rate stands at 2.1%.


Penetration Rates. Initial estimates for eventual penetration stood at 40-70% seven months ago. Recently, the head of the C.D.C. believes that more than 90% of the population has not been exposed to the virus. Possible penetration rates make the rush to the vaccine all the more important. Next Summer remains the best-guess time-frame most widely mentioned to achieve widespread availability, assuming success of 'Operation Warp Speed'. 
 
Yet death tolls have a good chance of remaining lower than projected (i.e., 336,000 deaths) as a vaccine may well become operational for at-risk population segments by January. Thus far, the progression of community spread also appears to be slow enough for a vaccine to obviate the high penetration levels required for herd immunity. To clarify the importance of the penetration rates, assume an infection level of 90% occurs, together with the estimated 2.6% mortality rate experienced this far.

Such assumptions, if realised, would generate 300 million cases (i.e., 40x the level today) with a death total of and 7.8 million deaths (i.e., 39x the current death toll). Obviously, this outcome, or any ultimate level near it, will not occur; the illustration confirms the importance of penetration rates and the timing of vaccines. Currently, four vaccines are in 'Phase III' trials in the United States.

The Trump Factor. The one wild-card in the mix is President Trump's sinking confidence in his health-care experts. The President has taken to contradicting openly his experts  on the Coronavirus Task Force, especially when it comes to the timing and ultimate efficacy of any rapidly developped vaccine. He also disputes the risk of deep penetration.

The President's actions over-rides the opinions of Drs Robert Redfield, Anthony Fauci, and Deborah Birx in in favour of others with less expertise. The President's contastant badgering is damaging morale at the C.D.C. and the N.I.H. Nevertheless, President Trump has a point.

Static pool rates (i.e. #deaths / #resolved cases) in rural states where the spread is evident (e.g., Arkansas, Idaho, Iowa, Minnesota, Nevada, South Dakota, Utah and Wisconsin) are a third of the national average and in line with their mortality run-rates. 

These data argue that death rates in rural America are likely to remain low for the foreseeable future. Oregon's higher static pool rate of 9% likely reflects that state's low level of testing failing to capture asymptomatic cases. It could be a consequence of the protests there during the past four months.

A Neglected Concern. With exception of Asian-Americans, who have endured a death toll below their percentage of the population (i.e., 4.2% of the deaths versus 4.8% of the population), other American minorities have suffered from the coronavirus contagion disproportionately:

• Whites with 61% of the population and 51% of the deaths due to COVID-19 (i.e., a mortality intensity ratio of 51.1% / 60.7% = 0.86);
  
  
• Hispanics with 16% of the population and 21% of the deaths (i.e., a mortality intensity ratio of 21.1% / 16.3%  = 1.29);
  
  
• Blacks with 13% of the population and 21% of the deaths (i.e., a mortality intensity ratio of 21.0% / 12.6% = 1.67);
  
  
• Asians with 5% of the population and 4% of the deaths (i.e., a mortality intensity ratio of 4.2% / 4.8% = 0.88); as well as,
  
  
• Native American with <1% of the population and >1% of the deaths (i.e., a mortality intensity ratio of 1.3% to 0.7% = 1.86).

The disparity is likely not rooted in various genome sequences. The more likely factors are socio-economic (arguably manifesting systemic racism) in which Hispanics, Blacks, and Native Americans tend to be less affluent.

This lower personal income and wealth translates into lower access to quality health-care, and over-representation in the lower paying spectrum of 'essential functions' (e.g., rapid transit, retail, lower level hospital, and sanitation). Possibly complicating these factors for Native Americans is their dispersion through remote areas.

OUTLOOK: UNCERTAIN.
This uncertainty created by the urinary olympics between the Trump Administration and its health experts has led to potentially rash decisions. Florida has re-opened despite a relatively high growth-rate in death toll and a weekly positivity rate (i.e., percentage of test takers with the coronavirus detected) at twice the 5% level recommended by the World Health Organisation as a pre-condition for re-opening.

Louisiana and the Carolinas may be opening prematurely as well as states that have fared better (e.g., Michigan and California) are reversing their actions. Other opened states -- Minnesota, Oregon, Wisconsin, and Utah -- have set one day records for infections though mortality run rates continue to run low.