NedNotes (not blog): 11dec20 weekly COVIData Sweep

In remembrance of five fellow citizens felled by the coronavirus; a rotten time of year for a loved one's seat at the table to go dark. Four men and one woman. Two immigrants and one veteran. Average age of seventy and median of seventy-one. A horticulturalist, an elections judge, an advocate for medicine for America's rural poor. From states afflicted by this second wave (i.e., IL, MO, OK). 😢🙏😷

B.L.U.F. (bottom-line, up front): this week saw the end result of political negligence from the 0val Office and petty defiance in the face of contagion. A new datum is added starting this week – I.C.U. available – to gauge a state’s ability to manage a surge in her hospitals.

ALERT: Politics are inextricably intertwined with the coronavirus community spread. To keep the politics away from the data, please revert to the political analysis of the epidemic; please note that the essay reflects my deep bias against the Trump Administration. The key take-away of that long essay is that the Trump Administration and, to a lesser extent, Democratic leadership in Congress, have politicized this epidemic. 

Additionally, the essay makes the case that the wide gulf vis à vis this epidemic is less political than cultural. As time passes, the defining difference will be less the political preferences of a state’s populace and more the resources available to it. States urgently to watch:

1. Alabama with insufficient oversight, 35% positivity, poor testing, and hospitals almost overwhelmed;
2. California with her population, 15% case growth, 11% positivity, average testing, and hospitals strained;
3. Colorado with 12% case growth, 15% death growth, 10% positivity, and poor testing;
4. Idaho with 10% case growth, 12% death growth, 57% positivity, poor testing, and hospitals strained;
5. Iowa with 20% death growth, 37% positivity, and poor testing;
6. Michigan with her population, 9% death growth, 10% positivity, and hospitals challenged;
7. Nevada with 9% death growth, 19% positivity, inadequate testing, and hospitals almost overwhelmed;
8. New México with 11% death growth, 13% positivity, and hospitals overwhelmed;
9. Ohio with her population, 9% death growth, 20% positivity, inadequate testing, and hospitals strained;
10. Oklahoma with 10% case growth, 8% death growth, 16% positivity, inadequate testing, and hospitals almost overwhelmed;
11. Pennsylvania with her population, 10% death growth, 38% positivity, inadequate testing, and hospitals strained, particularly in Pittsburgh;
12. South Dakota with 14% death growth, inadequate oversight, 45% positivity, poor testing, and hospitals strained; as well as,
13. Tejas with her population, 11% positivity, poor testing, and hospitals challenged.

Please note that only D.C., Hawaii, Maine and Vermont test below the positivity threshold of 5% for two weeks set by the World Health Organization; Massachusetts, New York and Washington State are close. Notable improvements in Pacific Northwest this week.

INTRODUCTION and OVERVIEW
After a couple of weeks of unsettled forward indicators, the force of the Thanksgiving surge has kicked in during the latter half of the week in which daily deaths have exceeded those of the worst days of last Spring, rising above 3,000 deaths for the first time ever and then for three consecutive days and very nearly a fourth. This time around – with the exceptions of Illinois, Michigan, and Pennsylvania – those states hit the hardest last spring comprise only 10% of this death-wave while representing 15-20% of the population.

The five inland industrial states – Illinois, Michigan, Ohio, Pennsylvania, and Wisconsin – have suffered again due to hesitance in the state-houses and, possibly, citizens defying masking orders and other behavioral mitigants. Interestingly, three of those states are among four facing a flood of law-suits by the outgoing Trump Administration that contests the election results within them. Individual defiance and the cultural split between the urban and rural economies often give Governors elected on an urban voter base like Pritzker (D-IL), Whitmer (D-MI), Wolf (D-PA), and Evers (D-WI) pause in taking muscular measures to respond to surges.

These agro-industrial states contribute 30% of the deaths; that percentage is likely to climb throughout the winter. The remaining states are either agrarian or urban states with large rural regions (e.g., Kansas and Texas, each with 4-8% of the cases for the week). Several states may be under-reporting their data. The leading national indicators (based on daily fatality levels as well as the number of patients hospitalized and in critical care) indicate worse times ahead for at least one-to-two months.

The daily fatality run rate has risen from the 0.5-0.7% range to 1.2-1.5% in ten days, while such fatalities to people in intensive care for thirteen days or more has tripled. One ominous piece of this puzzle is the level of daily new cases now averaging more than twenty times the level deemed by Dr Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, as necessary for adequate containment (i.e., 10,000 cases). Another grim harbinger reflects the percentage of hospitalizations in intensive care continuing to decline, likely meaning that deaths and serious deteriorations of conditions will continue since these cases of full-blown COVID tend to have ten-to-twenty day lag-times.

Offsetting these trends, albeit slightly, in the short-term but decisively over time, is the ‘Emergency Use Authorization’ approval of the Pfizer manufactured vaccine. The E.U.A. is a contingent approval that suspends some of the rigor usually applied by the Food & Drug Administration in evaluating new pharmaceutical products. The protocol expedites roll-out of a new medication in the face of a national emergency. Eleven month ago, the Trump Administration declared a state of emergency. Selective vaccinations are to begin shortly. In all, the nine-month-old 'Operation Warp Speed' has been a signature achievement of the exiting Administration.

THREE HUMAN INTEREST TOPICS RE-SURFACE
Reports of the stress of higher death tolls and burn-out among medical first responders  and other essential workers abound. The popular support is not as vocal for these beleaguered professionals as it used to be. This apparent indifference by the host population reflects a general demoralization across the society, despite humanitarian measures undertaken by some governors. Hard-core voters in the Trump base are finally understanding that the President’s and his Party’s negligence has left them in the cold with more than a cold. Others in urban areas know they will not be seeing promised vaccinations for another six-to-eight months. 

Community influencers are now stepping into the cultural breach to encourage wider adoption of behavioral mitigants. As mentioned briefly in a previous data sweep, pregnancies have emerged as a possibly fatal co-morbidity, a tragedy Detroit has discovered the hard way this week. Sadly, conflicts are emerging of who gets a vaccine or financial support and when. Colorado provides a typical view of the problem as fire-fighters take umbrage at not being given as high a priority as hospital employees while Governor Jared Polis (D-CO) is facing a racial discrimination suit for his comprehensive economic policies that elevate the priority of assistance to people of color for small business relief.

GENERAL REVIEW
The week has seen any pretense of an epidemic under control smashed to pieces. Governors left to their own devices vary widely in their responses with a few throwing up their hands and avoiding the pressing issues at hand and others taking no chance by preparing to surge capacity; gather resources for expected hospitalizations; and, / or, issuing regulations in lieu of the absentee Federal government. Nationally, cases are up 9% with 1.7 million newly confirmed cases; deaths have increased 5-6% with more than seventeen thousand fatalities. Population centers are also taking the initiative.

Remember that the low periodic death rates (i.e., < 1%) may not account for the lag-time between hospitalization and death. Once again, one must keep in mind that the lethal aspects of full-blown COVID lie in the rate of penetration of the general population and demographics, not so much in its being lethal. The private sector is pushing a ‘COVID passport’ to loosen travelling restrictions between destinations inside and among states managing their contagions well; with the porousness of airport controls in stopping the spread, this idea is likely a non-starter until technology and vaccinations can catch up.

The important part of that passport story remains its implication of a discriminative tiering between urban states with pro-active leadership and the poorer, rural states failing to contain the second wave. As discussed in the accompanying political analysis, such a caste system among states will have far-reaching consequences already being exploited politically. States have been responding to the second wave rolling across the country, some more rigorously than others.

One common response is the scheduling of phased vaccine distribution statewide as well as specific plans for larger metropolitan areas. The defining differences are two: the cultural gaps discussed elsewhere and the amount of resources available. While the Trump Administration continues to clutter the judicial arteries with the bad cholesterol of groundless law-suits, some Republican States led by politicians previously allied with Trump are breaking away from the conservative chorus with comprehensive catch-up plans.

This dilatory diversion by Trump should be winding down, now that the Supreme Court has dismissed the Texas law-suit that was joined by seventeen other state Attorneys General and the President as well as seconded by over a hundred G.O.P. Congressmen. The two emerging stars in recent weeks include:

1. Louisiana, led by Republican Senator William Cassidy publicly acknowledging President Biden adding heft to Democratic Governor John Edwards’s steady vigilance (e.g., way ahead in testing) after the suffering of last Spring; as well as,
2. Georgia, with her pro-Trump Governor, Brian Kemp, ignoring the President’s browbeating by implementing the most exhaustive guidance of any state (that I have reviewed) to weather the second wave by reducing weekly fatality rates to below 1%.

Please note many states that enjoy low cumulative and periodic mortality run rates right now are likely to see increases due to the lags between detection and full-blown COVID, hospitalization, and death. Such data understate the coming severity of deaths due to an exploding number of cases (e.g., Colorado, though Democratic Governor Polis has started to bring the stubborn spike under control) and / or under-reporting (e.g., Florida). The states like Georgia, Louisiana, New York, and California are likely to manage their way through this wave creditably by divorcing the pandemic from the politics, by maintaining steady vigilance, and by practicing strict data integrity.

For example, many people criticize Governor Andrew Cuomo (D-N.Y.) for his focus on clusters of cases before they become epicenters of new outbreaks. Yet New York City is one of the safer spots in the country to reside in right now; for example, Brooklyn and Queens – the City’s two hardest hit boroughs due to substantial minority populations -- have posted mortality run rates of 0.8% and 0.7% for the past week during their second surges; lag-times, however, may inch these numbers upward. California, equally rich in resources, has also taken a robust approach led by Democratic Governor Gavin Newsom.

¡HEAD’s UP!
A great source upon which I alighted this week may be very helpful to people in keeping track of which states are doing what when. As one has seen with these weekly data sweeps and the monthly letters on family clusters, the sources I present can be random results of search engine madness. This National Law Review tracks state-level policy or legislative actions and initiatives; one item of value is checking to see which states are actually trying to respond to this dreary winter spike. One should note the following states and their inactivity.

Please note that cluster states are in red-italic font while bellwether states are in red-bold font.

1. States with two-to-four weeks of little to no substantive action include Florida, Illinois, Kansas, Maryland, Minnesota, Montana, New Hampshire, North Dakota, Ohio, Oklahoma, Oregon, South Carolina, Utah, Wisconsin, and Wyoming.
2. States with four-to-eight weeks with little or no initiative include Alabama, Indiana, Idaho, Michigan, Nebraska, Vermont, Virginia, Washington State, West Virginia, and Wisconsin.
3. States inactive for more than two months include the territories except D.C. (i.e., D.C. being vey recent but the others at least three months) and South Dakota (seven months).

Once again there is no hard and fast rule toward interpretation of these proxy data. Some states have set up comprehensive plans (e.g., Maryland) that require tweaks via press release. Other states may use alternate channels, aside from agency or gubernatorial orders, outside the formal governmental structure to implement policy (e.g., Michigan and Illinois). Another source collects these data to inform readers of policy changes through state governments.

WEEKLY CLUSTER-FACTS
Baltimore-Annapolis. Maryland is headed toward a partial lock-down starting with Baltimore. Effective Wednesday, Anne Arundel County will reduce capacity limits in all public places to 25% and prohibit indoor dining.

Boston & the Cape. Trouble in paradise as outlying counties and the Cape complain about neglect and resistance builds toward new measures viewed as draconian.

Chicago proper. Initial vaccine arrival good for 2-4% of health-care workers in the windy city. Chicago struggles with post-Thanksgiving surge.

Colorado statewide. Spread continues with 10-11% positivity rate around Denver; 24.4% in Delores County. Possibility of micro-measures based on conduct.

Detroit Metro. Despite almost one thousand deaths in the last week (for 9% of total to date), Michigan is making progress on containment; reflects lag-time. Still minor but growing group of re-infections; immunity may last only ninety days.

New York METRO. Debate heating up over restrictions hurting N.Y.C. economy. Spread accelerating in Connecticut. Details for New Jersey. The City surpasses its containment thresholds.

Pennsylvania. Governor placing new restrictions after vacillation: entertainment venues closed and gatherings limited to ten indoors and fifty outdoors. Restaurant employment off by more than a third in PGH. On-line learning sagging in Camden, N.J., particularly in early years and junior high school. The costs of hesitance at the top.

METHODOLOGY
Since this data sweep serves as a information supplement without very little research, this week provides an opportunity to clean up the presentation through the following changes. For informational purposes, this text will follow the second table on thirty-eight states and five territories in subsequent weeks. For comprehensive explanations on methodology and purpose, please revert to Appendix I. 

1st, the two averages of weekly growth rates for the ten bellwether states are clarified in the Appendix. Essentially, the geometric or compound average growth rate is a smoothed average that allows for growth-on-growth increases (i.e., similar to compounding interest). The time weighted weekly averages are a trend-weighted average of each week's particular growth rates. While the compound rate is theoretically more defensible, comparing the two averages gives one a sense of more recent trends and volatilities.

2nd, in the 3table (of thirty-eight states and five territories), the risk classifications  -- of very low; low; moderate; high; and, very high -- remain the same. The parameters, however, are loosened to reflect nine months of experience. The new parameters center upon the first year base case fatality level of 335,301 souls that I forecast eight months ago, together with the updated projection from the University of Washington of 470,974 deaths. On 04dec20, the old and new parameters are applied to facilitate  transition.

3rd,changes in how positivity rates are presented in the 38+ now align the data with the original intention behind presenting them. The intent here is to show whether positivity is trending up or down and to what degree. The parameters are loosened to match the practical reporting constraints and data lags facing most states. 

States with changed positivity rates of less than 10% up (i.e., worsening) or down (i.e., improving) are deemed unchanged and the information unformatted (i.e., appearing in plain black font). The formatting differentiates deteriorations from improvements in the color of the font between 10-20%. Bold fonts indicate material deteriorations or improvements of more than 20%. 

Keep in mind that these percentage changes are based on percentages; percentages of percentages can attenuate the utility of data.

4th, a refresher on the assessment of a state’s testing capacity, again on the 38+ table. The data pivot off of the tests per million people expressed as a percentage. The symbology uses hand gestures to assessment the degree of testing capability and commitment relative to the national average for the week under review. Colors indicate whether testing is declining (red font) or improving (blue font) when a states results place its commitment to a new category of, specifically:

• 👎👎 meaning a state's testing level materially below the concurrent national benchmark (i.e., > 15 points below);
• 👎 meaning a state's testing is noticeably below the weekly national average (i.e., 5-15 points below);
• 👈 meaning a state's testing activity is slightly lower than average (i.e., < 5 points below);
• 👉👈 meaning a state's testing level is basically equal to that of the nation;
• 👉 meaning a state's testing level is < 5 points above the benchmark;
• 👍 meaning a state's testing activity is 10-15 points above the weekly national level; and,
• 👍👍 meaning a state's testing commitment is > 15 points above the concurrent average.