NedNotes (not blog): Christmas week COVIData Sweep

In remembrance of five of my fellow countrymen taken from us this week by this terrible virus. Average age of seventy-seven; median of seventy-one years old. From Illinois to Florida. Two immigrants; one Native American. An attorney, a social worker, a warehouse manager. G-d, what an awful week to depart.

B.L.U.F. (bottom-line, up-front): A pause before the storm. Blowing right past what were deemed to be conservative estimates for deaths at the end of one year.

INTRODUCTION
A brief review of the data for the week with a focus on the three last places where I have lived since I still enjoy many friendships in Alabama, México, and Tunisia. The period under review saw some improvement in the COVID epidemic toward week's end. That is not expected to last long. 

Base-case projections for total deaths during the first year will be surpassed some sixty-six days ahead of the end-date. Hospitals are already strained, and the anticipated Christmas surge may sink them. The United States may be facing Italy’s nightmare of last Spring of rationing health-care, leaving elderly to die.

OVERVIEW of DATA
The week has witnessed the United States basically surmounting the Thanksgiving spike, within the context of inappropriately high case counts and fatality rates. While the Christmas surge shall likely prove adverse, one can see some light at the end of that tunnel (i.e., late January or early February). 

The number of deaths – up by almost 18,000 this week – will surpass the one-year mortality level (through 01mar21) projected almost nine months ago in the next day or two. That level of 335,100 assumed half the current penetration and twice the mortality run rate. 

What is significant to note here is that, at the time of the calculation, the Trump Administration had forecasted something like 100-240,000 deaths for the whole (i.e., all waves) of the epidemic; I felt my one-year projection would prove to be far too high. Among the bellwether states, California had far and away the worst problem with new cases.

That difficulty for the Golden State may lie with particularly high infection and fatality rates in the Mexican state of Baja California, spreading the virus through the Tijuana-San Diego super-region and up to Los Angeles. Missouri and Wisconsin continue to post mortality run rates significantly above those of the country. 

In the other states featured on the ‘38+’, posted below, Pennsylvania continues to be a state that is losing control. New cases are rising rapidly and the number of deaths are pulling ahead of its region. Additionally, the Governor has his hands full with the economic side of the crisis. 

The Keystone State may well lack the infrastructure (e.g., testing capacity) to contain the epidemic after the current spike. The family cluster states by-and-large are faring quite well in bringing the coronavirus contagion steadily under control. 

Many states have improved or remained stable this week, with Minnesota, New México, and Kentucky turning out notably strong performances. This pause may be brief since the week encountered a 50% drop in critical care availability across the country. Most of the states in the Deep South and West are stretched already as are Maryland, Michigan, and Pennsylvania.

FEATURE: MÉXICO, LA TUNISIE, and ALABAMA
Mi querido México
Mi querido México dura un de los epidémicos más severos sobre la tierra. Los casos se concentran en las entidades federales con populaciones densas en las grandes ciudades, así como en las aquellas frente a la frontera estadounidense. 

Esas entidades del norte representan un 15% de la población nacional, pero ellas son responsables para 21% de ambos los casos y las muertes. Por supuestos, los casos y las muertes por millón son un 40% más altos, también, a 14,578 y 1,319 respectivamente. La tasa de desechos por la región es 19.9%, un doble del nivel nacional.

Estas cifras desafiantes son las peores ahora en las entidades de Tijuana y Ciudad de Juárez cerca de San Diego y El Paso. Tristemente, Baja California y Chihuahua tienen tasas de muertes de los 16% y 12%, más alto del nivel regional (que corresponde con la tasa nacional). 

De las seis entidades próximos a losU.S.A. – Baja California, Sonora, Chihuahua, Coahuila, Nuevo León, y Tamaulipas – solamente Nuevo León tiene una carga de mortalidad similar, y Chihuahua sufra una tasa de casos, similar al todo el país.

El más grande reto sigue siendo la inclinación del presidente populista, Andrés Manuel López Obrador (A.M.L.O.) a minimizar la amenaza del epidémico mexicano. Aunque la república tenga el mismo nivel de casos por millón como el resto de la tierra, ella tiene cuatro veces el número de muertes. 

Este error se manifiesta especialmente en el área metropolitano de capital (es decir, el D.F. y EdoMex). A.M.L.O. ha adoptado la misma actitud de Trump y el presidente Bolsonaro de Brasil. Al menos, las cifras para el último no están tan malas que las dos naciones norteamericanas. 

¿Hay buenas noticias aquí? Si, los primeros 42,900 dosis de la vacuna de Pfizer acaban de llegar al país, para ayudar a los primeros respondedores médicos en D.F. y Nuevo León. Con un poco suerte, habrá 1.4 millones de dosis a través de la república para al fin de enero. Además, la diáspora mexicana está enviando muchos más fondos a los familiares asediados en su país natal para ayudarles en este crisis. 

Ma chère Tunisie
La contagion du coronavirus s’arrive à la Tunisie avec une plus grande augmentation cette fois-ci que cela de la première vague d’infections au printemps de 2020. Cependant, la république islamique, la société la plus progressive a travers la région du Moyen-Orient et du nord de l’Afrique, a réalisé une performance supérieure que les derniers neuf mois aux États-Unis. Je crois que les cas campestraux aillent être plus sévères pour les femmes à cause des autres conditions difficiles pour elles.

De plus, les résultats positifs (c'est a dire une confirmation de la présence du virus méchant) des tests, jusque maintenant, se trouve entre des 22% et 29%. Une partie du réussit préliminaire se base aux mesures pris par le gouvernement pour minimiser le contact (par exemple, le renforcement d’en un couvre-feu de 20h00 à 05h00 pour chaque jour). Le Ministère de la Santé vient d’interdire fêtes de célébration la nouvelle année pour lutter contre la possibilité bien contestée de l’arrive d'une mutation britannique qui fait plus contagieux le virus vicieux.

Seulement dans la semaine passée, la Tunis a commencé la dispersion des tests rapides avec une premier étape de quelques huit cents trente a Tunis. Maintenant, il y a plus que quarante souches documentées de la maladie COVID-19 au pays. ll n’y aucune évidence encore que l’un de ces souches puisse survivre une attaque des anticorps synthétiques produits par un vaccin. 

Cependant, le président Kaïs Saïed a fermé les frontières par bloquer les vols des pays britanniques a cause de la nouvelle souche anglaise. Hélas, des vaccins ne vont pas atteindre a la République avant de mars 2021. En la révision de ma chère Tunisie, la banque mondiale juge l’économie tunisienne comme beaucoup blessée par la pandémie, au moins durant 2020, avec une chute de 9%. 

Mais on espère qu'elle élèvera de 6% en 2021. La controverse, qui se continue constamment se manifester, implique une manque générale de confiance et certitude par le peuple vers le vrai niveau des infections de COVID supplémentées le reportage discutable des morts a travers la nation. À mon avis, le taux de fatalité tunisien approche 2% quand on inclue les cas ni symptomatiques ni détectés.

My Belovèd Birmingham
As noted elsewhere in this series, if not emphatically, Alabama is a ‘watch-list’ state due to its rapidly growing death toll. Much of the current wave affects two urban areas – Birmingham and Huntsville – that anchor the northwestern quarter of the state. This region represents the southern tip of Appalachia, a region largely characterized by its widespread and chronic poverty. 

These Alabamans will likely face the epidemic with fewer hospitals, resources, or insurance support. University of Alabama-Birmingham proudly hosts a nationally ranked research hospital and even it is overwhelmed. These areas approach or exceed the country’s already high levels of 1,020 souls per one million. The state’s leadership remains open to question.

The testing capacity remains unready, fewer restrictions have been imposed too late, and one of the nation’s lowest availability levels of beds plagues intensive care units (i.e., 12%). One can imagine the situation in the Northwest outside of Huntsville and Birmingham. The State is also confronting a growth in pediatric cases and an allergic reaction to the Pfizer vaccine.

CLUSTER FACTS
Moderna vaccine starting in next ten days
Baltimore-Annapolis. G.O.P. Governor Hogan fires up vaccine distribution for elderly and medical first responders, including the National Institutes for Health.

Boston and the Cape. Boston ranked 22nd for mortality rates among fifty most lethal U.S. cities; joined by Springfield (#14) and Worcester (#31). Vaccine distribution started in Massachusetts.

Chicago proper. Windy City welcomes the hardship aid to live performers of $15 billion (for the whole country) under U.S.G. relief package. Food insecurity and uncharitable landlords exacerbate the coronavirus contagion; resources for the disabled.

Colorado state-wide. In-n-Out burger break-out reaches Denver with forty-four cases. Democratic Governor Polis continues to respond. Denver proper with 14% of cases and 1.5% mortality run rate. Denver metro with 60-65% of cases and mortality run rate of 1.4%, No deaths yet in Delores County.

Detroit metro. Detroit area ranked as the 24th deadliest city in the U.S., along with Bay City (#25), Muskegon (#46), and Saginaw (#12).

New York METRO. Metro area has the 8th highest fatality rate among fifty deadliest U.S. cities, along with Stamford (#18), Ocean City, N.J. (#48), and Princeton (#11). Delta screening travellers from U.K. through J.F.K. Subway up for air with U.S.G. relief package.

Pittsburgh and Philadelphia. The R.K. Mellon Foundation steps up. Hick-up with vaccines in Camden area of New Jersey. Court rejects petition to contravene Democratic Governor Wolf's mandate to close restaurants for twenty-one days.

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.