Ned Notes (not blog): mid-January 2021 COVIData Sweep
In remembrance of five fellow Americans torn away by the vicious virus this week. Two men; three women. Two immigrants; one holocaust survivor. A conservationist, seamstress, and journalist. Ranging from forty-six to ninety-six years old; average age of seventy-two; median of of seventy-seven. From California to Oklahoma to Virginia.
B.L.U.F. (bottom-line up front): despite an increase in deaths, January's New Year's spike may work out better than expected. Addition to notes on methodology about presenting testing data.
OVERVIEW
Summary. Mixed results with tentative indications of improvements ahead based on positivity rates and patient loads coming down.
Deaths increased by 7% (i.e., 23,585), yet another high, and exceeded 395,000, Despite those dreary top-line numbers, some good-news on the data for testing and patients emerged this week. This week's high death toll may have indicated a run-down of the fifteen-to-thirty day lag-time between coming down with full-blown COVID ending up in critical care followed by death. Should this very preliminary conclusion hold, the second half of January may see the death tolls levelling or even coming down. Trump busted on another big lie about releasing a vaccine reserve that does not exist. The United States has one option left: vaccines without infrastructure. The plan outlined by President Biden aims to build physical and human infrastructure to try to inoculate one hundred million people in his first one hundred days.
The number of Americans hospitalized has decreased over the last week by 3½% to 127,235 while patients in critical care have also declined slightly to 29,000. The best news came with a dramatic improvement in testing positivity, led by New Jersey cutting her rate by almost half. All three-quarters of the states reported lower positivity rates. The states raising concern with deteriorating mortality results are Mississippi and Kentucky. Roughly one of every twenty-five Americans has received at least one of the two vaccine doses; still very few have received the second.
DATA REVIEW
Summary. The situations have become acute in California, Arizona, and Alabama while Pennsylvania, Georgia, Tennessee and North Carolina are close behind in their troubling trends.
Among the bellwether states, California and Arizona appear to have lost control of their efforts to contain the epidemic. Much of the problem appears to center on the border with México. Though México currently suffers a menacing climb in cases, she appears to be managing her side of the border, at least when it comes to fatalities, better than her northern neighbor. Ranking countries by deaths per million people, México used to rank higher than the United States, indicating a higher number of fatalities relative to population. Now the U.S. ranks eleventh in the world with 1,226 deaths per million people while México comes in twentieth at 1,085. These data basically support the idea that the virus may be spreading in both directions.
Though declining for five or six weeks, California has posted the highest growth in cases among the ten bellwether states with Arizona being the only other bellwether state with double-digit growth. As the Center for Disease Control (C.D.C.) 'ensemble' forecast indicates, the outlook for the two southwestern states appears to be bleak in the short-term and also more uncertain than most other states in the longer run. (An ensemble forecast is a composite of more than three dozen other forecasts integrated by the C.D.C.) One must keep in mind that swings occur from week-to-week due to many factors: arrivals of vaccines, better enforcement of behavioral mitigants, and reporting changes. The Golden State has also the second highest weekly growth in the nation in fatalities.
The only other states recording double-digit weekly growth rates in deaths have been Alabama, Arizona and Oregon, though Oregon starts with a far lower base. Alabama is likely the state causing the most concern due to her lagging the other forty-nine states in vaccinations administered; sponsoring one of the lowest testing penetration rates; and, occupying twenty-four of every twenty-five beds for intensive care. Arizona, for her part, has some of the highest infection rates in the country along her southern border. Compounding this increased infection rate, Arizona's testing performance has been poor, making disease tracking and, therefore, timely and targeted responses more difficult. Though strained, Arizona has adequate hospital capacity for now.
What these three watch-list states share in common is a large agricultural sector. This fact is less true for Arizona, but that state remains home to the Navajo Nation and other indigenous peoples adversely affected by this epidemic. Other states losing their grip on the coronavirus contagion include those with large rural areas (e.g., Pennsylvania with low testing levels, strained I.C.U. capacity, and weekly mortality growth rates consistently 40% or more above the national rate). One note on the positivity rates: only three small states and one territory (i.e. Alaska, Hawaii, Vermont, and the District of Columbia) generate positivity rates below the 5% threshold set by the World Health Organization (W.H.O.) for re-opening. One larger state, Minnesota, is very close. Deaths will continue to be higher than historical averages as the C.D.C. expects 20,000 fatalities per week for the foreseeable future. Aside from Alabama, Arizona, California, and Pennsylvania, the other six states on this week's watch-list include:
- Georgia with high fatality growth rates, almost no I.C.U. availability, poor testing penetration, and vaccination rates running half to two-thirds of the national rate;
- Tennessee with 40% more fatalities relative to the population than the U.S., stubbornly high positivity rates, and an almost tapped out I.C.U. accommodation supply;
- both Carolinas with unceasing growth in death-rates, unsatisfactory testing regimens, vaccination rates at least a third below the national average, and quickly shrinking I.C.U. availability;
- Oklahoma with 50% more rapid growth in fatalities than average, poor testing, little I.C.U. capacity available, and positivity rates 4x the W.H.O. level; as well as,
- Massachusetts mainly due to her ageing population and capacity constraints for critical care.
What drives the concern here with many more than these ten states cited above remains the rapid spread of the virus across the rural areas of America, particularly in the deep South and plains states, which host fewer medical professionals for vaccines and treatment, maintain fewer hospitals, and often offer little or no insurance support. Most perplexing, however, is the fact that this list represents my opinion only; others could easily make cases to include seven-to-ten other states (e.g., Michigan, Ohio, Indiana, New México, Nevada, Louisiana, Mississippi, et al.) This handy resource does a great job at filling one in on the possible calamity looming for our less urbanized brethren; it also gives the reader good intel. on the challenges along parts of the U.S.-Mexican border.
FEATURE: NO NEEDLES and the DAMAGE DONE
Summary. The question of the year looks like it is: ¿if not now when? The three hundred
million dollar question goes on: ¿why do we know so little? Some
answers are emerging.
Current mass-production constraints. Confusion reigns around vaccine distribution
and administration. One is already familiar with the logistical and production
challenges of the Pfizer vaccine and the catch-up required of the Moderna
formula. Preliminary good
news from Israël that people over sixty who previously have not contracted
COVID-19, are one-third less likely to become infected. That finding, if it
bears out, may buy some time for J.&J.
one-shot inoculation that has hit a production speed-bump, likely missing
its two milestones of twelve million doses produced late next month and a
hundred by late Spring.
The U.S.
Army has progressed in its development of a ‘mutation-proof’ vaccine. This
vaccine will not buy time, but as a pan-coronavirus vaccine, it should be
durable in maintaining herd immunity once that mass inoculation is achieved. While
production constraints have emerged, epidemiologists anticipate that up to
three-quarters of the U.S. population will “get the point” come July. Finally,
Stanford is transferring its lessons from previous work in experimenting with an
Ebola vaccine to produce miniature
replicas of the coronavirus through nano-particles of iron. The idea is
that these miniatures tax the body less while creating anti-bodies more effectively
and efficiently.
Bigger concerns with mass consumption. The more pressing question,
growing more ‘pointed’ each day, remains communications, namely transparency and
truthfulness. One sign of serious constraints to getting needles in the arms of
the first round of recipients is anecdotal. When I do research on-line for
vaccines in general, or local performance in family clusters in particular, several
employment solicitations for specialized
medical first responders to treat the coronavirus, (e.g., managing frequent
cases of delirium
recorded among ventillated patients), frequently appear on at least the
first page of search engine results.
Compounding this personnel challenge is the dwindling
of supplies in hard-hit areas. The paucity of nursing care in critical areas
likely explains
the low rates (i.e., 30-40%) of shots administered for scarcer than
expected supplies. This communications
necessity has become
acute as the more contagious coronavirus starts proliferating through the
country, infecting vulnerable states like Wisconsin.
Additionally, in many states like California,
Pennsylvania, and, particularly, Alabama,
the coronavirus contagion rages out of control. Eligible New Yorkers of seven
million are signing up for vaccine shots in New York so rapidly that there will
be, evidently, no new vaccine appointments accepted at state-run centers prior
to April.
New York receives only 300,000 doses per week right now, or enough
for the two-shot protocol to be administered to 2% of that eligible pool; note
that those seven million exclude the other twelve million residents of the Empire
State. That implies at best a one-year roll-out. Compounding this slow pace is
the Trump Administration’s headliners
of releasing the current U.S. Government (i.e., U.S.G.) stockpile to the
states. In reality exactly ZERO
new doses have become available since that stockpile proves yet another
feel-good phantasm. Trump is also seeking a $4
billion reduction in U.S.G. funding of vaccine distribution in poorer
countries.
Beyond pharmacies and drug manufacturers, the private sector is trying to aid the effort, often indirectly. One area is creating incentives for employees to overcome resistance to being inoculated through payment of financial rewards or disseminating knowledge and facilitating transportation. While communications remain uncertain, President Biden has presented a comprehensive coronavirus plan not only to accelerate vaccinations, but also to address the widespread hardship, food insecurity, unemployment support ($2,000 up-front plus $400 per week), and housing allowances. The initiative enables restaurants to produce food, landlords to maintain rental property ownership, and other small businesses to remain solvent. As always, the devil will lurk in the shadow of the details.
CLUSTER FACTS
Baltimore-Annapolis: 3% of state with at least one vaccine; ahead of thirty-two states; ramping up distribution through Giant, Walgreen, and CVS; of vaccines received, a third have been administered; 20-25% availability in intensive care units (i.e., I.C.U.s). New coronaviral strain in Maryland. Racing against the clock for vaccination of
elderly and health-care workers. Governor Hogan states that there is no evidence that this more contagious strain of COVID-19 is more harmful than what people have faced to date. Side effects of the virus occur in one out of every two people vaccinated. Annapolis hospitalizations approach previous highs; outreach for all immigrants whether or note documented. Restaurants at 25% capacity and houses of worship at 33% capacity.
Boston and the Cape: 2½% of state with at least one vaccine shot; I.C.U. availability very low (i.e., 14% for Massachusetts). The state has a high rate of cases in many of the older urban areas. The western half of the state generally runs at half the penetration while the Cape runs at about a quarter; historically, Cape has been in line with the mainland with 3-5% of the cases for 3-5% of the population. An ominous indicator of the virus thriving in Massachusetts is present; not only more people infected but more of the virus around. Governor Baker pushing Trump Administration to widen the pipeline; debates over distribution planning, including through polling stations, for anticipated ramp-up.
Colorado state-wide: 3.9% of the state with at least one vaccine shot; 37% I.C.U. availability. Colorado hitting record levels of infections with children, though numbers remain low; challenge is with COVID increasing vulnerability to other pediatric respiratory issues. Herd immunity will require 70-80% vaccination rate. Denver leading a drive among Mayors of larger cities in seeking from the incoming Biden Administration direct attainment of vaccines and funding for distribution.
Chicago proper: Illinois lagging other states with less then 1% of state receiving at least one vaccine shot to date; I.C.U. availability strong at 30%+. Governor Pritzker easing restrictions despite 9.5 positivity rate in Chicago as economic fall-out increases pressure. Pressure building for keeping in-person schooling an open option as more virulent strain penetrates Illinois. Criteria for easing restrictions.
Detroit Metro: 2½% of state with at least one vaccine; two year pace. I.C.U. availability tight but stable in Detroit as Michigan has 22% overall availability. Distribution problems center on availability and muddled communications aggravated by vaccine requests overwhelming help-lines. Detroit residents finally receiving vaccine.
New York METRO: only 1-2% of metro area vaccinated; very difficult for elderly New Yorkers to access vaccine. Empire State's vaccine supply cut by 16%; I.C.U. availability stable for now at 32%, with 37% availability in New Jersey. Governor Cuomo putting Washington on notice about excessive contributions by the State of tax revenues to D.C. while New York herself remains a political target. Elderly facing obstacle to vaccination. Outer boroughs like Brooklyn overwhelmed with requests for vaccinations. Westchester facing new spike of infections as U.K. variant enters the state. Long Island opening mega-vaccine administration center but very few vaccinated yet. New Jersey suburbs and Connecticut face a surge with vaccines slow to arrive and and erratic inoculation pace.
Pittsburgh-Philadelphia; 3% of Pennsylvanians with at least one vaccination shot; intensive care availability strained across the Keystone State at 22%. West Virginia putting Pittsburgh to shame on COVID vaccination pace. Despite higher penetration from new, more virulent virulent strain, Philadelphia eases restrictions. As with other COVID-driven problems, Pennsylvania's split agro-industrial identity aggravates tensions and vaccinations, making vaccines unavailable to the general public as other states are beginning to do.
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, please remember that percentages for 'population tested' implicitly assumes that anyone taking a COVID test does so only one time. Many people are getting multiple tests. For example, for various reasons, I have had four tests. That would count as four people taking tests for the datum calculated for Maryland. My S.W.A.G. (scientifically wild-assed guess) is that a more accurate level of people actually tested is half, or less, of the percentage cited in the ‘38+ table’ above.
2nd, 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.
3rd, in the '38+' table (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 projections of November 2020 from the University of Washington of 470,974 deaths. On 04dec20, the old and new parameters are applied to facilitate transition.
4th, changes in how positivity rates are presented in the '38+' table above 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.
5th, 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.
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