NedNotes (not blog): 12feb21 COVIData Sweep

In remembrance of five fellow citizens of the United States of America felled by this virus during the past week. Three immigrants from India and the Philippines; three men, two women; one African and one Native American; a saxophonist and I.C.U. nurse; from Detroit to Washington; average age of seventy; median age of seventy-three.

B.L.U.F. (bottom-line, up-front): new deaths higher than expected due largely to an addition of previously unreported fatalities. I.C.U. availability easing and 10-11% of the country with at least one vaccination.

INTRODUCTION
Summary. Most states improved as mortality growth slowed moderately across the country to 4.7%. Alabama remains unmanageable, while Pennsylvania slowly turns around. Other states to watch include Arizona, California (with a new variant), Oklahoma, Ohio, and Georgia.
Review of salient issues during the week

1. The U.S.G. expects to have an open season for vaccinations by spring-time to enable open schools, followed by a completed vaccines roll-out by the Summer.
2. Capacity to track unintended consequences of policy and side-effects of vaccines is under-resourced.
3. Variants are making their way across the U.S. with the arguably deadlier South African variant already in several states and territories (e.g., Maryland and Illinois); case counts remain low.
4. Every cluster reporting issues around racial / ethnic equity for, and mistrust of, vaccine distribution and inoculation as well as subversion of targeting régimes.
5. The even more lethal Brazilian variant in Minnesota and Oklahoma; case count still low on this potentially most dangerous of the mutations.
6. South Africa variant undermines AstraZeneca vaccine; conflicting reports on time needed to fix the vaccine.
7. A newly detected ‘L.A. variant’ is spreading; limited data do not yet indicate increased lethality.
8. Not only evading anti-bodies of the common mutations, these newer variants are increasingly liable to yield erratic testing validity.
9. On a lighter note, keep drinking water to your heart’s content!

REVIEW of the DATA
Summary. Disappointing week with new fatalities still twice the level of the week prior to Thanksgiving. Variants are in the U.S. with the U.K. mutation proliferating. Mortality run rates continue to inch up at 1.74% while the periodic rate for the week was high at 2.82%.

The decrease in cases, expected to be five-to-seven thousand has been negligible – with fatalities falling only 4-5% to 21,793 last week from 22,591 the previous week – despite improving numbers on hospitalizations (down 17.2% for the week to 71,504), active cases (down 6.6% to 9.2 million), and critical care patients (down 11.7% to 19,927).

If not for Ohio counting in 3-4,000 cases previously uncaptured, the fatality level for the week would exceed modestly the upper end of the forecast range. 10.5% of Americans have received at least one dose of a vaccine while the positivity rate has generally improved to 7.0% with twenty-four states coming in below the World Health Organization threshold for containment of 5% sustained for two weeks.

The bellwether states have posted roughly a 2% growth in confirmed cases, less than half of the 4.7% national rate. The concern remains with the fatalities doubling or tripling the number of confirmed cases in California (2.1% case growth versus 6.1% increase in fatalities), Arizona (2.2% versus 6.3%), and Oklahoma (2.8% versus 6.7%). This level of fatalities has been indicative of higher mortality run rates across the South.

Louisiana is proving to be by far the best performer in a rough neighborhood with only a 2.2% growth in deaths for the week, together with a much improved 5.2% positivity rate on the deepest testing capacity in the region and the most I.C.U. beds available. While Alabama’s testing results are the most improved, her testing capacity is half that of the country while the growth in fatalities remains the worst in the country.

States that continue to improve toward superior performance include New York, Colorado, Connecticut, Massachusetts, Michigan, and Illinois. The states belonging on the watch-list continue to be the following.

• Alabama with the worst fatality growth this week (8.7%); a nearly overwhelmed health-care system; and, a below average vaccination rate.
• Arizona, despite her improvements with a 6.3% increase in cumulative deaths during the week; high positivity rates; and, a testing capacity just over half that of the nation.
• California with 6.1% fatality growth; the Tijuana-Sand Diego epicenter; the ‘Hollywood mutation’; and, a severely challenged health-care system.
• Georgia with her population density around Atlanta; 5.7% mortality increase; nearly twice the national average in positivity rates; testing capacity two-thirds of the average; an overwhelmed health-care delivery system; and, a lagging vaccination rate.
• North Carolina with an above average mortality growth for the week; a burdened health-care system; and, a weak testing capacity.
• Ohio (replacing South Carolina) with a 30% growth rate in cumulative deaths explained largely by capturing some 3,500 previously unrecorded deaths; a high positivity rate; and, a weak testing capacity.
• Oklahoma with 6.7% growth in fatalities; an overwhelmed health-care system; and, a positivity rate five percentage points above the national average.
• Pennsylvania struggling with a lagging vaccination program; her population; poor testing capacity; an improving but still high 8.3% positivity rate; and a strained I.C.U. availability.
• Tennessee with a high level of deaths; positivity 35% worse than average; poor testing; and. a health-care capacity close to being overwhelmed.
• Texas with her population and her long border with México; a significantly strained health-care system; an 11.6% positivity rate; and, only 18% of the I.C.U. beds available.

CLUSTER FACTS
Baltimore-Annapolis: 8.9% ≥ one dose; 18% I.C.U. availability; 5.5% positivity. Vaccine supplies are thin as Governor Hogan appeals to President Biden for the U.S.G. to vaccinate its employees in Maryland. Preparations underway to resume in-class schooling with COVID-testing, together with $1 billion of supplies and aid to schools and families. Anne Arundel County with the highest rate of viral spread in the State.

Boston & the Cape:  10.4% (MA) ≥ one dose; 21% I.C.U. availability; 3.9% positivity. Vaccine equity issues compounded by those gaming the system for money. Cape Cod, with the third oldest local population in the country, smarting from what perceives as neglect by the State on vaccinations. Governor Baker urges those who recovered from COVID to receive the vaccine anyway.

Chicago proper: 7.7% ≥ one dose; 33% I.C.U. availability; 5.0% positivity. Racial equity issues and vaccine scams mar Chicago’s efforts. The first case of the more lethal (than the U.K.) South African variant detected in Illinois, on the Iowa border. Chicago trailing Illinois (9.8%) with vaccination rates; Health Department update on vaccines and re-opening. Number of new cases down by roughly 25%; restaurant availability to double to lesser of 25% capacity or fifty people per room or floor.

Colorado state-wide: est. 10.9% (Denver) ≥ one dose; 28% I.C.U. availability (Denver); 2.8% positivity. Dolores County positivity rate down dramatically. Vaccine refusal rates may jeopardize prospects for herd immunity. COVID legacy of cocktails on the run?

Detroit metro: 8.0% ≥ one dose; 29% I.C.U. availability; 4.9% positivity
Good news: Detroit joins Maryland, OH, N.M. in expanding vaccinations to include the disabled. COVID vaccine distribution sites extended to include churches and large retail chains. Two cases of the more contagious U.K. variant (likely to be less lethal than highly contagious South African variant) spotted in Motown.

New York METRO: estimated 9.8% ≥ one dose; 36% I.C.U. availability; 8.5% positivity
New Jersey suburbs addressing ethnic equity issues. Biden Admin. aiding N.Y.C. efforts to roll out vaccine as part of national effort. Connecticut leads the cluster in vaccination rates at 12.3%. N.Y.C. leads in positivity rate with 3.9% versus 6.3% for Long Island, 8.6% for Westchester. Brooklyn positivity remains high at 7.8%. New Jersey suburbs lagging with 9.3% positivity rate. Without a summer-spike, New York opening up faster than San Francisco.

Philadelphia metro: estimated 5.0% ≥ one dose; 28% I.C.U. availability; 6.9% positivity. Racial equity issues and mistrust remain acute in the city proper. Devolution of school re-openings to individual facilities with testing, vaccination and in-person training plans. Push-back continues from teachers’ union with the community bringing pressure on teachers to return to the class-room. New Jersey suburbs lead with a 10.2% vaccination rate. Much of the cluster’s lag in Philadelphia with 1% vaccination rate; without Philadelphia County, metro rate would be 7.5%.

Pittsburgh metro: estimated 6.4% ≥ one dose; 23% I.C.U. availability; 6.7% positivity. Presby sending 2,000 doses through community centers to under-served segments as the Governor praises the locally focussed inoculation programs in Western Pennsylvania. First report of U.K. variant in Allegheny County.

México has had a difficult second half of 2020. Nevertheless, México is easing some restrictions (but not yet allowing any indoor dining) as hospitalizations decline modestly. A.M.L.O. is back, saying he got the coronavirus due to having to work; he remains consistent by refusing to wear a mask. Tijuana suffers with a double whammy of the coronavirus contagion and narco-traficante violence. In total, México has lost almost half a million people to COVID and drug-related murders. Vaccine supplies remain low and inflow uncertain, prompting the República increasingly to rely upon Chinese and Indian vaccines.

La Tunisie is as occupied with her mass demonstrations against poor economic conditions as we are with Trump’s impeachment. The current COVID wave is overwhelming the health-care systems, though the trend is stabilizing. The country is scrambling to find vaccines, looking even to the reputedly less reliable Russian ‘Sputnik’ medicine. The Republic is aiming to inoculate 20% of the population by mid-summer. She is receiving the first third of the doses from Pfizer (93,600) next week and AstraZeneca (600,000) next month principally through the W.H.O.-lead COVAX global distribution syndicate. To date only 374,000 Tunisians (i.e., 3.5% of the population and less than 10% of the adults) have signed up for the vaccine.

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 five tests. That would count as five 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.