NedNotes (not blog): 19feb21 COVIData Sweep

In remembrance of five Americans taken away this week by the coronavirus. One immigrant; one decorated veteran from the war in Viêt Nam; one Ph.D. in science and a family farmer; three men, two women; ages raging from sixty-three to ninety-five; average age of seventy-seven and median of seventy-six.

B.L.U.F. (bottom-line, up-front): antepenultimate data sweep; tapering off this week and next with data-only for last installment as supplement to last letter of a series to friends and familiares on 05mar21. The data broke the right way. Now it is a matter of racing against the clock on vaccination.

INTRODUCTION
Great week, as hoped for, with deaths falling by more than a third week-over-week. Two obvious reasons explain these data: vaccines and the holiday surge finally working its way through the health-care system. It is important to note that the current weekly fatality level of 14,409 souls remains 35-50% above pre-Thanksgiving mortality tolls. 

Though stalled this week by weather-related supply-chain disruptions, vaccines have reached 12.4% of the country, contributing to a much improved nation-wide positivity rate of 5.1%. (i.e., very close to the 5% 're-opening' threshold, sustained for two weeks, set by the World Health Organization). While other states on the watchlist are turning their performances around, Ohio and Alabama have yet to make notable progress.

DATA REVIEW
Summary. Performance has improved across-the-board this week, though California, Missouri, Ohio, and several Southern states still endure fatality rates significantly higher than most others. Vaccinations have been impeded by the winter storms. Positivity rates have come down significantly, though seven states have testing capacity less than half the average. As cases drop, I.C.U. availability improves modestly.

REVIEW of the WEEK
Introduction. Despite a slow week of vaccine distribution due to inclement weather and demand exceeding supply, the Biden Administration is delivering on its promises to inoculate 100 million people, in two months instead of three, and planning ahead to re-open the economy. Deaths have fallen abruptly across the United States but remain well above the pre-holiday levels. States across the South and Southwest continue to lag most of the country while Ohio’s situation grows increasingly precarious. Cross-border vaccine equity becomes ever more urgent.

Overview. The winter snow and slush crush has slowed vaccine deliveries to a trickle. Cities have begun more effectively to distribute vaccines to minority populations, though some smaller groups (e.g., Asian immigrants) face prejudice and others (e.g., Native Americans and the military) remain skeptical of inoculations. The COVID epidemic has cut life expectancy noticeably in the U.S., particularly among people of color. 

Vaccine equity is taking on a cross-border dimension, since formula-resistant strains have entered the U.S. from around the world. The uneven distribution involves more than the stark question of morality. The rest of the world, outside of the ten wealthy nations consuming an out-sized proportion (i.e., 75%) of doses in a neo-bullionism around vaccines, is fast morphing into a petri dish for new and more lethal variants. The movements to re-open economies and schools continue gaining momentum, though teachers seek accelerated vaccinations before returning to the class-rooms.

Data Dadaism. Only New México has turned around her performance among the states bordering Mexico. Florida is becoming the U.S. green-house for new variants. While the growth-rate in new cases has slowed materially among the bellwether states, the increases in fatalities remain at disturbing levels in Florida, Texas, California, Oklahoma, and Missouri. California is the epicenter of the ‘Hollywood mutation’, while Governor Newsom faces pressure to accelerate relief and school re-opening measures. 

Tejas confronts the ordeal of the winter storm crowding out intensive and critical care for her coronavirus contagion. Arizona studies an insidious correlation between exposure to certain ‘forever’ chemicals commonly encountered and susceptibility to the coronavirus. In other regions of the country, the state causing the most concern is Ohio with her rising fatality rates and questionable control of her data. Oklahoma’s improvement remains tenuous while Missouri steps up genomic surveillance to contain the spread of more contagious strains of the virus.

Trivial Pursuits. Enough of the negative! Here are some other ‘data points’ that make a point on this week’s marked progress:

• average daily new confirmed cases for the week down by 28% week-over-week to 69,429;
• new fatalities down 34% week-over-week to 14,409 souls lost to the coronavirus;
• hospitalizations down 16% week-over-week to 59,882;
• decrease of 11% week-over-week in critical care to 17,672 patients in intensive care;
• active cases down week-over-week by 2.9% to 9.7 million Americans;
• slowing weekly growth rate in new deaths to 3.0% versus 5.5% in previous weeks;
• 1.8% increase in cumulative case count to 28.2 million confirmed cases during the week;
• critical easing of I.C.U. bed use in four states (TN, OK, AZ, MD) during the week;
• periodic mortality rate of 2.9% this week versus 3.2% the previous week (i.e., ¡fatalities declining more rapidly than new cases!); 
• only ten states (AL, AZ, CA, FLA, GA, MO, N.C., OH, OK, S.C.) with 4% or higher growth in fatalities (versus 3% for the country) during the week;
• star performances among fourteen states, some with dramatic turn-arounds, (ranking from 0.8% to 1.9% in  mortality run rates: MN, S.D., CO, MI, TN, IL, MS, ID, WI, N.J., LA, VA, IN, CT); 
• only two of the twelve states not studied, Kansas and Rhode Island, facing severe challenges with ‘very high severity levels’ (i.e., restated fatalities of 526,007 and 746,997, respectively), lagging vaccination rates of 10.3%, testing capacity at 40% of the national level (KS), a positivity level of 22.7% (KS), strained health-care system with 17% I.C.U. availability (R.I.); as well as,
• of states not reviewed, six (AK, HI, ME, N.H., W.V., WY) qualifying as current stars with low positivity rates (i.e., 1.1%-5.2%, median of 2.1%), plentiful I.C.U. capacity, strong vaccination rates (11.6%-23.1%, median of 13.0%), and enviable mortality run rates (i.e., 0.5%-1.6%; median 1.5%).

PRÉCIS of the TEN WATCH-LIST STATES
Summary. Most of the states have improved. The states that remain a particular concern include California, due to its origin of a fourth new powerful mutation, as well as Georgia and Alabama (still sub-par performances and poor testing capacities). The vaccines are making a dent, despite weather-related disruptions this week. In disturbing news, infections by more contagious variants are up 73% with Florida leading the way.

The UNITED STATES of HYSTERIA: 1.8% mortality run rate (up from 1.7% last week); please see addendum below; 5.1% positivity rate; 29% I.C.U. available; 12.4% ≥ one vaccine. Data vailable from The Centers for Disease Control; solid progress during the week and challenges remain.

ALABAMA: 2.0% mortality run rate; 21.6% positivity rate; 15% I.C.U. available; 10.3% ≥ one vaccine. Still less than ten cases of U.K. variant in State.

ARIZONA: 1.9% mortality run rate; 5.0% positivity rate; 39% I.C.U. available; 12.6% ≥ one vaccine. One hundred, forty cases cases of Hollywood mutation; possibly, a variant able to resist current anti-bodies.

CALIPORNO: 1.4% mortality run rate; 3.1% positivity rate; 16% I.C.U. available; 12.3% ≥ one vaccine. $9.6 billion relief bill passed; may be too little, too late for many family businesses. Fatalities still very high.

GEORGIA: 1.7% mortality run rate; 11.0% positivity rate; 13% I.C.U. available; 10.1% ≥ one vaccine. Though doing well relative to population (8th largest state; 12th highest in deaths), Georgia’s post-peak performance lags most of the country.

NORTH CAROLINA: 1.8% mortality run rate; 6.9% positivity rate; 22% I.C.U. available; 11.8% ≥ one vaccine. Using a data driven approach toward phased re-opening.

OHIO: 1.8% mortality run rate; 7.5% positivity rate; 33% I.C.U. available; 11.5% ≥ one vaccine. Eighty-four of eighty-eight counties still on red-alert owing to more than one hundred deaths per 100,000.

OKLAHOMA: 1.0% mortality run rate; 12.8% positivity rate; 21% I.C.U. available; 12.3% ≥ one vaccine. Senior state official targeting for contagion to end by Decoration Day.

PENNSYLVANIA: 2.6% mortality run rate; 6.7% positivity rate; 26% I.C.U. available; 11.5% ≥ one vaccine. Democratic Governor and Republican Legislature clash on liability protections (from frivolous law-suits) for elder-care facilities and certain other businesses. Disaster declaration renewed by Governor Wolf.

TENNESSEE: 1.5% mortality run rate; 9.9% positivity rate; 25% I.C.U. available; 10.1% ≥ one vaccine. Now inoculating people aged 64+ and teachers.

TEXAS: 1.6% mortality run rate; 5.8% positivity rate; 19% I.C.U. available; 10.6% ≥ one vaccine
Storms delaying COVID administration; one million doses missed in last few days. 

ADDENDUM 21feb20 on incremental fatalities: ¿Much Ado About Not Much?
My apologies for omitting a tentative finding based upon a sequence of mortality run rates, compiled over the last month, for the United States. When the daily domestic cumulative fatality rate seemed to be stuck at 1.7% for too long a time (i.e., almost a month), I started calculating the percentage out to three decimal places. ¡Et voilà! The daily mortality run rate has been edging up slowly, but steadily, over the subsequent month.

The negligible increases have not created a sense of alarm owing to the possibility, even probability, that these persistent increases each day might be attributable to rounding errors or uncaptured deaths, reported later. During that month of daily scrutiny, the U.S. daily run rate has increased by one-tenth of one per cent. The persistency of daily increases for each of twenty-eight days or more argues against randomness. This trend has emerged as consistently after the holiday surge as during its peak. Nevertheless, viral testing and recoveries have accelerated. 

These forces should be driving down the mortality run rates under the weight of many passive carriers detected and confirmed as nominal cases. Additionally, new deaths appear to be heading down as well. Yet, despite an expected addition of asymptomatic cases (i.e., increasing the denominator of the mortality run rate = cumulative fatalities divided by cumulative cases) and apparently fewer fatalities (i.e., decreasing the numerator), mortality experience still inches up-ward each day.

This intuitively unlikely trend reflects one of three phenomena: first, new cases declining more rapidly, day-over-day, than new deaths (i.e., best spin-cycle); second, a higher degree of lethality introduced into the population by a new variant (e.g., South Africa or Brazil); or / and, some factor undetected. New cases, however, have declined at 28% versus a 34% decrease in deaths. Barring some other factor that I have not identified, these consistent, albeit miniscule, increases arguably point toward enhanced lethality. 

CLUSTER FACTS
Summary. The week’s big story is the Siberian Express and snow dump across much of the United States hampering vaccine deliveries. Every area posted improving results, suggesting the holiday peak is firmly in the rear-view mirror.

Baltimore-Annapolis: 4.5% positivity rate; 18% I.C.U. availability; 11.7% ≥ one poke. Brazilian variant now detected in Maryland. Annapolitan teachers in the class-room for months now pressing for vaccinations as Marylanders learn to negotiate the vaccine maze. Re-opening proceeds apace as people can linger for more than an hour over dinner. Flu-shots may be slowing COVID spread in Maryland.

Boston & the Cape: 4.2% positivity rate; 26% I.C.U. availability; 19.0% and 14.5% ≥ one poke in Boston metro and the Cape. Mixed results for vaccines: boon for elder care facilities and bane in absentia for Cape Cod. U.K variant poised as a medical Nor’easter; South African variant discovered in a home-body.

Chicago proper: 3.5% positivity rate; 33% I.C.U. availability; 9.6% ≥ one poke. Mayor Lightfoot use of $282 million of COVID relief funds for police payroll. Chicago partnering with a local university for genomic surveillance to trace transmission of variants and anticipate vaccine fixes. Northwestern study leading the charge against impact of long-term COVID suffering; informing Chicagoan policy to reach the vulnerable.

Colorado state-wide: 3.6% positivity rate (Denver); 27% I.C.U. availability (Denver); 12.6% ≥ one poke (state-wide). Despite an attenuating supply chain for vaccines across Colorado creating anxiety for essential workers, nine of ten medical first responders already poked. Emerging co-mortality in elder-care facilities: starvation. Dolores County with 3.3% positivity rate.

Detroit Metro: 4.8% positivity rate; 26% I.C.U. availability; 9.1% ≥ one poke. Essential workers prone to super-spreading (e.g., food-related industries) to be vaccinated. Sixty year olds with co-morbidities now eligible for vaccine. Tax revenues down as COVID chokes Detroit. Restauranteurs pushing for re-openings contingent upon positivity rates. F.E.M.A. coming in to aid Michigan vaccine effort. State slowing shipments of vaccines to Oakland County.

New York METRO: 7.7% positivity rate; 36% I.C.U. availability; 10.5% ≥ one poke. City running low on vaccine availability; 97% of 1.4 million doses used. Brooklyn ahead of the City with a 6.7% positivity rate. Emergence of U.K. and other variants slowing plans to re-open schools and business in metro area, Northern Jersey. Connecticut patient tests positive in N.Y.C. for South African variant. State to re-open summer camps, amusement parks (33% capacity), other indoor entertainment (25%).

Philadelphia Metro: 6.1% positivity rate; 28% I.C.U. availability; 6.0% and 8.7% ≥ one poke, including / excluding Philly proper. F.E.M.A. stepping in to continue vaccinations in place of failed start-up. Philadelphia facing substantial deficit due to economic fall-out of coronavirus contagion. City of Brotherly Love not expanding eligibility for another six weeks.

Pittsburgh Metro: 5.9% positivity rate; 25% I.C.U. availability; 11.1% ≥ one poke.
State narrowing distribution channels mainly to hospitals, proven channels. Over-vaccination on first round is shorting second round for at least 100,000 doses; Pittsburgh area affected. Respiratory inflammation, reaction to COVID in children, accelerating; still low case count. The tragedy of pandemic prejudice.

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MÉXICO: 8.8% mortality run rate; 32.0% positivity rate; < 20% I.C.U. availability; 1.0% ≥ one poke. When will to epidemic peak in Mexico? Perhaps as late as August. Vaccines arriving from Russia and China to supplement AstraZeneca.

TUNISIE: 3.4% mortality run rate; 43.5% positivity rate; < 10% I.C.U. availability; 0-1% ≥ one poke. Tunisia has a second epidemic: 17.4% unemployment. Tunisia's mortality run rate remains a little above the average for Africa as the pandemic overwhelms health-care systems across Africa. 

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.