This post is long and rambling and my thoughts have evolved while writing. Here’s the summary:

Ok and now the long post. Maybe later I’ll break this out.

This past week, I have been reflecting on the different local perceptions that people have of the epidemic in their local area. This is in part based on what FB friends have posted and commented and on chatting with friends in other parts of the country. Some of my musing is based on the media, though I often find that the ‘real’ people featured in the media are often extreme while real people have views that are more nuanced and certainly not summarized by a click-bait headline.

Anyhow, it is clear that in some areas the view is that ‘What’s the big deal? The response is overblown.’ while in other areas friends are freaking out and praying ‘Please god, stop this epidemic. Stop the deaths.’ So I added a y-axis to my graphs that shows the new cases (and deaths) per million (and thousand). To me this really shows why in, say, FL the view is ‘This is not a big deal.’ while in NY, NJ, MA, CT, people are freaking out and can’t understand how people in other parts of the country can be so cavilier.

First, let’s put “new cases per million” and “deaths per thousand” in some context by looking at Europe. Instead of comparing to other diseases, which I don’t think makes much sense for a novel disease with no cure and so many unknowns, let’s look at countries that are put up as examples of a “bad case” (Italy, Spain and Belgium) and the examples of “good cases” (Denmark, Germany).

Caveat: I am going to show numbers using positive cases (“new cases”) and deaths across countries. Testing criteria vary across countries. Some, like Italy, were so swamped that tests were reserved for the worst cases. Others, like Germany, did broad testing. One way to try to adjust (mentally) is to scale by the CFR. These are all developed countries so CFRs should be similar (I think) and differences are probably due to testing. An exception is Italy, where home-care (more on that later) versus hospitalization, was associated with high mortality. Also ‘deaths’ are reported COVID-19 deaths, which are under-reported.

Europe

Let’s start with Lombardy, the ‘poster region’ for a severe outbreak. Here is an interesting article what went wrong in Lombardy: https://apnews.com/de2794327607a3a67ed551f0b6b71404

At the peak of the epidemic, the new cases/million was 200. They have had 13449 deaths which is 0.67 per 1000 people; projected deaths are 20000 which will come out to 1 per 1000. This is considered the worst region in Europe. So 200/million new cases per day and 1 per 1000 deaths are big numbers. Let’s look at other ‘bad’ countries:

So these are the “bad” numbers. You can also see why Belgium is being mentioned as a country which is really being hit hard. Let’s look at “good” numbers:

And let’s look at a few other countries:

So this gives us an idea of “bad” to Europeans: 0.5 to 1 deaths/1000, +100 new cases/million and CFRs over 15% (fraction of positives that die). CFR is not the infection mortality rate at all since only really sick people tend to get tested, esp in the hard hit countries.

United States

The hardest hit area is the upper east coast:

Let’s look at some other regions:

So you can see that there are really big differences. I think this explains why in some parts people (lay people not necessarily their health departments) feel like the epidemic and death rates are manageable and they can think of this more like a bad flu year (and take those kind of precautions). Certainly looking at the numbers in FL, I can understand that view.

But we don’t know why NY, NJ, CT, MA etc. ‘blew up’ and FL did not (or more precisely, has not as we don’t know what’s to come). FL has the elements to have ‘blown up’: lots of tourists bringing in infection, late closing of gatherings and plenty of cities. We just don’t understand this virus yet and many of the patterns we see in the US, don’t make a lot of sense.

But the numbers do illustrate why your view of the epidemic can be very different than in other parts of the US.

The response in WA, OR and Northern CA is interesting. Our numbers are like in parts of the country where a higher fraction of people feel like ‘this is no big deal’. The ‘vibe’ I get from Western WA though is a lot of concern. All my friends are locked down and around town, people wear masks and keep distant. My Seattle FB friends seem to look to NY and Italy and fear that future much more than my FB friends in other parts of the country with higher new cases/million. I can’t explain it, but I share it. We don’t understand why we have been ‘spared’ so far. There are conjectures and just-so stories, but we don’t really know. It is still early in this epidemic. Why has Massachusetts blow-up now when they were doing ok and went into shelter-in-place early? Why there when GA and FL didn’t blow up?

Regional status:

Right now there are three areas in the US where the new cases are going down or are stabilized. Stabilized new cases are ‘workable’. As long as the health system is not overwhelmed, then the state can manage a steady rate. But new cases going up and up will eventually overwhelm any health system.

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West coast In WA, OR and Northern CA, new cases per million are low and being driven down. Unfortunately Los Angeles County has been ticking upward. Last M-F, the 5 day total jumped to 6200 from 2500 the previous week. If it jumps again this week, that’s bad. In contrast, new cases are quite low in many CA counties. And even in the Bay Area (Santa Clara, Alameda, San Francisco), the 5-day total was only ca 600. But the CA lockdown was extended to June 1. In some states (Iowa), they are removing restrictions in counties with few states but unless Los Angeles County can be quarantined, I can’t see how that would work in CA.

East North Central Midwest (OH, IL, IN, WI, MI) The new cases have not peaked yet. Right they are ca 100 per million and projected deaths are over 1 per thousand unless things turn around soon. However, OH, IL, and IN (probably the others too) and starting to lift lockdown orders. With the new cases so high and projected death rate so high, I find this surprising. But what I really find surprising is that the media is jumping all over Georgia, which has a much lower rate per million and actually has kept things in control, but not jumped all over OH, IL and IN for loosening up. On the otherhand, the death curve is fairly flat at about 250 deaths per day in the region and maybe that is manageable. Coming from WA this is alarming, but it’s like what NY and NJ experienced just spread out over 8 months. I guess…

West North Central Midwest The whole region is still going up, but I want to focus on Iowa and Nebraska. California is the top food producer (ca 11%), but #2 and #3 are Iowa and Nebraska. These states have only 5 million people but produce ca 15% of the US food. In the last week, new cases per million have jumped to 150 per million. Deaths are low (0.03 per 1000) but that reflects what was happening last week when there were 250 new cases per day. Now it has jumped to 750 new cases per day (IA+NE) and deaths will start jumping too. One of the places it is spreading is the meat-packing plants in rural counties. If they can figure out how to stop that then they’ll stop a lot of the spread. But so far that hasn’t happened.

Four Corners (CO, UT, NM, AZ) None of these four have flattened. Right now the region is at 75 new cases per million.

East South Central (AL, KY, TN, MS) AL has flattened, the others not. Right now at 60 new cases per million.