BTRTN: In Which State Are You Most Likely to Contract the Coronavirus?

Since March, Tom has been meticulously recording, tracking, and analyzing comprehensive data on the growth of coronavirus contagion in major nations, as well as in each of the fifty states in the U.S. Today, Steve offers perspective on one of the more frightening trends yet in the morphing U.S. pandemic...and why it may be much harder to reverse the new surges. 

The South will rise again. And again. And again the week after. With COVID-19 cases, that is. 

And the Wild West? It is raging, on a path to become a whole lot wilder. 

What’s the state in which you are most likely to be infected with the coronavirus?

That’s easy. It is the state of Denial.

Yes, if you live in a state of denial – like, for example, the President of the United States – you are failing to realize that the American West is burning. The South is aflame. The rates of contagion in many of these states are shockingly high, and no one seems to be willing to take the decisive steps to tame them. Certainly not a President who is trying to pretend that the new cases are merely a reflection of increased testing, and not the Governors whose political fates are tied to Trump's.  

Here are the simple facts: overall, the U.S. is witnessing a frightening uptick in coronavirus cases, with new weekly infections increasing by 36%.  However, the increases are skewed to the West and the South. The number of new cases in the West is up 58% vs. one week ago. New cases in the South have increased 42% versus the prior week. The most worrisome situations are in California, Florida, Texas, and Arizona, which have the lethal combination of large populations and contagion rates above 50%.

The absolute numbers are larger in the South than the West. There were 107,857 new cases in the South last week, compared with 75,787 the week before.  For context, the entire number of new cases last week in the original epicenter of the pandemic – New York, New Jersey, and Connecticut – was 7,197, a reduction from the prior week’s total of 8,375.

Contagion is geometry, not simple addition. If those the rates of new cases in the West and the South were to continue at their current level for just two weeks, each of those regions would be adding more new weekly cases of the coronavirus than were added in the entire United States last week. Each. 

The numbers are scary. 

But what is terrifying is that the contagion does not appear to be being met with any of the urgent action and harsh measures that enabled Northern states to finally wrestle the virus to a daily draw. Indeed, many of these states do not even seem to have learned from the scientific facts about containing contagion that are readily available through observation of the processes used in other states and countries. 

The memory of the situation in New York City in March and April is still raw and vivid, as we recall images of overwhelmed hospitals, terrified citizens, and a governor who told brutal, harsh truths on a daily basis. Back when people suddenly realized that New York City had become the global epicenter of pandemic catastrophe, the metropolitan region was mandated into a non-negotiable and comprehensive lock down by state and local governments that was grounded in science and guided by medical wisdom. 

Residents in New York, New Jersey, and Connecticut generally took the lock down extremely seriously. New York, Connecticut, and New Jersey flattened their curves. These states are now beginning to re-open, and we have yet to see sharp spikes or a resurgence of contagion. 

There’s a little known but very important story behind those numbers that is acutely relevant today. 

Back then, Donald Trump liked to say that New York “cried wolf,” as Trump claimed that New York's projections about how many hospital beds and ventilators it would need turned out to be higher than the actual case. It was true: New York did not end up needing as much of the capacity of the quickly reconfigured Javits Center and the U.S. Navy hospital ship Comfort as had been anticipated. 

But there was a simple and profound explanation: the high initial projections were based on fears harbored by health officials that only roughly half of the population would agree to follow social distancing and shelter-in-place protocols. When 90% of the population adhered to these requirements, the need for beds and ventilators dropped significantly.

In other words: the New York metropolitan area – following the powerful leadership of Andrew Cuomo – took the pandemic with utmost seriousness. They listened to Governors who were, in turn, listening to scientists. There was a broadly embraced culture of commitment to take the hard actions and the sacrifices necessary to stop the virus. That culture of commitment saved lives. It flattened the curve.

  

But there appears to be a decided cultural difference in what is happening in today in many states in the South and the West. Call it denial.

Right now, many Republican governors are rolling with the direction of a President who desperately wants people to believe and act as if the coronavirus was just one more annoying little risk that humans beings must deal with as they once again go about their daily business. 

The data reflects this attitudinal perspective. The rate of new weekly cases in states with Republican governors is up 47%, well above the U.S average. States with Democratic governors are up 31%... scary, yes, but below the U.S. average.  

Share some of these statistics with friends from these regions and prepare to be scolded that you are making an unfair comparison. They will say that you can’t contrast the statistics about Southern and Western states that are only being hit with the full brunt of the pandemic now relative to statistics about New York that is now emerging from the worst of horrendous carnage. 

Hmmmm. 

This perspective may seem logical at first blush, but misses the much bigger truth: for precisely the same reason, Southern and Western states had an enormous opportunity to observe and learn from what was occurring in the Northern urban areas. Their ability to manage the virus should have been vastly superior to the situation in the early states by virtue of the fact that they had so much more time to observe the relative strategies and success rates in the states and indeed countries that had been hit before them. They had the time to design implement broad based testing and contact tracing programs. They could have used the advantage of time to be vastly better prepared than New York was at the dawn of the pandemic's outbreak in the U.S.

  

Learn? Nah. Many of these governors seemed to feel that they were naturally protected from COVID-19 by the fact that their populations did not have the urban density that made New York and Detroit breeding zones for an intensely contagious virus. Denial, it turns out, is not necessarily a densely populated state, it is simply governed by dense leaders. 

And now we have the wonderful contrast of North Carolina and Oklahoma, two Southern states that differ in local leadership… North Carolina is led by a Democrat, and Oklahoma is governed by a Republican. North Carolina’s Democratic Governor, Roy Cooper, refused to loosen social distancing protocols when pressured by the White House, and Donald Trump elected to move the Republican Convention out of his state.  Oklahoma, however, is led by Republican Kevin Stitt, who allowed Donald Trump to hold his first political rally in the state capital of Tulsa. Masks optional, social distancing protocols be damned. 

Last week, coronavirus cases in North Carolina were up by 7%. Weekly cases in Oklahoma were up 83%. Do you begin to see a pattern?

Turns out that in the great states of Denial, politics drive public health decisions.

Follow this: one of the reasons Trump cites for justifying his resumption of indoor rallies is that he thinks it is only fair that he be allowed to gather his supporters, just as crowds have been allowed to gather for the “Black Lives Matter” protests that have blossomed across the nation. The unstated message is profound: in this logic construct, Trump positions the “Black Lives Matter” protests against societal and police racism as his political opposition… they get to hold rallies, why can’t I? 

Leave it to Trump to fail to discern the difference between a protest march against egregious violations of human rights and a political rally. 

Heck, leave it to Trump to fail to see the difference between an indoor rally in which masks are optional and no social distancing protocols are followed, and an outdoor march in which masks and distancing were prevalent.

It sickening to articulate this point out loud, but nonetheless fair to hypothesize that one of the reasons Trump has chosen to take such an aggressive, divisive, and demeaning stance toward the Black Lives Matter movement is that he sees the advantage in shifting the national dialog away from the coronavirus. He thinks it is a winning strategy: ridiculing the Black Lives Matter protesters will please his base while simultaneously diverting the focus from the spectacular rise in COVID cases in the states that support Trump the most.  

Those who paid any attention to Donald Trump’s remarks at his Tulsa rally will note the extremes to which Donald Trump went to avoid the elephant-sized virus in the room. Trump devoted large chunks of his rambling monologue to defending his halting walk from the podium at his West Point address, and even to his ability to drink a glass of water with one hand. When you would rather talk about your inability to drink a glass of water than a raging Category 5 public health disaster, you pretty much know what is being forcibly shoved to the bottom of the agenda. The only mention of the virus was when Trump referred to the pandemic with the racially-charged phrase "Kung Flu."

There’s one last unspoken but fascinating reality in the politics of COVID-19. You have yet to hear of a single Republican voice imploring the President of the United States to wear a mask and adhere to social distancing measures to protect his own life. Think about it. 

Here is a guy who has completely, wholly, and unabashedly seized the entire identity of his party. There is no other person in the party who is in a position to replicate the ferocious loyalty and devotion that Trump wields. There is no central, organized belief system holding the party together, only the cumulative blather of Trump’s twitter feed. It is obvious: the fate of the party and the election is wholly bound up in a single individual. Yet no one in his party is saying, “please, Mister President, for your own safety, and so that our party may succeed in November, take care of your own health. Wear a mask. Practice social distancing.”

It is that simple: Republican leaders slavishly bow to Trump, and many mimic the utterly cavalier attitude Trump takes to the virus. The signal that is sent to his followers is that the pandemic is not to be taken seriously. Citizens adopt a cavalier attitude. It is a cultural mindset, and a cultural mindset will not be easy to change.

At the end of April, Newsweek reported on a study that ranked the states according to how thoroughly they had adhered to social distancing protocols. 

Of the ten states that were rated as poorest in conforming to social distancing protocols, eight had Republican Governors: South Carolina, Georgia, Tennessee, Ohio, Alabama, Arkansas, Missouri, and Oklahoma. 

The ten states with the best adherence to social distancing? Eight had Democratic Governors: Maine, Pennsylvania, New York, New Jersey, Nevada, Vermont, Hawaii, and New Mexico. 

Social distancing, sheltering, and masks will stop the spread of the virus, but only if citizens make a fanatical commitment to them. New Yorkers got the message loud and clear from Andrew Cuomo. Republican governors are not sending the same message.

The four states that should have us the most worried are California, Florida, Texas, and Arizona. These states  have both a large population and a 7-day new case rate of over 60%.


                                    Population      7-Day New Case Rate   Weekly New Cases Per Million Pop
Arizona                          7,278,717                 72%                                  2,617
California                     39,512,223                 59%                                     747
Florida                         21,477,737                 71%                                  1,224
Texas                           28,995,881                 78%                                     937

One of these states has a Democratic Governor... Gavin Newsom of California. Newsom was given high marks for his early sweeping lock down in the most populous state. By virtue of is huge population, California trails the other three states when ranked by the relative measure of "new cases per million of population." California has huge challenges with this new spike, but it is clear that Newsom takes this threat extremely seriously.

The other three states -- each with contagion rates above 70% -- have Republican Governors... and they have been among the staunchest Trump supporters on COVID-19 issues.

Arizona Republican Governor Doug Ducey has been one of Donald Trump's most reliable sycophants, allowing Trump to hold a rally just this past Tuesday, even as his state's contagion rate roared out of control. 

Florida Republican Governor Ron DeSantis, a world-class Trump acolyte who, is the guy who allowed college students to continue their spring break raging on his state's beaches even as the virus wrought havoc in New York City. A study conducted using cell phone data showed that six of the counties in the United States that showed the most widespread local travel in the month of March-- and therefore the least compliance to sheltering-in-place -- were in Florida, where DeSantis had failed to order a statewide lock down until April 1.

And Texas is, of course, home to Lt. Governor Dan Patrick, the man who suggested that his state's senior citizens would willingly sacrifice their lives to the coronavirus in order to maintain a thriving economy. “No one reached out to me and said, 'As a senior citizen, are you willing to take a chance on your survival in exchange for keeping the America that America loves for its children and grandchildren?' And if that is the exchange, I'm all in,” the Lieutenant Governor asserted.

The messages coming out of the leaders of these states has consistently be one of supporting Trump, minimizing the threat of the virus, and eagerly re-opening their states for business. 

We wish we could say that this stuff was really hard to predict, but predicting gets a lot easier when you have a wealth of existent, real world data to model projections from. The data tells a simple story: as contagion rates start to spike dramatically, there are only three choices: (1) develop a vaccine or a cure, (2) flatten the curve by re-implementing strict social distancing and shelter-in-place measures, including masks, and (3) allow the virus to flood the population on the theory that eventually a “herd immunity” will develop. 

Right now, the three Republican governors seem to be going for an option number 4, which is to ignore the fact that there are only three choices.  Option 4 is denial. 

It was only back on April 26 – the day Georgia announced that it was “re-opening,” despite meeting none of the CDC’s published criteria for such a move – that we published a piece entitled “Operation Gambit: Kemp Offers Georgia as a Test for What Happens When We Ignore Science.” Reflecting on the inevitability of a second spike in cases due to Governor Kemp’s premature action to open the state, my brother Tom predicted pretty much precisely what would unfold in Georgia over the next 60 days:

“And it is easy to see that as this first wave continues to slowly wind down to 500 cases per day – still a ton – a new ‘second wave’ will emerge slowly but soon enough, additive to the first. The second wave could build the same way as the first, though not as fast, given the caution of the populace and the fact that not every business is open. Without testing and proper contact tracing in place, slowly, inexorably, the dozens of new ‘second wave’ cases that emerge in the next few months will turn into hundreds and then thousands yet again. With a more cautious re-opening policy, Georgia’s 20,000 cases today might have ended at, say, 60,000, but the new cases that emerge could ultimately drive it well beyond that."

Guess what? As of yesterday, there were 69,381 cumulative cases in Georgia, and the rate of contagion had spiked back up to 55%... meaning that Georgia is adding new cases at the rate of 9,351 a week. Oh, yes… just as Tom predicted:  that is a trajectory that will lead Georgia’s infection rate “well beyond” 60,000 indeed. Sometimes there is little solace and no joy in being able to make a prediction that is, well, dead on. 

Here's the crux of the matter. We've now proven that you can pretty much stop the coronavirus in its tracks if you are able to implement a 100% lock down, with masks, social distancing, proper personal hygiene, and sheltering-in-place. You can shut it down if you can put such a program in place.

The problem is that you just can't flip a switch with people, particularly with people who have been told for months that the coronavirus isn't all that big a deal, and they shouldn't be worried about it. People who have been getting that cultural message from their leaders, colleagues, and personal ecosystem for four months are simply not going to switch overnight to the 90% compliance that we witnessed in New York. That cultural re-education will take time, and it will take and absolute and emphatic reversal from their government leaders -- starting with Trump-- in order for it to happen. We have yet to see any of Ducey, Abbott, or DeSantis take the kind of bold, uncompromising stand that Cuomo took when his state was on fire.

So the wild, wild West is about to get a lot wilder. The South will rise again next week. And the week after. And it will keep rising until somebody realizes that the curve has to be flattened. Highly restrictive social distancing protocols will need to be implemented. Masks must be required. Sheltering in place will be re-instituted.

The biggest shame of it all is how easily avoidable it all was. You could sense it in the newscasts and in conversations with friends living in the south. “You people from New York City don’t get it. We’re fine here in Texas. We’ve only had about ten COVID cases in the whole city. And yet we’ve got to lock down in our houses, ruin our economy, all because of what’s happening in New York City. It’s just not that big a deal here… it makes no sense. Your cure is worse than the disease.”

And all that time, the virus was traveling, silently spreading, building its geometric velocity until it reaches a point when officials finally begin to feel the impact on local hospitals and healthcare providers. As the geometric proliferation continues to mushroom unchecked, the elderly care facilities will begin to crack and the death toll among this most vulnerable population segment will swell. The razor thin infrastructure of rural healthcare facilities in the American South will be inundated. 

BTW: please spare me from any more misguided Facebook links telling me that the “cure is worse than the disease.” The Northeast is actually re-opening, and doing so with every indication that it will not experience another wrenching spike. It is the South and West that are soon going to discover the extended, unending economic carnage that results from never coming to grips with the problem.

Now, it will be extremely difficult to reverse what is happening, because of a cultural attitude, powerfully enforced by political allegiance. It will be hard for many people in Southern and Western states to suddenly admit that they were wrong to believe Trump, wrong to listen to their politically motivated governor, and wrong to think that science would not happen in their state. 

Yesterday, in Texas, where new cases have increased in the past week by a gruesome 78%, Republican Governor Greg Abbott demonstrated the box that Republican Governors are in. He “urged” proper behavior, but did not mandate it, as Andrew Cuomo had in New York in March. Abbott was advocating but unwilling to Governor-up and give orders. Like a parent who is afraid of disciplining a wayward child, Abbot was coaxing but refusing to take action.

“We want to make sure everyone reinforces the best safe practices of wearing a mask, hand sanitation, maintaining safe distance, but importantly, because the spread is so rapid right now, there’s never a reason for you to have to leave your home unless you need to go out. The safest place for you is at your home… if we are unable to contain the spiraling spread of COVID-19, there will be more requirements put on business, including even considering having to ratchet back on the expansion of opening businesses in Texas. Closing down Texas again will always be the last option.”

Yes, it is going to be very difficult to put this evil genie back in the bottle, as now the politics of saving face, maintaining consistency with past positions, and allegiance to an ignorant President continue to warp the judgment of the local leaders who must actually implement policy in the South and the West.

What appears more likely is that a number of large Republican states will have to live with a constant coronavirus presence, as the number of infections soars and elevates the odds of routine spread. The coronavirus will become a chronic illness, never eradicated until such time as a vaccine is developed and broadly available. Facing that degree of inundation and their allegiance to Trump, one wonders whether these states will have the will to commit to a new, sustained lock down. The unfortunate people under the sway of Trump will learn, over a painful and protracted period of time, that this disease is indeed far worse than the cure. 

Or, consider these breathtaking words of supposed comfort from Vice President Mike Pence just this week. "The past five days, deaths are down to fewer than 750 a day, a dramatic decline from 2,500 a day a few weeks ago—and a far cry from the 5,000 a day that some were predicting." Do the math, Mike. You appear pleased that the U.S. is "down to" 750 deaths per day. Multiple that by 365 days and tell me that 273,750 American deaths per year is a figure that makes you feel proud of the work you and your administration are doing.

If you want to avoid contracting the coronavirus, there is one state to steer clear of. 

It is the state of Denial.  

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