We Are Number One!

I woke up to the news on the BBC that the United States has scored another first. Yesterday, the US reported over 3,000 deaths for the day: According to Johns Hopkins’s COVID site, the number was 3,124, surpassing the toll from 9/11. The difference, of course, is that tomorrow will see roughly the same mortality figures, while even when we count all the US deaths due to the prolonged military actions following the 9/11 attacks, we get a total of about half a week’s worth of COVID deaths.

Of course, these numbers aren’t spread evenly across the country. Illinois contributed 227 to the total while Delaware, for example, had 10 deaths. Part of the discrepancy lies in the fact that the state with the largest population, California, has approximately 68 times the population of Wyoming, which has the smallest population. But population is not the only, or even the most important, factor. Even with this example, we can see that Wyoming’s daily deaths (27) were approximately 14% of California’s 190, while the relative populations would suggest that if everything were equal, Wyoming should experience about 1.4% of California’s rate.  

Scientists warned during the summer that when the weather got cold and people started to congregate more indoors the numbers were bound to go up, and every country is experiencing this increase. But in the US, densely populated states or cities like New York and New Jersey that were hit very hard at the beginning of the pandemic have made concerted efforts to handle the pandemic and have been rewarded with current rates of death and hospitalization that are lower than many European countries. If the entire country followed the measures that are in place in those states, the US would not keep breaking new records for deaths and illness. Instead, COVID has been treated as a political issue rather than a health crisis. The President, of course, has hosted his own superspreader events, with Rudy Giuliani the latest victim of the anti-science bias encouraged by the White House. Giuliani can be seen in this video from one of the innumerable election-challenge hearings asking a witness to remove her mask “if you feel comfortable.” This was a day before he was diagnosed, so it’s lucky she had the courage to refuse:

Then there was this Wall Street Journal editorial from Kristi Noem, the governor of South Dakota. In it, Noem claims that South Dakota has achieved better COVID numbers than Illinois, New Jersey, and New York, while keeping the economy open and experiencing the third-lowest lowest unemployment rate, 3.6%, in the country. I thought this was interesting because the last I’d read, South Dakota and North Dakota, two of the least populous states, were experiencing shortages in ICU beds because their numbers were going up so rapidly, so I was interested in what Noem had to say.  

Noem first looks at Illinois’s deaths on December 2, which she says was a new single-day record. According to Johns Hopkins, on December 2, Illinois, with a population of approximately 12.6 million, experienced 266 deaths. That same day, South Dakota, whose population is 884,659, experienced 47 deaths according to the same source. So South Dakota, with just 6.9% of Illinois’s population, recorded 17.6% of that state’s deaths. Put another way, South Dakota had 5.31 deaths per 100,000 people on that day, while Illinois had 2.10 deaths per 100,000. And this was Noem’s own first example.

She goes on to take on New Jersey: “New Jersey, which still has had the most deaths in the country per capita, has had a mask mandate in place since June and has imposed $15,000-a-day fines on businesses that refuse to close. Still, over the last two weeks of November, its hospitalizations increased by 34%, a six-month high.”

New Jersey and New York, of course, have been the targets of a lot of people on the right who use the fact that both states, plagued with high density areas, an aging population, and a very early introduction of the virus, made mistakes, particularly relating to care homes, that cost lives. The first thing we might notice here, which is not unique to Noem, is the shift from daily numbers to cumulative deaths. New Jersey experienced its first deaths at the end of March and the number of daily deaths from COVID peaked in the middle of April. Throughout the world, the mortality rate was higher in the early stages as people struggled to develop treatments and protocols to deal with the disease.

By the beginning of July, New Jersey had already experienced 15,000 of its total 17,336 deaths. South Dakota, by contrast, had a few scattered deaths early on, but the virus did not really hit the sparsely-populated and remote state until the middle of September, after treatments had improved considerably—and people knew the measures to take to reduce the risk of infection. So let’s look at the deaths in New Jersey and South Dakota from September 15 to December 7. New Jersey had a total of 1,293 deaths in that time period, while South Dakota had 926, so if we don’t take population or density into account, yes, New Jersey would be doing about 30% worse than South Dakota. But, once again, South Dakota’s population is almost exactly 1/10 of New Jersey’s, so, all else being equal, we would expect New Jersey to have 10 times the cumulative deaths of South Dakota. Instead, it had 1.3 times the cumulative deaths. But it’s even more extreme than that. New Jersey is the most densely populated state, with 1,210.1 people per square mile. South Dakota is the 46^th most densely populated state, with only 11.1 people per square mile. Taking all these numbers into account, it’s almost impossible to understand how South Dakota could be experiencing such high numbers without intentionality. When we look at New Jersey and New York, after the pandemic is over, we will see two states that made some bad mistakes early on and worked for the rest of the pandemic to fix those mistakes. When we look at South Dakota, we will see a state that went out of its way not to take even the most rudimentary measure to ensure the safety of its citizens. And then the governor wrote an article crowing about that fact and criticizing (and mischaracterizing) the measures New Jersey took to avoid more deaths and serious illness.

I’m not suggesting that South Dakota needed to shut down completely, in the way that New York or New Jersey had to in the early days. What I am saying is that anyone who wasn’t trying to score political points would realize that South Dakota had huge natural advantages that could have allowed the state to go through the pandemic fairly unscathed. Not only is the state very sparsely populated, it doesn’t even have a huge city. The most populous city in South Dakota is Sioux Falls, with 190,519 people, putting it in the same category as Paterson, New Jersey, and 1/44 the size of New York City. It is also not a hub for flights, with no international airports. The largest regional airport is Sioux Falls, which served approximately half a million people in 2017. While tourism is important to the South Dakota economy, the total number of tourists in 2019 was 14.1 million, compared to 253 million in New York and 116 million in New Jersey. This relative isolation is the reason it took so long for the virus to gain a foothold in South Dakota, and probably means that the state would have been able to go about its business with little disruption and very few deaths or hospitalizations. All they had to do was implement a few common-sense measures, including wearing face masks, restricting large crowds, and generally practicing social distancing and hand-washing. Noem could have kept her great unemployment figures without the carnage if she’d tried to deal with the problem instead of playing politics.

One last point on the statistics Noem uses. She says that New Jersey’s hospitalization rate went up 34% over the last two weeks in November. According to the COVID Tracking Project at The Atlantic, New Jersey’s hospitalizations went from 2004 to 2961 in that time period, so the increase is actually slightly more than Noem said. South Dakota’s, by contrast, went from 553 to 570, or only about 3%, so from just this measure, it would appear Noem was right. But this is a little like Donald Trump’s contention that New Zealand was doing worse than the US because its case load doubled. No, they just had a really low starting number. And then did something about the increase before it got out of hand. So if we take population into account again, South Dakota’s starting figure of 553 was 3 times that of New Jersey. Even after New Jersey’s increase, South Dakota’s numbers were twice the numbers in New Jersey. And just like New Zealand, New Jersey did something about it, subjecting it to Noem’s derision. One final thing to consider: New Jersey started out with approximately 23,000 hospital beds in 71 facilities and have taken steps to increase that capacity. South Dakota has 2,397 hospital beds, which explains why the state felt compelled to include neonatal beds in its totals.

Now Joe Biden has said he will implement a mask mandate for 100 days after his inauguration, or until May 1. The mask resisters are already complaining, saying that now that the vaccine is here, it’s just stupid to require masks. Well, no. The vaccine is given in 2 doses, three weeks apart, and the recommendation is that recipients not resume pre-COVID life until a week after they receive the second dose. So if you got the vaccine today, if you were a good citizen, you’d be wearing your mask until January 10. But you most likely won’t be getting the vaccine today. It will take at least until late spring to produce enough doses and inoculate most of the population. In the UK, this means that when you get the vaccine depends on how vulnerable you are. People over 80 and care home staff are first on the list and then it goes down according to age range and pre-existing conditions. I am happy to say that no one will be allowed to pay to jump the queue. This might not be true in the US, where the care Rudy Giuliani and Donald Trump received for mild COVID cases tells you that some people are deemed more worthy of living than others. (Although that may change after January 20, too.) But even given that difference, it will still be pretty far into the spring before most people will be vaccinated. If all goes extremely well, we might be able to shave a few days off that 100, but May 1 seems like a pretty good target date to me. It’s just refreshing that we’ll actually have a plan to move forward without killing people and a target date for the end of the pandemic.

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