It has been much noted in the news in recent days that confirmed cases of Covid-19 have been soaring in a number of states in the US, primarily in the south and southwest. But it is of interest to examine how widespread this is, and how it correlates with the politics of the different states. With the politicization by Trump of what should be a matter of public health, states (and their residents) are responding differently in their management of this public health crisis.
One way to look at this is to group the states according to who won there in 2016: Trump or Clinton. This divides the country roughly in half, between more liberal and more conservative areas. The chart above shows what then results for daily new confirmed cases (on a 7-day moving average).
The division is stark. The states won by Clinton (which included New York, New Jersey, the Northeast, Illinois, California, and Washington) were exposed early to Covid-19. These states are generally more highly urbanized and there is more international travel by both residents and visitors. This left them especially vulnerable as the virus that causes Covid-19 started to spread (first with little knowledge of how fast it was spreading, due to blunders in rolling out the necessary testing program in February and into much of March). But after peaking in April, these states brought down the daily number of new cases by over 60%, although with a partial and still limited reversal in the past week.
The pattern in the Trump states is quite different. Confirmed cases rose in the period leading up to April (in part as testing only became broadly available then), but then leveled off in these states through essentially all of April and May. Furthermore, the numbers leveled off at roughly 10,000 cases a day, or less than half the 21,000 cases per day seen in the Clinton states at their peak. The Trump states are often more rural, and there is less international travel (by both residents and visitors), so the lower numbers there were taken by some as indicating they were less vulnerable to this infectious disease.
But this then changed markedly at the end of May. As the states that voted for Trump relaxed their lockdown and social distancing measures, often rapidly, the case numbers began to rise. And over the last ten days they have accelerated markedly. The number of confirmed new cases is now significantly higher in the Trump states than they ever were in the Clinton states. And there is no sign yet of this leveling off. Quite the contrary – it is accelerating rapidly.
The similar figure for the number of deaths per day from Covid-19:
The number of daily deaths (again using 7-day moving averages) peaked in the Clinton states in mid-April at about 1,670, and has since come down to about 300 (or by 82%). In the Trump states the peak was only around 600, but it stayed there longer and then came down more slowly, to also around 300 now (so by half).
That the death rates have come down in each is encouraging, but it is still too early to know precisely why. It may be a combination of factors, including that doctors and hospitals know better now how to treat the most severe cases (with some therapeutics, such as dexamethasone and remdesivir, showing promise, while the doctors also now know that the therapeutic promoted strongly by Trump, hydroxychloroquine, may in fact increase death rates – the FDA has warned against its use). Also, hospitals have become less crowded at centers of the outbreak, at least until recently, which has allowed them to provide better care. Finally (and I would guess likely the most important reason, although I have seen no data on this), lower death rates would result if the age distribution of those infected has shifted to those who are younger. Death rates for the elderly are an order of magnitude higher than for the middle-aged (and two orders of magnitude higher than for the young), so even a relatively modest shift in the age distribution of those infected could lead to a marked change in mortality rates.
Finally, deaths from Covid-19 come only with an average lag that may be a month or more from the day of initial exposure (with this also differing by age). The number of daily confirmed cases began to rise less than a month ago in the Trump states (around May 30), and more sharply about ten days ago. We will see in the days and weeks ahead whether this will now lead to a rise in the death figures. So far, it appears that the daily death numbers have leveled off (since June 17 in the Trump states, and June 21 in the Clinton states), while they had been declining before.
But the sharp increase in the number of new cases over the last month, in particular in the Trump states as social distancing measures were lifted, suggests a number of lessons. One is that social distancing measures worked. When they were in place they brought down the number of new cases and deaths from the disease, while lifting them (or increasingly, ignoring them even while formally still in place) has led to a sharp rebound in the number of cases. Trump has now made this into a political issue, with his flagrant refusal to wear a mask or to keep a distance from others. In other times this would be considered bizarre behavior in a public health crisis, but is seen here by his supporters as a signal of freedom and independence rather than as a behavior that will lead many of them, as well as others, to become sick (and some to die).
The problem starts at the top. Rather than model responsible behavior, Trump has insisted he will never wear a mask in public – he believes it hurts his image. Trump also orchestrated his daily press briefings on the crisis so that through most of March the other officials present were crowded around him, shoulder to shoulder, with no masks. This only changed (and changed only partially) later. And now Trump has restarted his political rallies in large indoor arenas, with people crowded tightly together but with few wearing masks, while loud cheering is strongly encouraged.
Most importantly, the Trump administration has failed to address the real and important challenges of this pandemic. Rather, he has said recently (such as on an interview on June 17 on Fox News) that the coronavirus is “fading away, it’s going to fade away” even if no vaccine is ever developed. Similarly, at a rally at a megachurch in Phoenix, Arizona, on June 23, to an estimated 3,000 (mostly young) cheering supporters (with few, if any, wearing protective masks), Trump asserted that “It’s going away” while claiming his administration had done a wonderful job. And over the last week he has repeatedly said that he has asked for less testing to be done, since with less testing there will be fewer cases confirmed. See, for example, this June 23 tweet, where he says “With smaller [sic] testing we would show fewer cases!”. Certainly true, but why he would think this wise is worrisome.
Over 124,000 Americans are now dead from the virus (as of today). This is well more than in any other country in the world (Brazil is second at 55,000). The US has had 377 deaths per million of population. In contrast, Japan has had 8 deaths per million, South Korea 6, Australia 4, New Zealand 4, Singapore 4, Hong Kong 0.9, and Taiwan 0.3. As noted in an earlier post on this blog, the US could learn a lot by simply examining why those countries, all with far closer interactions with China through travel and trade than is the case for the US, have been able to contain the virus while the US has not.
While there are a number of elements to a successful program, one simple but key component is the wearing of masks. This is common in East Asia, and no one there treats the wearing or not of a mask as a political statement (nor did anyone in the US, until this crisis). It is simply something easy to do that will protect the health of you, the ones you love, and others.
Yet even now, a full half-year since the start of this crisis, it remains difficult to find in the US the N-95 masks that are the most protective against a viral infection. Supplies are short, and the masks that are available are provided (as they should be under the circumstances) only to health professionals (although even here there are shortages). The regular population cannot find such masks other than on a black market (with those available of uncertain pedigree and reliability). Yet N-95 masks are not hard to make. 3M is the major manufacturer, it is based here in the US, and it would be straightforward to open up additional production lines. Why hasn’t the Trump administration done something to ensure an adequate supply?
Consider, for example, what a more capable administration might have done. After ensuring an adequate supply, a box of say a dozen masks per person could be mailed to every household in the US. With 120 million households (an average of 2.6 people per household), and assuming a production and mailing cost of $20 per household, the total cost would be $2.4 billion. This is less than one / one-thousandth of the $2.8 trillion that Congress has already approved to be spent to provide partial relief to the effects of the economic crisis brought on by the pandemic. If everyone then wore such a mask every time they left their home, within a few weeks there would likely be a major knock-back of the infection chain to where focused efforts on the hotspots that might then still remain, or hotspots that later spring up, could be very effective.
This might well be unrealistic. But even if feasible it would not go far in the current political environment. Even if an adequate supply of such masks were made available, the politicization by Trump of this public health crisis means that many of his supporters would refuse to wear a mask. They now see it as a statement of their political, and indeed cultural, beliefs to openly and flagrantly refuse.
As others have noted, it would be hard to find a time when the US was more poorly served by its president than now.