The Increase in Covid-19 Cases is Real: Hospitalization Has Gone Up in Trump States

Cases of Covid-19 infection are going up in the US.  Indeed, the daily number of new confirmed cases have been hitting record levels, with almost all of the recent increase recorded in states that Trump won in 2016.  But Trump has continued to insist the record highs are only because his administration has done such a great job in making tests finally available.  Health professionals who actually have expertise in such issues dispute this.  And many more people are seeking tests, even waiting in lines in their cars that are miles (and many hours) long.  You don’t do this if it does not look serious.

But while it is true that there would be fewer cases confirmed if we did not know about them due to fewer tests, one statistic this would not affect would be the number of those being sent to a hospital having contracted a severe case of the infection.  Numbers on those hospitalized due to the virus are available for most US states (with Florida an important exception – this will be discussed below).  One then gets the chart above when the hospitalization numbers for those states won by Trump in 2016 are compared to those won by Clinton (as a proxy for the more conservative, mostly Republican, states compared to the more liberal, mostly Democratic, ones).

The chart shows that there has been a marked increase in hospitalizations in the Trump states since about June 15.  Excluding Florida, hospitalizations in the Trump states have grown to almost 20,000 as of June 29 from only about 12,000 in early June, an increase of two-thirds.  In contrast, hospitalizations in the states won by Clinton rose fast early, but then fell.  Little was known early on about the virus and how fast it was spreading in the US, particularly in dense urban locations, in part because of the early blunders of the Trump administration that severely limited testing in February and into most of March.  But from a peak in hospitalizations in mid-April in the states won by Clinton, the numbers have come down steadily, although with some leveling off since mid-June.  They are now well below the number hospitalized in the Trump states.

The data comes from figures assembled by the CovidTracking project, a private initiative launched by The Atlantic Monthly.  The project has assembled, on a daily basis, figures officially reported by US states and territories on Covid-19 tests being conducted (and the positive or negative results), the number of deaths, the numbers hospitalized, those in an ICU and those on ventilators, and more.  The data available, and its quality, are only as good, however, as what the states and territories report.  While the figures on confirmed positive tests and on deaths appear to be of fairly good quality and completeness, what the states report on the other variables is uneven and often incomplete.  One then has to be careful in interpreting the numbers, as figures not reported by certain states (or on certain dates) are left blank and then treated as a zero when the national numbers are aggregated.  The figures on numbers in ICU beds or on ventilators are notably incomplete.  And one should be especially careful with the earlier numbers, as they are often quite partial.  The later numbers are more complete and generally more reliable.

The figures on those hospitalized due to Covid-19 are complete (as I write this) except for four states:  Kansas, Idaho, Hawaii, and notably Florida.  The number of cases in Kansas, Idaho, and especially Hawaii are all relatively small, in part as all three are relatively small states.  Based on a 7-day moving average to smooth out day to day fluctuations, the daily number of new confirmed cases in the three states totaled only 482 as of June 29 (with only 12 in the case of Hawaii, which has done a superb job of containing the virus that causes Covid-19).  In contrast, Florida alone averaged 6,589 cases daily in the 7-day period ending on June 29, or almost 14 times the other three states combined.  Florida matters – the other three states not so much.

But data reporting on the spread of Covid-19 by Florida has been especially poor, and politicized.  Rebekah Jones, the state employee who developed the Florida “dashboard” that presented the Covid-19 results by county was fired in May when she refused to manipulate the data in a way to make it appear that much of the state was meeting the criteria for reopening when in fact they were not.  She has since developed and made available over the internet a dashboard similar to the one she had developed for the State of Florida, but with data that has not been so manipulated.

The underlying problem was that Florida Governor Ron DeSantis (a close ally of Trump) had been declaring victory over the virus that causes Covid-19 already in early May, as he proceeded to reopen the state early and aggressively.  He held news conferences, including at the White House, claiming he had succeeded where others had failed, and that Florida should serve as a model for the country.  Trump lavished praise on the governor, saying he was doing a “spectacular job”.

It is therefore more than a bit embarrassing for DeSantis that cases in Florida have been rising so fast since his May 1 reopening.  For the US as a whole, the average number of daily new cases for the 7-day period ending June 29 was 37% higher than what it was for the period ending on May 1.  But in Florida, the number of daily new cases for the 7-day period ending June 29 was 11.0 times higher than what it was for the 7-day period ending May 1.

With the high number of cases in Florida, it is worthwhile to try to estimate, even if only roughly, what the hospitalization figures would look like if Florida reported its results.  They do have such data – they have reported on the number of new hospitalizations each day.  But this is incompatible with what most other states report.  And knowing the number of those infected with the virus who are currently hospitalized is closely monitored everywhere as it is important to know how close one is to current hospital limits on the ability to handle more cases.  But Florida has not made these figures available.

One can, however, make a rough estimate of what the impact would be if figures for Florida were available.  Other states with a similarly sharp rise in new cases since mid-June include Texas, Arizona, and Georgia.  Hospitalization figures are available for each.  In those states, the ratio of the number currently hospitalized (where one should keep in mind that those hospitalized for Covid-19 are always there for at least several days, and sometimes several weeks), to the 7-day average daily number of new cases, averages across the three states and on two dates to 1.015 (with not much variation around this average).  Using that ratio, one can estimate what the hospitalization figures in Florida might be, given the number of new cases found in Florida.

The result is shown in the curve in orange in the chart above.  The number of patients hospitalized due to the coronavirus in the Trump states would, with this estimate for Florida, have risen to over 26,000 as of June 29.  This is a third higher than the 19,600 hospitalized in the Trump states as of that date excluding Florida.  Or in another comparison, the increase in hospitalizations in the Trump states between June 15 and June 29 was 51% excluding Florida.  But with these estimates for Florida included, the increase over that period was an even higher 78%.

Trump’s reaction to this sharp increase in cases, concentrated in states that supported him in 2016?  It appears that he simply does not know what to do.  So while it has become clear that the increase in cases is real, with the increase in hospitalizations now also confirming this, Trump appears to have retreated into a fantasy world where the virus that causes Covid-19 simply disappears.  In an interview on June 29 on the Trump-friendly Fox Business Network, Trump said:

“I think we’re going to be very good with the coronavirus. I think that at some point that’s going to sort of just disappear”

He then added, “I hope”.  During the worst health crisis the nation has been through since the Spanish Flu pandemic of 1918/19, the US has a president who is lost, does not know what to do, and is reduced to hoping it will just go away.