It has been obvious for quite a while that death rates from covid-19 vary from rural to urban states, in somewhat the same manner as the transmission rates (overall) have varied — low in rural states, high in urban states. As the case rates for all states continue to converge (rural states on the upswing, urban states on the downswing), I took a look back at death rates.
Death rates start low and increase because of the lag between cases being detected and them running their course. The period of illness for covid-19 is notoriously long (and expensive) so it makes sense that death rates would start low and then increase. It also makes sense that as testing increases and the percent of people testing positive decreases (which happened across rural to urban states), the death rate would decrease as more people with mild cases are detected. In the early days, only the sickest were tested and the death rate was consequently much higher. So we see a decrease in death rate after an initial peak in all but the most urban states. Now, after a few months, the disparity in death rates is still there. One could argue there are three groups — the most rural 20% of states with the lowest death rate at 2.5% of confirmed cases, the most urban 20% of states with the highest death rate, and the middle 60%, which is currently just below the most urban states (at 4-5% instead of 6%).
Many things could explain these differences — different demographics (age distribution), pre-existing conditions, different standards of care, level of hospital crowding, how long people wait to get medical care (correlated with poverty and fear of medical bankruptcy), systematic differences in vulnerability associated with genetics (see https://www.washingtonpost.com/…/f6acc1a0-ab35-11ea-9063-e6…) and the list goes on.
A couple of other interesting things pop out looking at the composite graph of positive rate, testing rate, and death rate. The positive rate in the most urban state is still only just over 10%. That means at the state level those states, which have been hit the hardest, are still no where near herd immunity (if infection gives any sort of long-term immunity). Even if we use the lower death rate for rural states, allowing the positive rate to get to 70% continues to look like a humanitarian disaster. The alternative is to continue and expand efforts to stop the spread of the virus through continued distancing measures and mask wearing. But there we have to deal with a staggering level of ignorance, apathy, and open hostility from a portion of the public that no longer trusts any experts other than their favorite TV or radio personality. The neutral expert who is actually interested in protecting the public welfare still exists, but is not accepted based on politics.
Arizona. You are still in the spotlight. But the rest of the south has been heating up as well.
Travis Longcore 