Which states in the US should reopen first?

In the US, the debate regarding when the economy should reopen is intensifying.

On April 16, multiple reports suggested that the following nine states will be among the first to reopen in the US: Alaska, Hawaii, Maine, Montana, Nebraska, North Dakota, Vermont, West Virginia and Wyoming. In a statement made on the evening of April 16th, Dr. Deborah Birx, a medical expert on President Trump’s coronavirus task force, indicated that two key characteristics common among these nine states are: 1) each state has experienced fewer than 1,000 Covid-19 cases, and 2) each state has experienced fewer than 30 new cases per day.

While Dr. Birx’s statement is true, we obviously must consider the fact that the average population of these nine states is approximately 1.1 million. In contrast, the average population of the other 41 states is 7.7 million.

If we account for differences in population, how do the nine states identified for reopening on April 16 compare to the rest of the country? OnFrontiers has recently established the Covid-19 Expert Helpdesk to address these types of complex questions. 

The following visualization illustrates differences between the nine states targeted for reopening (represented by black dots) and the other 41 states and Washington, D.C. (represented by orange dots). We define ‘cases’ here as the cumulative number of Covid-19 cases reported by each state as of April 12th based on data reported by Johns Hopkins University. We define ‘tests’ as the cumulative number of Covid-19 tests conducted in each state as of April 12th based on data reported by covidtracking.com.

While each of the nine states have clearly experienced a relatively low number of cases, after we adjust for total population (i.e. the number of cases per state per 1,000 people) these nine states do not differ substantially from dozens of other states. The average number of cases per 1,000 people in the nine states is 0.48 while the average number of cases per 1,000 people in 24 other states that have experienced the least number of cases is 0.56. Of the nine states, Vermont has the highest number of cases per 1,000 people, at 1.17. Of the other 41 states, 26 have experienced fewer than 1.17 cases per 1,000 people.

Another factor that we must consider when interpreting these data is the number of tests conducted in each state. When we compare the nine states to the other 41 states in terms of testing per 1,000 people, we see little difference between these two groups of states. The average number of tests per 1,000 people in the nine states is 10.24, while the average number of tests per 1,000 people in the other 41 states is 9.05. In the nine states, Maine has conducted only 5 tests per 1,000 people. Only five states (Virginia, California, Kansas, Alabama, and Texas) have conducted fewer tests per 1,000 people than Maine. In the other 41 states, 36 states have conducted more tests per 1,000 people than Maine. 

Events in South Dakota over the last week highlight the potential trend in Covid-19 cases that the nine states targeted for reopening could experience after they reopen. South Dakota’s total population (884,659) is similar to that of Montana (1,068,778). As of April 12th, South Dakota had conducted more testing per 1,000 people (9.67) than Montana (8.34). However, from April 12th to April 17th (as of 2:25pm EST) the number of cases in South Dakota nearly doubled - increasing from 730 to 1,411. This has led to an increase from 0.83 cases per 1,000 people on April 12th (less than the number of cases per 1,000 people in Vermont as of that day) to approximately 1.6 cases per 1,000 on April 17th. 

This evidence is concerning given that more than one of the nine states targeted to reopen could experience an increase in cases similar to that seen in South Dakota. A state with a small population and relatively few total cases as of a specific date is neither necessary nor sufficient to justify reopening.

OnFrontiers’ Covid-19 Expert Helpdesk

OnFrontiers has established the Covid-19 Expert Helpdesk to accelerate learning about strategies to combat Covid-19 and minimize its impact on society. More than 100 experts have joined the Covid-19 Expert Helpdesk and we are continually adding more experts. A sample of our experts can be viewed here.

If you are interested in learning more about the Helpdesk or supporting this initiative, please contact Derek Willis at: [email protected]

Visualization developed by Carol Castillo Cavero and Rachel Sevey.