Week 26 COVID-19 State Status Ranking Update
Robert Kofsky
Retired Executive Director of Operational Excellence and Business Operations
The two Key Performance Indicators (KPIs) outlined in a former article, “COVID-19 Pandemic, How Does Your State Rank?”, generated the following high-level state status update at the end of week 26 (June 26, 2021).?
Summary: The week 26 COVID-19 update shows the United States has turned the corner concerning the pandemic with a decline in the daily death rate by approximately 22% over the last 4 weeks and a 91% decline from the peak which occurred in week 3 (January 16, 2021), as quantified in the Week 26 COVID-19 State Status Ranking Dashboard and summarized in this article.
As seen in Figure 1, the US daily death rate has been dramatically dropping since week 7, with a week 26 average daily death rate of 337 deaths per day in the United States (50 states plus the District of Columbia) or 2,359 deaths per week. This decline is good news; however, the magnitude or number of deaths is still approximately 2.1 times the flu/pneumonia death rate.
Using a simple extrapolation of the daily death rates over the last three weeks, it is estimated the COVID-19 death rate will be similar to the annualized US influenza or the flu death rate (161.7 deaths/day) in later part of week 29, specifically July 17th as seen in Figure 2.
Based on the state ranking dashboard for week 26, 19 states have an overall status in the green (see Figure 3) resulting from both a declining death rate and a reduction in the magnitude of deaths compared to the annual influenza/pneumonia death rate. Fourteen states had an overall yellow status. Unfortunately, 17 states had an overall status in the red.
The logic to rank states (1 - 50) shifts as states achieve maximum scores for both the Death Rate KPI and Magnitude of Deaths Comparison to Influenza/Pneumonia KPI. For states with maximum scores for both these KPIs, the ranking is done using the following criteria.
Figure 4 shows how this alternate ranking method was used for the first 15 states with an overall green status and with maximum scores for both KPIs.?The ranking was done by first comparing the Last 7 Days COVID-19 Deaths per Capita metric, and then by the Overall or Total COVID-19 Deaths per Capita metric.
The remaining 4 states with an overall status as green (South Carolina, Iowa, West Virginia, & Maine) did not have a perfect score and were ranked by the overall score.
Overall Improvement as highlighted in Figure 1, is consistent with the decline in the number of cases since January 15th as seen in Figure 5, published by the CDC. Around April 9th (week 15), there was a slight increase in cases which may account for the slow reduction in the number of deaths from week 15 to week 18; however, since April 9th the number of cases has been declining by approximately 822 cases/day (slope of line) or 2.6%.
End of July Estimate: Using the week 26 numbers, the simple algorithm used to project the total US deaths found in the State Ranking Dashboard was updated and projects approximately 9,973 additional deaths between week 26 and the end of July, bringing the total end of July projected deaths from COVID-19 to 607,370 for the 50 states and the District of Columbia. See Figure 6. This algorithm estimates the daily death rate to be approximately 230 deaths/day at the end of July, which is a 32% decrease from the week 26 rate of 337 deaths/day. This projection estimate is heavily influenced by the slowing death rate decline from week 25 (339 deaths/day) to week 26 (337 deaths/day) and is inconsistent with the simple extrapolation in Figure 2, which shows a greater decline in death rate. Unfortunately, the CDC daily case numbers in Figure 5 shows a recent flattening of the curve that supports the declining death rate numbers and the Figure 6 projection.
It should be noted that many US deaths reported by the media include US Territory deaths, which are not included in this model or reported in this article. United State Territory deaths are approximately 17,108 at the time of this article.
Best States: As shown in Figure 7, all of the top 10 best ranked states have an overall status as green.
Worst States: Colorado is the worst ranked state in week 26, followed by Wyoming, as seen in Figure 8.
Other States: Figure 9 summarizes the remaining states that are not in either the top 10 or bottom 10 states. Encouraging is the number of states (9) with an overall status as green in this list of other states.
Overall, 18 states improved compared to the prior week (week 25), 13 stayed the same, and 19 declined as summarized in Figure 10. Oregon had the largest improvement; whereas, Delaware had the greatest decline in week 26, followed by Utah. See Figure 11 for the other states.
Overall Direction: Using the Red, Amber, & Green scores for each state, a simple method is used to determine the overall direction of the COVID-19 impact. By assigning a numerical value to each color (Red = 0, Amber = 7, & Green = 10) an overall score ranging from 0 - 100 is calculated, with 100 being the best possible score.
Figure 12 is a trend chart of these overall state scores based on the State Status icons (red, amber, & green) for all 50 states in the dashboard. The week 25 score of 63 and the week 26 score of 58 out of a possible maximum score of 100 shows a large improvement since this data was being collected. The decline from week 25 to week 26 implies a potential negative directional change, but additional weekly data is needed to determine if this trend continues.
Figures 13 and 14 show this same quantification for the two KPIs used to calculate the overall score. The Death Rate KPI (Figure 13) score of 47 out of a possible 100 shows a decline from week 25 and is driving the drop in the overall score (Figure 12). Figure 14 shows the quantification of the KPI comparing the magnitude of COVID-19 deaths to influenza/pneumonia or flu deaths is at 72 out of 100, indicating states' COVID-19 magnitude of deaths has dramatically improved over the last several weeks.
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The Normalized Death Rate KPI may be partially impacted by the lower death rate numbers and possible reporting issues. Figure 15 shows how Utah's rate declined 2 weeks ago and then jumped up over the last past 7 days. At 4.32 deaths/day, Utah's death rate is approximately 4.5 times the annualized flu/pneumonia rate for the state.
Magnitude of Deaths: The week 26 COVID-19 death rate comparison to the influenza/pneumonia mortality rate is summarized in Figure 16. As seen in this graph, Colorado's daily death rate averaged over the last 7 days would produce a total number of deaths in a year which is 872% of the total annual deaths due to influenza/pneumonia. Montana (506% of flu/pneumonia rate) has the second highest followed by Idaho (499% of flu/pneumonia rate).
The Influenza/Pneumonia Comparison KPI is scaled from 0 to 10 with a score of 10 given when the daily death rate averaged over the last 7 days would produce a total number of deaths in a year less than or equal to 200% of the annual influenza/pneumonia deaths. A KPI score of 0 is assigned when this comparison is greater than 300%. Between 200% and 300%, the KPI is scored proportionately.
For week 26, 29 states had scores of 10 for this KPI (Figure 17). Ten states (North Dakota, New Mexico, California, Ohio, New Jersey, Nevada, Louisiana, Oklahoma, Minnesota, & Texas) were in the 200% to 300% range and had graduated scores between 0 - 10. The remaining 11 states (Georgia, Michigan, Washington, Wyoming, Arizona, Florida, Delaware, Utah, Idaho, Montana, & Colorado) had death rates above the 300% of influenza/pneumonia rate and scored zero for this KPI.
Total Deaths per Capita: Figure 18 visualizes the total deaths to date per 100K of population, or deaths per capita. As of week 26, New Jersey has the highest deaths per 100K of population, followed by New York. Hawaii and Vermont have the lowest total deaths per capita.
Total Deaths to Date: At the end of week 26 there were 597,397 COVID-19 deaths in the continental United States plus Hawaii. Figure 19 breaks down these deaths by state. California has the highest Covid-19 deaths (62,739). Vermont, with 256 deaths, has the lowest number of total deaths.
Percent of State Population Infected to Date is calculated to provide an insight on progress towards herd immunity. This is achieved when the spread of the virus in the population is hindered due to a high level of immunity. For COVID-19 it is estimated 60% - 70% of the population needs to be immune, resulting from disease recovery or vaccination, for this to occur; however, for the new more transmissible variants, a value of 80% - 85% may be needed.
Assuming an overall mortality rate of 0.4%, a crude state estimate of percent already infected is calculated as seen in Figure 20. New Jersey (74%) and New York (68%) have the highest estimated percent infected to date. In terms of the entire United States, this methodology estimates 45.5% have already been infected as of week 26.
Vaccines: At the time of this article (June 30, 2021) vaccines are being administered at a rate of 1,002,134 doses per day in the United States (including territories). This is up 4.7% from the 956,705 doses per day in the last state ranking update (June 3, 2021). Since April 19th, the vaccines administered have been declining by approximately 31,059 doses per day as seen in Figure 21.
In the 50 states and the District of Columbia, 377,197,741 vaccine doses have been distributed to date and 321,251,049 have been administered (85.2%) with approximately 54.0% of the United States population having received at least one dose of the vaccine.
Figure 22 summarizes the percent of each state's population that has received at least one dose of a COVID-19 vaccine as of June 30, 2021. Vermont (73.97%) and Massachusetts (70.4%) have been most successful in vaccinating their population. Mississippi (36.2%) and Louisiana (38.1%) have been the least successful in vaccinating their population.
Unfortunately, there are no available data to determine progress toward herd immunity from a combination of natural immunity (recovering from the virus) and through vaccinations. As such, the best estimate of when herd immunity will be reached should be based on vaccination progress. Using the following assumptions, a rough estimate of when each state will reach herd immunity, or 80% of the population vaccinated, was developed (Figure 23).
Assumptions
Based on the current vaccination rates, herd immunity in the United States will not be achieved until 2023. As seen in Figure 23, North Carolina is projected to be the first state to reach herd immunity in September 2021 and North Dakota will be the last with an estimated date of May 2023.
As noted in the last several updates, there has been a dramatic change in the wrong direction as to when herd immunity will be reached, which is a direct result of the vaccination rate slowdown. Figure 24 shows the additional time (red bars) needed by 35 states and the District of Columbia to achieve herd immunity from the week 22 update. The green bars indicate those states needing less time to achieve herd immunity compared to the last update (week 22).?
The large reduction in the time required to reach herd immunity in both North Carolina and Alabama is surprising and could be a result of data reporting issues. For example, the North Carolina Vaccination Rate illustrated in Figure 25 shows a recent spike in the state’s vaccination rate as reported on the Bloomberg Vaccine Tracker website.
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