The White House has steadily raised the forecasts for COVID-19 deaths and this week, President Trump warned >100,000 deaths are likely compared to what looked like 65,000 a few weeks ago. Part of this can be attributed to states opening up their economies and thus, naturally making a trade-off between economic hardship and pandemic hardship. And part of it is better tracking by states. The CDC released some data comparing reported US deaths in 2020 (2/1-4/25/2020) vs what was expected and it shows overall US deaths are 3% below expected–the lockdown has led to “avoided” deaths in car accidents, overdoses, murders, etc.
This pandemic is a global tragedy. And when we look at the mortality, the risks are much greater for older Americans.
But nursing homes have been a much greater source of COVID-19 cases and deaths. Our data scientist, tireless Ken, compiled nursing home statistics for 10 state (~50% of US population) and the statistics are heartbreaking (and a full discussion is Point #3 below):
In these 10 states:
– nursing home residents total 671k or 0.4% of the population
– nursing home residents account for 18% of cases or 44X the pop ratio
– nursing home residents account for 42% of deaths or 102X the pop ratio
These are absolutely shocking to me — nursing home residents are a mere 0.4% of the population but are 18% of cases.
This has many policy implications and it particularly weighs in one the policy trade-off of economic hardship vs healthcare. Nursing home residents need special protection and accommodations. But residents of these homes are not part of the workforce, nor large consumers of the movement economy. And this also suggests less healthcare risks for non-nursing population if the economy is re-opened.
But this is simply a really difficult challenge to navigate.
POINT #1: US new cases up to 24,320 (vs 22,483) — CA reports >1k 1D surge and mostly from LA county (like last week). NY cases steady
On the COVID-19 new cases front, Wednesday was another day of ups and downs (by state) and the overall US reported cases was 24,320, up from the day prior. Total cases have a strange cadence of downward progress, followed by spikes. So today’s rise falls within that normal volatility. And as the chart below shows, the 24K reported today is 36% below the peak reported 12 days ago on 4/24/2020 of 36k cases.
Source: COVID-19 Tracking Project + Johns Hopkins
On a state-by-state basis, NY #1 again as NJ cases plunge. CA + MA + Delaware see surges…
There is value in looking at daily reported cases by state because outbreaks are regional and state-level data is a good place to “dashboard” the breakouts. Looking at the state-level data, we see 3 states posting sizable jumps:
– CA saw cases surge to 2,603 vs 1,275 (yesterday) +1,328 delta
– MA saw cases rise to 1,754 vs 1,184 (yesterday) +570 delta
– Delaware cases leaped to 407 vs 83 (yesterday) +324 delta
Total 3 states +2,222 delta
So these 3 states pretty much explain the >1,800 rise in cases reported by the US today.
And as a side note, Virginia had a technical error today and did not report COVID-19 data today.
Source: COVID19 Tracking Project + Johns Hopkins
California 1D rise is almost solely from LA County…
California reported a new high in cases at 2,603. According to L.A. County Public Health Director Barbara Ferrer, this >1,300 increase in reported cases is due to a “lag in data” over the weekend.
The “lag” makes sense. The state is set to open up parts of its economy by Friday, and yet, CA Governor Gavin Newsome made scant reference to the case surge in his daily press briefing. The focus today was on the depths of the economic carnage and how long it would take the state to recover. The governor may be right (that it will take a long time), as the future is uncertain. But it is also smart policy. Set expectations low and “beat and raise” — I am sure one of the many tech companies in CA could provide similar advice.
Source: CA Dept of Health
Like last week, LA county posted a peculiar and unexplained 1D >1K surge…
The county level case data for CA is shown below. And as shown, the >1,300K increase is almost solely due to LA county. San Bernadino and San Diego and Orange saw rises, but much more modest.
– As you look down the list, so many CA counties have few reported cases.
– Look at Santa Clara (1.9mm residents) and 11 cases
– Sacramento 1.6mm residents and 6 cases
Source: CA Dept of Health
NY state cases are flat, a good sign given the massive decline pasted in past few days…
Since passing its apex and now decisively seeing a sustained drop in cases, NY state is receding from prominence, to an extent. That is not entirely true since the opening of NY state fully and especially NYC will be a “global event” given that NYC/NY has been the epicenter of the crisis.
But for today’s note, we see little need to focus on the case data there.
Source: NY Dept of Health and COVID-19 tracking project
POINT #2: Despite improving “daily new case” statistics, deaths are lingering at a high level in the US
So far, the US has reported 67,332 deaths from COVID-19 and the daily death figures still hover around ~2,000 per day. So while cases have fallen 36% and many states are seeing rapid declines in cases, the deaths reported have not declined. This is a pretty unusual divergence, in the sense that other nations showed a fairly predictable lag between peak cases and subsequent peak death. But in the US, the deaths have lingered.
Source: COVID-19 Tracking Project
White House has warned deaths could exceed 100,000 vs prior forecasted peak of 65,000 or so…
The projected cumulative deaths are also on the rise for America. The White House this week warned that death tolls could exceed 100,000 from a prior 65,000 or so. So this is a sizable jump. There are many reasons posited for this rise, including the fact states are relaxing some restrictions, and also due to expanded testing and forensically re-categorizing deaths since Feb.
And the IHME model, which we found to be remarkably accurate, forecasts US total deaths to reach >134,000 by August 4, 2020. This model previously expected 65,000 deaths, so it has been revised sharply higher.
Source: IHME
But the projected rise in COVID-19 deaths does not necessarily mean more Americans are dying in total in 2020…
The CDC recently published additional data on death surveillance for COVID-19 (special thanks to the folks at Deltec for flagging good info for us on this CDC data and on NYC transit info). Among their analyses:
– they provided cumulative deaths in the US from 2/1/2020 to 4/25/2020 compared to “expected” based on past seasonal patterns
– this data is also calculated by the state.
Below is the data by state (the USA overall shown in blue) and the number represents – 2020 deaths (during the period noted) compared to “expected” based on past patterns.
– Notably, the US deaths in the 2020 period at 3% below (97% of expected) what is expected 2/1/2020 to 4/25/2020.
Basically, the quarantine has resulted in “avoided” deaths from car accidents, drug overdoses, accidents, etc and thus, total deaths are lower. This is true for the US overall. But the hardest COVID-19 hit states tell another story:
– NYC deaths are 119% higher than expected (219), a horrifying outcome, and MA is +12% higher.
– Of the 50 states, 40 have deaths BELOW expected.
https://www.cdc.gov/nchs/nvss/vsrr/covid19/index.htm
POINT #3: US nursing homes are 0.4% of US population, 18% of COVID-19 cases (44X greater) and 42% of deaths (102X greater)My good friend, Xuan Yong, founder and CEO of Rig-up, has been puzzled by the disproportionate hit taken by nursing homes and asked if we had any data. Rig-up is a renewable, utilities, and energy technology services company, backed by Founders Fund.
Nursing homes have been the absolute epicenter of the COVID-19 crisis…
Our data scientist, tireless Ken, was able to gather COVID-19 statistics for 10 states in the US and it is presented in the table below. These 10 states have a total of 164 million residents (~50% of US) so it is a very representative sample set. And the data is extremely troubling:
– Nursing home residents total 671k rin these 10 states or 0.4% of the total.
– Nursing home total 79,734 COVID-19 cases, or 18% of the total. 44X vs population share.
– Nursing home total 25,489 COVID-19 deaths, or 42% of the total. 102X vs population share.
Source: Dept of Health of each state
Residents of nursing homes are 44X more likely to catch COVID-19… how is this possible??
Think about that.
How can nursing homes represent 18% of the COVID-19 cases when nursing home residents are 0.4% of the population. It means the chances of catching COVID-19 are 44X higher in a nursing home than a non-nursing home.
Does that make sense?
We are a bit speechless.
And the death toll is staggering. Almost half of all deaths from COVID-19 are nursing home residents. Perhaps this is the reason the White House is expecting higher death tolls. Nursing home residents are very vulnerable individuals.
In CT and IL, 43% and 11% of nursing home residents have COVID-19…
CT and IL provide case data by age and we took those figures for residents >age 60. And we can compare the COVID-19 statistics between those in LTC (nursing homes) and those not in LTC.
– In CT and IL, about 2.5% of those over age >60 are in a nursing home.
– COVID-19 case prevalence is 42%/11% of nursing home residents of CT/IL
– For >age 60 in CT/IL, COVID-19 prevalence is 0.3%/0.1%
For someone >age 60, the chances of catching COVID-19 in a nursing home is 157X in CT and 105X greater in IL.
That is a staggering difference, when looking only at those >age 60.
Source: CT and IL dept of health
The tragic toll at nursing homes is well known and states are sanctioning nursing homes for under-reporting cases and deaths…
The tragedy of nursing homes has been well known in NY state. Gov Cuomo has been vocal and criticized and likely pursues other actions against NY state nursing homes which have under-reported deaths from COVID-19. And example is below.
STRATEGY: Policy and economic implications of nursing homes accounting for 18% of COVID-19 cases (vs 0.4% population) and 42% of deaths
I think this is just heartbreaking. How is it possible that 1 in 5 COVID-19 cases is in a nursing home? Perhaps because older adults have presumably weaker immune systems, the chances of transmission are higher.
Taking a step back, the high concentration of cases and deaths in nursing homes also implies significantly lower risks outside nursing homes.
– the US economy largely functions outside nursing homes.
– the risks of deaths and case transmission are lower outside nursing homes.
And as such, the implication of this data suggests the risks of re-opening the US economy are lower. But steps need to be taken to mitigate this tragedy in nursing homes.
