Acknowledgement

 

Takuo Aoyagi, an inventor of the pulse oximeter, an ingenious and indispensable medical device that measures oxygen in the blood and has become a staple of hospitals around the world, emerging in recent months as a key tool in the fight against the novel coronavirus, died April 18. He was 84.  Washington Post

This US County health analysis is dedicated to individuals who are the victims of the Covid-19 virus and to all the people working hard to keep our US Counties safe and nourished.   Takuo Aoyagi was 84.

 

Analysis Background — Data as of May 7, 2020

 

This analysis uses County statistics to report on public health outcomes relating to the covid-19 crisis.  The hope is that this information will help support investment decisions by County administrators to improve resident health services and public health.  This analysis uses County ethnicity statistics to learn about the impact of covid-19 across 3,142 US Counties.

 

The upshot on ethnicity is that Counties with above average White American populations have fared very well in the crisis.  While it is early still and this may change, the analysis suggests Counties with above average Hispanic American and African American populations require investment to improve their public health and health care services and reverse the current covid-19 trend.

 

The chart shows covid-19 deaths as a percentage of state population and the ethnic percentages for each state.  States are ranked by number of covid-19 deaths from low to high.

 

 

“Prosperity is more complex than just consumption.”  The covid crisis has proven that a healthy, safe workforce is required for a strong consumer society and is essential to a sustainable economy.  Can US economists begin to measure our markets and corporations by valuing what they create not just in terms of goods and services, but also in how much sustainable value they deliver in the form of improved health outcomes for our workforce and consumers?

 

 

Analysis of Covid-19 Deaths

 

This analysis reports covid-19 deaths against key County health and demographic statistics, such as ethnicity.  These characteristics are used to split Counties into two unequal-sized groups, with Counties having the characteristic accounting for roughly 40% of the US population and the balance of Counties without the characteristic accounting for about 60% of the US population.  County health and demographics, as well as covid-19 deaths, are then examined.  All things being equal, covid-19 death percentages should also split by the same 60/40 ratio, but of course, they do not.  Side-by-side bar charts illustrate what’s going on in each County group and for the County populations when split by those with and without the characteristic in question.

 

The pandemic fell early and heavily on 6 NY state counties.  This especially affects the results of the group of 44 large US metropolitan “A” Counties with 1 million residents or more.  They account for 28% of the US population and 47%, or about 33,000 of the 70,000 covid-19 deaths today.  When New York state is removed, the proportionate balance is restored: 1 million+ “A” Counties are 27% of the US population excluding New York state and report 27%, or about 12,000 of 45,000 covid-19 deaths.

 

However, on removing New York state, another imbalance comes to light for 228 “B” Counties having between 250,000 to 1 million residents.  They account for 36% of the US population and 55% of covid-19 deaths when New York state is removed.

 

To better understand these imbalances, this analysis goes back to all states and works backwards looking at the County characteristics associated with the fewest covid-19 deaths, beginning first with above average White American populations according to the Census.  In the graph below, US Counties are split into two groups with the results for above average White American population Counties highlighted in orange.  The above average white population Counties have 34% of US residents, yet they only account for 13%, or 9,000 of all covid-19 deaths.

 

The population percentage and covid-19 death percentage among above average White American population Counties are an imbalance.  The graphs show for largest to smallest County Sizes that each group of above average White American population Counties (orange bars) has a proportionately larger share of the US population percentage (left chart) than share of US covid-19 deaths (right chart).  If covid-19 public health and health care were equally available to all US Counties the left and right orange bars would be the same size, but there is an imbalance indicating above average White American Counties are safer.

 

Counties where White Americans are 85% or more of the population (orange) or not (blue)

 

The imbalance of covid-19 deaths in above average White American Counties must be made up in Counties with either above average Hispanic American or African American populations, or both.

 

Above average Hispanic American population Counties account for 39% of the US population.  They account for 57% of covid-19 deaths as of today.  The imbalance in “B” Counties is apparent for this split of the data as above average Hispanic American populations in “B” Counties have a disproportionately larger share of covid-19 deaths than their population would indicate.  When New York state is excluded this imbalance in more than expected covid-19 deaths in “B” Counties with above average Hispanic American populations appears.

 

Counties where Hispanic Americans are 18% or more of the population (orange) or not (blue)

 

 

 

Counties with above average African American populations account for 37% of US residents.  All things being equal, one would expect the same percent of covid-19 deaths but their share of covid-19 deaths is 60%.  The imbalance described here is the mirror image opposite of what was illustrated earlier for above average White American Counties.  Where Counties have above average Where American populations the share of covid-19 deaths is smaller than expected.  Where Counties have above average African American populations the share of covid-19 deaths is larger than expected.

 

Counties where African Americans are 13% or more of the population (orange) or not (blue)

 

It is worth noting that race and ethnicity are defined separately on the Census, so many Hispanic residents also report their race.  As a result, some end these numbers end up what we think of as the White American or African American totals.  This is the double counting in the Census data when working with ethnic populations that needs to be managed: Whites are 77%, Hispanic are 18%, African are 13% which comes to 108%.  Adjustments are not commonly made and would not change the outcome of this analysis in any case, so none have been attempted here.

 

Counties with above average White American populations are faring well through the covid crisis. Counties with above average Hispanic American populations, especially “B” Counties, and above average African American populations require more investment if they are to reverse the current trend in covid-19 deaths and improve their public health and health care services.

 

“Prosperity is more complex than just consumption.”  The covid crisis has proven that a healthy, safe workforce is required for a strong consumer society and is essential to a sustainable economy.  Can US economists begin to measure our markets and corporations by valuing what they create not just in terms of goods and services, but also by in how they create sustainable value delivered as improved health outcomes for our workforce and consumers?

 

Update on Forecasted Covid-19 Deaths

 

The University of Washington’s IMHE is the pre-eminent US source for estimates of future covid deaths.  It creates the “covid curves”.  Last week the IMHE raised the estimate to 134,000 deaths by August, 2020.  It had previously been 70,000 but US Counties already reported that many, so the IMHE update was obviously needed.  (Our leaders should learn from TV weather forecasters who call for rain even when there’s a relatively small chance.  We’d at least like to know – and I’m referring to County health officials here — about the worst case scenario.)

 

Estimated infections were added to the IMHE data repository and contribute to improvements in their latest models.  Newly available covid-19 test samples, stratified by US geography, help estimate infection rates across each state.  Currently, IMHE assumes the US has a total of 11 million covid-19 infections.  This is close to 10X more than the 1.2 million confirmed cases we see in today’s news.

 

That said, confirmed cases are difficult to make much use of because of how they are reported.  The same goes for number of tests administered.  Confirmed cases are positive test outcomes made at hospitals but there are a lot of “if’s” behind them: a) if the test is given to someone with symptoms b) if a trip was made to a test center c) if results were reported to county health commissioners, d) if there was no mistaken false negative, and e) if someone doesn’t have symptoms we’ll never know.  The IMHE uses testing per capita perhaps as a public health measure but not the raw number of confirmed cases in their covid-19 models.  They use estimated infections.  And, TV news would do well to report that there have been an estimated 11 million covid-19 infections to date.

 

The IMHE models continue to rely on factors that affect transmission rates including state school and business closures, travel restrictions and mobility, hospital resource availability, and social distancing measures.  (It would surprise me if IMHE does not use County health and census demographics in their models.  I would hope they do but don’t seen any indication so far.)  Some numbers to keep in mind:

 

• Deaths per Capita 0.02% rising to 0.04% by August — 1 to 2 out of every 5,000 people
• Deaths per Infection 0.53% (1 out of every 200 covid-19 infections die)

 

But as is evident in this chart, and in the discussion above, Deaths per Capita is a generalization.  The likely outcome from a covid-19 infection depends heavily on your County health and demographic characteristics – as well as your own health.

 

State Deaths per Capita and per Infection — States ranked from low to high number of covid deaths

 

The chart ranks states from low to high by number of covid-19 deaths, similar to the ethnicity graph shown in the beginning of this analysis.  The message is simple: if the number of infections grow then more people die.  That may be seem obvious, but some County administrators are making decisions as if this is not going to happen.  The IMHE model does account for ill-advised decisions when they see them.  And, in case you’re wondering, “immunity percent” does not enter into the IMHE equations.

 

 

Update on Past Analyses

 

Above Average Minority Counties.  US counties where populations of African American or Hispanic are 50% or above the US averages — that is, 19%+ for African American or 27%+ for Hispanic — have 43% of the US population and account for 52% of US covid-19 deaths.   We note that D Counties with above average Minority populations also have very large covid-19 death rates (bottom orange bar at right), though this is a small number overall.  Note this chart will be replaced with the current analysis charts next week.

 

Counties with 19%+ African American or 27%+ Hispanic (orange) or not (blue) by County Size

 

 

Age 60+.  35% of the US population live in older Counties with above average Age 60+ populations (orange bars on the left graph).  Since 8 of 10 covid-19 deaths are adults 65 years and older Counties with above average Age 60+ populations, especially C and D Counties, are vulnerable in the covid crisis.

 

Counties where Adult Age 60+ is (orange) or is not (blue) 23%+ of County population by County Size

 

 

Heart Disease.  It may seem like Heart Disease is a “city problem”, and it is, even when New York state is removed most covid-19 deaths are found in counties with above average Heart Disease deaths.  Populations in rural C and D Counties with above average Heart Disease deaths also have relatively more covid-19 deaths, but this is not related to these Counties have older age populations.

 

Counties where Heart Disease causes 0.2% or more population deaths (orange) or not (blue)

 

 

 

Cancer.  The above average Cancer death Counties (orange bars in the charts) account for 38% of the US population and 27% of covid-19 deaths.  The chart shows that above average Cancer deaths trends with covid-19 deaths.  When New York state is removed, however, the share of covid-19 deaths exceed the population percentage of above average Cancer death Counties among the 38 remaining “A” counties.  We’ve seen C and D Counties have older populations and this makes their populations vulnerable to both Cancer and covid-19.

 

Counties where Cancer causes 0.19% or more population deaths (orange) or not (blue) by County Size

 

 

More on County Groups, more on the US Excluding NY

 

3,142 US Counties are geographic and administrative districts for which lots of statistics are gathered, including covid-19 deaths.  Each County can be characterized as urban and rural, and they range in population from 2,600,000 down to 88 residents.  In these reports, comparisons are made between four groups of counties depending on population size as indicated in the chart axes.

 

 

New York state accounts for 6% of the US population and disproportionately more covid-19 deaths, so it is useful to look at total US results excluding New York state.  This is done in the chart below which shows the disproportionately large number and majority of covid-19 deaths occuring suburban B Counties (second bar on right graph).

 

US Population and Covid-19 Deaths by County Size Group – Excluding NY State

 

 

 

What Next?

 

In future reports we’ll continue to examine county health statistics that might help put covid-19 statistics in helpful light.

 

Some other measures that may tell the developing covid-19 story:

• How do Covid-19 deaths change when adjusted for the first date one was reported?
• Do Counties’ previous flu or respiratory deaths tell us about County covid-19 death rates?
• Do County median income or education tell us about the likelihood of covid-19 deaths?
• Do results change if we use the exact density of County population instead of County Size?
• Do average temperatures or levels of particulate matters matter?

 

If you have any questions about this analysis or the data, or if you have suggestions, please don’t hesitate to contact me.

 

-Pete

 

Sources: US Census, USA Facts Covid-19, IHME forecasts, US Cancer Deaths NIH 5 year average, CDC Handbook on Death Reporting, 2003; New York Times; Median Income; CDC Wonder Detailed Mortality; CDC Fine Particulate Matter 2003-2011