By Neil McGovern, April 16th, 2020
Wednesday April 15th, 2020 saw a pushback organized by the Michigan Conservative Coalition against Governor Gretchen Whitmer’s orders to keep people at home and businesses locked during the current Coronavirus outbreak. The very fact that the protesters could congregate without fear of retribution belied the “Gov. Whitmer We Are Not Prisoners” theme of course. But instead of telling everybody what they didn’t want, the protesters might have pointed to South Dakota as their model. South Dakota has persisted in keeping business-as-usual. South Dakota Governor Kristi Noem said it was up to individuals — not government — to decide whether “to exercise their right to work, to worship and to play. Or to even stay at home.”
I’m concerned for the people of South Dakota, because my ongoing analysis of the infection and death rates does not bode well for the state. There are three trends, which if they continue, put South Dakota in the bullseye for the next Coronavirus wave.
Trend 1: Highest Growth in Infections in South Dakota
Currently South Dakota is an outlier in growth. For the three-day period from April 13th to April 15th South Dakota was growing at 16.0% per day. This is almost twice Rhode Island (8.9%), and actually twice Iowa, in third place, with 8.0% daily growth. This is not a blip. South Dakota has recorded 17.6% growth since March 22nd so the curve is definitely not flattening. To put this in other terms, South Dakota is doubling every 5 days (next closest, Rhode Island, is 8 days). Also, if the current rate continues, 10% of the population will have tested positive by May 14th, 10 full days before any other state at current growth rates, and most other states have been flattening their growth and hope to continue to do so. And since positive tests do not reflect the total infection rate, the actual numbers in South Dakota could be multiples higher.
Trend 2: Growth in Rural America
The more urbanized states have been bearing the brunt of the Coronavirus impact so far, however in the last few days there has been a stunning reversal. The link between how urbanized a state is and the growth in new cases has flipped. For the period March 23rd to April 12th there was a 19.6% correlation between states that were more urbanized compared to those that are more rural. Basically if you lived in a state with more cities where more people were packed closer together, you had higher growth in new cases.
In a stunning reversal, this has changed. The correlation for the three days form April 13th to 15th shows 3.6% more growth in more rural states than in more urbanized ones. The disease isn’t a coastal problem any longer. It is making its way into rural America and despite the huge challenges faced in densely packed cities, growth rates are now higher in less densely populated areas.
Trend 3: Surviving an Infection is More Likely in Urban America
The number of infections is one aspect, but the real tragedy is the number of deaths. If you do get the disease, are you going to survive? There are many factors that come into play, but when we look at outcomes, the numbers are not telling a comforting story for the more rural states.
Since March 23rd, there has been an overall correlation between cases per million and urbanization of 38.4% – for most of the last three or four weeks, if you live in a city, you were more likely to get Coronavirus. However, the correlation between urbanization and death rates per million in the same period was only 22.5% – despite higher infection rates, the difference in deaths is relatively lower in urban America. Compounding this is that most of the impact has been in the North Eastern states where the medical systems have been severely stressed. The fact that even over-stressed urbanized medical systems are outperforming rural medical systems hints that the real discrepancy between your chance of surviving is significantly less in rural America. South Dakota is very definitely in rural America.
The Issue for South Dakota
South Dakota is not alone in being rural. It isn’t even the most rural state by a large margin, that honor is tied by Maine and Vermont, whose census defined urbanization is only 39%, against South Dakota, Arkansas, Montana which are 56-7% urbanized. Also, South Dakota isn’t unique in having rural-scale healthcare systems, often with fewer doctors and larger distances to hospitals. However South Dakota is unique in having all three factors, and the growth factor seems to be closely linked to their reluctance to take active measures at the gubernatorial level.
Final Note
America as a nation has bent the curve on Coronavirus due to the measures we have undertaken to date. California, a very urbanized state (95% vs 57% for South Dakota) has growth a three-day growth rate of 5.4% per day from April 12th to April 15th – not great, but a lot better than the growth rate of 22.4% it was recording on March 27th. The right actions work.
Nobody is happy with the restrictions we are accepting in America to help keep our medical system, first responders, and other essential workers safe, but I’d plead with the better informed politicians and pundits who know and understand the actual numbers and trends to put their “Don’t Tread on Me” attitude aside for the sake of their own supporters and viewers.
| 4/14/2020 | Population | Urbanized | Growth (last 3 Days) | Growth (from 3/22) | Total Cases | % Population | 1% Tested Positive by | 10% Tested Positive by |
| Alabama | 4,903,185 | 59% | 105.0% | 114.0% | 3,953 | 0.081% | 4-Jun | 21-Jul |
| Alaska | 731,545 | 66% | 102.4% | 110.7% | 285 | 0.039% | 31-Aug | 7-Dec |
| Arizona | 7,278,717 | 90% | 103.7% | 113.6% | 3,806 | 0.052% | 4-Jul | 5-Sep |
| Arkansas | 3,017,825 | 56% | 108.2% | 109.5% | 1,498 | 0.050% | 22-May | 20-Jun |
| California | 39,512,223 | 95% | 105.0% | 112.2% | 25,536 | 0.065% | 9-Jun | 27-Jul |
| Colorado | 5,758,736 | 86% | 104.3% | 111.3% | 7,941 | 0.138% | 31-May | 25-Jul |
| Connecticut | 3,565,287 | 88% | 107.8% | 117.6% | 13,989 | 0.392% | 26-Apr | 27-May |
| Delaware | 973,764 | 83% | 108.9% | 116.4% | 1,926 | 0.198% | 3-May | 30-May |
| District of Columbia | 705,749 | 100% | 104.8% | 113.4% | 2,058 | 0.292% | 10-May | 28-Jun |
| Florida | 21,477,737 | 91% | 104.3% | 114.2% | 21,628 | 0.101% | 7-Jun | 2-Aug |
| Georgia | 10,617,423 | 75% | 107.8% | 114.1% | 14,578 | 0.137% | 10-May | 10-Jun |
| Hawaii | 1,415,872 | 92% | 101.8% | 109.9% | 517 | 0.037% | 17-Oct | 24-Feb |
| Idaho | 1,787,147 | 71% | 101.3% | 116.4% | 1,464 | 0.082% | 21-Oct | 14-Apr |
| Illinois | 12,671,821 | 89% | 105.6% | 114.3% | 23,247 | 0.183% | 15-May | 26-Jun |
| Indiana | 6,732,219 | 72% | 103.7% | 117.2% | 8,527 | 0.127% | 9-Jun | 11-Aug |
| Iowa | 3,155,070 | 64% | 109.4% | 114.1% | 1,899 | 0.060% | 15-May | 9-Jun |
| Kansas | 2,913,314 | 74% | 103.3% | 114.2% | 1,426 | 0.049% | 16-Jul | 26-Sep |
| Kentucky | 4,467,673 | 58% | 106.1% | 113.7% | 2,210 | 0.049% | 3-Jun | 12-Jul |
| Louisiana | 4,648,794 | 73% | 102.2% | 115.5% | 21,518 | 0.463% | 19-May | 1-Sep |
| Maine | 1,344,212 | 39% | 107.7% | 109.3% | 734 | 0.055% | 23-May | 23-Jun |
| Maryland | 6,045,680 | 87% | 107.3% | 117.6% | 9,472 | 0.157% | 10-May | 11-Jun |
| Massachusetts | 6,949,503 | 92% | 105.1% | 116.6% | 28,163 | 0.405% | 2-May | 16-Jun |
| Michigan | 9,986,857 | 75% | 104.7% | 114.9% | 27,001 | 0.270% | 12-May | 1-Jul |
| Minnesota | 5,639,632 | 73% | 102.3% | 109.8% | 1,695 | 0.030% | 18-Sep | 30-Dec |
| Mississippi | 2,976,149 | 49% | 105.4% | 112.0% | 3,087 | 0.104% | 27-May | 10-Jul |
| Missouri | 6,137,428 | 70% | 106.5% | 115.9% | 4,714 | 0.077% | 25-May | 30-Jun |
| Montana | 1,068,778 | 56% | 101.5% | 110.9% | 399 | 0.037% | 15-Nov | 15-Apr |
| Nebraska | 1,934,408 | 73% | 106.7% | 115.0% | 901 | 0.047% | 31-May | 5-Jul |
| Nevada | 3,080,156 | 94% | 104.3% | 112.7% | 3,088 | 0.100% | 7-Jun | 31-Jul |
| New Hampshire | 1,359,711 | 60% | 105.2% | 112.1% | 1,091 | 0.080% | 2-Jun | 17-Jul |
| New Jersey | 8,882,190 | 95% | 105.5% | 115.8% | 68,824 | 0.775% | 18-Apr | 31-May |
| New Mexico | 2,096,829 | 77% | 106.3% | 114.3% | 1,407 | 0.067% | 28-May | 4-Jul |
| New York | 19,453,561 | 88% | 103.6% | 110.9% | 203,123 | 1.044% | 13-Apr | 17-Jun |
| North Carolina | 10,488,084 | 66% | 105.8% | 112.6% | 5,133 | 0.049% | 6-Jun | 16-Jul |
| North Dakota | 762,062 | 60% | 105.2% | 111.5% | 341 | 0.045% | 14-Jun | 29-Jul |
| Ohio | 11,689,100 | 78% | 105.0% | 113.7% | 7,280 | 0.062% | 9-Jun | 27-Jul |
| Oklahoma | 3,956,971 | 66% | 105.3% | 115.7% | 2,184 | 0.055% | 9-Jun | 23-Jul |
| Oregon | 4,217,737 | 81% | 103.4% | 110.3% | 1,633 | 0.039% | 19-Jul | 26-Sep |
| Pennsylvania | 12,801,989 | 79% | 105.4% | 118.6% | 25,465 | 0.199% | 14-May | 27-Jun |
| Rhode Island | 1,059,361 | 91% | 110.4% | 117.5% | 3,251 | 0.307% | 25-Apr | 19-May |
| South Carolina | 5,148,714 | 66% | 103.5% | 113.0% | 3,553 | 0.069% | 1-Jul | 7-Sep |
| South Dakota | 884,659 | 57% | 116.3% | 117.7% | 988 | 0.112% | 28-Apr | 13-May |
| Tennessee | 6,833,174 | 66% | 104.7% | 110.8% | 5,823 | 0.085% | 6-Jun | 25-Jul |
| Texas | 28,995,881 | 85% | 104.9% | 114.8% | 15,013 | 0.052% | 14-Jun | 1-Aug |
| Utah | 3,205,958 | 91% | 102.3% | 111.4% | 2,412 | 0.075% | 3-Aug | 11-Nov |
| Vermont | 623,989 | 39% | 101.7% | 111.2% | 752 | 0.121% | 17-Aug | 31-Dec |
| Virginia | 8,535,519 | 76% | 108.2% | 116.1% | 6,171 | 0.072% | 17-May | 15-Jun |
| Washington | 7,614,893 | 84% | 101.3% | 107.8% | 10,795 | 0.142% | 18-Sep | 22-Mar |
| West Virginia | 1,792,065 | 49% | 106.6% | 117.3% | 694 | 0.039% | 4-Jun | 10-Jul |
| Wisconsin | 5,822,434 | 70% | 103.2% | 110.3% | 3,555 | 0.061% | 13-Jul | 25-Sep |
| Wyoming | 578,759 | 65% | 102.2% | 111.1% | 282 | 0.049% | 30-Aug | 14-Dec |
| zz-USA | 328,300,544 | 81% | 104.7% | 112.9% | 613,886 | 0.187% | 20-May | 10-Jul |
| CORRELATION | ||||||||
| Growth to Cases/M | 2.0% | 20.1% | ||||||
| Urbanization to Cases/M | 38.6% | 38.6% | ||||||
| Urbanization to Growth | -10.8% | 19.3% | ||||||
| Urbanization to Death | 24.8% | 24.8% |
I want to present some math here. Sadly, the nutbars have it right, but for all the wrong reasons.
Some assumptions:
1. A vaccine is going to take 12 months to get designed, mass manufactured, and the logistics created to deliver it everyone. (Yeah, I know, the poor will never get vaccinated).
2. When economies are opened up, this virus is not going away.
3. The amount of infected is twice the “official cases”, because of how many people are asymptomatic.
So, let’s work with that.
The amount of official cases is 734,000. So based on assumption 3, it is more like 1.47 million infected.
Now, the growth rate in official cases today was 3.5% in the U.S. Let’s pretend that the growth rate goes down to 2%, from the 3.5% today, even taking into account relaxed lockdowns.
Anyone who understand compound interest knows the rule of 72. So, based on a 2% increase in infected people daily, that is a “doubling cycle” of 36 days.
So, in 8 cycles (288 days), that is 256 fold increase in infected people, or 376 million. At an infection rate that almost half of what it is today, and that is before the lockdowns are relaxed, the entire U.S. population will be infected long before a vaccine can be created and delivered. Herd immunity will kick in before a vaccine.
It makes far more sense to grasp this reality, that everyone is going to get it, and get a really good handle on what the health system’s capacity is for a long term influx of infected people (health care professionals cannot maintain this pace), and then open up the economy based on that inevitability. This thing is NOT going away, and the economy has to be opened up before a vaccine will be available.
Just read this on another site. Nasty surprises continue to unroll from the Stimulus. This one’s a shocker. We know where the “pay-for” will come from – Social programs and services. I know all of you are smart enough to figure out who this will hurt.
https://www.theguardian.com/world/2020/apr/15/tax-change-coronavirus-stimulus-act-millionaires-billionaires?
I have no idea how many of the recent 22 million jobless claims are folks who lost employer based health insurance but have to assume some did. The CARES ACT is providing hospitals with Medicare level reimbursement for all hospitals caring for COVID 19 patients via medicare reimbursement regardless of their insurance or ability to pay. The caveat is hospitals must agree to no patient billing IF they take the reimbursement. The concern was sick people with insurance were not seeking help due to high deductibles or fear of out of pocket costs.
This sounds eerily like what Americans have been asking for in regards to health care reform. Sick people were avoiding hospitals due to their inability to cover their deductible and fear of out of pocket costs. So, even with insurance they weren’t getting care…why have the insurance?
If the pandemic proved anything, is the fragility of our insurance based health system.
https://khn.org/news/in-fine-print-hhs-appears-to-ban-all-surprise-billing-during-the-pandemic/
My apologies for my post based on the KHR report and rollout of the administration’s program…as it appears they screwed up the rollout and have no clear methodology for plan rolling out this support to hospitals and providers. This is going to overwhelm rural and regional hospitals…they were living on the edge before the pandemic but without cash infusions I don’t see how they make payroll by July.
https://www.politico.com/news/2020/04/20/coronavirus-treatment-uninsured-195218
The best thing about South Dakota is the eighty mile an hour speed limit, it will get you through that shit hole state in good time.
The “Tests” have too many false positives/negatives to be really useful right now
The solution is to do what we have done (NZ) – the Hammer – then the Dance
The Hammer has to come down early and HARD to cut the spread right down
THEN it’s time to start the Dance – testing and tracing every new case and everybody they have been in contact with
We havent started the Dance yet – maybe next week – although I would put it off a bit longer if I was in charge
This is somewhat unrelated.
Just watched HBO’s “Too Big to Fail” that chronicled Paulson’s moves in 2008 to stabilize the financial markets.
It is irrelevant how accurate the story is. The numbers are, and what struck me were they are a fraction of the numbers today. To think that the last Great Recession was only 12 years ago and the dollars actually injected were small compared to today gives some perspective on how close the entire modern world is to ruin right now.
The money spent so far is only the first chapter in this story. If there is no scientific handle on controlling this virus (eradicating it is not going to happen in 6 months, or 12), the moves by the red states to sacrifice lives will be seen as the right move. I have stated that already.
The 2008 crash was about Wall Street bringing down Main Street. This time, it will be Joe Worker running out of cash that brings down the system.
South Dakota) has growth a three-day growth
Thanks Neil for breaking that down. The number in my particular urban area (Houston) looks pretty low (93.6 cases per 100K and 1.4 deaths per 100k) compared to the other comparably big cities (NYC – 1458.4/ 100k, 135.9/100k; LA 107.9/100k, 4.5/100k; Chicago 371.2/100k, 14.5/100k; Philadelphia 516.5/100k , 16.8/100k). So were we just lucky (it landed other places first through dumb luck), our lack of mass transit, our local officials were more proactive, we’re more spread out than the others (except for LA), something else?
Thanks to the absence of any state level effort to deliver testing (TX ranks 49th in tests per capita), no one has the slightest idea how many people in Houston have COVID-19. There’s a choice excerpt from an NBC story last week that sums up the problem:
“The 25-county region surrounding Houston had reported fewer than 950 confirmed coronavirus cases among its 9.3 million residents as of Monday. But on that same day, there were 996 people hospitalized in the region with confirmed or suspected cases of COVID-19, according to the advisory council count. That figure is not cumulative and does not include patients with COVID-19 who were hospitalized and released before Monday.”
https://www.nbcnews.com/news/us-news/houston-hasn-t-reported-surge-coronavirus-cases-its-hospitals-tell-n1175291
Basically, testing is off the table in Texas. Health officials are flying blind. It’s likely the only way we’ll ever know how many Texans were killed by this pandemic will be to review the daily death statistics and compare them to baselines. That will take years.
Under testing was the answer I was hoping against, but I’m not shocked. But one good thing is your link is from 2 weeks ago, and so far our hospitals aren’t as bad off as NY and Detroit (key words, so far). We’ll see what happens in the next couple weeks. But in spite of the testing deficit, Abbott is ready to start easing restrictions next week. I’m not going to be dining in at any restaurants, even if they do put tables 6 feet apart. Take out, yes. Movies at home. Groceries online/curbside.
A friend of mine very likely caught the virus; she was in NOLA for Mardi Gras. Fortunately she recovered, but she didn’t get tested, and won’t be part of the count.
Lack of testing is a festering boil in TX. Only 1/2 of 1% of 23M TX residents have been tested. It was intentional. Abbott promises a more robust testing program is coming. So did DJT. I’m waiting. “Don’t ask, don’t tell” has been replaced by, “Don’t test, don’t fail.”
No, what’s happening here (re the push for reopening) is predicated on the “argument” that we are at greater risk from a tanking economy than from dying from covid-19. This is an orchestrated campaign effort. Full stop. Ending sheltering will benefit trump’s re-election. The man feeds on crowd adulation. This pandemic is becoming a real pain in the ass. So what if a “few” more people die. He’s tired of having to work in his job. No golf, no rallies, too few scurrilous tweets (They’re starting- Note his “nasty” tweets directed at protests in three swing states.) Coincidence? I don’t think so from my years of watching dirty republican politics. A president who derides governors who are in the throes of trying to save lives in their states, (shouldering much of trump’s job by default), by inciting and encouraging opposition to the governors efforts, is despicable. But, we already knew that about trump. Trump is narcissistic but he’s also cruel and vengeful. Yet, he keeps delivering- one after another, worse and worse, it just doesn’t stop.
Team trump is doing what he does best: playing to people’s fears and greed. The economic cost is real, but a premature re-opening will have far worse consequences for our nation. That, of course, is Donald Trump’s least concern. May I remind all that if re-elected, the federal crimes trump has committed will prescribe and he can ride happily off in his golf cart flush with millions of stimulus funds and lots of IOUs.
There are a few folks who see through the bullshit. I latch onto their words.
https://www.nytimes.com/2020/04/16/opinion/coronavirus-texas-republicans.html?
Great post, Neil! Informative, well-written and interesting. I look forward to future posts from you.
Yet another reason not to elect someone with so little qualifications to an important office.
“What have you got to lose?”
I do hope this drives the final nail into the coffin of the absurd notion of “vote for so&so because he’s a businessman, not a politician” (even when so&so was actually good at business, as opposed to being a fraud like Trump).
Also all the fools who thought that a bull in a china shop would be a good thing for the world cannot have their noses rubbed in this nearly enough.
“I do hope this drives the final nail into the coffin of the absurd notion of “vote for so&so because he’s a businessman, not a politician” (even when so&so was actually good at business, as opposed to being a fraud like Trump).
Also all the fools who thought that a bull in a china shop would be a good thing for the world cannot have their noses rubbed in this nearly enough.”
People adapt, they don’t change. When this pandemic is normalized into a season cycle of illness like the rest the same people who blamed the Deep State on their neighbor’s heroin overdose is going to blame the failure of the state on their grandmother choking on her own lung scar-tissue. If the evidence that the government is corrupt and doesn’t care for the people drove them to vote for an ‘outsider’ before, it’s failure to keep them alive will drive them to vote for ‘outsiders’ in the future.
They’ll just have changed from yelling at retail workers for not smiling right to yelling at retail workers for not wearing facemasks.