United States: The Experiment

The response of the United States’ plethora of governments and bureaucracies has been severely lacking. Instead of a prepared disaster plan, or even any kind of actual scientifically based, risk assessed guidance, US residents have been subjected to mostly panicked reactive restrictions, based more on fears of losing elections rather than fears of overwhelming the US health care system.

The latter issue, you might recall, was the main reason that restrictions were felt necessary for a virus that for 90 percent or more of people infected, causes no symptoms or only mild symptoms. Because if twenty million people got infected all at once—that still might mean two million people needing medical care all at once, including maybe 200,000 or 300,000 needing intensive interventions like an ICU stay.

We bring this point up, because, if you spend too much time reading media scare stories, you might lose track of this important point. The point of restrictions is to “flatten the curve,” which means to slow the rate of infections to a manageable point. At no time was there supposed be no cases, or sadly, no deaths. No because that wouldn’t be nice, but because that’s just not how viruses operate.

But as they say, when life gives you lemons…. If the US response has been more socially than scientifically driven, and varied from state to state, we then have a real life “laboratory” to maybe answer the question:  What works and what doesn’t?

However, if you are going to compare states you need to be careful, and compare apples to apples, not apples to oranges. You can’t compare New York with Idaho, and decide that one of these states did a “better job” because these are two states with very different population figures numbers, urban areas and exposures.

Raw numbers don’t really help either. A state with 40 million people is going to have a larger number of total cases and deaths than a state with four million. You have to look at the rates per population instead. And even that comes with severe limitations. Even the rate of infection can reflect testing differences instead of actual differences. That is, if one state is doing more testing, they are going to find more cases.

Okay, with the disclaimers out of the way what can we discover?

First let’s compare two similar states in terms of population density numbers, Alabama and Wisconsin.

 

                        Alabama                                        Wisconsin

Pop.               4.9 million                                       5.7 million

Density          95 per sq. mile                              106 per sq mile

Metro area    Birmingham 1.14 million            Chicagoland 900,000, Milwaukee 600,000

Stay at home order    Yes     4/4/20 5pm     Yes        3/25/20 8am

Essentials OK          Yes                                          Yes

TO/delivery only?  Yes                                      Yes

Limit occupancy   Yes                                        Yes

Fun closed             Yes                                        Yes

Gyms closed          Yes                                        Yes

Beaches closed      Yes                                        ? (kind of cold there)

Max rules   10 people max including             10 people max in church or enclosed space

weddings, funerals, worship

 

4/19 cases/deaths    4723/154                   4199/211      

Rate case/10,000          10                              7

Fatality rate                    3%                           5%

So? Hard to draw any conclusions so far. Coronavirus cases are rare in both states, and both the modestly lower overall rate and higher fatality rate in Wisconsin could reflect lower testing rates. Overall, the restrictions in both places seem similar, but Wisconsin started restrictions about a week or two earlier—which in and of itself does NOT seem to have made much difference in mortality, although the infection rate is a bit lower per 10,000.

Let’s look at two even more similar states, Iowa and Arkansas. Both these states are not only demographically similar, but both have not issued a blanket “stay at home” order, although they have effectively put the same restrictions in place as those states that have done so.

 

                      Arkansas                                         Iowa

Pop.             3 million                                         3.1  million

Density       57 per sq. mi.                                 55 per sq. mi.

Metro        750,000 Little Rock                        700,000 Des Moines

 

Stay at home order  No                                       No

Nonessential closed  No                                     Yes, except online/delivery

TO/delivery only       Yes                                      Yes

No elective surgery   Yes                                     Yes

Gyms closed               Yes                                     Yes

Casinos closed            Yes                                     Yes

Gatherings       limited to                                    limited to 10 people      

10 people in confined spaces;

outdoor gathers and

in places of worship

allowed, but

social distancing advised

 

Number of cases/fatalities    1777/38                     2513/74

Rate per 10,000                         6                                8

Fatality rate                       2%                                      3%

 

Wow, who knew Arkansas and Iowa were so similar? They have virtually the same population, population density and large urban area.

Their coronavirus numbers are also pretty similar. In both states it’s very rare. Arkansas has somewhat better numbers, however, despite less restrictions. Since Arkansas is poorer (median income 2017 45,869 dollars which was 14,467 dollars below the US median income) versus Iowa (median income 2017 58,570 or 1,766 below the US median) and has more minorities (Iowa is about 88% non-Hispanic white and Arkansas is about 74% so) both things that are supposed to be public health liabilities, it is even more interesting that Arkansas is doing better than Iowa.

On paper at least, Arkansas would also seem to be less restrictive than Iowa. Yet Arkansas’ numbers are better. Alabama and Wisconsin are pretty similar in restrictions, but Wisconsin does a bit worse than Alabama in mortality and a little better in overall infection rate. But it is still difficult to draw any firm conclusions. Leaving aside the very real question of whether or not any of this was an appropriate response to this viral infection scenario all you can say is that when the restrictions started (Alabama versus Wisconsin) or the exact number and place of gatherings makes little difference in reported numbers.

Part of the reason for that is alluded to above. These are social, not scientific interventions. Do you think a virus visits a grocery store and tells all its friends “Back off man, she’s buying bread! Let’s go infect that person buying a book?”  Do you think a virus knows what is “essential,” like a marijuana dispensary, and what is isn’t, like a barber shop?

And we don’t know how the enforcement is in each state, how the people in the state associate, or how many exceptions the state granted to closures, or how soon the virus arrived.

None of the above should be taken to mean we need MORE non-scientific interventions. Right now, each state government seems to remain in panic mode, piling on more and more restrictions without any scientific backing. That would be fine, if none of these interventions came with a cost, but they do. Not a cost to Amazon and Walmart, of course. They are making money hand over fist from this situation and desperately trying to hire more workers. No, it’s the small, local businesses without billions in cash and huge online presences, that don’t have the political clout to stay open, that will go under. And it’s the manufacturing jobs that will go away due to lack of orders. Welcome to the gig economy, former union members!

This is not prioritizing money over lives, by the way. It is well documented that economic hard times result in an increase in deaths directly related to the decline. And since no US state has been willing to “let nature take its course” and go without any reaction it will take some careful study to see if our responses to this viral infection ultimately cost or saved more lives. Again, though, it will never be a case of no lives lost. Even when it consists of lemons, there’s no such thing as a free lunch.