Like politics, pandemics are a local phenomenon. As we pointed out over the weekend, while all eyes (a least those with a big megaphone) look to Washington, DC for answers about testing, diagnosis and treatment, the disease is battled at the local level through decisions made by city and county health departments in collaboration with state officials. How proactive and effective a local government is in defeating COVID-19, makes itself known in local case volumes.
It is for that reason that we have chosen to assemble case data at the local level using press releases from state and local health officials, forum post on FluTrackers.com and other miscellaneous sources which we then cross reference with Johns Hopkins COVID-19 case tracker of state data. We have also decided to isolate case volumes to hotspots characterized by large populations and high case growth. While it is certainly important to the people of Medford, OR area that there is a case of COVID-19 in their midsts, population density and case volumes, at this point anyway, suggest it won't have a big impact on the Pacific Northwest's economy.
The hotspots we are tracking - and we may add more as cases are reported - are:
- Seattle, WA
- San Francicso/Bay Area
- New York City
- Chicago, IL
- Los Angeles, CA
- Houston, TX
- Boston, MA
- Washington, DC
Additionally we are keeping an eye on Florida, Oregon and Arizona. In all, our focus areas account for about 72% (437) of all US cases excluding repatriated American and cruise ship passengers. Case confirmation accelerated on a day over day basis through yesterday with 113 cases confirmed in hotspot areas versus 73 the previous day and 14 the previous week.
The biggest contributors to the case count were the Seattle area which added 40 cases to its load. New York City added 37 versus 34 the previous day and zero the previous week. Boston also contributed heavily to the case count, a result of aggressive testing in response to case identification at Biogen conference.
The incremental increases in case identification are a result of increased testing brought on by addiitonal capacity from the private and non-profit sectors. It is also, no doubt a result of increased awareness of the disease.
As the disease spreads, we anticipate the local health response will shift from containment to mitigation. Federal officials like Tony Fauci of NIH made the rounds at the Sunday talk shows and suggested mitigation measures like self-restriction on travel or congregation in large groups by the elderly. Santa Clara County's Health Department issued an order yesterday prohibiting all gatherings in excess of 1,000 people. These measures are likely to be expanded by local officials as they seek to balance the rights of individuals against the need to limit spread of the disease. The private sector is and will continue to respond with their own mitigation efforts like cancellation of classes and meetings.
As we all watch for that inflection point in case growth, we recommend that you be careful about comparisons. The roughly 600 cases (as of last night) are spread over a country with a land mass of 4 million square miles and 327 million people. We also note, that the quality of tests and the protocols for testing and diagnostics can very dramatically from country to country. Mortality rates, for example, are very difficult to assess when the denominator can not always be trusted. Finally, we must recognize that test availability has been limited and we will see accelerations and decelerations as test venues change/expand and reporting systems are updated.
Call with questions.
Emily Evans
Managing Director – Health Policy
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