While it’s always tempting to think of the coronavirus pandemic in terms of numbers endlessly piling up — especially as the United States passes the 100,000 death mark, an unfathomable toll that is likely still an undercount — it’s important to remember that the outbreak is also constantly changing and evolving. We should be updating our understanding of the situation on the ground at all times, because it is never stable.
With that in mind, I thought it would be worthwhile to answer a very simple question: What is actually going on with Covid-19 right now? Because I think that even for people who are closely following the news about the pandemic, myself and my colleagues included, it is easy to lose sight of the big picture.
I looked at the data and talked to several public health experts, hoping to synthesize what I saw in the numbers. Here are three takeaways, my situation report on coronavirus here at the end of May.
1) Nationally, new Covid-19 cases are on a gradual decline
If we zoom all the way out and look at the United States as a whole, the number of new Covid-19 cases reported each day has gradually fallen over the last month, from a peak of nearly 37,000 new cases on April 24 to about 19,000 new cases on May 26, according to data compiled by the New York Times.
As you’ll see in the chart below, there is a lot of noise in this metric. Sometimes, there are lags in government agencies reporting new cases and the number of daily new cases reported is partly dependent on how many tests are being conducted at a given time. But this should give you a general sense of the trendlines: the rapid growth in new cases in March and into April, before the rate starts to level off and then declines through May.
The higher number of daily cases reflects both the coronavirus’s spread throughout the United States and the increased testing, which improves our surveillance of how widespread the disease actually is. There is no one ideal number of tests to be performed, but experts have said the percentage of tests that come back positive should be at least below 10 percent and even lower (5 percent or less) if countries are going to relax social distancing.
On May 26, the positive test rate in the US was 5.4 percent — a significant improvement from the days when 20 percent of tests were positive, but still not quite down to the 3 percent or so that South Korea, the global model of early and widespread testing, achieved weeks ago.
Still, there has generally speaking been a decline in new cases nationwide over the last month, which recent research indicates is a reflection of the social distancing policies put in place by states and cities.
But the national picture can be a bit misleading depending on where you live. There is a lot of variation across the states.
“Some areas, like NYC, are slowing. As big as their outbreak was, that alone makes for a marked decline in new cases nationwide that we’re seeing,” Tara Smith, a Kent State University professor who studies infectious diseases, told me. “Most other places seem to be better than they were in March as far as rate of new cases.”
“But even if the epidemic has slowed, it’s not gone, and some places are picking up.”
2) Some states are seeing declines in new cases, but in others, cases are flat or increasing
The New York Times continually updates this reference page that has some handy charts showing where coronavirus outbreaks seem to be tailing off and where they may be intensifying.
The Times breaks the states down into three categories: states where new Covid-19 cases are increasing, states where new cases are mostly the same, and the states where the number of new cases is declining. Let’s run through the two extremes quickly; if your state isn’t on the lists below, that means the situation appears stable, not worsening but not improving.
States where daily new coronavirus cases are increasing, as of May 27:
- North Carolina
- North Dakota
- South Carolina
States where daily new coronavirus cases are decreasing, as of May 27:
- New Hampshire
- New Jersey
- Rhode Island
- South Dakota
- Washington, DC
It’s important to remember that these states are starting from different places, though. New Jersey’s daily counts have been going down, but it has to date seen far more cumulative Covid-19 cases (about 155,000) than has Alabama (15,700) or North Carolina (24,000), some of the states where the number of daily new cases is on the rise.
It is also difficult to say for certain how much the relaxation of social distancing policies in some states has affected Covid-19’s spread so far and whether those policy changes explain some of the trends in new cases. The coronavirus is a very sneaky pathogen with symptoms often taking a week or more to show up. Yet people can begin infecting others before symptoms set in. It could then take another week or two for those people to realize they may be sick.
Given the lag in new infections revealing themselves, and the fact that an infected person will on average (and without social distancing) infect two or three other people, it may be some time before we have a good idea of how much states’ reopening has affected the pandemic’s arc. The reopenings only began a month ago. Increased testing could again help to explain some of the increases in new confirmed cases, further complicating efforts to isolate the impact of easing social distancing.
“I think speculation there is premature,” says David Rehkopf, a Stanford professor and fellow at the university’s Center for Population Health Sciences.
If you look at other metrics — such as the number of daily new cases as a share of a state’s population — there isn’t really a clean breakdown between different types of states. As much as we might want it to, the coronavirus has generally not conformed to tidy narratives.
The bottom line: the general plateau of new cases nationally obscures the variations across states, which are driven more by local conditions. To repeat, this is not one coronavirus outbreak but many.
On that point, some of the recent spikes in cases can be linked to specific incidents; Arkansas has traced its recent surge in cases to a high school swim party, a church gathering, and poultry plants (at least for starters).
The latter is representative of one other important trend in America’s Covid-19 pandemic.
3) The pandemic started in wealthier environs but has shifted to working-class settings
To paint with a very broad brush, the coronavirus pandemic in the US seems to have started with the jetsetting crowd. People taking cruises. International travelers who brought the virus to the US in the first place from China or from Europe. The metropolitan areas where Covid-19 initially appeared — New York and Seattle and Boston and San Francisco — are among the wealthiest places in the country.
But the pandemic has quickly become stratified along socioeconomic and racial lines. The coronavirus may have been blind to color and class during the early weeks, especially when it was spreading undetected. But once states and cities began to lock down, the disparities began to deepen. People who have higher incomes generally find it easier to work from home or even take time off work. They may also be able to simply leave a city where Covid-19 is running rampant: the New York Times reported that wealthier neighborhoods in the Big Apple have seen a much higher percentage of their residents leave during the pandemic compared to working-class neighborhoods.
People with lower incomes (who are also more likely to be black or Hispanic) typically have less flexibility in their work situation. So they are more likely to be laid off or they have been asked to continue working despite the ongoing risk because their job is considered essential. These populations have higher rates of preexisting conditions like diabetes and heart disease that can make them more susceptible to the coronavirus, too. They may also live in places more exposed to air pollution or have other economic restraints that affect, for example, their ability to seek out medical care.
The exact causes of these disparities in Covid-19’s toll will be studied for years. But the data already shows black people in particular are getting infected and dying at higher rates than white people.
One example of these trends in practice would be the high rates of infection among New York City transportation workers. Another would be the outbreaks in meatpacking plants across the country. In addition to occupational hazards, these populations are also more likely to live in intergenerational households and that can induce more spread, an observation made to me recently by an epidemiologist based in New Orleans.
“There are a wide range of health behaviors and environmental exposures, not the least of which are crowding and occupations that require more exposures, that come together to explain this,” Rehkopf told me.
Now the coronavirus is spreading to rural areas, which are also often at a financial disadvantage compared to wealthy enclaves, which may exacerbate these socioeconomic trends.
Taken together, these three trends should help explain where the coronavirus pandemic stands in the US as June approaches. The virus is still widespread, and hitting vulnerable populations the hardest, even if at the national level, we have begun to see this gradual decline in new cases.
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