I’ve focused most of my attention on tracking the internal dynamics of the coronavirus in Massachusetts, with only one previous post with a comparison to other states, (https://www.masscoronavirus.net/massachusetts-isnt-as-great-as-it-thinks-it-is/) back at the end of August. But one of the things that has stood out is Massachusetts’ very high death rate relative to other states. It has either the second or third highest (more likely 3rd, more on this later) per capita death rate among states over the course of the pandemic, but a high percentage of deaths in Massachusetts were during the spring. As a consequence, I wanted to analyze how well Massachusetts has been handling the pandemic relative to other states since the spring – if possible examining cases, deaths, testing and test positivity.
I used data from the Covid Tracking Project (CTP) (https://covidtracking.com/data) as my primary source, because it is easy to download daily historical state-by-state information from their website. However, I checked the CTP’s overall case and death statistics against the New York Times (https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html?action=click&module=Top%20Stories&pgtype=Homepage) and Worldometers (https://www.worldometers.info/coronavirus/country/us/) databases. All data is as of October 28.
I defined three phases of the pandemic to date using the New York Times calculation of the 7-day average of the national total of cases, looking for troughs in the data to define the end of each phase of the pandemic. Table 1 summarizes peaks and troughs for both cases and deaths.
|Table 1: Pandemic Phases Based on Data Peaks and Troughs|
|March 1 through October 28, 2020|
|Peak and Trough Dates|
For example, based on national case data, the spring phase of the pandemic lasted from March 1st through May 28th, because May 28th is the day when total cases fell to a minimum after peaking on April 10th (they began increasing again on May 29th). Based on national death data, the spring phase would have ended on July 5th.
There are some interesting tidbits in Table 1. First, the troughs in cases coincide with a few days lag to the holidays that bookend the summer – Memorial Day and Labor Day. This does not necessarily imply that increased social activities on those holidays led to upswings in cases, but they certainly may have played a part.
Second, the death peaks for the spring and summer phases occur roughly one week after the case peaks, but the death troughs occur roughly five weeks after the case troughs. I would not read too much into this, as the national statistics are just the sum of state statistics, each of which has its own ebb and flow of cases and deaths. In addition, this is based on a sample of only two phases for the pandemic (and let’s hope there are not many more). However, the lag between the case and death troughs correspond more naturally to our understanding of how covid progresses from diagnosis to death.
Based on the peaks and trough data in Table 1, I defined the pandemic phases using troughs based on cases, even when I analyze death data. This is primarily because the current (Fall) phase based on death data has had too few days to draw any meaningful conclusions (twelve days so far)
A few caveats about the data are in order. First, the CTP generally obtains its data from state agencies charged with compiling and publishing Covid information for that state. To the extent that different states have different procedures for counting cases and deaths, the data published by Covid Tracking is not uniform across jurisdictions.
Second, the CTP (and Worldometers, for that matter) are not particularly adept at handling data restatements from the states. For example, when Massachusetts dropped roughly 8,000 probable cases and 26 deaths from its tally in early September, both sources just showed one day drops in case and death totals reflecting those changes. In other words, neither data aggregator restated the data historically, so that it appeared that there were a large number of negative cases in Massachusetts on September 2nd. This means that although the total number of cases and deaths are accurate, they are improperly distributed into the three pandemic phases.
Finally, although agreement among the three data aggregators is generally good, there are some large discrepancies in aggregate death and case statistics that call into question some of the results from the Covid Tracking Project.
Table 2, a comparison of the largest differences between the cumulative death rates among the three data sources, illustrates these issues. The entries in the tables are the percentage difference in the death rate to date for each pair of aggregators. As is evident from the table, the agreement was best between the New York Times and Worldometers, and second best between the CTP and Worldometers.
|Table 2: Largest Death Discrepancies Among Data Sources|
|March 1 through October 28, 2020|
|Largest||Alaska||5.6%||North Dakota||30.4%||New York||30.5%|
|2nd Largest||Kentucky||4.6%||New York||28.5%||North Dakota||29.1%|
Table 2 points out particular issues for the Covid Tracking Project data for New York and North Dakota, where the agreement between the New York Times and Worldometers is close. The CTP shows 25,773 deaths for New York, compared to over 33,000 for the other two aggregators. The CTP data aligns with the NY State website, which excludes probable cases from its totals. This implies that the CTP is under counting deaths in New York. (Is Cuomo fudging the stats?)
For less clear reasons, The CTP is also under counting deaths for North Dakota relative to Worldometers and the New York Times. Death totals from these two sources align much more closely with the North Dakota state website.
These data discrepancies have implications for the results shown in Table 3, which show the death rates and rank for Massachusetts as well as the top-ranked and bottom-ranked states (including Washington D.C.) for each phase of the pandemic.
|Table 3: Death Rates per 100000 and Rank By Pandemic Phase|
|March 1 through October 28, 2020|
Based on the CTP data, Massachusetts has the second highest per capita death rate from the pandemic in total. However, Massachusetts would drop to 3rd place if New York State included probable cases. Even so, Massachusetts has had a very high relative rate of deaths in each phase of the pandemic, only dropping to 9th worst during the summer, and to 21st worst for the fall pandemic to date. Not an enviable record.
This table makes concrete how the pandemic has affected different areas of the country in the three phases to date. As it well known, the first and deadliest phase in the spring affected the Northeast most heavily – of the eleven states (and D.C.) with the highest death rates, all but Michigan and Louisiana were in New England or the Mid-Atlantic. Only the more rural states in New England were spared.
The summer phase impacted the sunbelt most heavily, with eight of the ten states with the highest death rates in the Southeast or Southwest. But Massachusetts and Rhode Island were in the top ten as well. Finally, the current phase is more of a mixed bag, although the states with the highest death rates are generally more rural. There is less clarity about this phase to date.
Overall, the states with the lowest death rates overall are sparsely populated, or geographically isolated (Hawaii), or both. This is true for the ten states with the lowest death rates overall, except for Oregon and Washington. While there have been some changes in the ranking of these low death rate states during different phases or the pandemic, for the most part this has been the case.
Why has Massachusetts fared so poorly? An obvious thought is that this is from the high percentage of deaths in long-term care facilities in the state. Almost 70% of Massachusetts deaths have been in long-term care facilities, compared to about 40% nationwide.
However, this is not the entire answer. As a hypothetical, for each phase in the pandemic and in total, I adjusted Massachusetts’ deaths so that 40% instead of 70% were in long-term care facilities. What would have changed? In overall death rates, the state would have dropped from 2nd (or 3rd) overall to 9th, from 4th to 7th during the spring phase, from 9th to 28th during the summer phase, and from 21st to 30rd during the fall phase. Improved, but not stellar. Because death rates during the spring were so high compared to later death rates, those early deaths dominate the overall results, even adjusting for long-term care deaths.