Featured photo: Image by fernando zhiminaicela from Pixabay
As it stands according to the Johns Hopkins University the US has a 5.29% positivity rate and around 71k are testing positive per day, this is actually not too bad in ratio to the US population size and is almost down to the 5% rate that Johns Hopkins considers to be the level at which lockdowns can begin being eased. Of course, for the US lockdowns are for each individual state to decide upon, so it is more complicated for an effective national approach, so it is only fair we look into what state governments are also doing, the positivity rates in this instance within each state I would say are more important to know. So, for California the positivity rate is currently around 3.5% according to the covid19.ca.gov website, which would be sufficient to reduce lockdown restrictions, and for New York it sits at around 2.99% according to governor.ny.gov. Johns Hopkins notes that a low positive rate is a good indication that the vast populace is being tested rather than those just presenting as sick, although many other factors can also reduce the rate, even without widespread testing.
So, the above seems to indicate that, at least in New York and California, testing appears to be being conducted on a wide scale access approach, and this seems to be correlated to a degree via a ranking on beckershospitalreview that shows states with the lowest testing per 100k of population have far higher positivity rates compared to states with higher testing per 100k of population. So, for example at the top is South Dakota with a 22.4% positivity rate with 72.9 per 100k people being tested, while at the bottom is Hawaii on 1.1% while testing 315.8 people per 100k population, or we can also look at Vermont at 1.8% positivity testing 1,124.1 people per 100k population.
Beckers shows us that as of 19th Feb 24 States are above the 5% positivity rate meaning they should be implementing lockdowns and also putting effort and funding into testing more people at once to try and get the rate downwards. One of these states are Texas which has a 14.7% positivity rate and are as of the 19th Feb only testing 150 per 100k population. Looking into what actions the state is currently taking against COVID-19 according to NYT, Texas is enforcing the wearing of masks, counties have the ability to exempt themselves from face covering. Texas does have a number of restrictions in place on a case-by-case basis, many places have since reopened with certain restrictions in place. Texas does have a system of contact tracing in place, sick people are encouraged to self-isolate and call a doctor if things get worse or call a doctor right away if you’re considered high-risk, doctors will help decide if individuals should go and get testing, with public testing centres and drive-thru locations in certain parts of Texas, those without health insurance can still get tested if their doctor or health professional recommends it, according to dshs.state.tx.us. There is a possibility certain testing sites won’t accept all types of health insurance; some may also require referral by a Doctor first.
Texas gives guidance and varied restrictions for various groups all the way from individuals, to employees and businesses, to events, to those at-risk, and different types of gatherings, but there is no full lockdown in place and current executive orders signed by the Governor aim to reopen the state, the last Order signed related to this was on 8th October last year. There is the risk that these very varied rules and restrictions may be confusing to many, and lots may ignore or be ignorant of such rules, more so the general populace/individuals as they are harder to police, in particular this was the problem with the UK’s local tier lockdowns, which led to a national lockdown being re-implemented. All of the current protocols in place for Texas to follow have not been revised since 2020, at least according to the dshs website.
Now let’s look at a state with a lower positivity rating, I’ll go with California as we were already made familiar with it earlier on. California is currently testing around 571.4 per 100k population and as said its positivity rate is around 3.5%.
California is not currently under a total lockdown as it recently came out of it from January 25th and so is now doing lockdowns/restrictions on a county-by-county tiered basis which goes Minimal, Moderate, Substantial, and Widespread. As it stood from 16th Feb the vast majority of the state’s counties were under the Widespread tier (99.8% of its population) while around 0.2% of the population are under lower tiers (six counties), no counties have as of 16th Feb been lowered to Minimal tier. This info comes from the covid19.ca.gov website.
The changing of these tiers is not only based on COVID-19 positivity and case rates for the whole county but also on a health equity metric neighborhood-by-neighborhood basis, which means counties need to address coronavirus issues in all their communities, so for example if the county as a whole is legible to move down a tier but there are certain communities lagging behind, then that will prevent the county from being moved down a tier, or could lead to a county going up a tier as a whole if communities continue to fall further behind the rest of the county, this forces counties to not ignore them and to address the issues, which makes it a pretty good system and also helps minorities and essential worker communities who would be disproportionately affected by such neglect.
Currently California is enforcing Food and Drink places to be closed, including bars, although some counties are allowing limited indoors dining depending on tier level, many places are allowed to remain open with limited exceptions and restrictions based on tier level, for example although entertainment is allowed it is widely limited on a county-by-county basis due to the tier level, with many places still closed. Stay at-home orders may also be issued by the state government in any region where intensive care unit capacity drops below 15%. This info comes from the NYT.
Business and activities within the state are also placed within tiers based on the risk of them being open leading to increased spread of coronavirus, this is also a way to encourage them to implement measures to help prevent the spread of coronavirus within them such as mask wearing and distancing regulations. Ultimately this plays a role in whether they can open or not.
California is encouraging its populace to stay-at-home, mandatory wearing of face masks, regularly washing of hands, keeping at least six-feet distance from others, and limiting contact with people outside their households, doing these things the state government says will help enable counties to be put into less strict tiers.
California has testing centres for its populace, these include drive-through testing with Verily and testing centres by OptumServe, both require appointments to be made, testing is available to everyone and if individuals do not have health insurance the state government will pay for their test. During high demand for testing certain limits may be introduced where high-risk get priority, as of now this is not currently the case as demand for testing is at comfortable levels. The state does have a contact tracing system in place. There are other companies and clinics performing coronavirus testing, but OptumServe and Verily are the main two companies promoted by the California state government.
So, the above really goes to show you how different two states can handle the pandemic and the effect it has on positivity levels, cases, and so on. It highlights how important it is for state governments to do their fair part in combating the coronavirus pandemic, and why not all blame should be laid at the feet of federal government.
And as we saw in Texas those not covered by health insurance can only receive a test if recommended by a health professional and they may need to pay for it, and it is also possible not all health insurance covers all testing sites, presenting some other potential difficulties. Texas testing areas also appear to be less widespread in the state compared to California and also less centralised. So, for example in California the government heavily promotes two private companies testing locations, Verily and OptumServe, in Texas though there is no such specification or promotion.
California has also tested a far higher percentage of its population overall compared to Texas. California’s testing plan included testing over 28.6 million of its 39.5 million population by the end of 2020, while for Texas it only planned to test just over 7 million of its 29 million population by the end of 2020. This is according to data from ourworldindata.org. As it now stands Texas has conducted over 19 million total tests, while California has conducted over 47 million tests (more than its populace), data from covidtracking.com. It is to be noted that for both Texas and California unique tests have not been reported and it is entirely possible the number of unique tests are a lot lower than total tests, that include repeat testing.
South Dakota, currently with the highest positive rate, has tested 950k times, with 417k of those being unique, so although total tests are above its population level, total unique tests only make up just under half the states total population. This can really give us an indication that those getting tested are likely only due to being sick and is why its positivity rate is inflated.
Restrictions and Mask Wearing Overall
Mask wearing is mandatory in a number of states including California and Texas – again in Texas there is the ability for counties to apply to be exempt from mask wearing rules. There are only 12 States that do not enforce wearing of masks and 6 States where mask wearing is sometimes required, all other states (32) require mandatory mask wearing.
Businesses are mostly open across the United States, only 7 States are mixed restrictions on businesses being opened, these are California, Oregon, Arizona, New Mexico, Colorado, Massachusetts, and Connecticut. There are no states where businesses are mostly made to close.
Only two US States have stay-at-home orders or curfews in place to try and stop the spread of coronavirus, these are Virginia and North Carolina. 6 other States are advising its populace to remain at home and only leave if essentially needed, these are California, New Mexico, Wisconsin, Kentucky, Rhode Island and Delaware.
North Carolina put a stay-at-home order in place where the populace must remain at home from 10pm to 5am local time, which has been in place since December and was extended until Feb 28th before its next review, the measures were in response to rising cases and high hospitalizations. When measures were put in place the curve of cases hit its peak by mid-Jan and have been falling since then.
In Virginia there is a curfew from midnight to 5am local time and a limit on more than 10-people gathering also in response to increasing cases, after measures were put in place the curve hit its peak near the end of January and have been declining since then. There are capacity limits on entertainment venues, outdoor amusement parks and zoos.
But despite the stay-at-home orders and curfews for the above two states, businesses remain mostly open and as can be seen from the trend in cases there have been little adverse effects on not implementing a full-on lockdown, thanks to other restrictions that are in place. The current restrictions for Virginia have also been increased through to 28th Feb for the next review.
But overall, all 50 US States are currently seeing a decline in cases irrespective of what restrictions they do or do not have, states have been seeing cases decline from peaks in either December or January. Of course, though as current restrictions get eased more and more there is the obvious possibility of a third wave later this year. But it is also likely that the current vaccination process will make the next wave less severe.
So, although each state is handling things differently from the other, all states are still seeing a current decline in cases, but the removal of restrictions needs to be a careful and considered process to try and hold off a 3rd wave for as long as possible. Each state has an individual basis on rules and conditions for increasing or decreasing restrictions and there is no one way to an end, restrictions reduced can just as easily be re-implemented again by order of the state’s Governor.
The hardest hit sector overall from restrictions and from being made to close are those that provide Food & Drink, followed by the Entertainment sector. If a State chooses to shut down businesses, then those most likely targeted are for now Food and Drink places and this is hardly surprising as such places provide some of the highest risk factors from contamination due to proximity of people, those preparing and making food, and the fact that you can’t really effectively wear a mask while eating and drinking.
And while states are managing to now handle their coronavirus cases the new 7-point plan that is being implemented by the new Biden administration should serve to consolidate the current success even further.
Above information is provided by the NYT and respective state government websites.
And so, although the 500k deaths in the US is a grim point to reach, it was unfortunately inevitable. Actions of the Trump administration certainly boosted the deaths to this level quicker than it otherwise would have happened, but it will likely be up for debate for years to come whether the 500k death mark could have been avoided even if Trump’s actions were not a factor. The death toll will continue to rise as it lags behind case rates quite a bit, but that to will eventually decline along with the cases.
Once the death rate has declined there will be a clearer picture of whether the Biden administration’s plans will limit any future spikes in deaths in the likely future spikes of coronavirus cases as restrictions are eased. It is yet far too early to say the plans of the Biden administration for coronavirus are working (with many plans still yet to pass through Congress and be implemented, such as the COVID-19 Relief Bill) in the US or how much of an effect they will have, but there is large optimism for them to be a far better success than Trump’s unconsolidated, slow, and muddled response. I’d say give it at least a year before any real analysis of Biden’s COVID-19 response can be assessed.
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