Louisiana’s first reported Covid-19 case was a patient in Jefferson Parish near New Orleans. He was diagnosed on March 9 and he is officially the Index case for Louisiana, so far as government and public health authorities can tell.
Our Governor has undertaken rapid and comprehensive public health measures since then to blunt the ravages expected from a viral pandemic sweeping the United States. When history is written, the first paragraph respecting US efforts to control the virus will take note of Trump.45’s stubbornly lackadaisical public health reaction for the first 90 days after he was first made aware of the initial surge in China, and the virus landing on US soil in the middle of January.
Time lost, advantage never to be regained. In the last 96 hours we have a declared National Emergency, and finally some serious efforts at surging test capacity outside of federal control and management, and an apparently meaningful commitment by the Federal government to implement sound public health mitigation strategies, though largely goaded in reaction to state governors’ aggressive actions, with the Federal response trailing behind.
In 40 years of public health practice, it is virtually unheard of for there to be such detailed information available in near real-time for so serious a public health emergency. Normally it takes weeks or more often months to match even our current state of knowledge. The Covid-19 epidemic is on steroids, but so too is our public information pool. That near Warp Speed availability of information may, just may, allow us to escape the otherwise inevitable effects of the initial slow-motion tardy response of Top Officials to recognize the Wave coming at us all. We might get somewhat lucky, if everybody gets serious instantly about significant social mitigation for at least 60 days. Pokey about and bust the rules, and the entire society will pay in more blood and treasure. Not Cassandra, Just the righteous facts.
Here is a set of core data charts for my home state of Louisiana starting almost literally at Epidemic Ground Zero for this state. We are 4.5 million souls. We are a strong Republican voting state, with a moderate Democratic governor. And he implemented some of the strongest protection policies adopted in any state within less than one week after learning of the First case here.
So, our state is a kind of unintended real-life experimental petri dish about what might help to blunt the epidemic curve, or prove that we acted too late to stem the tide. If people weren’t going to sicken and die and suffer major economic loss, it would be an epidemiological dream scenario in an alternate universe.
There are three core tracking tables, starting from the Week of March 8, and updating daily. The first table presents Louisiana’s Cumulative Reported Cases of Covid-19 by date. The second shows the extent of Louisiana’s Covid-19 Lab tests Completed by date. And the third offers the number of Louisiana’s Covid-19 deaths by date. These three simple charts are the basic tracking values for the initial upsurge in the pandemic in Louisiana. The data are provided twice per day on the official website of Louisiana’s Department of Health. That fact alone has already distinguished Louisiana’s public health facing transparency from the bumble stumble of Federal mismanagement so far. Congratulations to the providers of the public health advice heeded by the Governor.
These primary tables can be used to follow in a simple way granular changes in Louisiana over time, day by day, and week by week as we sail into the teeth of the pandemic. They can be made by inspection or simple chart comparison.
The data in the charts can also be used to compare the circumstances in our State to the rest of the United States and the rest of the World.
Two initial examples are described below. In an earlier post today, I introduced a Mental Abacus tool for simple tracking of Cumulative US cases organized by week and day. The Louisiana only chart given here is directly comparable.
For the time period where information is available for both, you can see how Louisiana stacks up compared to the whole country. Today Tuesday March 17 Louisiana has reported 196 cumulative cases compared to 6,362 in the United States as of 5 PM and 9 PM respectively. Louisiana has 4.65 million residents while the US population is 334.35 million.
Louisiana is 1.4% of the US by population but is experiencing 3.1% of reported Covid-19 cases in the country. So, Louisiana right now has about twice the national average statewide burden of diagnosed Covid-19 cases. We don’t know if that is because Louisiana residents are sicker, more susceptible, has an older population, had Mardi Gras at Time Zero here, has better organized testing, better public health preparedness, etc. We don’t know why yet, but we will sure be getting some better answers soon.
At some point soon ,merely comparing total cases in one geographic location to another will be increasingly less useful, since it ignores the enormous variations in population size which drastically affect raw numerical measures. Two states may have exactly the same risk, but if one has 10 times the population, the raw numbers would suggest it was 10 times more dangerous there.
The easiest was to adjust these figures to a much more informative metric is to present case rates per a standard population unit (for example cases per 1,000,000 population).Once a reasonable number of cases is achieved, say 100, comparison among different groups should favor population adjusted measures for risk review.
These core charts can easily be adopted to a case per million reporting structure, as seen below.
The diagnosed rate of infection in Louisiana is 42 per million as of Today. A week ago it was less than 1 per million. On Saturday it was 16 per million. The observed risk has more than doubled in less than a week since the Governor took strong action. Why? Future days will help answer that question.
Remember that the cases seen today are the result of exposure and infection a week ago (incubation time to overt symptoms averages 5 up to 12 days delay). And we are just beginning to get out from under the massive chokedown on testing, such that the Louisiana positive test rate is still above 30%, indicating a large reservoir of undiscovered infections circulating among us.
Similarly, the US reported case rate per million can be determined. As of this evening with 6,363 reported cases in the nation, the average US case rate is 19 per million averaged over all 50 states. For today, Louisiana is showing a rate per million about twice the national average, which would qualify us as a current hot spot statewide.
The comparison values will vary over time, but right now, that ought to mean that Louisiana should go near the head of the line for Federal medical assistance, testing allocation priorities, provision of protective masks for health providers, and logistical and engineering assistance from Federal stockpiles and personnel like the Army Corps of Engineers, and US Pubic Health Service personnel support. This is a science-based assessment, despite the fact that we have a Democratic Governor leading our response. We will wait to see if the Federal Allocation Gods wear a blindfold, or take instructions by tweet. It may be a difficult decision, since Louisiana cast its electoral votes for Trump. But the Governor, while a distinct moderate, is still of the wrong political stripe.
This new analytic chart can also be used to compare Louisiana to other World countries of interest, such as France, Germany, China and Italy. Here is a chart from WorldometerTracking that illustrates the point.
The absolute case numbers aren’t the best relative comparison. We can see that Louisiana’s current rate is nearing that of China (56-which has slowed its rate growth dramatically after 4 months) and is roughly 1/3 that of Germany (112) and France (118) which are still in the rapid epidemic growth phase. And Louisiana’s rate is currently less than 10% of that found in Italy (521). All these rates except that of China are on the way up and growing significantly but this is a snapshot in time, as the US tries to implement American style social distancing with a moderate hand, in hopes of falling well short of the European experience model. Again, these are approximations, but they don’t take days of computer programming and Monte Carlo simulations to get a reasonable idea of where we are now.
As the data accumulates more specific and detailed analyses can be done, say by age groups, or population density in each US state, which is not the same thing as total population. But you have to start somewhere, and this is a good place to do that.
Protect Yourself.
Be Responsible for the Sake of Those You Love and Others Too
Mitigate, Social Distance, and Shelter For 8 Weeks At Least
