November wasn't pretty

 We've all become even more tired of the pandemic, and its most recent surge.   Dr. Fauci and others keep warning about travel for the holidays, and suggest that we are on the cusp of the biggest surge yet.  I don't know about your colleagues, but ours have just sighed -- "ENOUGH ALREADY" seems to be the most prevalent response, while the Non-Believers (and there are plenty in our neighborhood) -- exclaimed with profane comments.

And yet, the news is getting ever more real

As one local specific, seven -- actually ALL SEVEN -- of the OR techs at our county hospital all got Covid from their own party last week.   Talk about infuriating the hospital leadership, not to mention affecting scheduled surgeries . . . .    As the director said, "WHAT THE 'ELL WERE THEY THINKING?"

It turns out that November was one-third of the nation's total confirmed cases for the whole year.   I put together some choropleths (geo-spatial maps) for per capita confirmed cases and deaths that show the first six months of the pandemic in America, the next three months, and then November.    I'm sure that you all remember how we compute these--there is a great interactive website that I commissioned and we maintain, at https://anywhereanytime.io/covid19/  Check it out, and have some fun.

If we start with these pictures, it is clear that the first period was very localized--deaths mostly in high-density urban settings and the Native American reservations (the upper left-hand choropleth).   The second period captured heavy case-loads in the South and upper Midwest, with both a high density death-rate in the South, and a rising incidence in the Upper Midwest.   The third--this past month of November--is center-weighted for cases in the Upper Midwest, but also in the Rocky Mountains, while the case-rates in the South have clearly declined.

The lower right-hand corner shows the entire year for America--the clearest conclusion here is that this Covid-19 pandemic has touched nearly every U.S. county to a significant degree.  If your county is orange on that map, it says that at least 1 person in 30 has been infected locally.  Death-rates are not quite so distributed, but even there, more than half of the counties (most in the South and Southwest) are denoted on the choropleth.

Let's turn to the data itself.   As noted above, the number of Confirmed Cases was nearly equal for each of the three periods.   Deaths, though, declined precipitously, so that the odds of dying from Covid-19 if you contracted it has gone from 3.5% to 0.8% -- more than 75% reduction.   Granted, a sizable part of this is due to a shift in the age of confirmed victims to much younger, more healthy patients, but it is also true that treatments have sizably improved.   Getting Covid is not nearly as dangerous today as it was eight months ago.

It turns out that each of those three periods had roughly the same number of total cases, but the periods were much more compressed.  Thus, the case rate first doubled, and then tripled--that should be a WOW for practically any observer.    Because the death-rate has come down dramatically, the total deaths for each period on a daily basis has been just about constant, although it did rise nearly 50% in the most recent period.  This is the statistic being focused on just now by the CDC and Dr. Fauci, and indeed it augurs to rise with the rapidly inflated rate of cases recently.   Bear in mind that there is usually a three week lag in deaths from confirmed cases, so the spate of high cases in the past 30 days may portend a high surge in deaths in December.

So, taken together, it is not yet time to let our guard down.  Au contrare, now it is imperative to heed the advice and stay vigilant, stay safe.   Viva la vaccine, but we're a long ways from having it universally available.

Some folk are sensible

 I've been critical of nonchalant or devil-may-care or even more ignorant attitudes about Covid in these posts, and in fact, a main motivator for my Dashboard has been to try to educate local leaders and citizens to the dangerous facts about this pandemic in our own area.  The tragedy unfolding in the Dakotas has been a particular target in the past three months, post the insanity of allowing / encouraging the Sturgis motorcycle rally and the governor denials for both states.

Recently, as each became the deadliest spots on earth, the North Dakota governor 'got with the program' and said, "Hey, let's use masks after all".   Wow!   But then, the viral post from the South Dakota nurse who said victims were still in denial even as they were dying--whew!  Viz. November 16 post.

So it was particularly encouraging to see the following news story this morning, from Mark Fisher et al, "Head Home or Hunker Down: The Thanksgiving Covid Dilemma"

Twelve hundred miles to the northwest, George Masters also decided to shrink the day’s festivities. He still plans to make his broccoli casserole; his daughter still plans to bring the mac and cheese. But the turkey will be half as big as the usual 20-pounder. And he has slimmed down the guest list, from 19 to six.

Although Masters and his family share a reluctance to embrace mandatory mask rules — “We all like Trump,” he said — the reality of the virus’s spread has become hard to ignore in North Dakota.

Since Oct. 1, the number of covid-19 deaths in the county where Minot sits has ballooned from 11 to 115 as of Tuesday. Masters knows two guys who have died of the disease — an Air Force buddy and a friend in town. The other day, his grandson and daughters came down with coronavirus-like symptoms.

“It’s starting to hit a little closer to home,” said Masters, 70, who runs a classic-car restoration shop. “A lot of people have passed away.”

On Thursday, Masters expects little, if any, talk of politics. Although his family supports Trump, they recognize Joe Biden as the president-elect. “Whatever the majority chose, that’s it,” he said. “That’s how it works and we just have to go with it.”

The gathering will be smaller than usual, but Masters said his family will still have a good time. He already knows what joke he’ll be telling:

“A guy goes to the doctor and asks, ‘When is this pandemic going to be over?’

And the doc says, ‘I don’t know — I’m a doctor, not a politician.’ ”

CALIFORNIA AGRICULTURAL COUNTIES

 You'll doubtless recall from our posts last summer that the agricultural counties of California--notably the "Big Four" (Fresno, Tulare (where I live), Kings and Kern) were 'out of control'     And so was California.

Recall, for example, the posts from June 7, July 6, and July 13.

Well, California just had its 'biggest week yet' in terms of New Cases--73,877 vs 68,253 in mid-July.   A piece of good news is that the state-wide death-rate has fallen nearly in half.   But, in common with nearly every state in America, the New Case Rate is at an all-time high.

The "Big Four" agricultural counties are down 60% in New Case rates, while California is UP 7%.   So, that is good news to be sure.  Moreover, the Death rate is also down by nearly 50%, like all of CA.  

Back then, the 4 Ag Counties (with 6.3% of CA population, had 15.9% of New Cases and 4.9% of deaths).  Today, the numbers for the Ag Counties are much more aligned with CA's total population, in fact better across the board--6.3% population, 6.1% of cases, and 4.3% of deaths.

So, one might ask--what changed?   Did the local residents "wise up"?   Did other CA counties forget what this is all about?  Or are these pretty random, and it is futile to attempt to find cause and effect?

A big change for our counties is that early on (well before either time-period shown), we had an unusual percentage of folk afflicted in nursing homes, food processing plants, and prisons.   More recently, and for both periods shown, the basic driver has been 'community spread'--but this is true state-wide.   So, in truth, I have no thesis for why these improvements in our local counties, but THANK GAWD it's true.

Dedication and perseverance

 We hosted a Pony Club clinic today at our Horse Stables https://www.sequoiahillsstables.com/ 

The trainer for the day, who gave private 45 minute lessons all morning, and then judged the afternoon show, was Lauren Billys, http://laurenbillys.com/     Lauren represented Puerto Rico in the 2016 Summer Olympics, and is on track for the 2020 Olympics which have now been postponed as you know into 2021.   

Lauren is a young lady from Visalia, California, whose grandmother is Puerto Rican, so that earned her the Olympic spot.   Imagine--a girl from here, 'in the spotlight'.   Her mother, Betsy Billys, was a well-known dermatologist in Visalia before her retirement--she says "I never went in for horses, but she did"

During lunch, Lauren shared 'her story' with a dozen eager young women, and it is a story well worth repeating.   She began riding with Laurel George, who is still training at our facility some 25 years later.  Laurel attended today with her husband Al, and they were just bursting with pride about this young lady.

As Laurel describes it (in front of Lauren even), Lauren was not a natural rider.   Her sister was, and I can relate to the situation where a sibling is better, even much better, at something than you are.   You can't hide from it, and there are really but two good answers--One is to persevere and get better and better; the other is to abandon the game and find a new game to play where the sibling doesn't compete so well.

Lauren chose to stay in the game, and her story of perseverance and overcoming handicaps was both heartwarming and affirming of the power of dedication.   She shared her emotions and fears along the way, and it was incredible to see the faces of the young ladies attending as they could feel their own histories and agonies.   

Her humility, her grace, and her successes are testament to a wonderful path of learning and perseverance.

Years ago, in Park City, Utah, we had the privilege of knowing two young boys, Charlie and Ted, the sons of neighbors and realtors Bill Ligety and Cyndi Sharp.   Charlie was the awesome skier-kid; Ted was a little bit less skilled, but loved the sport.   Charlie found other pursuits, but Ted persevered.  And dedicated himself to learning more and more.  And then, to everyone's surprise, he won an Olympic Gold Medal in 2006 for his slalom skiing.  And then went on, and on, and on.   And surpassed even the greats in American ski history, earning more international medals and awards, and yes, more Olympic medals than even Bode Miller or the Mahre brothers.

And like Lauren, he never lost that sense of humility, grace, and warmth that comes from the satisfaction of doing your best, and then better than your best, by dint of hard work, dedication and perseverance.   

You can indeed excel, if you just believe in yourself and give and give and give unstintingly.   Sound too good to be true?   Not for them, it wasn't.   Go for it!

California and others LAST WEEK

We've had a veritable explosion in California cases in the past week, well beyond any week this year for new Covid Cases.    But the per capita choropleth for New Cases and Deaths doesn't look ALL THAT BAD, at least compared to the "leaders" in the Dakotas and some neighboring states.   Take a look . . . 

Contrast that with the Dakotas, which just took the lead for the world, in per capita deaths.  And then try to reconcile the idiot Governor of South Dakota who yesterday urged her citizens "to get together for Thanksgiving" to celebrate this wonderful holiday in America.   She is so appallingly ignorant.

Neighoring states aren't "Quite As Bad" but hardly like California.   Note that the absolute numbers for all of these states are not too high, but the per capita numbsers (YOUR ODDS, actually) are terrible.

And another couple of Rocky Mountain states

And finally, some neighbors of the Dakotas.   This all seems to have been ignited by the famous (now infamous) Sturgis Motorcycle rally in mid-August.  Whoopee--how damn dumb can people be?

This can't be real -- really?

 November 16, 2020

The press coverage that stopped me cold was this: a South Dakota ER nurse @JodiDoering says her Covid-19 patients often “don’t want to believe that Covid is real.”

1 Alicia Kohn, The Hill, November 16, 2020, https://thehill.com/homenews/state-watch/526204-south-dakota-nurse-says-many-dying-patients-still-insist-covid-19-not

“Their last dying words are, ‘This can’t be happening. It’s not real.’ And when they should be... facetiming their families, they’re filled with anger and hatred.”

A South Dakota emergency room nurse on Monday expressed frustration that many of her patients don't believe they are dying of COVID-19.

Jodi Doering's tweet went viral on social media over the weekend after she tweeted about patients who "don’t believe the virus is real ... while gasping for breath on 100% Vapotherm."

"It wasn't one particular patient, it's just a culmination of so many people," Doering told CNN's "New Day." "And their last, dying words are, ‘This can’t be happening. It’s not real.... People want it to be influenza, they want it to be pneumonia," Doering said. "We've even had people say, 'You know, I think it might be lung cancer.' ... Even after positive results come back, some people just don't believe it."

Doering said multiple patients target nurses like her with their "anger and hatred."

"They call you names and ask why you have to wear all that 'stuff' because they don’t have COVID because it’s not real," she tweeted on Saturday. "I think it's just a belief that it's not real and nursing happens to be on the receiving end of that," she told CNN.

Other health professionals have accused South Dakota's leaders of also being in denial.

“You in the Dakotas … you knew it was coming,” Dr. Ali Mokdad, a professor at the Institute for Health Metrics and Evaluation at the University of Washington in Seattle, told USA TODAY this month. “You denied it ... even today you are denying it.”

Mokdad was responding to South Dakota Republican Gov. Kristi Noem saying her state's per capita death rate was better than New York's over the course of the pandemic. 

Tuesday data from the COVID Tracking Project shows that South Dakota and neighboring North Dakota continue to have the highest per capita rates of COVID-19 infection and death in the nation.  

In fact, their case-rates are higher than any nation on earth.  Governor Noem is correct that New York's per capita death rate is higher, which discounts two significant facts -- 1. those all happened early, before doctors had much sense about possible treatments; and 2. it happened selectively, mainly to nursing homes with elderly patients most susceptible, in NYC.   

Here are some comparative numbers for the past ten months, and for the past ten weeks.  Note that North and South Dakota are "out-performing" on new cases; their death rates are more modest until you look at recent data

Here's the overall data for Cases per 100K, and Deaths per 100K (Since January 2020), and yes, NY and NJ are well ahead of the Dakotas on total death-rate, even though the Dakotas 'win' the Case Loads

But here's the RECENT DATA, from the ill-fated Sturgis Motorcycle Rally in South Dakota to now

We have clear winners in the Dakotas on both Case-rates and Death-rates. One out of 11 are infected in North Dakota recently, and 1 out of 14 in South Dakota, but "THIS ISN'T REAL?"

COMPARATIVE STATS FOR USA and some of EUROPE

 Lest we forget, or fail to read or listen to International News, Covid is resurging in Europe, a region given lots of praise for 'handling the pandemic better than the US' during the spring and summer.   And more than a few US pundits have said "See, their methods (by which they mean 'lock-down') didn't work any better than ours--so we can stay on the (lunatic) course that we're on."

I know, I know--I'm letting my emotional self get in the way of unbiased reporting here, but myGawd, how can people be so myopic on the severity and extent of this pandemic.

So, with respect to the US vs. some other countries, how'ze it goin' now?   Well, herewith some insight

So that story is pretty dynamic at the moment.   Just how dynamic?   Well, let's include France and Spain alongside the UK, since they are truly experiencing a recent sky-rocketing case-load

How do these numbers compare with the recent boost in USA states?   Well, not too worrisome if you are 'on the continent'.     Check out especially the Dakotas, three months downstream from the Sturgis motorcycle rally.   But the more significant story, in my view, is that many US states are way worse than nearly all countries on a per capita basis.    And with the recent explosion in US cases, this only portends to get worse, not better.

Just for completeness, here's the most recent compilation for US states in both absolute and per capita terms, for both Confirmed Cases and Deaths.

If your eyes aren't fully glazed over from all of these charts, I applaud your fortitude and enthusiasm.

If you would care to see more, just ask.

All the best, and stay as safe as possible.