32. Monthly Update: The U.S. is in an Extraordinary Recovery while Most of the World Stumbles

(4/14/21) There is no doubt that vaccines work and the stepped-up effort by our Administration to achieve widespread vaccination is saving tens of thousands of lives. Unfortunately, most of the world is seriously lagging and it correlates directly to the effectiveness of their vaccination programs.


At each of these monthly (or longer) interludes I hope (pray) that there will be no further need for these updates given the reality of this recovery. But things are never that simple and coronavirus is very much alive in most of the world. But the trends are good.

The Tables below give a dashboard view of per capita cumulative deaths and weekly death rates as indicators of total magnitude and current severity, respectively, of the epidemic in various populations ranging from local to international. The 4th column shows the direction and magnitude of changes in Covid-19 severity relative to the previous reporting period (6 weeks ago).

Cumulative death and death rate data for select populations around the world (as of 4/9/21).

In this short period of time CA and particularly Orange County and Los Angeles County have enormously reduced cases, hospitalizations, and deaths. OC and LAC have reduced the death rate to near zero. The U.S. has also made great strides with some exemptions, such as MI. The rest of the world, however, is stumbling along. Whereas the UK, ground zero for a new variant, has astonishingly beat (for now) their recent severe wave, other European nations, e.g., Italy, France, and Belgium are suffering through yet a new 4th wave. Brazil remains a basket case and continues as a world leader in government indifference. So, what accounts for these disparate trends? Vaccines! The UK aggressively deployed vaccinations and they did what I recommended months ago by maximizing the number of people getting first shots and delaying the second booster shot. This strategy worked incredibly well as you will see shortly in the more detailed discussion below. [An article in the NY Times yesterday, 4/13/21, recites experts who are now advocating for the single dose approach to maximize the inoculated population.] Israel is another great example of the success of aggressive vaccination.

The U.S. vaccine distribution program has progressed from total ineptness to becoming a world leader in just a couple of months. The EU was too bureaucratic to implement emergency measures and consequently late to procure vaccines and put a distribution plan in place. Perhaps Brexit was a blessing in allowing the UK to implement a rapid response plan without the bureaucratic drag of the EU.

Here are the latest death rate plots for the U.S. and CA as well as the US daily case rates.

Daily death and case rate data for the U.S. and CA. The case rate for the U.S. (middle plot) just covers the time-period for the third wave. Red line is 7-day moving average.

The U.S. and CA are on a clear downward trend with death rate down to 1/3 and 1/5 from their peaks for the U.S. and CA, respectively. U.S. case rates are also significantly down but notice there is now a clear rebound. I do not view this as very serious and in fact predicted this in my last update 6 weeks ago. This is because there are two opposing forces operating. Our country is tired of the pandemic and there is clear social relaxation everywhere in addition to the spread of new more contagious and maybe more potent virus variants. This upward pressure on cases is mitigated by an effective vaccination program to reduce the susceptible population. So, if you multiply a positive going function by a negative going function you get a function that looks like a hump. The size of that hump depends on how quickly we reduce the susceptible population by vaccination. So, I think the U.S. hump will be small. But you will see shortly that the hump will be, if not already, very big in countries where vaccine deployment is slow.

The Local Scene

In southern CA you couldn’t hope for better progress than what you see in the figures below. The rate of new cases and deaths for LAC and OC is just a few percent of its peak values just 2-3 months ago. This is not due just to social restrictions, though Gov. Newsom should get some credit here! It is also due to a high percentage of these populations becoming immune from having caught Covid-19 (perhaps 20% in OC and 33% in LAC) and even more so to effective vaccination deployment. To put this into perspective your chances of getting infected if you are not yet immune are only a few percent of what they were just a few months ago when I alerted that more than 1 in 100 people in both counties were infected and contagious at any given time. When I first heard Newsom say that June 15 will mark a full reopening, I thought this might be premature. But given the current positive trends and assuming it is more likely to get better than worse, then I agree, given there must be an easing date eventually, that this is not too reckless a date.

Cases, hospitalizations, and death rate for Los Angeles County (as of 4/9/21). Red line is 7-day moving average.
Cases, hospitalizations, and death rate for Orange County (as of 4/9/21). Red line is 7-day moving average.

A small mystery in the above plots is why hospitalizations due to Covid-19, though significantly lower than their peak, are not as close to the baseline as the case and death rates would suggest. The plot below shows hospitalization death rates for all and for intensive care unit (ICU) patients. These rates, which hovered around 2% and 6% for most of the pandemic are now decreasing. By the way, if anyone says that hospitals were not overtaxed by the most recent severe outbreak in CA just look at the hospitalization death probabilities that peaked to 20% and 15% for ICU in LAC and OC, respectively. This is because the level of care was extremely strained and that patients, other than the most severe, were turned away for lack of beds and resources. This was an especially dreadful time for hospital workers, the patients, and their families.

Hospitalization death rates. Solid lines are 2 week moving averages.

The Nation

Below are death rate plots for the same representative U.S. states we have shown before in case anyone is comparing.

Death rate plots for select U.S. states (as of 4/9/21). Red line is 7-day moving average.

Key observations are:

  • The situation around the U.S. is looking promising notwithstanding the case rebound seen in some states.
  • Some of the hardest hit states, e.g., FL, AZ, TX, that were lax on social distancing measures have recovered significantly from their peaks perhaps due to high immunity from pervasive infections in their states.
  • MI is reporting a severe new outbreak based on new case data. Oddly the death rate, though trending up, is still well below its wintertime peak. Deaths are a lagging indicator so we expect the daily rate to climb for another few weeks before recovering as vaccinations increase.

My last four monthly updates have reported the U.S. Covid-19 death 250,000 (11/20/20) to 330,000 (12/25/20) to 420,000 (1/22/21) to 510,000 deaths (2/26/21). Now 6 weeks later we stand at 560,000 with a chance we never see 600,000. However, that does not mean we should become complacent. The death rate even at 1/3 of its peak is still at about 1,000 deaths per day, which looks very grim when compared to historically huge tragedies in our nation’s past.


The world is mostly in recovery but with some disturbing hot spots. Death rate plots are presented below for selected countries that we have been following before.

Death rate plots for select countries and for worldwide (as of 4/9/21). Red line is 7-day moving average.

Key observations:

  • The EU has struggled to implement an effective vaccination program, which is evident in the slow recovery from the 3rd pandemic wave that peaked in Dec-Feb. and is now leading to a 4th wave spurred mostly by new virus variants and fatigue in continuing with lock downs. In terms of death rate Italy is suffering the worst of the rebounds followed by France, Belgium, and Spain (above plots and further above tables). However, looking at new case rates in the figure below one sees that per capita the order starting with the worst is France, Italy and Spain.
  • The UK being ground zero had one of the worst recent outbreaks in the world. However, unlike some its previous tepid responses, this time they put in herculean effort to combat the outbreak. Perhaps one of the most judicious decisions was to deviate from the prescribed vaccination protocol of giving individuals two shots and instead decided to spread single shots to the maximum number of people. As you can see from the plot above the UK smothered an out-of-control outbreak in just two months. Perhaps Brexit deserves some credit by freeing the UK from the series of missteps by the EU commission in vaccination planning that now plagues the rest of Europe.
  • One has to sympathize with Brazilians for being victims of a government that sneers at Covid-19 and makes little attempt to protect their citizens. They are by far suffering the greatest death rate of any country in the world and now exceed the records set by the U.S. This neglect is compounded by having entered the Fall season, typically an accelerator of flu transmission. They are destined to reach herd immunity by having the great majority of their population catch Covid-19.
  • We have focused on our perennial countries as I don’t have the time to delve into other countries. However, it is worth noting that India is now accounting for much of the uptick in worldwide cases. Also, the total reported deaths in Russian are very short of the number obtained by looking at the increase in total deaths relative to the same time period in prior years.
New cases per week per 100,000 inhabitants in Europe (as of 4/13/21). Data from Statista and Johns Hopkins University.