24. Biweekly Update: Is California Really Improving and What’s Up with Spain?

(9/8/20) California hospitalizations are on a steep decline so why isn’t the death rate following? Spain is getting a case of U.S.-itis with government neglect fueling another outbreak.


Whereas I thought I was lapsing into monthly updates, I find myself back after two weeks and living up to the Biweekly label. Covid-19 is still very dynamic with population changes occurring daily. I will continue to lead with per capita data for cumulative deaths and weekly death rate as an indicator of total magnitude and current severity of the epidemic in various populations ranging from local to international. In this snapshot one can see that the current per capita death rate places the U.S. second worst in the world behind Brazil though a number of Latin American countries are nipping at the bud.

The main observations are:

  • The benchmark worst in the world is Brazil and is exceeded by at least 3 U.S. states; even more disturbing is that Orange Country CA is suffering a similar death rate.
  • The U.S. is on track to exceed all major countries except Brazil as the deadliest nation for Covid-19.
  • It is easy to get desensitized to the magnitude of Covid-19 deaths in the U.S., however at recent rates of about 1,000 deaths a day, this is comparable to 5 airplane crashes a day or two 9-11’s every week. And to think it was 2-3x worse back in April.
  • The good news is that the recent U.S. outbreak states appear to have reached a death rate peak.  But hitting a peak means the downward trek will account for at least as many deaths as the way up.

Because I like to show death rate plots (no I am not morbid) here is the latest data for the U.S. and CA.

Daily death rate data for the U.S. and CA.

The Figure below shows the percent of all U.S. deaths that occurred in California. CA was once the model state, but the resurgence over June-August has now placed it on-par for the U.S. with a steady 12-13% of the deaths with about 12% of the population.

Relative daily deaths in CA as a percentage of the U.S.

The Local Scene

The last update (23. Biweekly Update – The U.S. has Given Up) gave a lot of hospitalization and death rate plots and these are still worth reading about. Below we show total hospitalization (which closely mirror ICU, which is about 1/3 of all Covid-19 patients) and death rate. There is an alarming disparity developing. Over a month ago on 8/3/20 (in Daily Rumblings – II) we first reported an incongruity in the hospitalization and death rate data such that the predicted decline in death rate following a 1-2 week lag from hospitalizations was not yet evident. We postulated that the lag might be longer and would manifest itself shortly. One month later that has not happened as you can see from these plots for LA and OC.

Hospitalizations and death rate for Los Angeles.
Hospitalizations and death rate for Orange County.

One can only surmise for what accounts for this contradiction. A possible explanation that I’ve voiced before is that patients may be getting released from hospitals earlier than usual thereby reducing the steady-state level of hospitalizations. Once again, the only true measure of the magnitude of an epidemic is death rate as that is hard to misreport. Cases are susceptible to inadequate testing and now hospitalizations may be susceptible to some new bias. The following Figure plots hospitalization mortality rate of all patients and ICU patients in LA and OC. It is clear that in just one month this percentage has increased alarmingly ranging from 56-92%. This is a mystery that has not to my knowledge been recognized let alone explained. I’ll be digging more into this for sure.

Mortality rate for hospitalizations in LA and OC.

The Nation

I lament when every two weeks I see that the Covid-19 situation is not improving. However, this time there is a reassuring reduction in death rate over the last few weeks and that bodes well for a recovery. Still the biggest hot spots in the nation of the more populous states haven’t changed in the last two weeks and continue to be FL, TX, AZ, GA, NC and CA bringing up the rear, but again almost all states are reporting declining death rates. The death rate plots were given in the last update on Aug 22, 2020 (23. Biweekly Update: The U.S. Has Given Update). The U.S. plot is given above.

Nice not to have to chastise too much this time.


Similar to the update for the U.S. states not much has changed internationally though there may be signs of a downward trend for the worst of the nations, e.g., Brazil and the U.S. The biggest hot spots in the world for the more populous countries in approximate order are still Brazil, U.S., Mexico, Peru, South Africa, Columbia, Iran, and Argentina. Russia and other countries may be under-reporting. Please refer to the daily death rates in the last update (Post 23.) to observe plots for early hotspots that recovered (Italy, Spain, France, U.K.) and countries that are having rebounds or first-time outbreaks (U.S., Brazil, Iran, and worldwide).

The Tale of Spain: We were more prescient than expected in sounding an early warning on Spain. I made the following comment (Post 23.) on 8/22/20:

“Spain has abdicated federal response and given control to regional governments, which could bite back.”

Shades of the U.S. lack of strategy, which is distressing since Spain worked so hard to snuff the virus out. Below is the death rate plot for Spain next to that for Worldwide. Spain is going through another outbreak with deaths approaching an average of 100 per day. Again, a warning about premature easing and abandoning leadership. From the WW plot it is evident that thevirus is still raging in many new hot spots around the world.

Death rate plot for (L) Spain showing a new outbreak and (R) Worldwide.