As Heritage Foundation researchers have demonstrated throughout the pandemic, the spread of COVID-19 in the U.S. has been heavily concentrated in a small number of states—and among a small number of counties within those states.
In recent months, the number of new cases has been more geographically dispersed, but COVID-19 fatalities remain highly concentrated.
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For instance, near the start of the pandemic, from March 1 to April 15, half of all the new cases were in just 22 counties (with just a 12% share of the population). Fifteen of those counties were in either New York or New Jersey, and all but 4 were in the Northeast corridor.
However, from Oct. 1 to Nov. 12, half of the new cases spread among 182 counties, in 42 states. Moreover, these counties contain 49.4% of the U.S. population, roughly equal to the share of new cases.
Although 18 of these counties are in New York and New Jersey (including many in the New York City area), states outside the Northeast contributed significantly to the rise in new cases. For instance, 13 of these counties are in Wisconsin, 12 are in Texas, 10 are in California (including Los Angeles), nine are in Illinois, and four are in North Dakota.
New COVID-19 deaths from Oct. 1 to Nov. 12 are even more geographically dispersed: 50% of those fatalities are spread among 234 counties.
From the beginning of the pandemic, total COVID-19 deaths in the U.S. remain heavily concentrated in a small number of states and counties. Given these figures, there are no new “hot spots” comparable to those during the earliest stages of the pandemic.
Heritage’s interactive graphic allows users to select data from the five counties with the most coronavirus-related deaths all the way up to the 50 counties with the most such deaths. It also allows users to select data from counties with zero deaths to counties with 10 deaths or fewer.
As of Nov. 12, the 10 counties with the most COVID-19 deaths account for 20.7% of all related deaths in the U.S., but only 11.2% of the population. The 30 counties with the most coronavirus deaths account for 34.9% of the related deaths in the U.S. and only 19.6% of the U.S. population.
The counties of New York City, one of the hardest-hit areas in the early stages of the pandemic, remain three of the five counties with the most deaths in the U.S. New York City still has a disproportionate effect on the perceived COVID-19 experience in the U.S.
According to the Centers for Disease Control and Prevention, New York City has a coronavirus death rate of 284 per 100,000, while the rest of the state has a rate of 81 per 100,000. The average COVID-19 death rate for the entirety of the U.S. is roughly 65 per 100,000. (For more on how New York City skews COVID-19 data in the U.S., see this Heritage Foundation backgrounder.)
This evidence suggests that as new locations in the U.S. experienced surges in COVID-19 cases throughout this pandemic, death rates remained lower.
Ultimately, several items could be at play, including a different, younger population being infected in many locations, such as Florida, during a surge in the disease.
Additionally, better treatment and lessons learned from coping with the pandemic could be part of the lower death rates, including lessons learned in limiting exposure in vulnerable populations, such as the elderly.
As of Sept. 4, the Institute for Health Metrics and Evaluation’s model projected that the U.S. would have 400,000 deaths from COVID-19 by Jan. 1. But as of now, the model projects roughly 350,000 deaths in its worst-case scenario and 328,000 for its current projection. The institute is now projecting 400,000 deaths by Feb 1.
Even so, to reach that new number by Jan. 1, the average daily death rate from COVID-19 would have to be roughly 1,300. The seven-day and 14-day average death rates for the U.S. have not been that high since May 20. However, as cases and deaths increase in the colder months, the U.S. now faces elevated reported deaths.
The worst day prior to May 20 saw an average of roughly 2,200 deaths, a figure that falls to 1,659 if New York City is excluded. The worst day since May 20 was a seven-day average of 1,215 on Aug. 1, but as of Nov. 12, the seven-day average is now 1,146.
Considering Nov. 12’s death count of 1,893, this rate could climb further. Though crude, over the past 30 days, the ratio of deaths to cases is roughly 1%. If we compare 30 days of cases lagged by 14 days, this ratio rises to 1.5%, still substantially lower than early days of the pandemic.
Now that COVID-19 testing has increased dramatically, and many state and local governments have relaxed stay-at-home orders, it’s even more critical to study the trends in deaths along with cases.
To make studying these trends easier, The Heritage Foundation now has two interactive COVID-19 trackers. One tracks trends in cases; the other tracks trends in deaths.
The trackers describe whether the trend of cases—or deaths—is increasing or decreasing over the prior 14 days. They also provide a visual depiction of new cases—or deaths—during this time period.
Those tools help put the concentrated nature of the pandemic in perspective with county-level data. They show just how difficult it can be to use only one metric to gauge whether a county—or state—is doing well.
Readers are invited to explore the information in the tracker and check back frequently for updates, as well as to explore the other visual tools on The Heritage Foundation’s COVID-19 resources page.