No other country in the world has attempted what the U.S. appears to be stumbling into. Right now, many, many communities have huge numbers of infections. When other countries reached this kind of takeoff point for viral spread, they took drastic measures. Although a few states like California are rolling back reopening, most American states are adamant about opening into the teeth of the outbreak. And this level of outbreak will not stay neatly within a governor’s political boundaries. There’s no way to win this state by state, and yet that’s exactly what we’re attempting. From the look of the map, the South and West—regions with a combined 200 million people—are in trouble.

The regional variation of the American outbreak is crucial to understanding both what happened and what’s going to happen next. Nationwide, the U.S. deaths per million tally—a hair under 400—is in the top ten globally. But look just at the Northeast’s 56 million people, and the death rate is more than double the national average: 1,100 deaths per million.

By contrast, the South and West—where SARS-CoV-2 is burning through the population—are much more populous than the Northeast. If those areas continue to see cases grow, they could see as many deaths per million as the Northeast did but multiplied by a larger number of people. At 1,100 deaths per million, the South and West would see 180,000 more deaths. Even at half the Northeast’s number, that’s another 69,000 Americans.

In truth, the fan of possibilities is probably wider. Looking at individual states, there was tremendous variation from low-death states like New Hampshire (288 deaths per million), to extremely high-death states like New Jersey (1,750 deaths per million), and a bunch in between, like Massachusetts (1,208); Washington, D.C. (805); and Pennsylvania (539).

It’s possible that the summer-outbreak states could follow the lower death trajectory traced by Pennsylvania or Washington, D.C. Right now, only Arizona, at 307 deaths per million has crossed even the lowest line above, New Hampshire; there is a lot of room for things to get worse, even if they do not come close to equaling the horrors of the spring.

New York City is and probably will remain the worst-case scenario. New York City has lost 23,353 lives. That’s 0.28 percent of the city’s population. If, as some antibody-prevalence surveys suggest, 20 percent of New Yorkers were infected, that’s an infection-fatality rate of more than 1.3 percent, which exceeds what the CDC or anyone else is planning for. To put it in the same terms discussed here, New York City saw 2,780 deaths per million people. A similar scenario across the South and West would kill over 550,000 more Americans in just a few months, moving the country to 680,000 dead. It is unthinkable, and yet, 130,000 deaths—the current national death toll—was once unthinkable, too.



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