COVID-19 is spiking in California, but here’s how it compares to other states

Amid spiking cases and hospitalizations, with new restrictions on the way, Californians can be forgiven for wondering whether our efforts have been worth it. We’ve been masking and social distancing for months now, and all we hear is how much worse things are getting.

But in truth, the latest numbers show that shutdown-happy California continues to do better at battling the coronavirus — on a relative basis — than most other states.

California is the only state with a grim record of 20,000 cases in one day — twice in the past week — but that doesn’t account for the overwhelming number of people who live here. In reality, 38 states reported more infections, as a proportion of their population, than California in the past week. As for deaths from coronavirus? We’re number 48 — only two others reported a lower seven-day total of fatalities per capita.

“I think we have to give California credit for keeping things relatively under control,” said Dr. George Rutherford, an infectious disease specialist at UC San Francisco. “Not that it’s under control now at all.”

That’s a point of pride for Gov. Gavin Newsom as well, even as he calls on Californians to hunker down and control the current surge.

“It is important to put into perspective California as a state vis-a-vis other states,” Newsom said recently, pointing to per-capita infection rates. “We are doing better, relatively speaking, than the overwhelming majority of states.

“That said, the alarming concern is the rate of growth.”

Indeed, hospitalizations and ICU intubations are rising rapidly in California, a known precursor to a rise in deaths that led Bay Area health officials from six counties to pile restrictions on top of our existing restrictions Friday. But state-to-state comparisons suggest these restrictions do indeed help. The states facing the worst rates, in general, have had the fewest rules.

So, how exactly does the Golden State stack up against its 49 peers?

• Cases: 42.4 per day per 100,000 over the past seven days (39th most)
• Deaths: 1.4 per 100,000 over the last week (48th most)
• Hospitalizations: 24.6 per 100,000 as of Friday (37th most)

Where is the pandemic worse than in California?

South Dakota

• Daily cases per 100,000: 116.4 (1st), -20% vs. 2 weeks ago
• Weekly deaths per 100,000: 21 (1st), +33%
• Active hospitalizations per 100,000: 60.8 (1st), -7%

Throughout the spring and summer, as cases surged in the Northeast then the South, COVID-19 stayed away from lightly-populated South Dakota. Rebuking health experts, Gov. Kristi Noem never implemented a mask mandate and chose to keep schools and businesses open, becoming a folk hero for the anti-restriction crowd.

But in August, more than 400,000 bikers descended on tiny Sturgis, S.D., for its famous annual rally. Noem welcomed them all. In the coming months, as many as 250,000 cases across multiple states were linked to the 10-day-rally, according to one study

Since the start of September, South Dakota has been vying with its neighbor to the north for the highest per-capita infection rate in the nation. This week, the state recorded its 1,000th death from COVID-19, half of which have occurred since the start of November.

Noem continues to describe wearing a mask as a “personal choice” and said she would not enforce a national mandate, as proposed by President-elect Joe Biden. Yet while schools have remained open, some districts have recently shifted to remote learning after too many staff called out sick.

In North Dakota, the infection rate peaked higher than in South Dakota but has also fallen further, to about 87.4/100K, seventh nationally. There, more than one in every 10 residents has been infected; in South Dakota, it’s just less than one in 10. In California, about one in 30 residents have been infected over the course of the pandemic, and in the Bay Area, it’s closer to one in 50.

“They’ve had a lot of disease,” Rutherford said. “At least in places, they may have a little bit of herd immunity.”

Wisconsin

• Daily cases per 100,000: 69.8 (22nd), -41%
• Weekly deaths per 100,000: 6.0 (16th), -11%
• Active hospitalizations per 100,000: 30.1 (34th), -17%

In Wisconsin, the infection rate has dropped by nearly half from its peak two weeks ago. Yet it remains 65% higher than the rate in California, which has soared over the same time.

Newsom has faced some court scrutiny for his COVID plans, but he’s got nothing on Gov. Tony Evers. Wisconsin’s top elected officials are awaiting a ruling on his statewide mask mandate from the state Supreme Court, which in May struck down the governor’s initial stay-at-home order. In October, Evers attempted to curb the capacity at indoor public gatherings, but that order also was quickly challenged and overturned by the high court.

When Evers issued the October order, the state was averaging close to 2,500 cases per day. Nearly a month after that, with Evers’ public-gathering rule moot, Wisconsin’s infection rate peaked at 7,000 per day. That’s a per-capita rate of more than 120 daily infections for every 100,000 residents.

Today in Wisconsin, about one in every 14 residents has been infected. Nearly everyone knows someone who has been sick. And yet, even with no new restrictions, cases are finally falling.

It’s possible all the publicity over the high-level tussle has been enough to change people’s behavior, Rutherford said, drawing a comparison to the HIV/AIDS epidemic in San Francisco.

“One of the things we learned from AIDS early on, is that in places where you saw HIV transmission decrease, people had a personal knowledge of someone who had AIDS or died from AIDS,” Rutherford said. “And that’s when behavior started to change.”

Where is the pandemic better than in California?

Maine

• Daily cases per 100,000: 13.7 (49th), -4%
• Weekly deaths per 100,000: 2.2 (41st), +150%
• Active hospitalizations per 100,000: 10.3 (48th), +58%

Heralded as the biggest success story in the contiguous U.S., Maine is beginning to strike a darker tone these days.

Even with the second-lowest infection rate in the country, the state this week reported its highest single-day total of cases since the pandemic began. That was a whopping 325, a number surpassed in a day by any county in the Bay Area recently. On a per-capita basis, the rate now in Maine is just a quarter of California’s. But it shouldn’t look too foreign to Bay Area residents: Our region’s case rates were lower than this as recently as the end of October.

The policies in Maine may also look familiar: Gov. Janet Mills enacted a mandatory quarantine for incoming travelers long before one existed in Los Angeles or Santa Clara County. And like her counterparts here, she is keeping the pressure on. As cases spiked at the start of November, Mills curtailed plans to open indoor service at bars, implemented a curfew for outdoor service and amended the statewide mask mandate to require a face covering in any public setting.

Hawaii

• Daily cases per 100,000: 5.8 (50th), +12%
• Weekly deaths per 100,000: 0.6 (50th)
• Active hospitalizations per 100,000: 4.0 (50th), -26%

Nine months into the pandemic, Hawaii has controlled the virus better than any other state, but it battered its tourism industry to do it. Now, restrictions have eased, but the wave of infections sweeping across the nation still hasn’t touched its pristine beaches.

When the pandemic hit, Hawaii faced a tough question: How does a tourist destination, cut off from the mainland, prevent visitors from bringing disease to its shores?

By implementing its toughest restrictions on anyone visiting the islands.

In March, not long after the Bay Area’s first-in-the-nation stay-at-home order, Gov. David Ige also took a bold step: In addition to closing bars and relegating restaurants to takeout only, he also requested tourists to stay away for the next 30 days. Then he implemented the country’s first mandatory quarantine for anyone arriving on the islands, punishable by hefty fines.

In October, tourists finally began to trickle back, as Hawaii’s first-of-its-kind pre-arrival testing program allowed travelers to exempt from the quarantine. In November, the first international visitors returned to the islands under the expanded testing program.

So far, the resumption of tourism hasn’t sparked a significant spike in cases on the islands.

But what about California’s true peers?

The nation’s four most populous states have taken diverging approaches to fighting the virus.

Molded by early surges and Democratic leadership, California and New York have locked down larger numbers of Americans than any other state. Meanwhile, Republican governors in Texas and Florida, both of which escaped the early wave of infections in the spring, have opted for hands-off approaches.

Yet, nine months into this thing, the per-capita infection rates this past week in California and Texas were nearly identical. In Florida, there were about 5% more infections per capita, and in New York, about 5% fewer, than in California over the past week. What gives?

A deeper look at the numbers indicates California is indeed faring better than the country’s other large states, restrictions or no. Just one data point:

About 50 in every 100,000 Californians have perished since the onset of the pandemic. In Texas, Florida and New York, the per-capita fatality rates are each at least 50% higher.