Which States Have Flattened The Coronavirus Curve?

There are plenty of lessons to learn from states where COVID-19 infection rates are flattening or declining. Here's what they did to make that happen.
Epidemic infographic created for the COVID-19 pandemic that demonstrates the benefits of slowing transmission – March 7, 2020. (Esther Kim and arl T. Bergstrom/Creative Commons)

Epidemic infographic created for the COVID-19 pandemic that demonstrates the benefits of slowing transmission – March 7, 2020. (Esther Kim and arl T. Bergstrom/Creative Commons)

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Since late January, when the first case of coronavirus in the United States was detected, over one million Americans have contracted COVID-19 and nearly 100,000 have lost their lives to the virus. What began as a trickle of cases from cruise ships and travel abroad turned into a deluge of community spread that swept the nation. States, faced with an absence of national leadership and resources, scrambled to institute lockdowns and slow the spread of COVID-19 infections.

These containment measures are often referred to as an effort to “flatten the curve,” and some states have been more successful than others at turning the tide. While infection rates in the United States overall have slowed, many experts worry the current curve is deceptive.

Some states like New York and New Jersey have steep curves and infection rates that have peaked and then fallen dramatically in the last few weeks. Those numbers skew the reality that in most states, as a majority of communities relax their guard and prepare to lift lockdowns, COVID-19 infection rates are actually rising.

What does it mean to flatten the curve?

The effort to flatten the curve is a focus on slowing the spread of coronavirus so healthcare capacity isn’t overwhelmed. In countries such as Italy we witnessed that when hospitals are inundated, mortality rates rise dramatically because healthcare providers must triage and use precious resources like ventilators sparingly. Exceeding healthcare capacity not only places doctors, nurses, and other patients at increased risk of contracting COVID-19, but it also worsens health outcomes across the board for everyone.

When assessing which states have flattened the curve and successfully reduced the number of coronavirus cases, it’s worthwhile to exercise caution for several reasons. First, a flatter curve doesn’t always mean a state or county has the healthcare capacity to deal with those who are currently sick. Secondly, as many states begin to lift lockdowns and move back into public spaces, it is almost inevitable outbreaks will occur and new hotspots will emerge. States that currently have flat or declining infection rates may suddenly see cases double or triple as they did in Germany.

And lastly, many rural states who believe they’ve escaped the worst have in actuality not yet hit the peak of their projected infection curve. It’s one of the reasons Dr. Fauci urgently warned the Senate this week that states lifting restrictions before meeting CDC guidelines are creating “suffering and death that could be avoided.”

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9 States That Are Flattening the Curve

While it’s difficult to compare coronavirus curves state to state because of demographics and population density, there are states that have largely shown consistent, declining rates of new cases of COVID-19 for the past two weeks. And there are lessons from the containment measures these governors and state health departments have taken that could help emerging hotspots in rural America.

Alaska

Confirmed Cases: 390+
Deaths: 10
Cases per 100,000: 52
Testing per 1,000: 41.9
Deaths per 100,000: 1

Surprisingly, Alaska was one of the early coronavirus hotspots in the United States, with community spread in tourist destinations like Fairbanks. Alaska was quick to react, ramping up testing until they had the 11th highest testing rate per capita in the nation and aggressively targeting pockets of COVID-19 early on in the outbreak.

Alaskan health officials also credit the community with doing an admirable job of observing the stay at home orders and social distancing that bought them crucial time to respond. Deaths in the state have just barely inched over the double-digit mark and restrictions began to relax in some Alaskan communities several weeks ago.

Hawaii

Confirmed Cases: 600+
Deaths: 17
Cases per 100,000: 44
Testing per 1,000: 27.1
Deaths per 100,000: 1

If there’s a US state that has mirrored the success of New Zealand and Australia in containing coronavirus, it’s Hawaii. As a fellow island, the state has worked hard to flatten the curve by shutting down travel and tourism and focusing on testing residents. As a result, cases plummeted to single digits recently and on Thursday Hawaii reported the first day of no new cases of COVID-19.

As a result, Hawaii’s economy is well-positioned to rebound and there are discussions regarding open schools and universities in the fall. While Hawaii’s outlook sounds like a slice of paradise, much of their future rosy economic forecast relies upon continuing containment measures and limiting tourism to the islands.

Louisiana

Confirmed Cases: 34,000+
Deaths: 2,400+
Cases per 100,000: 680
Testing per 1,000: 51.2
Deaths per 100,000: 49

At the beginning of the United States coronavirus crisis, Louisiana looked poised for a prolonged and particularly deadly disaster that could have rivaled Hurricane Katrina. The CDC warned that the decision to hold Mardi Gras festivities despite the looming pandemic accelerated community spread in New Orleans. As the virus ran rampant in the Big Easy, Louisiana led the nation with the 7th highest rate of COVID-19 infections and the 5th highest death rate per population.

Last week, Governor Edwards claimed 74% of coronavirus cases in the state are old or recovered cases as their curve continues to fall. Louisiana’s secret to success was not only the 6th highest testing rate in the nation but also one of the strictest lockdowns in America. New Orleans police department had a special force that did nothing but patrol the streets enforcing restrictions and ensuring New Orleans would not become the next coronavirus epicenter.

Massachusetts

Confirmed Cases: 84,000+
Deaths: 5,700+
Cases per 100,000: 1,129
Testing per 1,000: 59.5
Deaths per 100,000: 75

After a steep and devastating infection rate, Massachusetts is finally starting to plateau and is seeing new COVID-19 cases begin to decline. Governor Charlie Baker has warned residents to stay vigilant as the virus has ravaged the Boston area and beyond with the third-highest infection rate in the nation and the fourth-highest death rate.

The slow and gradual decline of cases was a hard-fought battle won with an aggressive testing approach, strict lockdowns that remain in effect for non-essential businesses, and face mask requirements enforced across Massachusetts. That diligence continues to pay off and Boston is looking to expand its approach with a massive push for antibody testing across the city.

Montana

Confirmed Cases: 460+
Deaths: 16
Cases per 100,000: 43
Testing per 1,000: 22.3
Deaths per 100,000: 1

As a rural state that’s fairly isolated, you might expect Montana to escape the worst of the coronavirus crisis. The state currently has the lowest infection rate and death rate of all 50 states, but that comes with the caveat that Montana is in the bottom 13 states for testing per capita.

Democratic Governor Steve Bullock hasn’t taken any chances in insulating his fellow Montanans. In addition to a lockdown that has recently been eased, he’s kept in place a strict 14-day quarantine for out-of-state visitors and Montana’s Yellowstone entrances remain closed to the public.

New Jersey

Confirmed Cases: 145,000+
Deaths: 10,000+
Cases per 100,000: 1,560
Testing per 1,000: 49.7
Deaths per 100,000: 107

Once the coronavirus took hold in New York, it seemed inevitable that it would spread to nearby New Jersey. The Garden State now has the second-highest rate of infection and the second-highest death rate in the country. However, the rate of new cases has begun to decline, offering some much-needed respite for New Jersey’s overwhelmed healthcare system.

Healthcare experts in New Jersey still remain cautious because while infection rates have slowed in some urban areas, they’ve increased in rural parts of the state. And recent pressure to open beaches in time for Memorial Day may result in a surge of new cases later this month.

New York

Confirmed Cases: 350,000+
Deaths: 27,000+
Cases per 100,000: 1,751
Testing per 1,000: 64.7
Deaths per 100,000: 140

New York City quickly became the epicenter of the US coronavirus crisis, with the highest infection rate and death rate in the nation. An aggressive testing strategy, the second-highest rate of testing per population in the US, likely saved many lives. However, the population density of many parts of the state made the outbreak nearly impossible to contain.

Because New York’s peak was so dramatic, it was initially difficult to discern from the data if the state had merely plateaued or if COVID-19 cases were truly declining. However, by the end of April, it became clear that hospitalization rates and deaths were easing and that New York’s darkest hour had finally passed. As parts of the state slowly began to ease restrictions earlier this month, Governor Cuomo, who has been praised for his capable and compassionate leadership during the crisis, warned that the state’s recovery was dependent on New Yorkers acting responsibly.

Vermont

Confirmed Cases: 900+
Deaths: 53
Cases per 100,000: 149
Testing per 1,000: 34.7
Deaths per 100,000: 9

While some might envision Vermont as a largely rural state, its close proximity to neighbors with some of the highest infection rates in the country should have made it a prime breeding ground for COVID-19 infections. Fortunately, this largely liberal state’s instinct to take the pandemic seriously in the early days likely saved lives.

Vermont has avoided the worst of the crisis with an early lockdown, mask requirements, and strict social distancing measures. Some parts of the state have begun to ease containment measures but areas that rely on tourism, such as Burlington, have been more cautious.

Washington

(Source: The New York Times)

(Source: The New York Times)

Confirmed Cases: 19,000+
Deaths: 1,000+
Cases per 100,000: 235
Testing per 1,000: 33.7
Deaths per 100,000: 13

As one of the very first hotspots in the nation, Washington and in particular, Seattle and Tacoma seemed to be in for the worst of the pandemic. Early death tolls mounted dramatically at nursing homes and as the state scrambled to contain the virus, Washington pivoted quickly to a stay at home environment.

Washington’s success in suppressing and containing the coronavirus may owe a lot to Seattle’s bustling tech hub that was well suited for the transition to social distancing. Tech companies quickly pivoted to remote work and King county sprang into action with a robust and sophisticated tracing program that boxed in and stamped out community spread and saved lives.

The Rantt Rundown

One thing of importance to note is that most of the states that have flattened the curve are run by Democratic governors whose coronavirus response was well informed by state public health officials and infectious disease experts.

Aggressive lockdowns, widespread testing, and effective public health messaging enabled these states to get ahead of the curve, prevent loss of life, and position their economies for a quicker recovery.

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