Cuba a Failed State?

The news media has recently reported on President Biden's calling Cuba a failed state.  There have been demonstrations there due to the corona virus pandemic.  The Cuban president responded by pointing out that the 60 year embargo of Cuba has exacerbated shortages of medical supplies and other basic resources.  I thought I would compare how Cuba is faring compared to surrounding island nations Jamaica and Haiti and to the U.S.

The graph above is from the Gapminder Institute showing income and life expectancy for the four countries.  We see that while per capita income is much higher in the U.S. than Cuba, life expectancy in years is virtually the same in both countries with Jamaica and Haiti lagging behind.  Infant mortality rates (an indication of the health of the infant and the mother) is actually 40% lower in Cuba (4/1,000 births) than the U.S. (5.6/1,000), as seen in the table below, followed by the Jamaica (13.5/1,000) and Haiti (52.2/1,0000).  

	Income per capita	Life Expectancy (years)	Infant Mortality per 1,000 births	COVID Case Mortality %	Covid deaths per 100,000
U.S.	$56,700	78.6	5.6	1.8	185.61
Cuba	$8,130	78.5	4	0.7	17.35
Jamaica	$8,310	74.9	13.5	2.3	39.18
Haiti	$1,640	65.7	52.2	2.6	4.51

The life expectancy and infant mortality data are from the World Health Organization from 2018 before the pandemic.  Johns-Hopkins University has been tracking mortality and cases for each nation from the Coronavirus.  The case mortality is 2.6 times higher for COVID in the U.S. (1.8%) compared to Cuba (0.7%) with higher rates in Jamaica (2.3) and Haiti (2.6).  The population adjusted death rate from COVID is more than 10 times higher in the US (185.61) than Cuba (17.35).  Haiti so far has a low death rate due to a low case rate.

Some may want to dismiss these numbers from the WHO and Johns-Hopkins due to their political beliefs.  The CIA (hardly a radical leftwing organization) also does estimates of life expectancy for each country in the world.  They estimate Cuba's life expectancy to be 79.41 years.  Haiti's is estimated to be 65.61 years. Jamaica's is estimated to be 73.71 years.  U.S.'s is estimated to be 80.43 years.

You can say what you want about the political system in Cuba, the mortality data do not indicate poorer outcomes there relative to their Caribbean neighbors and the U.S.  The U.S. embargo has given the Cuban government a convenient scapegoat for their problems,  the U.S.

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Higher COVID-19 Case Rates Outside of Johnstown: Even When Excluding Prisons

Coronavirus cases have slowed over the 4th of July holiday so I thought I would take a look at how they are now distributed throughout Cambria County.  This is what the distribution of cases in the county looked like in the image below on Dec 13 when the rise in cases and deaths was at its height.

Below the image at the right is the image from the PA Dept of Health website from today.  There, we see some darker colors in the central part of the Cambria County.  (I wish blogger would let me put the images side by side.)  The graph at the top shows the testing, positivity and case rates for each of the zip codes in Johnstown (15901-15909), Ebensburg (where the county jail is located), Loretto (where a federal prison is located), the county as a whole and the state.  

In the graph, there is a high positivity and case rate for the 15940 zip code (Loretto) while the testing rate is not especially high there.  A Federal Correctional Institution is located there called FCI Loretto as well as St. Francis University.  Only active cases are reported by the federal department of corrections on their website.  FCI Loretto reached its height in active cases on December 12.

Area	Testing Rate	Positive rate	cases/100000	% change pos	% Change in cases
Total Johnstown	42.86%	21.24%	9104.45	-19%	-33.46%
Outside Johnstown	52.21%	26.21%	13682.95	-1%	-6.88%
Outside Johnstown & Ebensburg	51.63%	26.43%	14693.59	7%	14.49%
Outside Johnstown, Ebensburg, & Loretto	51.82%	24.77%	12833.79
Cambria Total	47.54%	23.97%	11393.17

In the table above, I compared the rates of infection and the positivity rates for the city of Johnstown (zip codes 15901-15909) to the rest of the county, the rest of the county outside of Ebensburg and Johnstown, the rest of the county outside of Ebensburg, Johnstown, and Loretto, and Cambria County as a whole.  We see that the rates for Johnstown are 23% lower than the rest of the county for the positivity rate and likewise we see a 50% difference in the population adjusted case rates.  When we exclude Ebensburg and Johnstown from the county totals we we an additional 1% increase in the positivity rate and a 7% increase in the case rate.  When we exclude Ebensburg, Johnstown, and Loretto from the county totals, we see a 6% decrease in the positive rate and a 13% decrease in the case rate.  The case rate in the area outside of Johnstown, Ebensburg and Loretto is still 13% higher than the overall county rate.  The positivity rate is 3% higher for for this area compared to the rest of the county.

The testing rates for the three partitions of Cambria County are higher than the Johnstown rate.  Does this mean that there needs to be more testing inside of the six zip codes that make up Johnstown?  More testing is usually done when someone presents with symptoms.  I do not have vaccination or mortality data at the zip code level so some questions I cannot answer.

Hopefully on a lighter note, I remind you all that I will be having a discussion of my book at Classic Elements this Saturday at 1PM.  You are all welcome.  They are located at 314 Main St. in Johnstown, PA 15901.

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100 COVID-19 Deaths in Cambria County Since the Candlelight Vigil

I couldn't stay away from the Coronavirus pandemic in the area for long.  On January 19, In This Together: Cambria County held a candlelight vigil next to the Stone Bridge in Johnstown in honor of the 340 who died from the virus since the pandemic began here on March 23.  There was one candle for each of the deceased.  As of today, June 25, the death toll in the county reached 440, an increase of 100.  

The graph below shows the trend in deaths in the county since the first case was reported.  The first death occurred on April 7 of 2020.  Since the awful months of November through January, the number of deaths has decreased but have not ceased.  The 7 day average has hovered between 0.14 per day and 1 per day since April 8.  April 8 was the last day the 7 day death rate reached zero.

 

This is not to say that there are no encouraging signs of progress in the battle against the virus.  The 7 day average for new cases (2.29/day) is now at its lowest level since Sept 17 of last year (2.14/day).  Likewise, the number of patients on a ventilator (1) in the county is at its lowest level since November 7.  

The graph above shows that the new cases have decreased while the vaccination rates have increased, there are still areas of concern.  Vaccination rates have slowed from 891.1 full vaccinations per day on April 17th to 148.4 per day today.  Currently, 41.25% of the county is fully vaccinated. 40.3% of vaccine eligible Caucasians are fully vaccinated in the county while 18.4% of African Americans are.

With Thunder in the Valley coming to town there is the potential for another super spreader event like the Trump rallies last fall.  The more people at the rally who are vaccinated the less likely this event is to occur.  Highlands Health is offering free vaccinations at the rally but even if they are receiving the second shot the vaccine can take three weeks to take effect.  It will take a few weeks after the rally to see if there is an increase in cases which could fuel an increase in deaths.

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I Will Be Presenting my Book at Classic Elements and the Writers Association of Northern Appalachia Conference

I will be presenting my book Wuthering Depths in Johnstown: By the Numbers at the annual writers conference of the Writers Association of Northern Appalachia. It will be in Wheeling, WV on September 10-12 at Oglebay Park.

I will also be presenting my book at Classic Elements in Johnstown on July 10th at 1PM.  It's on Main St. in downtown Johnstown.  I'm looking forward to meeting you all at both events.

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Medicaid Expansion Update: What is its Impact on Uninsured Rates?

In the early days of this blog, I wrote extensively on how states were rolling out Medicaid expansion under the Affordable Care Act (aka Obamacare or ACA).  The 2012 Supreme Court decision that upheld the ACA made Medicaid expansion optional for the states.  This expansion allows states to raise the income eligibility level from 100% of the federal poverty level to 133%.

The above map shows that 12 states still refuse to expand Medicaid 11 years after the ACA was passed while 31 states have expanded and 8 states have used different methods to expand.  The map below shows where each state stood on expansion in 2012.  

The census bureau has 2018 as the most recent year where estimates of the uninsured are available.  Thus, to assess the impact of Medicaid expansion, I will compare uninsured rates at the state level between 2010 (the year the ACA was passed) and 2018.  The states will be grouped by whether they refused to expand it in 2018 (19 states), implemented expansion by 2018 (26 states), or implemented it with other methods (6 states).

	Expanded by 2018	2010		2018		Change in %
	N	M	SD	M	SD
none	19	18.6%	4.2%	12.5%	3.0%	6.1%
yes	26	14.6%	4.5%	7.6%	2.5%	7.0%
modified	6	16.0%	3.3%	8.7%	2.4%	7.4%

The table above shows the mean uninsured rates for each group of states with respect to Medicaid expansion.  There was a significant decrease in the uninsured in all three groups due to the implementation of other parts of the ACA.  The states that did not expand Medicaid had higher baseline mean or average uninsured rates at 18.6% compared to 14.6% for those that expanded traditionally and 16.0% for those who expanded using modified methods by 2018.  The uninsured rates for 2018 showed a wider gap in uninsured rates between states that did not expand (12.5%) and the other two groups (7.6% and 8.7% respectively). The standard deviation or SD's show less variability in uninsured rates in all three groups by 2018.

These numbers show that the ACA is having an impact on uninsured rates throughout the U.S.  Medicaid expansion increases this effect in states that have implemented it.  There is still a group of uninsured even in states that have implemented expansion.  A much harder number to measure is the number of uninsured individuals in then U.S.  Further steps will be needed to reach universal coverage.

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Ida, Nellie and Ida: Trailblazing Women Journalists in the Victorian Age

I thought I would take a break from the coronavirus pandemic and politics to take a look at the history of the craft we call journalism.  The late 1800s were a period of yellow journalism led by Joseph Pulitzer and William Randolph Hearst where sensational headlines were what sold newspapers.  There were trailblazing male and female journalists who worked on hard news stories that mattered to people's lives.

 

Ida B. Wells (profiled in the above video) was born into slavery in 1862.  She never forgot her background and she wrote extensively on the horrors of lynching and discrimination in post reconstruction south.  She died in 1931.  There is now the Ida B. Wells society to support investigative African American Journalism.  She also received a posthumous Pulitzer Prize in 2020.

Nellie Bly (a.k.a. Elizabeth Cochrane Seaman) was another female trailblazer who was born near Pittsburgh.  She went undercover in a mental institution to expose the abuse that women received there.  She then went on an journey to simulate Jules Verne's novel Around the World in 80 Days.  She managed to complete the journey in 72 days and had many great stories to tell.  She died in 1922 only 2 years after women got the right to vote.

The last trailblazer in this post is Ida Tarbell who wrote the seminal book (The History of Standard Oil) that brought down John D. Rockefeller's Standard Oil monopoly.  Like Nellie Bly, she was from the Western Pennsylvania.  Unlike Wells and Bly, she was born before the Civil War and lived until 1944.  The journalist and whistleblower Wendell Potter has created a news organization named after Tarbell.

I don't know if Ida, Nellie and Ida ever met.  They must have known about each other.  It  would make for an interesting play with the three of them discussing their work and comparing notes and the struggles they faced.  There were other significant male journalists at this time such as Upton Sinclair.  Did he have advantages that the other three ladies didn't?

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