The Seven Counties in PA that are Worse than Cambria in COVID Case Mortality

County	Cases	Deaths	Case Mortality %	Cases per death	Deaths per 100,000	Rank of Deaths per 100.000 in PA	% Fully Vaccinated
JUNIATA	3,009	120	3.99%	25.1	484.6	1	36%
SULLIVAN	607	24	3.95%	25.3	395.7	6	48%
WARREN	4,436	141	3.18%	31.5	359.8	10	41%
NORTHUMBERLAND	13,371	409	3.06%	32.7	450.2	3	51%
TIOGA	4,814	137	2.85%	35.1	337.5	14	39%
MIFFLIN	7,494	212	2.83%	35.3	459.5	2	43%
MONTOUR	2,599	73	2.81%	35.6	400.4	5	68%
CAMBRIA	20,420	535	2.62%	38.2	410.9	4	48%
PENNSYLVANIA	1,608,022	32,188	2.01%	50.0	251.4		51%

Last week I posted on Cambria County's high case mortality rate from COVID.  It has the eighth highest rate in the state.  The case mortality is an estimate of the probability of a person dying when they are diagnosed with the disease.  This week I thought that I would take a look at the seven counties with higher case mortality rates than Cambria.  You can find these states in the map below.

The table above shows the top 8 counties in case mortality from COVID. Juniata County has the worst rate in the state with the probability of dying is one out of 25.1 cases when diagnosed with the disease.  Close behind is Sullivan County with a probability of one in every 25.3 cases.  Cambria's is one in every 38.2 cases.  Pennsylvania's rate is one in every 50 cases.  All of the counties with rates higher than Cambria have populations less than 100,000.

Not surprisingly, the population adjusted mortality rates for each county are higher than the state rate of 251.4 deaths/100,000.  Except for Warren and Tioga, all of them are in the top 8 counties for this metric.  Looking at vaccination rates, 6 of the 8 counties have full vaccination rates lower than the state rate of 51%.  Montour County actually has the highest full vaccination rate in Pennsylvania at 68%.  

 

The rates in the above table are cumulative from the beginning of the pandemic in PA.  Case mortality can vary with time as cases and deaths fluctuate.  The dotted green line shows the 7 day case mortality rate which is the 7 day average for deaths divided by the 7 day average for cases.  A rise in cases precedes a rise in deaths which makes the case mortality decrease.  

Since the vaccine has been rolled out, the cumulative rates decreased from a high of 3.41% on Jan 21 in Cambria to 2.62% today.  Over the same period for Pennsylvania, it decreased from 2.55% to 2.01%.  In the U.S., the rate decreased from 1.67% to 1.62% during this period.  The 7 day case mortality is not a continuous line because there were periods in Cambria where there were no deaths.  

I have written on Montour and Sullivan Counties on this blog before.  In January, Montour had a high rate of vaccinations, hospitalizations and patients on a ventilator.  It still has high rates in these areas.  Sullivan County had one of the highest uninsured rates and the lowest median income in PA before the Affordable Care Act was passed.  

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Case Mortality in Cambria County Explained

I was thinking about writing about the Gabby Petito case but events here in Cambria County have trumped (no pun intended) that and put it on the back burner.  COVID deaths have been rising again in the county.  On Oct 23 the county reached 500 deaths.  Eleven days later we have reached 521 for an average of 1.91 deaths per day.

The graph above shows the case mortality rates for Cambria County, Pennsylvania, and the U.S.  The case mortality rate is simply the number of deaths divided by the number of cases.  The rates have remained fairly steady for all three entities as the rate of new cases have kept pace with the rate of new deaths.  

The current rate of 2.63% for Cambria may not seem that much larger than the corresponding PA rate of 2.01% and the U.S. rate of 1.62%.  It we take the reciprocal of these rates (cases divided by deaths) we see a different picture.  The reciprocal of Cambria's rate shows that 1 out of every 38 individuals who have COVID has died.  For PA it is 1 out of every 50 cases dying and for the U.S., it is one out of every 62 cases dying.  This means that someone is 31% more likely to die in Cambria than in PA as a whole and 62% nore likely to die than in the U.S. as a whole.

In my last post I talked about how more people are getting the 3rd booster show than are getting the first two.  To date only 48.06% of the county population has received the first two shots.  This number should rise with the approval of the vaccine for children aged 5-11 years old.  Let's hope the rate of vaccinations keeps pace with the rest of the U.S.  The lagging vaccination rate here suggests that most of the recent deaths were preventable.

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

African Americans Still Lag Behind in Life Expectancy in Cambria County

Group	Cambria County	Pennsylvania	U.S.
Overall	76.1	78.4	78.7
Caucasian	76.4	78.9*	78.6
African American	67.3	73.4*	74.7
Hispanic	91.3	85.3*	81.8

*Pennsylvania life expectancy by race numbers are from 2010 (Measure of America, 2013) 

In my book, Wuthering Depths in Johnstown: By the Numbers.  I wrote extensively on the 2020 County Health Rankings for Cambria County (where Johnstown is located).  The number that jumped out at me most was racial disparities in mortality data in Cambria county where African Americans had a life expectancy of 65.6 years, Caucasians 76.2 years, and Hispanics 89.0 years.  

This year's life expectancy numbers from the 2021 County Health Rankings are displayed above in the table above for the years 2017-2019 (corona virus deaths are not included).  Cambria County's overall life expectancy increased from 75.6 to 76.1 years (63rd in PA).  Among counties with life expectancies by race, African American life expectancy increased by 1.7 years to 67.3 (the lowest in PA).  Caucasians increased by 0.2 years to 76.4 (3rd lowest ).  Hispanics increased the most by 2.3 years to 91.3 (5th highest in the state).  

Counties with miniscule racial/ethnic minority populations do not have a breakdown for life expectancy by race.  African Americans comprise 3.5% (10.9% of PA) of the county and Hispanics make up 1.8% (7.8% of PA).  Caucasians comprise 92.6% of the county (75.7% of the state).  Approximately 59% of the African Americans in the county live inside the city of Johnstown

Overall the county is 2.6 years behind the US life expectancy.  Caucasians are 2.2 years behind, African Americans are 7.4 years behind, and Hispanics are 9.5 years ahead of the US rate.  Life expectancy is not included in the overall County Health Rankings for Health Outcomes.  Mortality Measured as Years of Potential Life Lost is factored into the rankings which is a measure related to life expectancy.

Years of potential life lost (YPLL) is the number of years lost if someone dies before age 75.  For example, if someone dies at age 25, they have 50 years for potential life lost.  The overall YPLL rate is 9,700 years per 100,000 for the county.  It is 19,900 years per 100,000 for African Americans and 9,400 years per 100,000 for Caucasians.  

The premature age adjusted death rate for the county is the number of deaths under age 75 per 100,000 for the years 2017-2019.  For Cambria it is 440 deaths/100,000.  For African Americans it is 840 deaths/100,000 and for Caucasians it is 430 deaths/100,000.  For Pennsylvania, the overall rate is 350 deaths/100,000.  This measure is provided by County Health Rankings but not factored into the rankings.

The most shocking mortality rate is the child mortality rate which is the number of deaths under the age of 18 per 100,000 for the years 2016-2019.  For Cambria the rate is 50 deaths/100,000 which is the same as PA's rate.  For African Americans in the county, it is 210 deaths/100,000 (the highest in PA) while for Caucasians it is 40 deaths/100,000.  The rate is more than 5 times higher for African Americans. 

The health factors data for the county provides some clues for this discrepancy.  I will discus it in my next post.

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Why do African Americans live to be 64.8 years in Cambria County?

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Protests and Pandemics: Lessons from History

Watching the developments of the past week were surprising even to me. Were the up swelling of protests over the death of George Floyd and the corona virus pandemic totally unrelated?  Is Trump's generally incompetent leadership a factor?  The mostly peaceful demonstrations have been occurring just as the turbulent restriction from the pandemic are being lifted.  Do people just have more time now to pay attention to the news surrounding Floyd's death?  History may provide some clues.

The late 1910s were a largely forgotten turbulent time in our nation's history.  We had just entered World War I, the battle over women's right to vote was reaching a critical stage, the brutal race riots in Tulsa, OK were happening just as the Ku Klux Klan was becoming a national force, and of course the Spanish Flu epidemic was rampaging globally,  None of these things occurred in a vacuum.  

The Spanish Flu may not have originated in Spain but it was the first country to report on it as the news was censored in the neighboring countries fighting in World War I.  It unknown where the pandemic started but it was first observed in Europe just as U.S. soldiers arrived there in 1918.  Returning soldiers brought it back home with them and it spread quickly.  Worldwide it killed approximately 50 million and in the U.S. the death toll was around 675,000.

While this was going on the suffragettes led by Alice Paul were getting close to the Seneca Falls convention of 1848's goal of achieving votes for women.  Woodrow Wilson eventually was convinced to support the amendment along with the proposed 18th amendment to usher in prohibition.  The suffragettes hoped that prohibiting drinking would curb domestic violence against women. 

Maurice Decaul: Commentary on "Close Ranks" and "Returning Soldiers" by W.E.B. Du Bois from The Gilder Lehrman Institute on Vimeo.

African American's fought in World War I hoping that it would improve their standing in society, it did not.  They came home to the same racism that they had experiences before.  W.E.B. DuBois had supported Wilson but was disappointed when they returned home.  Two years later things exploded when lynchings occurred and the KKK began a resurgence.  Things came to a boiling point when a race riot occurred in 1919 in Chicago and the  deadliest race massacre in U.S. history in Tulsa, Oklahoma in 1921.  In Johnstown, PA, another racial incident occurred in the Rosedale section when African American and Mexicans were driven out of the city in response to the shooting of police officers.

In addition to these other issues the government was involved in the Palmer raids which were conducted against suspected communists who had just come to power in Russia.  This was a precursor to the McCarthy hearings of the 1950's.  The socialist Presidential candidate Eugene Debs and Alice Paul were briefly imprisoned as a result.

These problems were exacerbated by small economic depression which followed the war.  In response to all of this, Warren G. Harding ran for president where he promised a "return to normalcy" from the turbulence of the last years of Wilson's Presidency.  He won in a landslide with the votes of women who could vote for the first time.  The roaring 20's and the corruption and hypocrisy of prohibition followed.

History does not repeat itself but it does rhyme sometimes.  Many of the same forces at work then are at work now.  Mostly peaceful protests occurred in response to the death of George Floyd as in the video above.  Joe Biden may be successful running as a normalcy president but will he be able to address all of these forces in a way that Trump is unwilling to?

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A Comparison of State Mortality Rates: Pennsylvania is 6th Highest, Michigan is Highest

In my last post I spoke of how Pennsylvania's case mortality rate (7.16%) was greater than the U.S. rate (5.91%).  At the time I was unsure how the state compared to the other states in the case mortality rate.  To do this I looked at the cases reported on Johns-Hopkins Coronavirus Dashboard.  The numbers that they report for Pennsylvania (74,045 cases, 5,373 deaths) are different than reported by the state department of health (70,042 cases, 5,373 deaths).  This is due to Johns-Hopkins relying on media reports of cases as well as government reports.  Deaths from the disease are easier to track than cases.

The case mortality rate is the number of deaths divided by the number of reported cases.  The numbers for each state as of yesterday are displayed at the table below.  Johns-Hopkins reports cases and deaths on the U.S. flagged Grand Princess and Diamond Princess cruise ships are included in the total.  Michigan has the highest case mortality rate at 9.59% followed by Connecticut at 9.21%, the U.S. Virgin Islands at 8.70%, New York at 8.08%, New Jersey at 7.24%, and Pennsylvania at 7.16%.  The high rate for Michigan is troubling given all of the protests against the coronavirus lockdown there.

Looking at the population adjusted mortality rate as deaths per 100,000 population, not surprisingly, New York has the highest rate at 151.56/100,000 followed by New Jersey at 127.66/100,000, Connecticut at 106.67/100,000, Massachusetts at 93.91/100,000, and the District of Columbia at 63.05/100,000.  Pennsylvania is 9th on this measure (41.13/100,000) and is right behind Michigan which is at 53.41/100,000.

New York is also first in coronavirus cases at 1,876.08/100,000 followed by New Jersey at 1763.39/100,000, Massachusetts at 1359.35/100,000, Rhode Island at 1354.87/100,000, and the District of Columbia at 1191.08/100,000.  Pennsylvania is 13th on this measure at 574.57/100,000 which is just ahead of Michigan which is at 556.84/100,000.  The U.S rate on this measure is 514.95/100,000.  

The graph above shows the state case mortality rate by population (the two cruise ships are excluded).  There is no linear association between the state's population and their case mortality rate.  The line crossing the graph just below 6% is the U.S. case mortality rate.  

The population rates indicate the prevalence in the population of coronavirus cases and deaths.  The case mortality rates are an indication of the strain that the disease has placed on the health care systems in that state.  Michigan Pennsylvania, and the Virgin Islands with low population adjusted mortality rates but high case mortality rates suggest additional strain.

State	cases	deaths	Case Mortality	case mortality rank	Population	Deaths per 100,000	Cases per 100,000
Michigan	55611	5334	9.59%	1	9,986,857	53.41	556.84
Connecticut	41288	3803	9.21%	2	3,565,287	106.67	1158.06
Virgin Islands	69	6	8.70%	3	104,901	5.72	65.78
New York	364965	29484	8.08%	4	19,453,561	151.56	1876.08
New Jersey	156628	11339	7.24%	5	8,882,190	127.66	1763.39
Pennsylvania	73557	5265	7.16%	6	12,801,989	41.13	574.57
Louisiana	38497	2723	7.07%	7	4,648,794	58.57	828.11
Massachusetts	93693	6473	6.91%	8	6,892,503	93.91	1359.35
Indiana	32437	2030	6.26%	9	6,732,219	30.15	481.82
Ohio	33439	2044	6.11%	10	11,689,100	17.49	286.07
Colorado	24754	1392	5.62%	11	5,758,736	24.17	429.85
Vermont	971	54	5.56%	12	623,989	8.65	155.61
Missouri	12798	688	5.38%	13	6,137,428	11.21	208.52
Washington	20181	1078	5.34%	14	7,614,893	14.16	265.02
DC	8406	445	5.29%	15	705,749	63.05	1191.08
Oklahoma	6229	322	5.17%	16	3,956,971	8.14	157.42
New Hampshire	4231	214	5.06%	17	1,359,711	15.74	311.17
Maryland	48423	2392	4.94%	18	6,045,680	39.57	800.95
Nevada	8113	396	4.88%	19	3,080,156	12.86	263.40
Arizona	17277	834	4.83%	20	7,278,717	11.46	237.36
Mississippi	14044	670	4.77%	21	2,976,149	22.51	471.88
Rhode Island	14353	655	4.56%	22	1,059,361	61.83	1354.87
New Mexico	7252	329	4.54%	23	2,096,829	15.69	345.86
Illinois	114306	5083	4.45%	24	12,671,821	40.11	902.05
Kentucky	9077	400	4.41%	25	4,467,673	8.95	203.17
Florida	52634	2319	4.41%	26	21,477,737	10.80	245.06
South Carolina	10623	466	4.39%	27	5,148,714	9.05	206.32
Georgia	44445	1908	4.29%	28	10,617,423	17.97	418.60
Minnesota	22464	942	4.19%	29	5,639,632	16.70	398.32
West Virginia	1899	74	3.90%	30	1,792,147	4.13	105.96
California	101032	3895	3.86%	31	39,512,223	9.86	255.70
Puerto Rico	3397	129	3.80%	32	3,193,694	4.04	106.37
Maine	2137	81	3.79%	33	1,344,212	6.03	158.98
Delaware	9096	344	3.78%	34	973,764	35.33	934.11
Alabama	15843	583	3.68%	35	4,903,185	11.89	323.12
Oregon	4038	148	3.67%	36	4,217,737	3.51	95.74
Montana	481	17	3.53%	37	1,068,778	1.59	45.00
North Carolina	24896	838	3.37%	38	10,488,084	7.99	237.37
Wisconsin	16462	539	3.27%	39	5,822,434	9.26	282.73
Virginia	40249	1281	3.18%	40	8,535,519	15.01	471.55
Idaho	2699	81	3.00%	41	1,787,065	4.53	151.03
Guam	170	5	2.94%	42	165,768	3.02	102.55
Grand Princess	103	3	2.91%	43
Texas	58537	1581	2.70%	44	28,995,881	5.45	201.88
Iowa	18360	493	2.69%	45	3,155,070	15.63	581.92
Hawaii	644	17	2.64%	46	1,415,872	1.20	45.48
Alaska	411	10	2.43%	47	731,545	1.37	56.18
North Dakota	2439	56	2.30%	48	762,062	7.35	320.05
Kansas	9270	212	2.29%	49	2,913,314	7.28	318.19
Arkansas	6277	120	1.91%	50	3,017,804	3.98	208.00
Tennessee	21288	353	1.66%	51	6,829,174	5.17	311.72
Wyoming	860	14	1.63%	52	578,759	2.42	148.59
Nebraska	12619	153	1.21%	53	1,934,408	7.91	652.34
Utah	8706	105	1.21%	54	3,205,958	3.28	271.56
South Dakota	4710	54	1.15%	55	884,659	6.10	532.41
Diamond Princess	49	0	0.00%	57
N Mariana	22	0	0.00%	57	56,882	0.00	38.68
Total	1697459	100274	5.91%		329,637,350	30.42	514.95

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