Is Florida Mishandling COVID-19?
Among the 5 most populated states only PA has lower excess COVID-19 death rate but at a significant cost.
How bad is COVID-19 in Florida?
I'm a Florida resident, but like many other snowbirds I travel north for the summer. Many of my New Jersey summer neighbors talk about how dangerous Florida is with regard to COVIOD-19. But is it?
The most naïve of my neighbors would point to the fact that Florida has the third-most COVID-19 deaths per state in the nation. But is it really fair to compare a state with a population of 22 million with much smaller states such as Wyoming, which has 600,000 inhabitants? Of course not. The more logical first step would be to compare death rates on a per-capita basis.
As you can see in the chart below, as of 10/1/2021 the Florida COVID-19 cumulative death rate per hundred thousand population is only worse in 8 states. Florida's daily death rate is currently higher than some of those states due to the Delta variant wave, so Florida is likely to pass (in a bad way) some of those states with poorer outcomes in the near future.
Not great for Florida so far. But given that covid-19 outcomes are highly dependent on the age of the patients, and that Florida has the second oldest population of the states, It is scientifically & epidemiologically more accurate to compare states on an age adjusted basis. Here is just one example from Dr. Martin Kulldorff at Harvard:
Using this age adjusted COVID-19 death rate, FL ranks 25th - roughly in the middle 50 states.
However, there are some issues when it comes to using age adjusted death rates to compare Florida to other states. First, this metric is somewhat abstract and involves combining data from a number of different sources. One of those sources is US Census data which provides the number of people in each age group for each state. This presents another problem with Florida in particular, because the number of inhabitants of the state varies greatly with the season. In addition to having over 1 million seasonal Snowbird inhabitants like me, Florida will typically have over a hundred million visitors per year!
A solution to this issue is to calculate what I refer to as excess deaths due to COVID-19 using US average COVID-19 death rates for each age group as the reference rate. All of the data that we need comes from one source and self-consistent analysis that controls for interstate seasonal migration is obtained. The source is the CDC Provisional COVID-19 Deaths by Sex and Age.
For simplicity, the analysis presented here compares the excess deaths in Florida with those for the other four most populous states. The five states of California, Texas, Florida, Pennsylvania, and New York have over one-third of the United States population.
The graph below shows the percentage of deaths for various ages groups that list COVID-19 on the death certificate for the five states. The period covers the entire pandemic through 9/25/2021.
Here is the same data displayed as Delta % from the national averages for each age group (excluding < 5 years age group).
If we take the percentage of deaths due to COVID-19 for each age group in each state compared to national averages and multiply by the number of total deaths each age group for each state we then obtain the chart below which shows the excess deaths per age group per state.
Several things stand out:
Pennsylvania had noticeably better outcomes than the US average in all age groups except for the 85 and older group.
New York stands out for having worse outcomes in all age groups and in particular the most vulnerable older age groups.
Texas also had worse outcomes for all age groups with notable excess deaths in the 50 to 75 year old range.
And what about Florida? Florida's COVID-19 death rate was close to the national average for all of the age ranges. We can derive a single COVID-19 outcome metric (CV19 Death Rate Delta %) by taking a weighted average of the values shown in Chart 2. This metric represents how the rate of death due to COVID-19 varies in each state from the national average. Table 1 below shows CV19 Death Rate Delta % values for the five most populated states.
As we can see, Florida has a COVID-19 death rate averaged over all ages close to the average for the whole United States which is consistent with the previously mentioned age-adjusted COVID-19 death rate analysis.
I will have to save the discussion and analysis as to why the outcomes vary between states to another article, but it is worth noting now that Pennsylvania, California, and New York have been strict lockdown states (mask mandates & business restrictions) while Texas and Florida have been criticized by some for having less restrictions on businesses and personal freedoms. Table 1 shows there's no clear relationship between COVID-19 death rate variances from national averages and lockdown mandates of the states.
One final graph before I end this article. Chart 3 below shows the COVID-19 Death Rate Delta % along with the change in GDP for each state between the 2019 Q4 and 2021 Q1, Which is the latest quarter available from the United States Department of Commerce Bureau of economic analysis (Source: U.S. Department of Commerce / Bureau of Economic Analysis / Regional Economic Accounts)
Although there is no clear benefit of strict lock-downs on the COVID-19 death rate shown in this data for the five most populated states, it appears that the lockdowns have harmed the economies of Pennsylvania, California and New York more than the economies of Florida and Texas since the beginning of the pandemic.