Policy Analysis | July 2020

Spread of COVID-19 within Regions of the United States

Mikko Lindberg and Roger Moore

Last updated: July 1, 2020 (previous updates: June 17, 2020 | June 3, 2020 | May 20, 2020)

Disclaimer: The research presented here draws upon statistics used by a wide range of governmental and media agencies. Many concerns have been raised about the over-reporting and under-reporting of positive cases of COVID-19 and deaths attributed to COVID-19. This SLC Policy Analysis does not address these concerns and utilizes only the numbers that are known.

While a multitude of governmental, private and nonprofit research entities are closely monitoring the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) – the novel coronavirus that causes coronavirus disease 2019 (COVID-19)1,2 – across the United States on city, county, state and national levels, only a limited amount of research exists for how the virus has circulated on a regional basis.3 Since the response of the federal government to the pandemic focused primarily on international travel restrictions, economic stimulus and distribution of medical supplies,4,5 public safety measures addressing social distancing, school closures, shelter-in-place orders and other precautions were established by state governors, city mayors and county executives. Across the nation, the timing and extent of these measures varied widely, particularly shelter-in-place orders and subsequent state reopenings (see Appendices I-III).6,7,8 Many experts and officials have warned that a similarly uncoordinated approach to lifting public safety measures may lead to a resurgence in positive cases and deaths.9,10,11,12

Given the limited amount of regional statistics for the proliferation of COVID-19, this SLC Policy Analysis, updated on a weekly basis, tracks the movement of SARS-Cov-2 in four regions of the United States, in relation to the state and territorial membership of The Council of Governments (CSG).

Regions of The Council of State Governments
Region Member states and territories
East Connecticut, Delaware, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont, Washington, D.C., Puerto Rico, U.S. Virgin Islands
Midwest Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin
South Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, West Virginia
West Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming, American Samoa, Guam, Northern Mariana Islands

Drawing on daily state-level data collected and published by The COVID Tracking Project – a volunteer organization launched from The Atlantic and referenced by Johns Hopkins,13 The White House and numerous national news syndicates – the following graphs portray seven-day moving averages14 for newly identified positive cases of COVID-19 and deaths attributed to COVID-19 within CSG’s regions. These figures are presented in two ways: 1) seven-day moving averages for the daily change in absolute numbers and 2) seven-day moving averages for the daily change per capita (see Appendix IV for population calculations).15

Of note, the sizable populations of certain states – such as California in the West; Florida and Texas in the South; New York and Pennsylvania in the East; and Illinois, Michigan and Ohio in the Midwest – have greater effect on the overall trend of their region. The state of New York, particularly, during the peak of the COVID-19 pandemic in the United States (April 12, 2020), accounted for 188,694 (34.2 percent) of the 552,094 confirmed positive cases of COVID-19 and 9,385 (42.2 percent) of the total 22,237 deaths,16 and became dubbed the “epicenter of the coronavirus pandemic.” Also, particular states in a region – for example, Louisiana in the South – implemented earlier and stricter shelter-in-place orders than surrounding states due to an unusually high number of cases. However, in general, as demonstrated in Appendices I-III, the response of state and local governments to the COVID-19 pandemic has been predominantly consistent within each CSG region and the actions of more populous states mostly correspond with the other member states of their respective region.


Figure 1: Seven-day moving average of daily change in positive cases of COVID-19 in CSG regions (March 15 – July 1, 2020)

(Clicking a region in the legend will show and hide its line)

Figure 1 shows three distinct trends for the average daily change in positive cases of COVID-19 in the CSG regions. In the East, the seven-day moving average peaked on April 12 and steadily decreased from thereon. In the Midwest, new positive cases peaked on May 4 and then declined until the middle of June, when there was an uptick in cases that continued through the second half of June and beginning of July. Meanwhile, the South and West follow similar paths, with moderate upward trajectories in the number of positive cases throughout the month of May, followed by more severe increases in June. The highest seven-day moving average of new cases for both the South and West occurred on July 1, and the data indicates further increases in the near term.


Figure 2: Seven-day moving average of daily change in positive cases of COVID-19 per one million people in CSG regions (March 15 – July 1, 2020)

(Clicking a region in the legend will show and hide its line)

A seven-day moving average for new positive cases per capita (Figure 2) closely mirrors the trajectories of absolute numbers for all four regions. The peak and decline of COVID-19 in the East and Midwest parallel the trajectory of absolute numbers for the regions. On a per capita basis, the South and West remained below the levels of the East and Midwest since the beginning of the outbreak; however, due to recent upward trajectories in the South and West, both regions surpassed the Midwest and East on June 6 and June 8, respectively.


Figure 3: Seven-day moving average of daily change in deaths caused by COVID-19 in CSG regions (March 15 – July 1, 2020)

(Clicking a region in the legend will show and hide its line)

Regionally, the progression of deaths attributed to COVID-19 (Figure 3) in the Midwest mostly follows the trajectory of seven-day moving averages in the daily change of positive cases. In the East, the downward trend for average daily deaths stopped on April 28, followed by another significant decline beginning on May 11. The sudden increase in deaths reported in the East at the end of June is attributed to New Jersey adding more than 1,800 probable deaths caused by COVID-19. Meanwhile, average daily deaths in the South and West have fallen since their respective peaks, but the trajectories have remained consistent, without a significant reduction, since the beginning of June.


Figure 4: Seven-day moving average of daily change in deaths caused by COVID-19 per one million people in CSG regions (March 15 – July 1, 2020)

(Clicking a region in the legend will show and hide its line)

The seven-day moving average for the daily change in deaths on a per capita basis (Figure 4) also displays a few notable differences in regional trajectories. Average daily deaths per capita in the East follow a nearly identical trajectory as the absolute numbers, with the increase at the end of June caused by the addition of New Jersey's reported probable deaths. In the Midwest and West, average daily deaths per capita began growing rapidly on March 28 and peaked near the end of April. Current data suggests that average daily deaths per capita reached their peak in the South on May 5; however, given the recent uptick in new positive cases of COVID-19 in the region, deaths attributed to it may begin to rise again.

Total positive cases of COVID-19 and deaths attributed to COVID-19 within CSG’s regions and the United States (last updated July 1, 2020)

Region Estimated 2019 Population Total positive cases Total positive cases per million people Percent of total U.S. positive cases Total deaths Total deaths per million people Percent of total U.S. deaths
East 67,008,095 933,523 13,931 34.9% 64,912 969 53.7%
Midwest 62,191,576 457,972 7,364 17.1% 22,585 363 18.7%
South 123,992,683 827,926 6,677 30.9% 21,132 170 17.5%
West 78,616,055 456,022 5,801 17.0% 12,224 155 10.1%
United States 331,808,409 2,675,443 8,063 100.0% 120,853 364 100.0%

As illustrated by Figures 1-4, although states in the East have been successful in curbing the spread of the novel coronavirus, positive cases of COVID-19 and deaths attributed to COVID-19 have been most prominent in the region. In fact, as of July 1, the Eastern region still accounted for approximately 35 percent of total positive cases in the nation and 54 percent of deaths, despite the continuing upward trajectories in the South and West. Although the speed and severity of how SARS-CoV-2 is transferred from person to person is affected by multiple factors, the regional trajectories of the virus provided in this SLC Policy Analysis indicate that this novel coronavirus is spreading steadily in many states, particularly in the South and West. However, there has not been a proportional increase in the number of deaths in the regions, though this could change in the weeks ahead as more people test positive for the virus.


Appendix I – Start date of statewide shelter-in-place orders (as of April 9, 2020)

Source: Jennifer Kates, Josh Michaud and Jennifer Tolbert, "Stay-At-Home Orders to Fight COVID-19 in the United States: The Risks of a Scattershot Approach," Kaiser Family Foundation, April 5, 2020, updated April 9, 2020, https://www.kff.org/coronavirus-policy-watch/stay-at-home-orders-to-fight-covid19/.


Appendix II – Shelter-in-place orders for COVID-19 (as of April 30, 2020)

Source: “Shutdown, Shelter in Place, and Back to Work Orders in the U.S.: Current Status,” Bryan Cave Leighton Paisner LLP, May 1, 2020, https://www.bclplaw.com/en-US/insights/shutdown-shelter-in-place-and-back-to-work-orders-in-the-us-current-status.html.


Appendix III – Lifting of shelter-in-place orders (as of May 13, 2020)

Source: Sarah Mervosh et al., “See Which States Are Reopening and Which Are Still Shut Down,” The New York Times, updated May 13, 2020, https://www.nytimes.com/interactive/2020/us/states-reopen-map-coronavirus.html.


Appendix IV – Populations of CSG Regions
State/Territory/Region Population
Connecticut 3,565,287
Delaware 973,764
Maine 1,344,212
Maryland 6,045,680
Massachusetts 6,892,503
New Jersey 8,882,190
New Hampshire 1,359,711
New York 19,453,561
Pennsylvania 12,801,989
Rhode Island 1,059,361
Vermont 623,989
District of Columbia 705,749
Puerto Rico 3,193,694
U.S. Virgin Islands * 106,405
East 67,008,095
Illinois 12,671,821
Indiana 6,732,219
Iowa 3,155,070
Kansas 2,913,314
Michigan 9,986,857
Minnesota 5,639,632
Nebraska 1,934,408
Ohio 11,689,100
North Dakota 762,062
South Dakota 884,659
Wisconsin 5,822,434
Midwest 62,191,576
Alabama 4,903,185
Arkansas 3,017,804
Florida 21,477,737
Georgia 10,617,423
Mississippi 2,976,149
Missouri 6,137,428
Kentucky 4,467,673
Louisiana 4,648,794
North Carolina 10,488,084
Oklahoma 3,956,971
South Carolina 5,148,714
Tennessee 6,829,174
Texas 28,995,881
Virginia 8,535,519
West Virginia 1,792,147
South 123,992,683
Alaska 731,545
Arizona 7,278,717
California 39,512,223
Colorado 5,758,736
Hawaii 1,415,872
Idaho 1,787,065
Montana 1,068,778
Nevada 3,080,156
New Mexico 2,096,829
Oregon 4,217,737
Utah 3,205,958
Washington 7,614,893
Wyoming 578,759
American Samoa * 55,519
Northern Mariana Islands * 53,883
Guam * 159,385
West 78,616,055

Sources: “Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2019 (NST-EST2019-01),” U.S. Census Bureau, accessed May 6, 2020, https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-total.html and “The U.S. Census Bureau Begins to Count U.S. Island Areas Populations,” Press Release, U.S. Census Bureau, March 2, 2020, https://www.census.gov/newsroom/press-releases/2020/2020-island-areas-populations.html.

* The U.S. Census Bureau does not estimate the populations of American Samoa, Guam, Northern Mariana Islands, and United States Virgin Islands between the decennial censuses. Their populations in 2010 are included and used in per capita calculations.


Notes:

1 “Human Coronavirus Types,” National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, U.S. Department of Health & Human Services, accessed May 7, 2020, https://www.cdc.gov/coronavirus/types.html.

2 “Naming the coronavirus disease (COVID-19) and the virus that causes it,” World Health Organization, accessed May 7, 2020, https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/naming-the-coronavirus-disease-(covid-2019)-and-the-virus-that-causes-it.

3 As of May 7, 2020, the authors of this analysis were able to identify only one report that included regional COVID-19 statistics: “COVID-19 Updates,” Center for Health Metrics and Evaluation, American Heart Association, May 5, 2020, https://healthmetrics.heart.org/wp-content/uploads/2020/03/COVID-19-Updates_5-5-2020.pdf.

4 Caitlin Oprysko, Anita Kumar and Nahal Toosi, “Trump administration expands travel ban,” Politico, January 31, 2020, https://www.politico.com/news/2020/01/31/trump-administration-expands-travel-ban-110005.

5 Sharon Parrott et al., “CARES Act Includes Essential Measures to Respond to Public Health, Economic Crises, But More Will Be Needed,” Center on Budget and Policy Priorities, March 27, 2020, https://www.cbpp.org/research/economy/cares-act-includes-essential-measures-to-respond-to-public-health-economic-crises.

6 Jennifer Kates, Josh Michaud and Jennifer Tolbert, "Stay-At-Home Orders to Fight COVID-19 in the United States: The Risks of a Scattershot Approach," Kaiser Family Foundation, April 5, 2020, updated April 9, 2020, https://www.kff.org/coronavirus-policy-watch/stay-at-home-orders-to-fight-covid19/.

7 “Shutdown, Shelter in Place, and Back to Work Orders in the U.S.: Current Status,” Bryan Cave Leighton Paisner LLP, May 1, 2020, https://www.bclplaw.com/en-US/insights/shutdown-shelter-in-place-and-back-to-work-orders-in-the-us-current-status.html.

8 Sarah Mervosh et al., “See Which States Are Reopening and Which Are Still Shut Down,” The New York Times, updated May 13, 2020, https://www.nytimes.com/interactive/2020/us/states-reopen-map-coronavirus.html.

9 Jennifer Kates et al., "Stay-At-Home Orders to Fight COVID-19." (See reference 6.)

10 Teresa Yamana, Sen Pei and Jeffrey Shaman, “Projection of COVID-19 Cases and Deaths in the US as Individual States Re-open,” May 4, 2020, Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, https://behcolumbia.files.wordpress.com/2020/05/yamana_etal_reopening_projections.pdf.

11 “Dr. Anthony Fauci & CDC Director Senate Testimony Transcript,” Rev.com, May 12, 2020, https://www.rev.com/blog/transcripts/dr-anthony-fauci-cdc-director-senate-testimony-transcript-may-12.

12 Teo Armus et al., “Live updates: Vaccine expert to warn of ‘darkest winter in modern history’ without coordinated U.S. response,” The Washington Post, accessed May 14, 2020, https://www.washingtonpost.com/nation/2020/05/14/coronavirus-update-us/.

13 The Coronavirus Resource Center of Johns Hopkins utilizes The Covid Tracking Project figures for testing and hospitalizations as one of multiple data sources to track COVID-19 globally and nationally.

14 Due to fluctuations in the timeliness in reporting new positive cases and deaths, a seven-day moving average is utilized to smooth out sporadic peaks and valleys of the reported numbers.

15 The total populations of CSG’s regions derive from the most recent state population (2019) and territorial (2010) estimates by the U.S. Census Bureau: “Annual Estimates of the Resident Population for the United States, Regions, States, and Puerto Rico: April 1, 2010 to July 1, 2019 (NST-EST2019-01),” U.S. Census Bureau, accessed May 6, 2020, https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-total.html and “The U.S. Census Bureau Begins to Count U.S. Island Areas Populations,” Press Release, U.S. Census Bureau, March 2, 2020, https://www.census.gov/newsroom/press-releases/2020/2020-island-areas-populations.html.

16 "Our Data," The Covid Tracking Project at The Atlantic, accessed May 19, 2020, https://covidtracking.com/data.