Interpretation of Basic Covid-19 Data for Lucas County, Ohio

By Dr. Houston Johnson, MD, and
Dr. Sammie Giles, MD

Institute for Innovation and Transformation

An Affiliate of The African American Legacy Project of Northwest Ohio

The Institute for Innovation and Transformation is a “Think Tank” borne out of the need to begin to address systemic issues facing communities of color.  This “Institute” - operating under the banner of The African American Legacy Project - was established to study, make recommendations, report on and ultimately serve as the African American community’s “NorthStar.”

Below Dr. Houston Johnson and Dr. Sammie Giles – two of the institute’s founding members – discuss the impact of COVID – 19 on the African-American community and Lucas County as a whole.

     Covid-19 is a new disease for the medical profession and consequently there is no existing pool of experts with a wealth of experience treating it, nor is there a known medical cure for it.

     It was determined early on during the emergence of this disease that it is viral in origin and that the virus belongs to a group of viruses called coronaviruses.  The medical profession has had longstanding experiences dealing with some coronaviruses.

     Growing experiences and expanding observations have established that this new disease has many features in common with familiar diseases (e.g. the flu and AIDS) but has been shockingly more aggressive and virulent than any prior experiences that we have witnessed.  More specifically, there has been more death as a consequence of infection. 

         It’s not surprising that the clinical/medical symptoms that occur and declare the possible presence of this new disease are very similar to the 14 or 15 symptoms that are found with other viruses causing respiratory illness with warnings ad include:  1) cough, 2) shortness of breath/difficulty breathing, 3) fever, 4) chills, 5) muscle pain, 6) sore throat, 7) new loss of taste or smell, 8) nausea, 9) vomiting, 10) diarrhea, 11) bluish lips or face, 12) pressure in chest, 13) new confusion, 14) inability to stay awake, and 15) blood clots.

     Symptoms are reported to appear two to 14 days after exposure and observations have established spread is mainly from person to person between people who are in close contact that are producing respiratory droplets by coughing, sneezing, kissing, talking or singing.

     Though there is no cure for the disease, there has been in place for decades preventive measures that effectively reduce the spread of infectious diseases that spread by droplets which is a common mechanism of spreading pathogens from infectious bodies.

     The Centers for Disease Control and Prevention (CDC) has had in place for decades recommendations for preventing and controlling diseases that spread by droplets.  The recommendations include restricting the infected individual to private quarters and requiring those in a hospitalized environment to wear a mask if they leave their private quarters.  Anyone entering their private space is encouraged to wear a facemask if a distance of three to six feet cannot be maintained between individuals; and hand washing coming into and leaving the restricted space is required. 

         Inherent in these recommendations is an understanding that physical distance (i.e. three to six feet) and a physical barrier (a face mask) are important implementations in optimal protection from person to person spread.  Use of these approaches applies whether the pathogens are known or unknown.

     Early observations also established that the virulence and aggressiveness of the COVID-19 disease was most prominently seen in the elderly (i.e. individuals greater that or equal to 60-65 years of age) in the general population.  More circumspect examination further dissected the details of those succumbing to the disease and found individuals who had pre-exiting complicated health histories with chronic health problems are most susceptible to the disease.  Among the chronic conditions influencing infection susceptibility are:  1) obesity, 2) diabetes, 3 ) renal disease, 4) heart disease, 5) high blood pressure, 6) cancers, 7) mental health problems.

     Though the preexisting conditions enumerated affect any individual in the population who is more likely to die from the disease, there are subgroups of the general population that are disproportionately impacted by the incidence and severity of these chronic health problems.

     This is specially applicable to African Americans who according to a publication generated by the US Department of Health and Human Services, Office of Minority Health, documents that among African Americans:  1) 48 percent of adults are obese, 2) 80 percent are more likely to be diagnosed with diabetes, 3) 2.4 times more likely to begin treatment for end stage renal disease, 4) 1.7 times more likely to be hospitalized, 5) 30 percent of men and 60 percent of women are more likely to have high blood pressure, 6) men are 1.3 times more likely to have new cases of colorectal cancer, 7) women are 40 percent more likely to die of breast cancer, and 8) more likely to have psychological distress; 50 percent more likely to receive mental health counseling or treatment.

     Should African Americans become infected with the novel coronavirus and are in the susceptible age groups, on the surface it seems that they would also be at a higher risk of dying from the disease.  It was recently reported that The Foundation for AIDS Research indicated that 22 percent of US counties are disproportionately black, and these counties have accounted for 52 percent of COVID-19 cases and 58 percent of COVID-19 deaths.  In April a CDC report indicated 33 percent of hospitalized patients with COVID-19 were black although they made up just 18 percent of the community being evaluated.

     The disproportionate adversity seen in the black community seems clear for some of theses observations; however, when we are trying to sort out the truth of how ethnicity is being reflected in epidemiological situations it is important to not become distracted by superficial difference.  Consequently, a deep dive into an analysis of the numbers that we hear so much about is imperative.

     So, we get a clearer understanding when we digest some of the information being disseminated via news media regarding the COVID-19 pandemic and its effects in the Lucas County, Ohio area.  A primary source of the medical data presented in print is usually the Coronavirus Research Center of The Center for Systems Sciences and Engineering at Johns Hopkins University (coronavirus.jhu.edu) and “Explore the Data” website of The World Health Organization (covid19.who.int); and sources for population data are the US Census Bureau and the United Nations Population Division which data are used by Worldometer.info online.  We often see cumulative (total) confirmed cases of the disease for specific regions and also cumulative (total) confirmed deaths therein.  Cases and deaths occurring daily—non-cumulative data—are also presented.  Neither the cumulative nor daily information is given regularly on a per capita basis that enables one to compare results for large populated countries or cities to smaller regions.  In addition, viral reproduction number statistics are being discussed for the USA, Ohio, and other regions.  To complicate matters further, all of the statistics are changing daily if not hourly forcing the reader to digest information very quickly or it’s lost for the day.

     We believe the cases and deaths are more palatable when normalized by population size, which makes more sense for our purpose to analyze what was going on for a given day.  Though not perfect, the basic findings follow for comparisons of Lucas County to Ohio, New York, USA, and nine selected global regions on May 7, 2020.

     We start with population data.  On this first target date, the inhabitants of the earth were approximately 7.7847 billion people.  The population of the USA was 330.8 million, New York 19.7 million, Ohio 11.8 million, Spain 46.8, Russia 145.9 million, Japan 126.5 million, South Africa 59.2 million, New Zealand 4.8, China 1.4393 billion, Nigeria 206.1 million, Taiwan 23.8 million, and Lucas County 431 thousand. 

     Next we look at the cumulative cases followed by deaths both in thousands (taken from “Covid-19 Alert: Coronavirus disease,” Wikipedia online):  the World had 3,417 confirmed cases and 240 confirmed deaths; the USA 1,130 cases and 65.6 deaths; New York 338 and 21.8; Ohio 25.06 and 1.46; Spain 220.3 and 26.1; Russia 114 and 1.17; Japan 16.1 and 0.7; South Africa 12.7 and 0.24; New Zealand 1 and 0.02; China 84 and 4.64; Nigeria 3.1 and 0.10; Taiwan 0.44 and 0.006; and Lucas County 1.7 and 0.15.  (The Lucas County data was taken from “Coronavirus Information,” the Toledo-Lucas County Health Department’s website lucascountyhealth.com;  corresponding state data is available from “State of Ohio Covid-19 Dashboard,” coronavirus.ohio.gov.)  Only super geniuses can decipher the above sets of numbers quickly.  The rest of us need a plan to help us understand better what is going on.

     We divide the cases and deaths by respective population in order to clarify the information.  We get the following per 100 thousand inhabitants in ordered pairs:  World (43.8, 3.08); USA (341.4, 19.82); New York (1716, 110.6); Ohio (214.9, 12.3); Spain (470.6, 55.6); Russia (78.1, 0.80); Japan (12.73, 0.55); South Africa (21.4, 0.40); New Zealand (20.8, 0.40); China (5.84, 0.32); Nigeria (1.53, 0.05), Taiwan (1.84, 0.025) and Lucas County (393.4, 34.8). 

       Nigeria has the lowest per capita cases and New York the highest.  Now we can compare results.  We see the countries are arranged in the order of COVID-19 deaths per 100 thousand inhabitants.  Moreover, the United States and Spain are in deep trouble; and New York is so far different it appears to be an outlier—as if it were intentionally attacked. 

       Ohio has done better than the USA, but Lucas County has not.  For what its worth, the nine ordered pairs for countries have a correlation coefficient of 0.945 indicating a strong straight-line relationship between normalized cases and deaths; that is, y = -2.093 + 0.101 x, where y is per capita deaths and x is per capita cases indicating that when the number of confirmed cases increases the number of deaths also increases.  (So, if you are around an infected person, quarantining yourself for two weeks may be ill advised.  Instead get tested and get help as soon as possible, if tested positive.)

     We divide the deaths by cases to get at a set of death rates, i.e. mortality information.  The results expressed in percentages are:  World 7.03, USA 5.81, New York 6.45, Ohio 5.81, Spain 11.8, Russia 1.03, Japan 4.32, South Africa 1.87, New Zealand 1.90, China 5.2, Nigeria 3.3, Taiwan 1.37, and Lucas County 8.82!  Among the countries selected, though Taiwan has the lowest number of deaths, Russia has the lowest death rate.  Lucas County with almost the highest death rate needs to identify more infected people early and take better care of them.

        If you are an average USA citizen in Russia and contract the disease, you should stay in Russia where you would stand a better chance of surviving the illness.  Likewise if you are trapped in New Zealand or South Africa, you may wish to seriously consider remaining away from home.

     A final important statistic is the effective reproduction number (R_e).  This tells us how many people one contagious person infects.  An R_e greater than one implies an explosive situation, i.e., an exponentially increasing number of infected people.  An R_e equal one is an unstable borderline situation.  An R_e less than one (but greater than zero) means the number of infected persons is decreasing.  An R_e equal to zero means there is no spreading of the infection.  The effective reproduction number for each state is available online at rt.live. 

        On May 7, there was no state with an R_e of zero.  However, four states had values in the 0 < R_e ≤ 0.75 range:  Alaska, Hawaii, Montana, and Vermont.  Nine states were in the range 0.75 < R_e ≤ 0.80:  Connecticut, Georgia, Louisiana, Massachusetts, Michigan, New Jersey, New York, Ohio, and South Carolina.  All other states were borderline or explosive.

     We can use the above approach to inform our readiness to participate in the new economy coming.  To facilitate this, a second target date, May 26, 2020, was chosen.  Table 1 below shows for May 26 population, cases per capita, deaths per capita, and death rates.  The correlation coefficient is lower 0.876 for this data.  The average number of cases per capita increased from 106.0 to 150.8 and the average per capita deaths increased from 8.66 to 10.75 over the same 19-day period.  Lucas County death rate increased from 8.82 to 9.41. 

        The novel coronavirus is spreading in a more scattered fashion in the selected countries.  Lucas County looks more and more like Spain.  Hawaii has a May 26 effective virus reproduction rate of 0.59, Alaska 0.70, Montana 0.71, Vermont 0.71; New York has 0.80, and Ohio has a rate of 0.94 which is much closer to the 1.00 borderline.  Lucas County has far more per capita cases and deaths than Ohio, and Lucas County cases are increasing faster than Ohio cases.  Should Lucas County reopen fully?  It is questionable.

Table 1:  May 26, 2020 Covid-19 Data of Selected Regions

     We in the USA have been in a slow-motion explosion defused by widely adopting nineteenth century health practices.  We are still not out of trouble.  On the other hand, China got its situation under control during the first week March—without a cure or a vaccine.  According to Wikipedia online, only one new case was reported from China on May 7 while the USA reported 27, 535 new cases and China reported zero cases on May 22 when we reported 23,310 new cases.  Taiwan also reported zero new cases on several days during the month of May. 

       The following are calls for action.  Hospitals in Lucas County must replace triage practices with life-saving practices including lung transplantations totally at government expense.  The Health Department must increase testing and tracing to include the use of mobile testing units in minority communities.  The State of Ohio must prepare to employ a system of mandatory quarantines, if a cure and a vaccine are not found soon.  The USA must learn from this pandemic quickly while preparing for the next one. 

     The underserved people of the USA must take action to defuse our pending catastrophe because the disease affects us disproportionately.  We must wear facemasks to cover our mouths and noses when in public.  Even in our homes, we should wear a mask when a family member is sick.  Wash our hands frequently.  Stay away from people not in our immediate families.  Shop only for necessities.  Take no unnecessary trips.  Follow the (leaked) CDC and the Food and Drug Administration guidelines.  Continue to disinfect surfaces.  Lastly, do not inject or ingest disinfectants.  Do not drink any kool-aid that says everything is going to be alright in the reopened economy.

     Stay safe and pray for our families—and country!

Copyright © 2019 by [The Sojourner's Truth]. All rights reserved.
Revised: 06/18/20 16:29:20 -0400.

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