Thoughts on the Virus and where it has spread

I am not, of course, a medical doctor or an epidemiologist, but I have always loved numbers and I've spent a lot of time playing with them--especially, although not exclusively, as they relate to baseball.  I am convinced that important facts about the covid-19 virus are hiding in available numbers, and I hope that more knowledgeable people than I are looking for them there.  I have spent some time playing with figures available at this web site, however, and I could not miss an important pattern.  Just now, New York Governor Andrew Cuomo--who has a good feel for the significance of numbers himself--made an argument in his Sunday news conference that very much fit in with what I was seeing.  I am going to share my thoughts very tentatively here.

The worldometers site I just linked gives total cases, new cases, total deaths, new deaths, total cases per million people, and total deaths per million people,  and several other statistics, for every country in the world every day.  Studying it, I decided to focus on just one of those statistics: total deaths due to the virus per million people.  That, I think, must be the most meaningful of these statistics.  Total cases at this point is still largely a function of total tests administered, a number which varies enormously from country to country (and from state to state) as a proportion of population.  Total death figures undoubtedly underestimate the number of people the virus has killed--but I would be amazed if it underestimated it by as much as a factor of 2.  And when we focus on that figure, we find that the virus is far more common in the North Atlantic World--really, in the NATO alliance--than anywhere else.  Let's begin with a few numbers.

Leaving aside a few very small countries whose percentages are not meaningful, Belgium has the most covid-19 identified deaths per million in the world, 577.  The next four countries are all in Europe, ranging from Spain (540) through Italy, the UK, and France (379.)  The Netherlands, Sweden, Ireland, and Switzerland range from 295 per million to 204, and the United States is the first significant non-European nation on that list, with 205 deaths per million as of this morning.  US deaths, however, are highly concentrated.  The state of New York shows 1,256 deaths per million people, followed by New Jersey (877), Connecticut (680), Massachusetts (563), and through Louisiana and Michigan to the District of Columbia (367.)  Rhode Island, Pennsylvania, and Maryland are the only other states whose deaths per million exceed the national average, and eighteen states have less than 50 deaths per million population.  Heading back to Europe, we find that Denmark and Germany have 84 and 81 cases per million. 

In the third world, the virus has had very little impact so far.  Ecuador leads Latin America with 89 deaths per million.  Turkey leads Asia with only 40.  Totals in Eastern Europe are very low.  China now reports only 3 deaths per million people. New Zealand and Australia have escaped almost entirely.

I didn't know what to make of these figures earlier this morning, but now, thanks to Governor Cuomo, I think I do.  It is now clear, he said, that the virus came to New York state (and evidently to the whole northeast) not from China, but from Europe.  While the Administration banned travel from China on February 1, it did not stop travel from Europe until the middle of March, and by then the virus was well established here.  It was not too long after that that travel largely shut down within the United States, and it has remained so.    COVID-19 so far is a disease of the world's wealthiest nations, because, I suspect, their citizens travel so much.  Now, two months of social distancing have apparently slowed its spread in these most affected areas--but those areas are still showing far more new cases and deaths than most of the rest of the United States where the virus hadn't gotten a foothold before interregional travel almost came to a halt.  And with the exception of China, where it looks to me now as if the spread of the virus never came close to what has happened in the major European countries and the US, it has yet to gain a significant foothold anywhere in the Third World--because there hasn't been enough travel between the North Atlantic world and the Third World to start one.  Interestingly enough, a New York Times story this morning that asks why the virus is so much more plentiful in some countries than others--and which does not reach any conclusions--added another key data point for me.  The Dominican Republic now has 30 deaths per million from COVID-19, while Haiti, on the very same island, has just 7.  The reason, I strongly suspect, is the very large Dominican minority in the northeast US--much larger than any Haitian community--and the correspondingly high rate of travel from the US to the DR.

What follows is, of course, speculative, but I will state it with relatively few disclaimers.  I am not, of course, even in touch with anyone who is investigating the virus's spread scientifically, but I suspect we will find out within a month or two whether my hypotheses are true or not.

Air travel evidently has played a critical role in the spread of the virus.  A critical question, and to my mind a very open one, is this:  did most American travelers who had been to Italy contract the virus in Italy, or did most of the contract them in airplanes?  Airplanes, like buses and subways, are enclosed spaces in which the virus could, it seems to me, easily move from one person to another through the air.  The very serious impact of the virus in nursing homes, where so many vulnerable people live so close together, suggests that proximity drives the spread.  So, alas, does the spread within hospitals, which we must do everything we can to control.  Obviously the virus has been spreading via face-to-face contact in the western European NATO countries and in the northeastern US, but the general halt to large-scale travel within the US and around the world seems to have stopped large-scale transmission elsewhere, at least for now.  The significance of travel to the virus's spread obviously could have implications for how we try to return to normal, as well.  Pressure to return to normal is mounting in some parts of the US because the virus hasn't made many inroads there.  Can those areas safely return to normal activities if they maintain some kind of quarantine from more affected areas?  That is a question for an epidemiologist, not an historian, and I don't know the answer.  I think however that we need to find out what the answer is.

Any sudden revival of world and interregional travel would evidently open up new danger of spread.  We need competent authorities (such as the WHO, from whom President Trump is trying to take away funding) to study these questions and make recommendations.  I do think we can say now, however, that we aren't facing a virus that is spreading around the world at a steady exponential rate.  It spread very rapidly in certain very rich areas before travel restrictions, and it seems not to have spread over long distances very rapidly since then.  That, it seems to me, must be an important clue to a solution.