Geographic Differences in COVID-19 Cases, Deaths, and Incidence — United States, February 12–April 7, 2020

CDC COVID-19 Response Team

Disclosures

Morbidity and Mortality Weekly Report. 2020;59(15):465-471. 

In This Article

Abstract and Introduction

Introduction

Community transmission of coronavirus disease 2019 (COVID-19) was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia (DC), New York City (NYC), and four U.S. territories had reported cases of COVID-19. This report describes the geographic distribution of laboratory-confirmed COVID-19 cases and related deaths reported by each U.S. state, each territory and freely associated state,* DC, and NYC during February 12–April 7, 2020, and estimates cumulative incidence for each jurisdiction. In addition, it projects the jurisdiction-level trajectory of this pandemic by estimating case doubling times on April 7 and changes in cumulative incidence during the most recent 7-day period (March 31–April 7). As of April 7, 2020, a total of 395,926 cases of COVID-19, including 12,757 related deaths, were reported in the United States. Cumulative COVID-19 incidence varied substantially by jurisdiction, ranging from 20.6 cases per 100,000 in Minnesota to 915.3 in NYC. On April 7, national case doubling time was approximately 6.5 days, although this ranged from 5.5 to 8.0 days in the 10 jurisdictions reporting the most cases. Absolute change in cumulative incidence during March 31–April 7 also varied widely, ranging from an increase of 8.3 cases per 100,000 in Minnesota to 418.0 in NYC. Geographic differences in numbers of COVID-19 cases and deaths, cumulative incidence, and changes in incidence likely reflect a combination of jurisdiction-specific epidemiologic and population-level factors, including 1) the timing of COVID-19 introductions; 2) population density; 3) age distribution and prevalence of underlying medical conditions among COVID-19 patients;[1–3] 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.

This analysis includes all laboratory-confirmed COVID-19 cases reported to CDC during February 12–April 7 from health departments in all 50 U.S. states, eight U.S. territories and freely associated states, DC, and NYC. Beginning on March 3, jurisdictions reported aggregate numbers of cases and deaths daily. Cases and deaths reported by the state of New York are exclusive of those reported by NYC. National and jurisdiction-specific case doubling times for the 10 jurisdictions with the most cases were estimated for April 7 by calculating the number of days before April 7 in which the observed cases were equal to half that reported on April 7. National and jurisdiction-specific cumulative incidences were estimated using 2018 population estimates.§ Absolute 7-day changes in cumulative incidence were calculated by subtracting the jurisdiction-specific cumulative incidence on March 31 from that observed on April 7.

As of April 7, a total of 395,926 COVID-19 cases were reported in the United States (Table). Cases were reported by all 50 states, DC, NYC, Guam, the Northern Mariana Islands, Puerto Rico, and the U.S. Virgin Islands. Two thirds of all COVID-19 cases (66.7%) were reported by eight jurisdictions: NYC (76,876), New York (61,897), New Jersey (44,416), Michigan (18,970), Louisiana (16,284), California (15,865), Massachusetts (15,202), and Pennsylvania (14,559) (Figure 1). The overall cumulative COVID-19 incidence in the United States was 119.6 cases per 100,000 population on April 7 (Table). Among jurisdictions in the continental United States, cumulative incidence was lowest in Minnesota (20.6) and highest in NYC (915.3). Nine reporting jurisdictions had rates above the national rate: NYC (915.3), New York (555.5), New Jersey (498.6), Louisiana (349.4), Massachusetts (220.3), Connecticut (217.8), Michigan (189.8), DC (172.4), and Rhode Island (133.7).

Figure 1.

Cumulative number of reported COVID-19 cases, by jurisdiction — selected U.S. jurisdictions,*,† April 7, 2020
Abbreviation: COVID-19 = coronavirus disease 2019.
*Restricted to U.S. reporting jurisdictions with ≥5,000 COVID-19 cases reported as of April 7, 2020.
Data from New York are exclusive of New York City.

On April 7, nationwide case doubling time was approximately 6.5 days. Among the 10 jurisdictions reporting the most cases, doubling time ranged from 5.5 days in Louisiana to 8.0 days in NYC. During March 31–April 7, the overall cumulative incidence of COVID-19 increased by 63.4 cases per 100,000 (Table). This increase ranged from 8.3 in Minnesota to 418.0 in NYC. During the 7-day period, increases in 11 jurisdictions exceeded the national increase: NYC (418.0), New Jersey (288.7), New York (262.4), Louisiana (237.1), Connecticut (130.2), Massachusetts (124.3), Michigan (113.6), DC (101.9), Rhode Island (84.6), Pennsylvania (75.9), and Maryland (64.0) (Figure 2).

Figure 2.

Cumulative incidence* of COVID-19, by report date — selected U.S. jurisdictions,†,§ March 10–April 7, 2020
Abbreviation: COVID-19 = coronavirus disease 2019.
*Cases per 100,000 population.
Restricted to the 11 jurisdictions reporting the largest absolute increase in COVID-19 cumulative incidence during the most recent 7-day reporting period, March 31–April 7, 2020.
§Data from New York are exclusive of New York City.

By April 7, 55 (98.2%) of the 56 jurisdictions reporting COVID-19 cases also reported at least one related death (Table); however, approximately half (52.7%) of all deaths (12,757) were reported from three jurisdictions: NYC (4,111), New York (1,378), and New Jersey (1,232) (Figure 3). Other jurisdictions reporting ≥300 deaths included Michigan (845), Louisiana (582), Washington (394), Illinois (380), California (374), Massachusetts (356), and Georgia (351). Case-fatality ratios ranged from 0.7% in Utah to 5.7% in Kentucky.

Figure 3.

Number of reported COVID-19–related deaths, by jurisdiction — selected U.S. jurisdictions,*,† April 7, 2020
Abbreviation: COVID-19 = coronavirus disease 2019.
*Restricted to U.S. reporting jurisdictions with ≥5,000 COVID-19 cases reported as of April 7, 2020.
Data from New York are exclusive of New York City.

*American Samoa, Federated States of Micronesia, Guam, Marshall Islands, Northern Mariana Islands, Palau, Puerto Rico, and U.S. Virgin Islands.
Laboratory-confirmed cases include those cases for which SARS-CoV-2, the virus that causes COVID-19, was detected by reverse transcription–polymerase chain reaction (RT-PCR) testing at a commercial, public health, or CDC laboratory. Cases among persons repatriated to the United States on State Department–chartered flights were excluded.
§2018 population estimates for the U.S. states, DC, and Puerto Rico were obtained from the U.S. Census Bureau (https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-total.html); 2018 population estimates for NYC were obtained from the U.S. Census State Population Totals and Components of Change: 2010–2019 tables (https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-total.html) and were subtracted from New York State estimates; the remaining jurisdictions' estimates were obtained from The World Bank (https://data.worldbank.org/).

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