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A patchwork quilt across the pond, thanks to COVID-19.

Yesterday, I shared analysis that illustrated how excess deaths in the 2nd wave are dramatically lower (so far) in different regions of the UK. For example, whilst in the 1st wave London saw 9,578 net excess deaths, in the 2nd wave the number is only 53. This is not to underplay the huge demands that winter and COVID-19 put on the health services. It reflects rather the terrible burden that London suffered at the start of this crisis as a world city, at the centre of the so many travel and trade routes.

Across the pond at the same time, the news networks were carrying pictures of refridgerated trucks on the Brooklyn waterfront as the city's morgues were stretched beyond capacity. According to data from the CDC, an estimated 26,250 excess deaths occurred in New York City between March and June, just over 3 deaths for every 1,000 citizens. However, as we are now seeing in London, even though the pandemic threat continues, the number of excess deaths plummeted (thankfully) to around 600 in the 2nd half of the year.

But as we have seen from many sources, the pattern of the pandemic has been very different across the US states. Rather than distinctive waves, the number of excess deaths has continued to build throughout the year until by week 50 there were more than 400,000 excess deaths. Table 1 illustrates these patterns, breaking the pandemic era into 3 phases.

Table 1 - Timeline of excess deaths for each US state from weeks 12-50

Another way to visualise this is to look at when the most excess deaths occurred in every US state. Perhaps unexpectedly, this occurred for 13 states over the period from July to September. This at a time when European governments were reducing restrictions and encouraging citizens to travel and eat out, but in an increasingly masked world.

Those 13 states in yellow would have been sweltering in the summer sun. Many environmental and behavioural factors were no doubt at work but a number of studies have indicated that while air conditioning would have made the temperature bearable, it may also have stoked the continuing pandemic.

And now as we move to the end of the year, it is mostly the inland states, more Red than Blue, that are seeing their worst phase of the pandemic. The CDC produces a weekly update on an ensemble of different projection models by leading institutions. The range of projections is a further 16-27K unexpected deaths across the USA over the next month.

The authorisations by the FDA in successive weeks for the Pfizer/BioNTech and Moderna vaccines are wonderful news but the roll-outs will take time. The target is to vaccinate 100 million by April, with the initial focus on the elderly and healthcare professionals. Clear and detailed analysis will lay bare the benefits as winter hardens.

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