Search This Blog


LA should consider nuanced response to virus

In Louisiana’s response to the Wuhan coronavirus pandemic, policy-makers must keep in mind that not only is it essentially a New Orleans-area problem, but that in per capita terms New Orleans right now is one of the world’s most dangerous hotspots for the disease.

While some elected officials have highlighted Louisiana’s incidence as something like one of the three highest per capita states, most have missed the fact that Orleans Parish has the second-highest rate per capita of any metropolitan county in the country. As of this morning, an astonishing 1 in fewer than 1,700 Orleanians have or had the virus. Extrapolate this nationwide and that would indicate over 193,000 cases when in fact the U.S. has reported only 10,442, and worldwide outside the U.S. the number is about 226,000.

King County, the location of Seattle, WA has drawn the most attention since the virus appeared there first in the U.S. But its incidence ratio is twice as high as Orleans’. The only ratio lower has appeared in Westchester County, NY: with about a million people, it has nearly 800 cases.

This could be an artifact of testing. New York is farther along than about any state, but Louisiana isn’t that much of a laggard. Unfortunately, New York doesn’t report publicly the number of tests given, but Louisiana and Texas do. Even though Texas has six times the population of Louisiana, it has done only roughly the same number of public lab tests (it also reports about 150 percent more private than public lab tests, but Louisiana doesn’t report that number).

Still, the Texas numbers are far lower than in Orleans, and its metropolitan county numbers fall roughly in line with the adjusted (that is, by a factor of six to account for roughly same number of public tests) figures for East Baton Rouge Parish and Caddo plus Bossier Parishes. For example, even if we assume Louisiana has tested six times the number of suspected cases per capita than has Texas, Harris County (Houston) – which has more people than the entire state of Louisiana – with just 10 cases has just two percent the incidence as in New Orleans (Caddo/Bossier is about four and East Baton Rouge less than two).

So, despite the comparison difficulties with the data, it seems clear that Orleans is a severe outlier in disease incidence. Jefferson isn’t that far behind, with a 7000:1 ratio that is only twice the size of New York City’s and King, four times higher than Orleans, and six times that of Westchester. To further illustrate how coronavirus in Louisiana almost exclusively is a New Orleans metropolitan area phenomenon, including all parishes adjacent to Orleans and Jefferson, 322 of the state’s 347 cases, or 93 percent, come from that area.

Going forward to deal with the crisis, it helps to understand the environment which has produced such an outsized incidence. In some ways, Orleans and King have similarities. Both have considerable amounts of international visitors and both found an unfortunate incubator: a health care recovery center in King and an assisted living facility in Orleans. King had a direct connection with the epicenter of the disease, Wuhan, Hubei, China (4.4 percent of its population is Chinese in origin, and the “patient zero” there had family he visited in Wuhan).

And Orleans had Carnival. About 99 percent of all who catch the virus show symptoms within 14 days. With the first Orleans case coming Mar. 9, two weeks back from that was Feb. 24 – Lundi Gras. While the median case is 5.1 days and 97.5 percent have it within 11.5 days – just after Ash Wednesday – transmission could have begun at the tail end of Carnival.

Some more anecdotal evidence to sustain this thesis: incidence roughly corresponds to the intensity of Carnival, in terms of parading and crowds gathering – highest in Orleans, then Jefferson, then Caddo, followed by East Baton Rouge and Lafayette and the parishes near Orleans and Jefferson. Significantly, Orleans, Jefferson, and Caddo are about the only celebrations that have a critical mass of out-of-state visitors, and Calcasieu Parish is the only one yet to report a case that has any substantial Carnival activities; with next to none of these, neither Rapides nor Ouachita among metropolitan areas has reported any cases.

That noted, to date the state government’s response, chiefly in the form of proclamations and executive orders by Democrat Gov. John Bel Edwards, has taken a one size fits all form. Increasingly as the statistics show extremely modest infection rates outside of Orleans and Jefferson while those two parishes sprint farther grimly ahead, that approach appears more and more heavy-handed, a thought perhaps he has considered. Bans on crowds and food/drink service have a substantial negative economic impact, in a state that already had suffered more perhaps than any other economically even while the rest of the country had done well. Bludgeoning the entire state when only a pocket of it needs such treatment might throw the baby out with the bathwater.

Wise policy-making would involve reviewing the situation at the end of the month, with the hopes of lifting the various activity bans across much of the state, and even clamping down more elsewhere. Didactic tunnel vision derived more as a panic response than reasoned decision-making that recognizes differentiation across demographics wouldn’t.

No comments: