Sometime next month, the United States will surpass one million reported deaths from COVID-19. So, how did your state compare in combating the pandemic? I graded each state by four measures: (1) total cases per 100,000 population, (2) total deaths per 100,000 population, (3) seroprevalence, and (4) percent of the population fully vaccinated. I then created a composite score using all four metrics to give an overall grade for every state plus Washington DC and Puerto Rico. Grades for each metric from A+ through F were assigned with 4 states getting any given grade.
- Total cases per 100,000 population. These are the cases reported by state health departments to the CDC as of April 28, 2022. The higher the number, the more documented cases occurred since January 2020 per capita. This number does not reflect the true number of cases since many people test positive with home test kits that are not reported to their health departments and many patients with mild or no symptoms do not get tested.
- Grade A+ states: Puerto Rico, Oregon, Maryland, Hawaii,
- Grade F states: Alaska, Rhode Island, North Dakota, Tennessee
- Total deaths per 100,000 population. These are the deaths reported by state health departments to the CDC as of April 28, 2022. The higher the number, the more deaths occurred since January 2020 per capita. Because the deaths from COVID are only counted if COVID is listed as a cause of death on the death certificate, these numbers are undoubtedly also an underestimate since COVID may not be listed on a death certificate if a person did not have a COVID test before dying or if a person died at home and no information about symptoms was available to the physician signing the death certificate.
- Grade A+ states:Vermont, Hawaii, Puerto Rico, Utah
- Grade F states: Mississippi, Arizona, Alabama, Tennessee
- Seroprevalence. This is from the February Nationwide Antibody Seroprevalence Survey. In this study, left-over blood samples from blood drawn from clinical labs are tested for antibodies against the COVID-19 virus. Notably, the specific antibodies tested for are those generated from actual infection and do not result from vaccination. The higher the number, the greater the percentage of the state’s population has actually had a true COVID-19 infection (of note, there is no recent data for North Dakota; because there was no data for Montana and New Hampshire from the February study, data from the January study was used for these two states). Overall, this study estimates that 57.5% of Americans have had a COVID infection. However, because antibody levels decline over time, many people who have had an infection many months previously will no longer have antibodies. Therefore, these numbers likely underestimate the actual percentage of the population that has had an infection.
- Grade A+ states: Vermont, New Hampshire, Hawaii, Puerto Rico,
- Grade F states: Iowa, Texas, Mississippi
- Percent of the population fully vaccinated. This is the percentage of people in each state that have received at least 2 doses of the Pfizer vaccine, 2 doses of the Moderna vaccine, or 1 dose of the Johnson & Johnson vaccine as reported by the CDC. This percentage reflects the entire population of the state, including young children who are not yet eligible to receive vaccinations and therefore the percentage of adults fully vaccinated will be higher.
- Grade A+ states: Puerto Rico, Rhode Island, Vermont, Maine
- Grade F states: Alabama, Wyoming, Mississippi, Louisiana
- Overall score. For each of the above four metrics, states (plus Washington D.C. and Puerto Rico) were ranked 1 through 52. The overall score was calculated by adding the ranks for each of the four metric and determining the average of those 4 numbers. For North Dakota, there is no data available for the seroprevalence study so the overall score was calculated by the average of the other 3 metrics.
- Grade A+ states: Puerto Rico, Vermont, Hawaii, Maine
- Grade F states: Tennessee, Mississippi, Arkansas, Alabama
Here are the scores for each state
Alabama
- Case Rate per 100,000 = 26,524; grade: C-
- Death Rate per 100,000 = 398; grade: F
- Seroprevalence = 66.0%; grade: D
- Percent Fully Vaccinated = 51.1%; grade: F
- Overall Rank = 49; grade: F
Alaska
- Case Rate per 100,000 = 33,479; grade: F
- Death Rate per 100,000 = 166; grade: A
- Seroprevalence = 61.0%; grade: C
- Percent Fully Vaccinated = 62.3%; grade: C+
- Overall Rank = 26; grade: C+
Arizona
- Case Rate per 100,000 = 27,773; grade: D
- Death Rate per 100,000 = 411; grade: F
- Seroprevalence = 63.0%; grade: C-
- Percent Fully Vaccinated = 61.5%; grade: C
- Overall Rank = 48; grade: D-
Arkansas
- Case Rate per 100,000 = 27,683; grade: D
- Death Rate per 100,000 = 377; grade: D-
- Seroprevalence = 64.0%; grade: D+
- Percent Fully Vaccinated = 54.4%; grade: D-
- Overall Rank = 50; grade: F
California
- Case Rate per 100,000 = 23,281; grade: B+
- Death Rate per 100,000 = 226; grade: B+
- Seroprevalence = 55.5%; grade: B
- Percent Fully Vaccinated = 72.0%; grade: B+
- Overall Rank = 12; grade: A-
Colorado
- Case Rate per 100,000 = 23,979; grade: B
- Death Rate per 100,000 = 210; grade: A-
- Seroprevalence = 47.9%; grade: A-
- Percent Fully Vaccinated = 70.2%; grade: B
- Overall Rank = 10; grade: A-
Connecticut
- Case Rate per 100,000 = 21,204; grade: A-
- Death Rate per 100,000 = 303; grade: C+
- Seroprevalence = 44.4%; grade: A
- Percent Fully Vaccinated = 79.2%; grade: A
- Overall Rank = 11; grade: A-
Delaware
- Case Rate per 100,000 = 26,902; grade: D+
- Death Rate per 100,000 = 298; grade: C+
- Seroprevalence = 54.0%; grade: B+
- Percent Fully Vaccinated = 69.1%; grade: B
- Overall Rank = 23; grade: B-
Washington D.C.
- Case Rate per 100,000 = 20,112; grade: A-
- Death Rate per 100,000 = 189; grade: A-
- Seroprevalence = 63.6%; grade: D+
- Percent Fully Vaccinated = 74.1%; grade: A-
- Overall Rank = 13; grade: B+
Florida
- Case Rate per 100,000 = 27,568; grade: D
- Death Rate per 100,000 = 344; grade: C-
- Seroprevalence = 58.4%; grade: B-
- Percent Fully Vaccinated = 66.9%; grade: B-
- Overall Rank = 35; grade: C-
Georgia
- Case Rate per 100,000 = 23,689; grade: B
- Death Rate per 100,000 = 356; grade: D
- Seroprevalence = 63.8%; grade: D+
- Percent Fully Vaccinated = 54.7%; grade: D-
- Overall Rank = 37; grade: D+
Hawaii
- Case Rate per 100,000 = 17,089; grade: A+
- Death Rate per 100,000 = 99; grade: A+
- Seroprevalence = 34.2%; grade: A+
- Percent Fully Vaccinated = 78.2%; grade: A
- Overall Rank = 3; grade: A+
Idaho
- Case Rate per 100,000 = 24,947; grade: C+
- Death Rate per 100,000 = 275; grade: B
- Seroprevalence = 67.8%; grade: D-
- Percent Fully Vaccinated = 54.0%; grade: D-
- Overall Rank = 31; grade: C
Illinois
- Case Rate per 100,000 = 24,686; grade: B-
- Death Rate per 100,000 = 298; grade: B-
- Seroprevalence = 60.8%; grade: C+
- Percent Fully Vaccinated = 68.7%; grade: B-
- Overall Rank = 20; grade: B
Indiana
- Case Rate per 100,000 = 25,263; grade: C+
- Death Rate per 100,000 = 350; grade: D+
- Seroprevalence = 61.2%; grade: C
- Percent Fully Vaccinated = 54.8%; grade: D
- Overall Rank = 39; grade: D+
Iowa
- Case Rate per 100,000 = 24,189; grade: B
- Death Rate per 100,000 = 302; grade: C+
- Seroprevalence = 70.7%; grade: F
- Percent Fully Vaccinated = 61.9%; grade: C+
- Overall Rank = 32; grade: C
Kansas
- Case Rate per 100,000 = 26,561; grade: C-
- Death Rate per 100,000 = 295; grade: B-
- Seroprevalence = 62.2%; grade: C-
- Percent Fully Vaccinated = 61.4%; grade: C
- Overall Rank = 29; grade: C
Kentucky
- Case Rate per 100,000 = 29706; grade: D-
- Death Rate per 100,000 = 346; grade: C-
- Seroprevalence = 56.6%; grade: B-
- Percent Fully Vaccinated = 57.4%; grade: D+
- Overall Rank = 42; grade: D
Louisiana
- Case Rate per 100,000 = 25,226; grade: C+
- Death Rate per 100,000 = 370; grade: D-
- Seroprevalence = 68.9%; grade: D-
- Percent Fully Vaccinated = 53.5%; grade: F
- Overall Rank = 45; grade: D-
Maine
- Case Rate per 100,000 = 18,124; grade: A
- Death Rate per 100,000 = 169; grade: A
- Seroprevalence = 35.3%; grade: A
- Percent Fully Vaccinated = 79.5%; grade: A+
- Overall Rank = 4; grade: A+
Maryland
- Case Rate per 100,000 = 17,039; grade: A+
- Death Rate per 100,000 = 239; grade: B
- Seroprevalence = 49.9%; grade: A-
- Percent Fully Vaccinated = 75.6%; grade: A-
- Overall Rank = 9; grade: A-
Massachusetts
- Case Rate per 100,000 = 25,387; grade: C
- Death Rate per 100,000 = 293; grade: B
- Seroprevalence = 52.6%; grade: B+
- Percent Fully Vaccinated = 78.9%; grade: A
- Overall Rank = 15; grade: B+
Michigan
- Case Rate per 100,000 = 24,291; grade: B-
- Death Rate per 100,000 = 360; grade: D
- Seroprevalence = 56.9%; grade: B-
- Percent Fully Vaccinated = 60.1%; grade: C-
- Overall Rank = 27; grade: C+
Minnesota
- Case Rate per 100,000 = 25,692; grade: C
- Death Rate per 100,000 = 226; grade: B+
- Seroprevalence = 60.8%; grade: C+
- Percent Fully Vaccinated = 69.1%; grade: B
- Overall Rank = 18; grade: B
Mississippi
- Case Rate per 100,000 = 26,788; grade: D+
- Death Rate per 100,000 = 417; grade: F
- Seroprevalence = 69.4%; grade: F
- Percent Fully Vaccinated = 51.8%; grade: F
- Overall Rank = 51; grade: F
Missouri
- Case Rate per 100,000 = 23,156; grade: B+
- Death Rate per 100,000 = 330; grade: C
- Seroprevalence = 55.7%; grade: B-
- Percent Fully Vaccinated = 56.0%; grade: D
- Overall Rank = 17; grade: B
Montana
- Case Rate per 100,000 = 25,617; grade: C
- Death Rate per 100,000 = 313; grade: C+
- Seroprevalence = 47.5%; grade: A-
- Percent Fully Vaccinated = 56.7%; grade: D+
- Overall Rank = 19; grade: B
Nebraska
- Case Rate per 100,000 = 24,798; grade: B-
- Death Rate per 100,000 = 216; grade: A-
- Seroprevalence = 65.4%; grade: D
- Percent Fully Vaccinated = 63.6%; grade: C+
- Overall Rank = 22; grade: B-
Nevada
- Case Rate per 100,000 = 23,332; grade: B
- Death Rate per 100,000 = 349; grade: D+
- Seroprevalence = 60.1%; grade: C+
- Percent Fully Vaccinated = 60.8%; grade: C-
- Overall Rank = 25; grade: C+
New Hampshire
- Case Rate per 100,000 = 22,740; grade: A-
- Death Rate per 100,000 = 182; grade: A-
- Seroprevalence = 33.1%; grade: A+
- Percent Fully Vaccinated = 70.2%; grade: B+
- Overall Rank = 6; grade: A
New Jersey
- Case Rate per 100,000 = 25,355; grade: C+
- Death Rate per 100,000 = 376; grade: D-
- Seroprevalence = 60.9%; grade: C+
- Percent Fully Vaccinated = 75.6%; grade: A-
- Overall Rank = 33; grade: C-
New Mexico
- Case Rate per 100,000 = 24,886; grade: B-
- Death Rate per 100,000 = 356; grade: D
- Seroprevalence = 49.1%; grade: A-
- Percent Fully Vaccinated = 71.0%; grade: B+
- Overall Rank = 21; grade: B-
New York
- Case Rate per 100,000 = 26,376; grade: C-
- Death Rate per 100,000 = 347; grade: D+
- Seroprevalence = 61.5%; grade: C
- Percent Fully Vaccinated = 76.9%; grade: A
- Overall Rank = 36; grade: C-
North Carolina
- Case Rate per 100,000 = 25,355; grade: C
- Death Rate per 100,000 = 223; grade: B+
- Seroprevalence = 52.0%; grade: B+
- Percent Fully Vaccinated = 61.0%; grade: C-
- Overall Rank = 14; grade: B+
North Dakota
- Case Rate per 100,000 = 31,620; grade: F
- Death Rate per 100,000 = 297; grade: B-
- Seroprevalence data not available
- Percent Fully Vaccinated = 54.9%; grade: D
- Overall Rank = 41; grade: D
Ohio
- Case Rate per 100,000 = 22,999; grade: B+
- Death Rate per 100,000 = 328; grade: C
- Seroprevalence = 63.2%; grade: C-
- Percent Fully Vaccinated = 58.4%; grade: C-
- Overall Rank = 24; grade: B-
Oklahoma
- Case Rate per 100,000 = 26,293; grade: C-
- Death Rate per 100,000 = 360; grade: D
- Seroprevalence = 69.1%; grade: D-
- Percent Fully Vaccinated = 57.2%; grade: D+
- Overall Rank = 47; grade: D-
Oregon
- Case Rate per 100,000 = 17,038; grade: A+
- Death Rate per 100,000 = 177; grade: A
- Seroprevalence = 46.9%; grade: A
- Percent Fully Vaccinated = 69.9%; grade: B
- Overall Rank = 5; grade: A
Pennsylvania
- Case Rate per 100,000 = 21,973; grade: A-
- Death Rate per 100,000 = 348; grade: D+
- Seroprevalence = 54.6%; grade: B
- Percent Fully Vaccinated = 68.4%; grade: B-
- Overall Rank = 16; grade: B+
Puerto Rico
- Case Rate per 100,000 = 16,358; grade: A+
- Death Rate per 100,000 = 131; grade: A+
- Seroprevalence = 34.3%; grade: A+
- Percent Fully Vaccinated = 83.0%; grade: A+
- Overall Rank = 1; grade: A+
Rhode Island
- Case Rate per 100,000 = 33,226; grade: F
- Death Rate per 100,000 = 333; grade: C-
- Seroprevalence = 53.4%; grade: B+
- Percent Fully Vaccinated = 82.5%; grade: A+
- Overall Rank = 30; grade: C
South Carolina
- Case Rate per 100,000 = 28,592; grade: D-
- Death Rate per 100,000 = 344; grade: C-
- Seroprevalence = 64.5%; grade: D+
- Percent Fully Vaccinated = 56.6%; grade: D
- Overall Rank = 46; grade: D-
South Dakota
- Case Rate per 100,000 = 26,882; grade: D+
- Death Rate per 100,000 = 329; grade: C
- Seroprevalence = 61.3%; grade: C
- Percent Fully Vaccinated = 61.4%; grade: C
- Overall Rank = 38; grade: D+
Tennessee
- Case Rate per 100,000 = 29,715; grade: F
- Death Rate per 100,000 = 382; grade: F
- Seroprevalence = 67.4%; grade: D
- Percent Fully Vaccinated = 54.5%; grade: D-
- Overall Rank = 52; grade: F
Texas
- Case Rate per 100,000 = 23,215; grade: B+
- Death Rate per 100,000 = 298; grade: B-
- Seroprevalence = 69.7%; grade: F
- Percent Fully Vaccinated = 61.4%; grade: C
- Overall Rank = 28; grade: C+
Utah
- Case Rate per 100,000 = 29,026; grade: D-
- Death Rate per 100,000 = 147; grade: A+
- Seroprevalence = 69.2%; grade: D-
- Percent Fully Vaccinated = 64.3%; grade: C+
- Overall Rank = 34; grade: C-
Vermont
- Case Rate per 100,000 = 18,336; grade: A
- Death Rate per 100,000 = 96; grade: A+
- Seroprevalence = 28.9%; grade: A+
- Percent Fully Vaccinated = 81.1%; grade: A+
- Overall Rank = 2; grade: A+
Virginia
- Case Rate per 100,000 = 19,912; grade: A
- Death Rate per 100,000 = 236; grade: B+
- Seroprevalence = 45.1%; grade: A
- Percent Fully Vaccinated = 73.1%; grade: A-
- Overall Rank = 8; grade: A
Washington State
- Case Rate per 100,000 = 19,609; grade: A
- Death Rate per 100,000 = 166; grade: A
- Seroprevalence = 54.3%; grade: B
- Percent Fully Vaccinated = 72.5%; grade: B+
- Overall Rank = 7; grade: A
West Virginia
- Case Rate per 100,000 = 27,938; grade: D-
- Death Rate per 100,000 = 382; grade: D-
- Seroprevalence = 54.6%; grade: B
- Percent Fully Vaccinated = 57.6%; grade: D+
- Overall Rank = 44; grade: D
Wisconsin
- Case Rate per 100,000 = 27,604; grade: D
- Death Rate per 100,000 = 247; grade: B
- Seroprevalence = 66.7%; grade: D
- Percent Fully Vaccinated = 65.5%; grade: B-
- Overall Rank = 40; grade: D+
Wyoming
- Case Rate per 100,000 = 27,049; grade: D+
- Death Rate per 100,000 = 313; grade: C
- Seroprevalence = 62.5%; grade: C-
- Percent Fully Vaccinated = 51.6%; grade: F
- Overall Rank = 43; grade: D
The data indicates that during the pandemic, you were best off living on an island (Puerto Rico or Hawaii). If you couldn’t live on an island, then you were best off living in either Vermont or Maine. The states that were the worst to live in during the pandemic were Tennessee, Mississippi, Arkansas, and Alabama.
But the pandemic is not yet over. Today’s epidemiologic data from the CDC shows that we are likely entering a new COVID -19 surge. Since the beginning of the pandemic, we have seen that the percent test positivity starts going up about 2 weeks before the case numbers rise followed a few days later by a rise in hospitalization rates and then about 2 weeks later by a rise in death rates. The graph below shows that the test percent positivity (yellow curve) began to increase on March 19, 2022 and the case numbers then began to increase on April 5, 2022.
The number of COVID-19 hospitalizations (yellow curve in the graph below) then began to rise on April 7, 2022:
The daily death rate began rising on April 27, 2022 (not shown). With a recent societal move toward elimination of masking and social distancing, the number of cases, hospitalizations, and deaths will likely continue to rise in the coming weeks. So, there is still a chance for states to pull up their grades. But given the geographic variation in cultural attitudes toward infection control, I don’t expect this to happen.
April 29, 2022
