Here we go again: Putting COVID numbers in context

A disclaimer: COVID-19 is serious. If you don’t take it seriously by following the rather simple alleviation tactics you have available to you (vaccination, mask-wearing, washing hands, etc.), it can kill you.

There is a difference, however, between it can kill you and it will kill you, and this is a distinction that is seldom clear from the media’s coverage of the pandemic. As I’ve discussed before, numbers are offered out of context and percentages – especially increases in cases, hospitalizations, or deaths – are presented in a hyperbolic manner that make things seem much worse than they really are:

“Alaska and Arkansas more than doubled cases in the last week.” Okay, is that from 50 cases to 100 cases, or is it from 1000 to 2000 cases? Context matters.

“In Missouri, hospitalizations jumped by nearly 30% over the weekend.” Considering the map I included yesterday, this isn’t surprising, and a surge in hospitalizations is what we want to avoid so we don’t overwhelm our facilities and, more importantly, our healthcare workers. But is this from 100 to 130 people hospitalized, or from 1000 to 1300? Again, context matters.

The data aren’t wrong, but the context isn’t there, so they’re less useful than they could be at best, and counter-productive to an informed discussion at worst.

I went to an in-person conference last week in Bellaire, Michigan, which is near Traverse City. Definitely “northern Michigan.” Before I left, I saw a story online that said that COVID-19 cases in “northern Michigan” had risen 50% in the previous week. Which sounds pretty alarming. But there was no definition of what “northern Michigan” meant. (Believe me, there’s no agreement between the various parts of this Great Lakes State on what it means!) Was that “north of Lansing,” or “north of Mount Pleasant,” or “north of Grayling,” or even just the Upper Peninsula? Didn’t say. And, like the examples above, was the 50% rise from 100 to 150 cases (drilling down, that’s what it was) or possibly from 2 cases to 3 (also a 50% increase). So maybe it was concerning… or maybe it wasn’t.

There’s been a lot of concern about children and COVID-19, which is understandable. Nobody likes to see a child suffer or possibly die from an illness, and until very recently vaccines weren’t available for anyone under the age of 18. We continue to recommend that everyone wear a mask indoors, as a precautionary measure. The precautions are more obvious if someone isn’t vaccinated; the mask may help prevent transmission to that person (as well as help prevent them from spreading the virus if they already have it). Unfortunately, the unvaccinated are the least likely to follow those guidelines.

Mask-wearing may help fully-vaccinated people from contracting a “breakthrough” case of COVID, but more often the reasoning is to keep them from spreading the virus unknowingly to unvaccinated people, including children and teenagers.

We rarely distinguish between the likelihood of a particular individual getting COVID, becoming seriously ill, and dying, though. It’s an across-the-board recommendation that treats every American as having an equal chance of death in the face of COVID-19, which isn’t true.

A second disclaimer: This isn’t breaking news; I’m not presenting some discovery that I came up with on my own. (In fact, I’ve already looked at this back in May.) The data have been available for months, but the conclusions, while not terribly complex, don’t fit neatly in a headline or the lead paragraph of a news story.

COVID-related death rates by age group in the United States

Daily death rate, 2 October 2021, per 100,000 people in the United States, by age group.
Graph: Tom Kephart. Source: Our World in Data.

Fully-vaccinated individuals

On 2 October, the number of deaths from COVID-19 per 100,000 fully-vaccinated people in the U.S. aged 12-17 was 0.03, which was 0.3% of all COVID-related deaths of fully-vaccinated people on that date. A fully-vaccinated American teenager had a 1 in approximately 3.3 million chance of dying of COVID on that date.

Also on 2 October, the number of deaths from COVID-19 per 100,000 fully-vaccinated people in the U.S. aged 65-79 was 1.57, which was 18.2% of all COVID-related deaths of fully-vaccinated people on that date. A fully-vaccinated American senior citizen in that age range had a 1 in approximately 63,000 chance of dying of COVID on that date.

Finally, on 2 October, the number of deaths from COVID-19 per 100,000 fully-vaccinated people in the U.S. aged 80 and older was 6.51, which was 75.6% of all COVID-related deaths of fully-vaccinated people on that date. Our oldest fully-vaccinated citizens had a 1 in about 15,300 chance of dying of COVID on that date.

Put another way, those 65 and over fully-vaccinated Americans were over 15 times more likely to die of COVID on October 2 than people in the other four age cohorts combined, and 269 times more likely to die than a fully-vaccinated teenager.

Unvaccinated individuals

On 2 October, the number of deaths from COVID-19 per 100,000 unvaccinated people in the U.S. aged 12-17 was 0.05, which was 0.1% of all COVID-related deaths of unvaccinated people on that date. An unvaccinated American teenager had a 1 in approximately 2 million chance of dying of COVID on that date.

Also on 2 October, the number of deaths from COVID-19 per 100,000 unvaccinated people in the U.S. aged 65-79 was 31.87, which was 39.6% of all COVID-related deaths of unvaccinated people on that date. An unvaccinated American senior citizen in that age range had a 1 in approximately 3100 chance of dying of COVID on that date.

Finally, on 2 October, the number of deaths from COVID-19 per 100,000 unvaccinated people in the U.S. aged 80 and older was 38.28, which was 47.6% of all COVID-related deaths of unvaccinated people on that date. Our oldest unvaccinated citizens had a 1 in about 2600 chance of dying of COVID on that date.

Put another way, those 65 and over unvaccinated Americans were nearly seven times more likely to die of COVID on October 2 than people in the other four age cohorts combined, and over 1400 times more likely to die than an unvaccinated teenager.

Variations between vaccines

There continues to be a lot of discussion about which vaccine is “better.” Looking at the daily death rate data from 10 April to 2 October 2021, there’s not a lot of difference between the three main vaccines available in the U.S. The death rate for those who received the Johnson & Johnson single shot was 0.91 per 100K in April and remained steady at 0.88 in October; Pfizer’s April rate was 0.28 and rose to 0.60 in October (a 119% relative increase); and Moderna’s April rate was 0.15 and rose to 0.46 in October (a 202% relative increase). Those increases for Pfizer and Moderna seem notable as they could indicate the slow wearing-off of immunity, yet they remain very low at less than one death per 100,000 among those who received that vaccine.

Among all age groups, from 10 April to 2 October 2021, unvaccinated people died from COVID at a rate of 3.89 per 100K in April and 7.29 per 100K in October (an 87% relative increase).

So which vaccine a person received has little significance, but being vaccinated versus unvaccinated certainly does.

Risk of dying from COVID versus driving a car

While the data sets don’t align perfectly, a male drivers aged 15-24 had a death rate of 19.0 per 100,000 in 2019; female drivers of the same age cohort had a death rate of 8.2 per 100,000. Both rates are significantly higher than the death rates from COVID for the 12-17 and 18-29 cohorts, approaching the rate of unvaccinated 50-64 year olds.


Let’s repeat this so there’s no misunderstanding of what I’m trying to do here: COVID-19 is serious. If you don’t take it seriously by following the rather simple alleviation tactics you have available to you (vaccination, mask-wearing, washing hands, etc.), it can kill you.

But we’re doing ourselves a disservice by reducing the statistics to the most alarming, and often misleading, components. The SARS-CoV-2 virus is particularly deadly to older people, including those 65 to 79 but especially those 80 and older. Overall health of older and elderly people is certainly a factor, as are possible underlying health issues (many of which are exacerbated by age as well). Vaccinating children is as important to keep them from spreading COVID to their grandparents and great-grandparents as it is protecting them from dying. We’ve been concerned about the health of our children while the focus really needs to be on our oldest community members.

We’re getting bogged down in the various numbers and seem to have lost track of what they mean or whether the really mean anything. In addition to the physical, economic, and mental realities of pandemic fatigue, we also seem to be losing the ability to muster much of a response to the changing data on numbers of cases, how full ERs and ICU wards are, or how many people are dying from a virus that probably won’t be eradicated but certainly could have been much more controlled at this point. Everyone has their own data point they’re watching – and some of them don’t make any sense or have been chosen to fit a specific narrative.

The endless focus on COVID also distracts us from other concerns, some of which are deadly (including other illnesses such as influenza) and some of which aren’t (our widening political gulf between right and left and its implications for the future of our nation). There are new vaccines on the horizon and antiviral pills even closer to being available. An honest discussion of where we are – as opposed to overheated, sensationalistic media and water cooler talk – is critical if we have any hope of resolving the problems that we’re facing.

Will the Pfizer and Merck pills move COVID-19 into endemic status?

From my inbox this morning:

Pfizer’s pill is the second to show significant effectiveness against COVID-19; Merck also has one that’s waiting for authorization from the FDA. Are these pills the next step toward moving COVID-19 from pandemic to endemic status?

A quick definition of our terms might be useful here:

  • A pandemic is a widespread outbreak of a disease, affecting multiple countries and their populations. The growth of the disease is exponential and there are few, if any, known preventive measures that can be taken against it.
  • An epidemic is an unexpected increase in disease cases in a specific geographic region. Epidemic diseases don’t have to be contagious; obesity and other health-related behaviors, such as smoking, can also be considered to be epidemic.
  • An endemic disease is one that is consistently present (like measles or influenza); in other words, it isn’t fully (or nearly fully) eradicated. There may be flare-ups in specific regions occasionally, but overall, the disease can be managed with existing preventative measures (as simple as effective hand-washing but also including the use of vaccines) or palliative measures (such as pharmaceuticals designed to alleviate the effects of the disease after it was contracted).

COVID-19 remains a pandemic. We have preventative measures, specifically several vaccines, that are proven to greatly reduce the chance of contracting the coronavirus that causes COVID-19. And those same vaccines also greatly reduce the severity of the illness, including nearly eliminating the chance of hospitalization and death, if someone gets COVID-19 in a “breakthrough” infection. To reach endemic status, as many people as possible need to be vaccinated or develop enough resistance to future infections from already having a COVID-19 infection (which doesn’t happen in every case, making getting a vaccination even after having COVID important).

Vaccinations have plateaued in the United States. According to CNN Health, the U.S. is 57.0% fully vaccinated, with an additional 9.1% having at least one dose administered to them. Among the G-20 nations that report overall vaccination percentages, the U.S. is twelfth, just behind Turkey and ahead of Mexico. (The table doesn’t include the European Union, which is the 20th G-20 member; or Brazil and China, which don’t report vaccination percentages for their populations.)

RankCountryFully vaccinatedOne-dose onlyTotal at least partially vaccinated
1South Korea76.2%4.5%80.7%
6United Kingdom67.1%6.4%73.5%
9Saudi Arabia61.4%7.3%68.7%
12United States57.0%9.1%66.1%
17South Africa21.0%4.9%25.9%
COVID-19 vaccination rates for G-20 countries (Source: CNN Health)

Considering the enormous advantage the U.S. when vaccines first became available last winter, it’s frustrating to see how far behind we are in getting people vaccinated. But is that really unusual? Leaving aside politics (admittedly a difficult thing to do these days), we’re historically averse to getting vaccines that aren’t required by law: in 2019-20, just as we were becoming aware of COVID-19, only 51.8% of Americans six months and older got that year’s readily-available influenza vaccine, according to CDC data. Our current COVID-19 vaccine rate of 57% is just slightly higher than that figure.

COVID-19 has declined again across most of the U.S. As of November 3, there are hotspots in Minnesota, Colorado, Arizona, New Mexico, and parts of Maine, New York, Michigan, and Alabama. But it’s nothing like early September, when infections were rising nearly everywhere. While the college where I’m employed requires masks inside campus buildings, in the rest of town it’s very rare to see anyone wearing a mask in a restaurant, grocery store, or other retail business. Yet our numbers remain low, including the Rt number I’ve discussed before.

If the pills from Pfizer and Merck can be rolled out and the costs aren’t prohibitive (not a safe assumption, unfortunately), we might reach a place where, like the flu, at least a slight majority of people have chosen to get a vaccine and those who don’t have a simple, effective remedy. At that point, the realistic goal of turning COVID-19 from a pandemic to an endemic disease could be in sight.

“The presidency is not a popularity contest.”

Joe Biden’s popularity with the American public continues to decline, per FiveThirtyEight:

To be clear, Biden wasn’t very popular to begin with. On Inauguration Day, only 53% of us approved, while 36% disapproved (leaving about 11 percent withholding judgement, which seems prudent now). That figure was at or below nearly every president since Harry S Truman, and only significantly higher than The Former Guy.

His current 42.9% number is similarly higher than few recent presidents after 286 days in office. (Trump had the worst number at only 38% approval, with Gerald Ford – who admittedly had a lot working against him, especially after pardoning Nixon – only slightly higher at 38.4%.)

What’s causing this erosion in popularity? Has he been charging the federal government millions of dollars to have international visitors, lobbyists, and staff stay at his hotels and golf courses? Nope. Has he been insulting minorities and our allies? Again, no. Has he proposed wide-reaching, xenophobic “travel bans” aimed at members of a particular religion? Not that I’ve noticed.

I’ll admit that I wasn’t very enthusiastic about Biden to begin with. I’m old enough to remember when, during the 1988 presidential primary race, he was caught plagiarizing in a speech, and it later came out that he’d done the same thing in law school. Plagiarism is hardly a capital offense, but it does open up a question of overall honesty, and frankly, he’s never really recovered from that in my mind. I voted for him for the same reason I voted for Hillary Clinton in 2016; he wasn’t Donald J. Trump. (I’m also old enough to remember that Trump has been a punchline for decades.)

Back in March, I wrote that if the Democrats weren’t able to move significant legislation through Congress in 2021, they’d pay for it in 2022:

If Democrats are unable to move significant legislation through both houses of Congress and to the president’s desk in the next two years, they will lose control of one or both houses. Republicans will be able to point at their inability to act, and they’ll be right. The time has come for bold action on the filibuster; if not eliminating it altogether, at least modifying it to require that those filibustering a bill actually hold the floor (and stopping all Senate business altogether while doing so), or perhaps reducing the number of votes required for cloture depending on how long the filibuster has gone on (60 for the first three hours, 58 for the next three, and so on). Democrats have the majority today. They should start acting like it.

Some of the president’s popularly decline is due to the relentless lying from the right-wing media, that mostly reaches those who already hated Biden because he wasn’t Trump. But some of that vitriol seeps onto the more independent-minded centrists who are malleable enough to be influenced against whoever the current president is based on the braying of media pundits.

But I think quite a bit of the decline is from Democrats themselves, who had great hopes for transformative work from a Congress that’s nominally controlled by their party. In return for that faith in November, they’ve gotten pretty much nothing. The filibuster allows Mitch McConnell and the Republican minority to dictate what can and what can’t be seriously considered in the Senate. And Krysten Sinema and Joe Manchin get to be kingmakers by refusing to go along with the elimination, or even the modification, of the filibuster rules. I’m not even certain what they want anymore outside of being the center of attention.

Biden himself is such a creation of the Senate that I think he finds it hard to imagine changing the filibuster. So he hasn’t pushed very hard for that. It needs to be done, however, and soon. As the calendar flips into 2022, all of the congress critters will go into full-time re-election mode (as if they ever leave that mode anymore!) and nothing – or perhaps more accurately, less than nothing – will get done.

Al Gore said “The presidency is more than a popularity contest.” As a leader, when you do the right things, it may lose you popularity points, and it may take months or years for the positive outcomes of your actions to be reflected in people’s retroactive judgement of you. Some of us had hopes that Joe Biden could be the type of leader who could cajole his party to make the hard decisions needed to move us away from the Trump era. So far, those hopes have turned out to be hollow, and it’s reflected in the poll numbers.

The rise and (hopefully) fall of the Delta variant in the U.S.

NOTE: This post uses several maps from Here are the keys for each type of map:

Using the excellent data visualizations on the site, I noticed an interesting “wave” effect as the Delta variant started to take hold in the United States in late spring. The first reports of significant spread of the highly contagious variant were in Missouri and Arkansas in mid-June.

Infections per 100K people as of 20 Jun 2021 (Source:

The signs were already there in the data, however. The effective reproduction number (Rt), which we’ve discussed before, is “the average number of people who will become infected by a person infected at time t. If it’s above 1.0, COVID-19 cases will increase in the near future. If it’s below 1.0, COVID-19 cases will decrease in the near future.” By May 23, both Missouri and Arkansas were seeing Rt numbers above 1.2 (orange and red on the map).

Effective reproduction number (Rt) as of 23 May 2021 ource:

By July 4, ironically at the same time as President Biden was suggesting that the nation was declaring independence from COVID (which this New York Times article by Sheryl Gay Stolberg correctly questioned as being too soon), the Rt numbers throughout the southeastern U.S. were very high and most of the rest of the country was following.

Effective reproduction number (Rt) as of 4 July 2021 ource:

Per capita infections were still low on Independence Day, but as predicted by the high Rt numbers, within three weeks that had changed for the worse.

Infections per 100K people as of 25 July 2021 (source:

The spread from the southeastern states, where vaccination rates have been the lowest and several Republican governors have deliberately worked to thwart public health measures including mandating (or even promoting) vaccinations and wearing of protective masks, through the southwestern and midwestern states, the Pacific Northwest, and even Alaska, happened next. Here’s the map on August 29 with Delta at what appears to be its widest extent.

Infections per 100K people as of 29 August 2021 (source:

Notice that at this point 18 days ago, Michigan was still experiencing lower rates of COVID infection (as was most of the rest of the upper midwest and New England). The state is still lagging in the percentage of residents who are fully vaccinated, unlike New England which has some of the highest vaccination rates.

At this same time (August 29), Rt numbers had begun to decline significantly in states that were still bright yellow and white on the infection per capita map.

Effective reproduction number (Rt) as of 29 August 2021 (source:

Perhaps some of this was the increase in vaccinations that followed the Delta outbreak in the southeastern states, or perhaps it’s a result of there being fewer people left to infect. In any case, with Rt numbers declining back under 1.0 in those states, a predictable decrease in infections per capita should happen… which it has, according to the most recent map from September 14.

Infections per 100K people as of 14 September 2021 (source:

Here are two animated GIFs of both sets of data covering the period from May 2 to September 14:

Effective reproduction number (Rt) from 2 May 2021 to 14 September 2021 (source: | animation: Tom Kephart)
Infections per 100K people from 2 May 2021 to 14 September 2021 (source: | animation: Tom Kephart)

There’s always the possibility that another variant could emerge and the whole pattern starts over again. However, the combination of vaccine mandates – which have started to have a positive effect as they expand to more businesses and organizations – and so-called “vaccine passports,” already established in Québec, coming to Ontario, and being considered in several U.S. states, which restrict access to non-essential activities such as bars, restaurants, sporting and music events, and more. Ultimately, it will be the level of vaccination that will move COVID-19 from a pandemic to an endemic virus that will likely require periodic boosters, similar to an annual vaccination for influenza, pneumonia, or other already-available prevention techniques.

Watching the Rt numbers, though, is an important way to cut through the media hype and misinformation (both intentional and well-intentioned) that continues to dominate our discussion about what the future holds for the COVID-19 pandemic.

My extra-innings proposal

Major League Baseball recently reached out to me to put together a proposal to fix the controversy caused by the rule, which started in 2020, that adds a runner on second to start each extra inning (the “Manfred Man,” as named by Craig Calcaterra). (EDITOR’S NOTE: This is a lie. MLB could care less what Tom thinks, and generally speaking, doesn’t care very much what any fan thinks.) (TOM’S NOTE: The preceding note is also a lie; I don’t have an editor.)

I concede that the diminished pitch counts for modern pitchers can make it difficult when a game goes into extended extra innings. Teams don’t want to burn up their entire bullpen, or even have a position player end up having to finish a game that actually matters, so it’s reasonable to think that some sort of rule that might bring a lengthy game to an earlier conclusion is needed. But altering the rules immediately following the regulation number of innings (whether that’s the normal nine or the shortened seven used in doubleheaders these days) is too soon. Both soccer and hockey play at least a short overtime before using a shootout to settle things, although hockey does gimmick things up a bit by playing with three skaters instead of five to open up the ice.

Anyway, here’s my proposal:

  • In the 10th and 11th innings, play normal baseball.
  • The 12th and 13th innings, add the runner on second at the start of each half-inning.
  • Each inning after the 13th, start a runner on second – and ban infield shifts. Two infielders on each side of second base, and they may not be positioned in the outfield.

Additionally, if the half-inning starts with a runner on second, the team in the field may not intentionally walk a batter until the runner on second moves up at least to third (or is retired). They can pitch around batters, of course, issuing the old “unintentional intentional walk,” but can’t ask for the automatic pass.

This would give us one or two traditional extra innings, then add elements to bring the game to a conclusion. For all of the flaws in the Manfred Man rule, at least they’re playing baseball and not deciding who wins with what amounts to a skills contest, which is what a shootout is.

Because I like hockey’s 3-on-3 overtime during the regular season, an alternative idea would be to reduce the number of fielders in extra innings: 8 in the 10th and 11th; 7 in the 12th and 13th; and so on.

Also, seven inning games in doubleheaders are horseshit.

You’re welcome.