Many US States are Leaving Italy Behind; All Eyes on New York

Tom Seufert, MD
3 min readMar 29, 2020

COVID-19 infections, hospitalizations and deaths are all soaring in New York, most heavily concentrated in the metropolitan area. We’re seeing heart-wrenching stories of hospitals there pushed to the brink. Per capita infections in New York have increased at a staggering rate; events there may increasingly prove more relevant to the rest of the US (and as a caution to the world) than those in Italy and Spain. My heart goes out to New York City, where I became a physician, but many states are on trajectories that will bring them into similar crisis within days. But when?

We cannot know, but it is possible to make a reasonable guess based on states’ recent trajectories. Using the average daily increase over the past week for each state, which smooths out noise in case reporting, we can project the coming days for each state. It is then simple to compute how many days it will take states to reach a comparable infection rate to New York:

A huge caveat: This assumes the past week’s dynamics proceed unchanged; states which have done well in social distancing over the past two weeks may hope to improve these numbers. Unfortunately, such a change must come VERY quickly in New Jersey, Louisiana, and Connecticut.

The population-adjusted chart shows New York’s position as the nation’s major crisis state, but also that several states (CT, IL, LA, MI, NJ) continuing their earlier trend of accelerating earlier and faster than that state. It is no coincidence that these states sit atop the table above. FL is rising rapidly, has a giant population of vulnerable elderly, and a governor who has shown skepticism of control efforts. In further grim news, Massachusetts is trending upward to join the rest of the states. Now, Massachusetts has increased its capacity to process tests in the past few days; if this spike is an artifact of clearing a testing backlog, we’ll see it depart the pack again soon. If not, it joins many other states in an increasingly large boat.

The chart of total cases shows the US curve crossing that of Italy. Astonishingly, many loud voices are currently arguing that the economic disruption of social distancing outweighs the potential dangers of COVID-19. If this view holds sway, the US is in for a brutal Spring and Summer — the NY Times has an interactive tool that lets you simulate the effect of stopping social distancing efforts at different times.

Stopping social distancing nationwide in early April, after 28 days total, results in over 80 million US infections and 786,000 deaths. That number could be a little high or a little low; it doesn’t matter. Either way, if that is allowed to happen, then Italy in March will seem like a dream to many states.

Heading into next week, it will clearly be more informative to track deaths in each state than infections; there are confounding patterns at different stages of infection (more on that in a future post) and it seems inevitable now that the death toll will be widespread and substantial.

Originally published at



Tom Seufert, MD

Emergency physician, clinical informaticist, software engineer, author, dad.