A deeper dive into COVID data: who's getting sick and dying, how that's changing, and what it might mean

Everyone no doubt knows that older people are at greater risk of severe complications and death from COVID-19 than are younger people. Most people have probably also heard that men are at greater risk than women. And many people have also probably heard that the age demographics of who's getting infected have been shifting toward younger people.

Let's look more closely at these trends with the numbers from the Ohio Department of Health.

First, here is a graph of the per capita case rates broken down by sex and age group:

Remember, these are known cases of COVID, so there may be biases that influence how likely people from different groups are to get tested if they are in fact infected. For example, older people are more likely to develop symptoms, and so would be more likely to go get a test.

The striking trends from this are that people over 80 are much more likely to have a known case, people under 20 are much, much less likely, the other age groups are pretty flat at a level between the oldest and youngest, and for most age groups, men are more likely than women to have a known case.

To see how likely it is that different groups develop more severe symptoms, let's look at the same graph but for hospitalizations:

Here there is a very clear increasing trend with age, as well as a clear tendency in the older age ranges for men to have higher rates of hospitalization for COVID.

Last, deaths:

Here, the bias toward worse outcomes in older people becomes far more dramatic, and the bias toward worse outcomes in men remains.

Let's also look at the rates of hospitalization and death among people with known COVID cases for the different groups.

Hospitalizations:

Deaths:

So, similar trends in terms of age and sex biases as the previous graphs.

Note that among men at least 80 years in age known to have had COVID in Ohio, a staggering four out of ten have died. That is pretty disturbing and really drives home how important it is to protect our older friends, neighbors, and relatives from this disease.

Some people look at these trends and think that younger people don't have to worry about COVID. That's a, to put it bluntly, stupid idea for multiple reasons.

One, young people can easily pass it on to old people who can get really sick and die, and the more people in the overall population who are infected the more likely that is to happen, and it's a really cruel and heartless attitude to think it doesn't matter if a bunch of old people die.

Two, even among young and otherwise healthy people, there is a real chance of severe complications and death, even if it's a small one, but by now there are a lot of young people whose lives have been ended by this virus.

Three, and this is probably the part that is most misunderstood: COVID outcomes aren't a binary between "dies" and "recovers to full, normal health." There are so many people out there, of all ages, who are continuing to have debilitating symptoms months after they were infected. In a lot of these people the effects of COVID might be with them for the rest of their lives even though they didn't die and they "recovered" from the disease. That's not something anyone should want.

For the next part of this post, let's look at how the age demographics of the outbreak have changed over time. I'm sure a lot of people have heard by now that we are seeing a shift toward a younger infected population. Some people are even saying that we shouldn't worry about the case spikes that are currently happening in many parts of the country because it's now mostly younger people getting sick.

This is another stupid idea, but I digress.

Although you may have heard about these trends, do you know what the actual numbers are like? Let's take a look.

Here is a graph of the share of all COVID cases in Ohio falling into each age range, separated by months of the pandemic:

This dramatically illustrates how the age demographics of the outbreak have changed. In March the group with the biggest share of cases was ages 50-59 followed closely by 60-69. There was some slight shifting around in April but then in May and especially into June there has been a huge shift toward younger people. In June the group with the biggest share is 20-29 by a fair margin, 30-39 is second, and even 0-19 has come up to surpass every group 60 and above.

Next let's look at hospitalizations:

The hospitalizations graph illustrates the same shift toward younger demographics but it's more subtle because younger people continue to be less likely to be hospitalized. Still, if you compare June to the earlier months you can clearly see the below 40 age groups coming up and the above 50 age groups coming down.

And last, the shares of deaths:

Here there honestly aren't any major changes, because the death rates for younger people remain much lower. However, as deaths are a lagging indicator and the case spikes in young people are currently getting worse, I'd expect a bit of a shift in this graph for July.

Let's also look at a different way of visualizing the data, to show how the absolute numbers are changing over time. Here I combined ages into just three groups because the graphs would be messy and hard to read with eight different lines.

This is the graph of the 7-day moving average of daily cases for (roughly speaking) younger people, middle-aged people, and older people. Note as always that the weird spike in April is from a bunch of cases in prisons all being reported at once. This makes it very clear how the cases in younger people have been continuing to increase while this has not been happening in older people.

And here's the hospitalizations graph:

This shows that the number of older people being hospitalized has come down dramatically from the peak, whereas the number of younger people being hospitalized has remained fairly steady.

Why are the shapes of the cases and hospitalizations curves so different? If cases go up in an age group, shouldn't hospitalizations also go up?

It's because the number of cases is strongly affected by how many tests are being performed, and we have been increasing the number of tests. Hospitalizations, on the other hand, are mainly just a factor of how many people are getting sick.

I think it's possible to make some interesting inferences based on this, which I'll discuss more in a little bit.

The overall conclusions from these trends are that the outbreak is definitely shifting to be more concentrated among younger people. It appears that older people have been better at taking the message to heart that they need to be careful and limit exposure, whereas younger people have become increasingly less careful. And let's be honest, that makes a lot of sense.

As a result of this, in the current outbreaks the death rates are almost certainly going to be lower than in the outbreaks back in March and April. And it is a good thing that the death rates will be lower, I will acknowledge that. But that doesn't mean the current outbreaks are not a problem or that we shouldn't be very worried. We should be very worried for reasons I've already discussed and will discuss more in the rest of this post.

Everything I've shown so far has been me just presenting the numbers as they exist. The only manipulation I've done to the numbers is creating moving averages of the daily numbers to show the trends more clearly. Going forward, I will be making some inferences that I think are reasonable and playing around with the numbers in ways that it's important to acknowledge have a fair amount of uncertainty. You definitely shouldn't take anything I'm saying as the gospel truth. And I'm very open to feedback. But I think that by thinking more about what these numbers mean, we can make some interesting, albeit very tentative, conclusions.

What is the current case load in Ohio relative to other times during the pandemic?

The most naive way of answering this question would be to simply look at the number of daily reported cases. If you spend any time looking at graphs of Ohio's COVID numbers, the shape of this curve, a 7-day moving average of the daily reported cases, probably looks familiar:

The numbers are normalized so that 1 is the peak level we have been at thus far (excluding the spike from batch reporting of prison cases). So looking at this, you might think, oh, as of very recently we are at the highest infection rate yet.

But we know that the number of cases strongly depends on the number of tests administered, and the number of tests administered has increased a lot compared to the earlier days of the pandemic. So the number of people being hospitalized is probably a better indication of the current case load:

Here we see from the red curve of hospitalizations that the peak was reached in late March. Then the numbers went down, leveled off for a while, went down again, and then started going back up, but are still well below the peak. (The numbers here use my estimation method for more recent numbers that I detailed in my previous post and that appears to be somewhat more accurate, but you'd see a similar trend if you looked up a traditional graph of the daily reported hospitalization numbers.)

But do the changing demographics of who is infected affect the accuracy of using hospitalization rates to estimate case load? I think it's pretty undeniably the case that they do. Among people who are known to have had COVID in Ohio, someone who is 70 or older is about 8-9 times as likely to have been hospitalized as someone who is younger than 30. Therefore, if there were ten new hospitalizations of people who were younger than 30, that would clearly indicate a higher case load in the overall population than ten new hospitalizations of people who are older than 70.

I attempted to account for this factor by making an adjustment to the hospitalization numbers. For every date, I looked at how many people in each age group were hospitalized, adjusted by the different hospitalization rates of different age groups, and summed the results to get what I would call an "inferred case load." There are no units to this metric; I am not trying to make any judgment about what the actual infected rate in the population is, only about how it's changing over time. Here's a graph showing the results of this adjustment with the blue line that has been added on top of the previous graph:

It was in late April that the demographics of the pandemic began their shift toward younger people and there you can see the blue and red curves diverge from each other. The share of total hospitalizations taken up by younger people grew, implying (relatively speaking) a larger case load than that implied by the hospitalization numbers with no age adjustment.

From this estimate, it appears that the plateau from mid April all the way to late May may have been an illusion. Total cases may have been growing during that time, but concentrated more among young people.

Any way we look at it, there was a real drop in the infected rate toward the end of May.

But then the numbers did start going up again. And with the adjustment, it appears that the numbers may now be going up more sharply than we realize, and we may already be much closer to the peak infection rate thus far.

(In fact, because this is a 7-day moving average and the numbers are continuing to rise, we may already be higher than the peak in late March.)

I don't know exactly why numbers would have been gradually rising from late April to early May and then dropped in late May before starting to rise again. One idea, although it's speculation: at the start of the stay-at-home order everyone was taking things really seriously, which clearly halted the rise and brought the numbers down at first. As more time went on, people started to relax and engage in somewhat more risky behaviors. Especially younger people. Then, in May, when the weather got nicer, people shifted their social activities to the outdoors, where less disease spread occurs.

But then the state made the premature and foolish decision to open a bunch of businesses like bars, indoor restaurants, and gyms that should not be open now, and this led to the ongoing increase in June.

That's just speculation that I think is plausible. Especially for the explanations of the changes during April and May. For the current rise I think it's pretty clear that the premature reopening is a factor, when we put what's happening in Ohio in the context of what's happening elsewhere in the country.

I will reiterate that the inferred case load (blue curve) is an estimate based on methods I think are reasonable, but with a fair amount of uncertainty. It hasn't been peer reviewed or anything like that. You shouldn't take it as something that's definitely or even probably the truth. But I myself would stake out a pretty confident claim that the age-adjusted numbers are at least a closer match to the real case load than the non-age-adjusted hospitalization numbers.

By the way, in my last post, I showed this graph:

And I said:

We have also been in a period of declining hospitalizations. If you are looking at a graph of new hospitalizations by their report date, which is the graph you'd normally see, it looks like the curve is still trending downward. But in the estimated curve, it appears that the downward trend has recently leveled off and (although the most recent estimated numbers contain the most uncertainty) we may be starting to head back up.

What does the same graph look like now?

So when I said, based on my estimate, that the numbers might be starting to head back up even though the graph of reported numbers still seemed to be heading down, it turns out that this was correct. And the reported numbers are now following along and rising as well, with an expected time lag.

What does this all mean for the future course of the pandemic?

As I said, the death rates in the months ahead will be lower than the death rates in the spring. And that is a good thing.

But the idea that we are okay now because the people getting infected trend younger is nonsensical.

The only way we can get back to some semblance of normal life is by successfully containing the virus. Many other countries are doing this. We're utterly failing.

Even if older and more at risk people are doing a better job of staying safe, do we really want to live in a society where anyone who is older or in a high risk group, or who lives with anyone who is older or in a high risk group, has to constantly live in fear and limit their exposure as much as possible for what could be an entire additional year?

Because that's what things will be like if we continue to just let the virus spread unchecked among a now younger skewing infected population. And even then, there will be cases that slip past those safety measures and get to more vulnerable people who will die. And even among younger people, there will be lots of long term debilitating health consequences and some deaths.

The only effective methods of containing the virus without shutting down huge segments of society are widespread mask wearing and contact tracing. For the latter to be effective, cases need to be at a manageable level. If there are so many cases floating around that it's impossible to know about most of them, contact tracing isn't going to make a big difference. That's where we are right now in most of the country.

These trends have also gotten me thinking about what will happen with schools this fall. The low infection rates among children do suggest the possibility that, with appropriate safety measures, primary schools could reopen. But colleges? College students are the demographic where cases are exploding right now because they take it the least seriously. And putting them back in dorms together will inevitably lead to massive outbreaks that will leak out to the rest of the population and make it impossible to get the pandemic under control. There's no way that colleges with students living on campus can safely reopen this fall. Just no way.

We need to back off from reopening (as Texas and Florida are already doing, and Ohio probably will eventually so better sooner than later) and we need to take social distancing and mask wearing seriously. This problem is not getting better with the measures we're currently taking, so if we don't take better measures it's going to continue to be with us for a long time.

A deeper dive into COVID data: what do those daily numbers actually mean? (Or: why growing hot spots are already worse than you know)

Every day we can go online and see a news report that today our state announced x new COVID cases, y new hospitalizations, and z new deaths. Have you ever wondered what those numbers actually mean?

Someone who was very new to all of this might think, oh, if those are the newly released numbers today, that means that yesterday there were x new cases, y new hospitalizations, and z new deaths.

Someone who has been following the numbers for a while would probably know by now that that's not quite true. They probably would have noticed that every week the number of daily deaths spikes in the middle of the week and plummets on the weekend. And they might know that this is because reporting slows down on the weekend and this creates a backlog that is cleared during the ensuing week.

Based on this knowledge, my general assumption was that most of the deaths reported on any given day were deaths that had occurred over the last few days, with some slowing down on the weekend and catching up during the week.

Turns out, it's more complicated than that!

Warning: this is going to be a very nerdy post full of graphs and number crunching, but if that sounds interesting to you, read on. The purpose of this post is largely educational, but if you don't feel like wading through the whole thing and want a take home message related to what's going on in the country right now, it's this: in places like Arizona, Texas, and several other southern states where numbers are now spiking, the real current numbers are likely already substantially higher than the reported numbers, and it might already be too late to avert disaster.

I've been following the numbers from covidtracking.com for quite some time. That site is the source for most visualizations of COVID daily numbers for the U.S. and its states that you'll see online. Every day the site updates and the number of newly reported cases, deaths, and (for many states) hospitalizations becomes available. What we are seeing there, and what is going into almost all the graphs that you might see, are the numbers by report date. Using the numbers from covidtracking.com, there's no way to see the actual dates on which those deaths, hospitalizations, or positive COVID tests occurred.

I recently started also looking at the numbers the state of Ohio provides on its COVID-19 dashboard. Here, the test date as well as (if applicable) hospitalization date and death date for each reported COVID case in Ohio are available. Here we can see on what dates all these events actually occurred, not just on what dates they were reported.

I've spent some time analyzing all these numbers and learned some things I found very interesting, so I wanted to share them with anyone else who'd like to learn more about this topic.

For the first set of graphs I looked at the numbers Ohio reported on each day of the one-week period from May 27 through June 2. This is a graph looking at all of the COVID cases Ohio reported during that week, by the case onset date (x-axis), with color coding indicating on which day of that week the cases were reported:

So, for example, new cases that occurred on May 26 were reported in large numbers on May 27, 28, and 29, and continued to be reported in decreasing numbers on May 30, 31, and June 1.

You can see from this graph that the bulk of the new cases reported between May 27 and June 2 happened relatively close in time to that week, but a quite substantial number of the cases occurred up to three weeks earlier, with smaller numbers going all the way back to March.

If you look closely, you might also notice that some of the colored bars are slightly negative, which would indicate that on the report date indicated by that color, the number of cases with that onset date was adjusted downward, presumably a result of corrections to make previously reported numbers more accurate.

Let's next look at the same graph but with hospitalizations:

It looks fairly similar to the new cases graph, although the peak at the right side is somewhat broader, indicating a tendency for there to be a bit more of a delay with the new hospitalization reporting than the new case reporting, at least over this time period.

And now the same graph for deaths:

Here the trends differ more from the other two graphs. The top of the peak is farther to the left, and the height of the peak relative to the height of the trailing bars toward its left is not as large, indicating that a greater proportion of deaths had reporting delays of more than a few days.

So those are examples of what the reporting delays can look like for cases, hospitalizations and deaths. Next let's look at the delays in a more quantitative manner. Here I used a longer period of time, from May 27 through June 10. For every case, hospitalization, or death reported in that time, I calculated the difference between reporting date and event date, and then I plotted the cumulative distributions of those values:

This graph shows, for any number of days from the day an event occurred, what fraction of events of that type are reported within that number of days. So for example, if you move right along the x-axis to 2 days, you can draw a line straight up and see that about 30% (0.3) of deaths are reported within two days of the death date, whereas for hospitalizations and cases it's more like 40%. Or say you want to see how many days it takes before half of a given event type are reported. Go up the y-axis to 0.5, then draw a line straight to the right and find that it takes 3 days for hospitalizations and cases but 5 days for deaths.

The distribution for deaths lags the distributions for cases and hospitalizations, meaning deaths tend to have longer delays, up to about 10 days or 75% reporting. Note that for all three types of event it takes about nine or ten days before you even get to three-quarters of full reporting! Beyond that point the trends reverse and it takes longer to pick up the most lagging cases and hospitalizations than the most lagging deaths; I'm not sure why that is. Also, the distributions for cases and hospitalizations are quite similar to each other.

You might wonder whether these distributions are affected by the day of the week on which the event occurred (or at least, I wondered that!).

The answer is yes. Here's a figure of the same thing except separated out by the day of week of each event (day of the event, not day the event was reported):

You can see that the delays are much more pronounced for deaths that occurred on a Tuesday, Wednesday, or Thursday, which makes sense with what I've already mentioned about reporting of deaths being slower on weekends. If a death isn't reported by Friday, there's a good chance it will take several additional days before it's reported. It takes a full seven days before there's even a 50% chance that a death occurring on a Wednesday will be reported.

Hospitalizations and new cases generally don't have as pronounced of a day-of-week effect on reporting delays. I did notice that for some reason, new cases occurring on Sundays apparently tend to have much longer delays.

So what does this all mean when it comes to interpreting the daily numbers that we see?

If you've read any of my posts about COVID you've seen graphs that look like this one:

The gray curve shows the number of deaths that were reported each day and shows the weekly oscillations I was talking about. You'll see trends like that on any COVID death graph that is showing the daily reported numbers with no smoothing. The black curve is a seven day moving average of the gray curve, which is another very common way of displaying COVID data. (Note: the dates for the black curve are the center dates of each seven-day period. Sometimes you might see the same sort of graph but with the dates being the end dates.) As each point is the average of seven days, it eliminates day-of-week effects and the weekly oscillations go away. You'll see this method of displaying the data on a lot of websites.

Similar graphs could be generated for cases and hospitalizations.

Now let's see what it looks like when we compare the numbers by their report date (which is the way they are almost always displayed) with the numbers by their event date.

First, new cases:

As I always do with the graph of daily cases for Ohio, I'll point out that the weird spike in mid-April is a result of a huge number of positive tests in prisons all being reported in a big bunch.

I will also point out, as usual, that reports of cases have to be put in the context of the total test numbers. If the cases are going up it might be because more testing is being done; you have to also pay attention to the percent positive. If cases and percent positive are both going up that's when you really know there's a problem. This is now happening in a number of states, mostly southern; it hasn't been happening in Ohio although the last few days unfortunately show signs we might be starting to head back in that direction...

You can see throughout the graph the delay between when positive tests happened and when they were reported. It does look like the delay was larger in March than it is now, which doesn't surprise me. But the delay still exists.

Next, hospitalizations:

And last, deaths:

So the theme of these three graphs is that when you're in a period of time where the numbers are going up, the average daily reported numbers are lower than the real daily average numbers. When you're in a period of time where the numbers are pretty flat, the two are about the same as each other. When you're in a period of time where the numbers are going down, the average daily reported numbers are higher than the real daily average numbers.

Another thing about these graphs is in all three, the numbers by event date (red) take a fairly sharp downward turn toward the end, but that's not real - that's from most of the numbers not having been reported yet. More on that in a moment.

Because with this pandemic the most rapid daily changes have always come from the growth phase, not the decline phase, the biggest deviation between the daily reported numbers and the real daily numbers always comes during times when the numbers are sharply rising. See, for example, around March 25-27 on the hospitalization graph. The real daily numbers were about twice the size of the numbers being reported at that time.

What does this mean in regard to what's going on today? There are a number of states, such as Arizona, Texas, Florida, and South Carolina, where numbers are currently going sharply up. Things are already looking bad but the reality is things are already worse than the numbers we're seeing!

And this doesn't take into account the delays from infection to onset of symptoms, from onset of symptoms to hospitalization, hospitalization to death, etc. I might explore those in another post. I think people are generally aware of these time lags and the fact that the numbers currently being reported reflect people who might have gotten infected a couple weeks ago. But the reporting delays explored in this post can create an even bigger time lag between "events on the ground" and when their effects really show up in the numbers we see.

This post is mainly about sharing some things I found interesting and trying to educate people, but if there's a big take home message, it's that if the numbers being reported are sharply rising, things are already worse than they look, so action needs to be taken ASAP. Fortunately in Ohio we did that in March early enough to avert disaster. In places like New York government officials waited too long and catastrophic death tolls were the result. Now, despite a much greater advance warning and much greater knowledge of the disease, it looks like the same mistakes might be in the process of being made in places like Arizona.

So that's the big takeaway, and now I also want to share some other analyses I found interesting.

The thing I mentioned about how the graphs of events by event date bend downward at the end but that's not real? So the graphs by report date have outdated numbers. And the graphs by event date have very incomplete numbers. Is there a way we can see what's really been going on, say, in the last week?

I took a stab at this by creating a function that takes the number of currently reported deaths or hospitalizations for each date along with how many days in the past each date was and returns an estimate of the "real" number of deaths or hospitalizations. The estimate is based on the cumulative distributions of reporting delays that I showed earlier.

So, for example, let's say that for a day five days in the past, there have currently been ten deaths reported. And say that the cumulative distribution shows that by day five, 50% of deaths for a given day are reported on average. Then the estimate for the "real" number of deaths for that day is doubled from ten to twenty. (The function is slightly more complicated because it uses the different distributions for each day of the week, which I found seemed to add a little accuracy.)

How do I know whether this method is effective? I can now look at the deaths that were reported by a date several weeks in the past, calculate the estimated daily deaths, and then compare them to what the numbers look like several weeks later, now that reporting is much closer to complete. I did find that the very most recent day has too much variability because the correction being made is very big, so I'm dropping the most recent day from the analysis, but other than that the results are pretty good. Let's take a look.

Here's a graph that shows the deaths by death date, both the most recent numbers and those that were reported by May 26, along with the estimated deaths from my calculations:

As you can see, the deaths that were reported by May 26 (gray curve) show the same downward bend at the end that we saw earlier in the graphs of the most recent numbers. The numbers for that same time range as of the most recent report (black) show that that downward bend was not real. The real numbers were basically flat at that time. But on May 26, using my estimation function, we would have seen that downward bend transformed into something that was basically flat (orange) and that turns out to be quite close to the more complete numbers that we now have for those dates.

The closer you get to the current date, the more uncertainty there is in these estimates, but all in all the method seems to work well. I also checked this with the function I made for hospitalizations as well as with the deaths/hospitalizations that were reported by a couple of other dates over the course of the last month, and I was quite pleased with how the results turned out.

Given the dual problems of the numbers by report date (what we usually see) being outdated, and the numbers by event date being very incomplete for more recent dates, this adjustment method seems like a decent way to better see what's really been going on recently. I'm not claiming that it provides any huge utility for informing decision making, but it does provide at least a little insight about the recent trends. Whether or not anyone else finds it useful, it was an interesting exercise for me to tackle!

Now let's update the graphs I showed earlier comparing events by report day to events by event day to include these estimates. Here's the updated graph for deaths:

You can see that, as we have been in a period of declining deaths, the estimated deaths from my calculation (blue) are in between the deaths by date reported and the deaths by event date.

The hospitalization graph is more interesting:

We have also been in a period of declining hospitalizations. If you are looking at a graph of new hospitalizations by their report date, which is the graph you'd normally see, it looks like the curve is still trending downward. But in the estimated curve, it appears that the downward trend has recently leveled off and (although the most recent estimated numbers contain the most uncertainty) we may be starting to head back up.

This is concerning. I was worried about what would happen when bars and restaurants reopened. We didn't see an immediate effect from that, but we may be seeing one now. The numbers will have to be closely watched in the coming days. If this is the start of a real upward trend, it suggests we need to back off from reopening for the types of businesses (such as bars and indoor dining at restaurants) with the most transmission risk.

It also reinforces the importance of everyone being careful and of wearing masks, for which there is now a lot of compelling evidence of benefit in slowing disease spread.

One last interesting tidbit I found from this analysis. We know that in the reported numbers there's a strong day of week effect with higher numbers midweek and lower numbers on the weekend. Are there day of week effects in the actual numbers by event day?

First, cases:

The numbers are much lower on the weekend, especially on Sunday. This isn't surprising. If someone gets tested as a result of, say, a doctor's appointment, that would clearly happen less on the weekend. (Note: in making this particular graph I excluded the very high single day totals from prison testing, which would bump up the Thursday and Friday numbers if they were included.)

Next, hospitalizations:

Similar to cases but with a less pronounced decline on the weekend. Also Monday appears to have a slight bump compared to other weekdays. This all makes sense as well. People would be somewhat less likely to go get admitted at a hospital on the weekend, and then there's a bump on Monday to partly make up for people delaying going over the weekend.

The deaths graph is what surprised me:

Friday really stands out from the other days and I wonder why this is. Now, I don't know for sure that all of the death dates are completely accurate. Perhaps there is some tendency for the dates to occasionally be in error in a way that biases them toward Fridays.

If it is a real trend, I do have a somewhat morbid hypothesis for why it might exist. Perhaps when someone is clearly going to die soon, there's a little bit of a tendency - whether it be in the dying person, in the family, or in the hospital staff - to want to "get it out of the way" before the weekend.

Just a thought. And it might not be a real trend.

So that wraps up this deeper dive into Ohio's COVID data. I hope you found it interesting and informative. I may do some other posts like this exploring other aspects of the data. I've always really loved numbers and analyzing numbers and making charts and graphs ever since I was a child. Now, between posts like this and analysis I'm doing of things directly related to my research job, I spend a huge amount of my time thinking about and working with COVID-related numbers. It can be a distressing topic to spend so much time on, but I think doing all this helps me feel a little less powerless, because I'm actively working on things to try to make a difference.

Stay safe, everyone.

Privileged bubbles and trying to pop them

Recent events in the news:

A Black man jogging through a White neighborhood in Georgia was murdered in a modern day lynching; this happened months ago and the killers would have gotten off scot-free, with help from local authorities, if not for a video being made public.

A Black woman EMT in Louisville was shot and killed in her own home by police officers executing a no-knock warrant at the wrong address.

A White woman called the police and threatened the life of a Black man by falsely claiming that he was threatening her after he asked her to obey the rules and leash her dog in Central Park.

A police officer in Minneapolis murdered a Black man by kneeling on his neck for nine minutes while the victim offered no resistance.

All this in the midst of a global pandemic that here in the United States is both taking advantage of and putting a spotlight on existing systemic inequities as it disproportionately kills people of color.

And now, police are violently cracking down on protesters against racist police violence, just weeks after police exhibited remarkably peaceful restraint when faced with heavily armed White protesters who stormed state government buildings because they were angry they couldn't get haircuts.

Noticing a theme?

My Facebook feed is full of people expressing well justified outrage at these events. I'm not criticizing people for posting hashtags. I'm glad that so many people want to do something to make a difference. But what can we (and by "we" I specifically mean White people) do to actually make a lasting difference? Plenty of awareness has been raised about these issues by now. I'd guess that most everyone who is going to care about the issues already cares about them. People who still don't care, even now, aren't going to start caring because they saw another hashtag.

I'm absolutely not faulting people for posting statuses on Facebook to raise awareness, but that's the easy part. We also have to do things that aren't easy.

In this day and age, with a virulent racist occupying our nation's highest office and with white supremacists emboldened by this fact, it is not enough to be "not racist." (It has never been enough to be just "not racist," but I think that's become far more obvious over the course of the last decade and especially last few years than it was for most of my own lifetime.) We have to be actively anti-racist if we want to do something about the underlying racism that affects everything in our society. What are some things we can do to be actively anti-racist?

I've thought about this a lot in recent years, ever since Ferguson, really. I won't claim to be an expert. But I'd like to share some of my thoughts relating to my own life experiences.

"Who would really have it any other way?"

It's so easy for White people to live in a bubble. I know this very well from my own life. And White people, generally speaking, have no idea what it's like to actually experience racism. But we know that racism is bad, because we've been told that all our lives. And we've been told that racists are bad people. And we don't think that we ourselves, or our close friends and loved ones, are bad people. Therefore we must not be racist and we must not be contributing to the racism that is everywhere in our society.

Being told that something we did or said was racist, or contributed to racism, does not feel good. I know this. It hurts our feelings. But that doesn't mean it's not true. (Nor does it necessarily mean you're a bad person.) We have to stop being so sensitive to our own hurt feelings. We have to stop being such snowflakes. If the worst racism-related thing you can imagine happening to you is being called a racist... imagine what it's like to actually be a victim of racism.

The killing of George Floyd in Minneapolis, for me, unavoidably recalls memories of events that demonstrated to me just how hard it is for White people to recognize and confront racist sentiments expressed by people close to them. Floyd was quoted as saying "I can't breathe" while that police officer choked the life out of him with a knee to the neck.

The phrase "I can't breathe" entered the national consciousness after a similar incident almost six years ago when Eric Garner, another unarmed Black man, uttered the same words while the life was choked out of him by an NYPD cop.

A relative of mine wrote an infamous newspaper column about Eric Garner's death. The column began [content warning: extremely inflammatory sentiments about victims of racist police violence]:

Eric Garner and Michael Brown [the victim of the police shooting in Ferguson, Missouri] had much in common, not the least of which was this: On the last day of their lives, they made bad decisions. Epically bad decisions. 

Each broke the law — petty offenses, to be sure, but sufficient to attract the attention of the police. 

And then — tragically, stupidly, fatally, inexplicably — each fought the law. 

The law won, of course, as it almost always does.

On a family email list, an email thread about this column - or more specifically, online reactions to this column - came up. Family members were offended at the insults online commenters were slinging at my relative who wrote those words. Some family members did, yes, express disagreement with the column's sentiments. But no one said anything remotely to the effect of, "hey, that's pretty... racist?"

Another passage in the infamous column was this:

Second, and this speaks to the ubiquitous allegation that cops are treated “differently” than ordinary citizens in deadly-force cases: Indeed they are — and it is the law itself that confers the privilege. 

The law gives cops the benefit of every reasonable doubt in the good-faith performance of their duties — and who would really have it any other way?

I'd say that the overall sentiments in this column are pretty racist, and it would require a pretty narrow definition of what qualifies as "racism" to deny that - but this is something of a semantics issue. It's literally impossible to have lived in society and not have racial biases that affect our thinking, because we're constantly bombarded with messages that implant these biases in our brains. Whether these biases rise to the level of being "racist"? Does it matter that much?

Whether or not it's "racist," that statement - the law itself... confers the privilege... The law gives cops the benefit of every reasonable doubt... and who would really have it any other way? - in light of the things that keep happening to Black people at the hands of law enforcement - over, and over, and over - is probably one of the most blatant examples of being blinded by one's one privilege that I've ever seen. Like, maybe you can't imagine why anyone would really have it any other way... but maybe the people who have to constantly live in fear of what cops might do to them or to their loved ones, maybe they would have it another way?

(Because people's feelings get hurt so much by any hint that they're guilty of racism, other terms have been invented to try to illustrate the same concepts in different ways. Such as "white privilege." "White privilege" is basically just another way of saying that society is racist against non-White people. And it doesn't mean that White people's lives are easy, just that when White people's lives aren't easy, the color of their skin isn't one of the reasons for that. But again, as with "racism," people get their feelings hurt by the term "white privilege." Stop being such fragile snowflakes.)

Although this newspaper column is nearly six years old now, it came up not too long ago on the same family email list, in an unrelated topic, but before all the current craziness (that is, COVID and mass protests) in this country started. And in that recent thread, family members from different parts of the political spectrum all seemed to scoff at the idea that the relative who wrote that column was racist or was even "racially biased."

Because of course. Racists are bad people. My relative, a person I care about, is not a bad person. Ergo, my relative is not racist.

It doesn't really work that way.

I reiterate, it is impossible to live in society and not be racially biased. It is a question of whether we actively work to recognize and confront those biases.

Not unrelated to this line of discussion, the relative in question, in other emails, has also favorably cited the writings of Charles Murray, author of noted work of pseudo-scientific racism The Bell Curve. Specifically, an article was shared that in essence claimed that if different racial groups had equal opportunities in society, that wouldn't necessarily result in the different racial groups having the same outcomes - "the same mean income, the same mean educational attainment, the same proportions who become janitors and who become CEOs."

This is pretty much by definition a racist claim by Murray.

Think about how many times in the average Black person's life they must encounter an Amy Cooper (the Central Park dog leash lady) or a Derek Chauvin (the Minneapolis cop who murdered George Floyd), and that Amy Cooper or that Derek Chauvin has some ability to influence the course of events in that Black person's life - grades they get, job hirings, promotions, criminal charges, etc.

In the real world we inhabit, it is impossible to test Murray's hypothesis that, given equal opportunities, different races would not attain equivalent outcomes, because we are so incredibly far away from equal opportunities.

This all happened a long time ago. But for whatever reason, these incidents just have a way of sticking in my mind forever. Incidents where someone put forth racist ideas and no one in the family stood up and called it what it was. I myself would sometimes try to push back, but I wouldn't go so far as to say, "hey, that's racist."

And perhaps that wouldn't have accomplished anything anyway, because, again, of the whole White people being fragile snowflakes about accusations of racism thing.

But how often do conversations like this happen in White families all over the country, and no one tries to advance the anti-racist narrative, and impressionable people - impressionable children, especially - are watching and listening and having their world views shaped by such statements going unchallenged?

So one not easy thing we have to do is, when someone we know says something racially problematic, we have to be able to point that out, ideally in a way that will encourage others to listen and not just shut down (that part of it is even less easy). Another not easy thing we have to do is, when someone does point out that we have done or said something racially problematic or that we bear some responsibility for the racism that permeates society, we have to get over our hurt feelings and make a good faith effort to listen and learn. White people's feelings are not the important thing right now.

Let me be very clear, this is not just a problem among conservative White people. This is a problem among numerous liberal White people as well. For another example from the dreaded family email list, a fairly liberal family member shared a statement by a fringe group of conservative African-American pastors decrying the Supreme Court's 2013 decision that the anti-gay Defense of Marriage Act was unconstitutional. The statement was, "We are devastated that the Supreme Court succumbed to political pressure by voting to weaken the sacred institution. They neglected our most precious children who need a mother and a father united in marriage for healthy development."

This liberal family member strongly disagreed with the Black pastors and expressed that they did not even know how to respond without being labeled racist. Basically, they felt that it was hypocritical for a Black person to say this because of the high rate of Black children being raised by single parents.

Obviously I do not agree with the Black pastors' stance on gay marriage. But saying that they're hypocrites because they're Black? Yes, yes that would, in fact, be racist.

And again no one else in the family seemed to have a problem with this.

Again, a long time ago. Again, something that stuck in my mind. That's just the way my brain works.

The point is not to demonize specific people in my extended family, it's to illustrate how pervasive these attitudes are, and how casually accepted they are, even among people who harbor no conscious animosity toward other races and who would absolutely never think of themselves as racist.

I don't want to just call out other people here. I'm not going to pretend I'm immune to this stuff.

Bubbles

I grew up in a total white privilege bubble. In school I learned about the Civil Rights movement and the message that came across was that, although there might still be racist individuals out there, and those individuals were bad for being racist, racism as a structural, societal issue had largely been solved in the 1960s.

I was in such a bubble that I actually believed this to be true until at least several years into my adult life.

(The most ironic part was probably learning about school integration in a classroom that was at least 95% White and no one ever pointing out that disconnect.)

I remember when I was in college, thinking that if affirmative action was used for school admissions, it should be focused only on economic status, not on race, because I thought disadvantages Black students faced in modern society were due to Blacks tending to be poorer as a result of racism in the past, but not because of racism that still existed in the present. And that low income White students were just as disadvantaged as low income Black students.

This seems completely crazy to me now. But when I was in college, I actually believed this.

(And just in case it's not clear - I am not saying that low income Whites face no disadvantages. Just that Blacks, of any income level, face many other obstacles that Whites don't face.)

I also remember making enormous use of "ironic racism" for the purpose of Internet humor when I was in my mid 20s. I thought I was just being absurd because I thought that people generally didn't believe those things anymore, for real, in modern society.

Talk about being in a bubble!

Truth is, I can only think of two Black people who I knew in person over the entire first eighteen years of my life. Both were people I went to school with and got along with but neither was a close friend. I had literally not the slightest comprehension of what it was like to be a Black person in America, because no one ever tried to tell me.

This is a map showing the block-by-block racial demographics of where I lived when I was growing up (from justicemap.org which uses Census data):

Purple indicates Whites are the most common race. The darkest shade of purple indicates greater than 90% White. I lived in one of the purplest of purple regions on this map.

Where I live now looks very different.

On this map, purple again indicates Whites are most common, red indicates Blacks are most common, and the deeper purple or red indicates a larger percentage of that particular race. I live right at a transition point between plurality White and plurality Black. I didn't choose where I live based on the racial demographics, I just happened to find a place I liked in this location.

So here's the thing. When I was younger, if I had been passing through this neighborhood and seen the people who lived here, there would have been a little voice in my head saying, in essence, "A lot of Black people live here so it's probably not a very good neighborhood."

No one in my life ever tried to instill racist values in me. Not remotely. But when you grow up around all White people, and don't really know any Black people, and most of the Black people you see in the media are either pro athletes (who are obviously very rare to encounter in everyday life) or people accused of crimes, that's just what happens to your brain.

(It's also worth pointing out the inherent privilege in these "good neighborhood" assessments. Most White people would see a neighborhood like the one in which Ahmaud Arbery was murdered for jogging while Black as a good neighborhood.)

So as I said before, it's not a question of whether or not someone is racially biased, because it's impossible to live in society and not be racially biased. It's a question of whether you recognize that those biases exist in your brain and then make an effort to actively confront those biases.

I'm not looking for a pat on the back, like "oh what a great guy you are for overcoming your biases." I mean honestly the biases are still there and it's a constant process of confronting them, and it's not easy to do, but it's also not nearly as hard as it must be to be a person who is constantly on the receiving end of those biases. So I think the least I can do as a decent human being is try to recognize and confront those biases and I hope other people can do the same.

School integration (or lack thereof)

If we zoom out from those maps I showed to the metro area level, we see two areas that are both quite segregated, Cleveland (second map below) even more than Columbus.

This is pretty typical of American cities. Why? There's a long, racist, history there that I won't get into (but look into redlining if you aren't familiar with the term).

Oh, one of the upshots of this clustering of Black Americans into inner city areas is that they are exposed to higher levels of pollution (thanks, urban freeways!), which has all sorts of negative health effects on both the brain and body. One of these is higher rates of asthma. Eric Garner's daughter Erica, who became an outspoken activist after her father was killed by the NYPD, tragically died at the age of 27 after an asthma-induced heart attack. Erica Garner was a victim of our racist society just as much as her father. It's also very likely the case that her health conditions were exacerbated by the stress of living in a world full of people making derogatory and deliberately inflammatory statements about her and her deceased father.

That said, I mainly bring up this segregation because it goes to one of the other important but not easy things that my life experiences have convinced me White people need to do.

Everyone wants what's best for their children. A big part of that, society tells all of us, is making sure our children go to a really good school. I have no doubt that most people, when thinking about where they are going to raise their children (a very big decision, to be sure), look up the ratings of the schools that their children would potentially attend.

Ohio school district report cards show that the Grandview Heights school district, where I grew up, gets an A grade. The Cleveland Heights-University Heights school district, where I currently live, gets a D grade.

"I would be a bad parent if I sent my kids to a D-rated school!" a lot of people undoubtedly think.

What those people may or may not know is that these school ratings are largely proxies for the socioeconomic statuses of the students who attend the schools, and do not really tell us anything independent of that about the quality of the schools.

The school funding system in the state of Ohio, where school districts are funded by local property taxes so that wealthier districts have better funded schools, has been declared unconstitutional multiple times going back to 1997, and yet still nothing has been done to fix this problem.

Furthermore, because Black people face numerous structural obstacles at every step of life as a result of living in a deeply racist society, Black students, on average, are more likely to struggle in school. Therefore a majority Black district will tend to get lower ratings regardless of how good the teachers in those schools are.

At Grandview Heights High School, by the most recent report, the student population is 91% White (non-Hispanic). At Cleveland Heights High School, it's 76% Black, 15% White.

This is interesting when compared to the overall demographics of the cities. Grandview Heights is 93% non-Hispanic White. Cleveland Heights is 46% White, 42% Black. The former's school demographics match the city demographics. The latter's are drastically different.

This is because in Cleveland Heights a much larger percentage of students, especially White students, attend private schools.

So the pattern is: White parents who live in a racially diverse area tend to either (a) move to a not diverse suburb (like the one where I grew up) or (b) send their kids to private school (like the schools a lot of White kids in my current city of residence attend), either way so they can ensure their kids go to a high-rated school.

(Cleveland Heights, by the way, is one of the most liberal cities in the entire country. Out-and-out, virulent racists are extremely rare here. So this is definitely an example of what I mean when I say these problems that contribute to a structurally racist society are present among White people of all political stripes.)

"Separate but equal" was ruled unconstitutional in 1954. The Supreme Court correctly ruled that there could not be equality under segregation. Yet today, school segregation in much of this country is almost as bad as ever.

This is definitely one of those things that's not easy, because society bombards parents with messages that they have to make sure their kids have the best possible path to success and they have to make sure their kids go to the best schools and they would be irresponsible parents if they didn't. And one part of solving this is that we have to demand equitable school funding. But I also contend that any time a well-to-do White family living in a racially diverse metropolitan area makes a decision to send their children to largely segregated schools - public or private - that decision contributes, in its own tiny way, to the vast racial divide that is tearing our country apart.

Now this does not mean that White parents who make these decisions are racists or bad people. Okay, some are, but most aren't. They're just doing what society tells them they have to do to be good parents. But as this ongoing pandemic is also illustrating, we have to think beyond our own selfish interests and think more about society at large. Everyone doing what they think is in their own best interests creates a disaster for society.

I expect this is uncomfortable for some people to think about because I know that lots and lots of the people I know come from families who made the decision, or are people who made the decision themselves, to enroll children in largely segregated schools because that's what society told them was what they had to do for their children. But we have to confront this issue. This is part of what I mean by doing things that aren't easy.

And I don't mean that all well-to-do White parents have an absolute moral obligation to send their kids somewhere like Cleveland Heights for school. There are a lot of factors that go into a decision like that. I'm just saying promoting diversity and equity in society should be one of those factors. I'm saying that what we do have an obligation to do, at the very least, is to reject the notion that being a good parent means making sure your kid goes to a "highly rated" school, when we know that those school ratings reflect the socioeconomic statuses of the student bodies and little else.

If I had gone to a school like Cleveland Heights instead of Grandview Heights, would I have any less success in life? I really doubt it. I think my ability to be successful comes a lot more from the resources and nourishing home environment my parents provided me than it comes from what school I attended. (Underprivileged children, of any racial background, would undoubtedly have much more to gain from attending exceptionally well funded schools that someone like me.) I also know that friends of mine who attended Cleveland Heights, both White and Black, seem to have gotten good educations and turned out just fine.

And if I had attended such a school, it would have helped me to not be in such a ridiculous white privilege bubble for the first two-plus decades of my life.

I think everyone benefits from getting to know people from diverse backgrounds, as well as from having adequately funded schools. Right now, poor kids who would have the most to gain from really well funded schools are mostly trapped in underfunded schools with other poor kids, and therefore have neither adequate school funding nor diversity. Rich kids who have far more resources at home and could get by more easily with slightly less well funded schools but would really benefit from more exposure to diversity are often in really well funded but also not diverse schools. Some places like Cleveland Heights do genuinely have a lot of socioeconomic diversity, but I suspect the increasing reliance on school ratings by parents who have the most ability to choose where to send their kids to school is making it harder to maintain that socioeconomic diversity in their student bodies.

I want to again emphasize the point that it's not enough, it's never enough, to be not racist, we have to be anti-racist. Let's imagine that, somehow, tomorrow, suddenly everyone in the whole world stopped having any racist motivations whatsoever, but everything else was the same. Black students would still tend to be in less well funded schools, as a result of our country's racist past. Financially comfortable White parents, taking a totally "race neutral" approach but still following the paradigm that they have to send their kids to the top rated schools, would continue to move to mostly White suburbs and/or send their children to private schools. Black parents, having on average less financial resources because, again, of the effects of past racism, would generally find it much harder to make those same decisions about where to enroll their own children. Despite no one being racist anymore, racial segregation and inequity would continue for generations if not into perpetuity!

That's one of the reasons why we can't, can't ever, settle for just being not racist. We have to do more.

Going forward

With the chaos engulfing our country now as cops nationwide choose to violently crack down on protesters rather than accept the possibility of being held accountable for their actions, and the president encourages that police violence, and an increasingly authoritarian and white nationalist Republican Party seems hellbent on dismantling our democracy, I fear everything I discuss in this post is insignificant next to the urgency of this moment. Things seem to have gotten so much worse even in the time since I began composing these words.

The most important thing for the remainder of this year is ensuring Trump and the complicit Republicans in Congress are removed from power. If that doesn't happen, there's a very real possibility all will be lost.

After that, I hope and pray we will all have the opportunity to come together and rebuild our country into a truly more perfect union. The suggestions I'm making are not quick fixes for anything. They're things we'll have to make a consistent effort on for probably the rest of our lives.

I'm not an expert on these issues. I'm just someone who has thought about them a lot and who is hopefully less naive than he was as a young man who had lived his whole life in a bubble, and who likes sharing his thoughts with the world. I've only touched on aspects of the race issue that I can directly relate to my own life experiences. There are other, exceedingly important, elements, that I haven't explored. Police reform seems like the most pressing issue at this moment and I haven't really touched on it, but this is already a long post. And although the problems with police forces are the most blatant right now, if we want lasting change we need to address so much more than that.

The message that I want all White people to hear and process is this - "racism," "racial bias," call it whatever you want, but it's something we all have in our brains, something that affects how we all view the world, whether or not we want to admit it. We've all been told that racism is bad, so it can be uncomfortable to admit these things about ourselves. But we can't prioritize our own comfort over other people's lives. We have to directly confront these biases both in ourselves and in the people around us.

When someone we consider a friend or loved one says something that illustrates racial bias, we can't just let it slide for the sake of avoiding conflict. I get it. I'm generally a conflict-averse person. One thing I've had to work on in therapy is recognizing that avoiding talking about uncomfortable issues to avoid conflict tends to lead to bigger problems in the long run. This is true for societal issues just as much as for personal issues. Maybe the Trumpists' ongoing looting of our country and everything we took for granted is the price we White people are paying for our failure to directly address these issues for so long.

Of course, vulnerable communities and people of color are paying much worse prices for our failures.

When I was a kid, not only did I not really know any Black people, but the people around me didn't really talk about race in any meaningful sense. It seems like people thought, "Well, MLK said we shouldn't judge people by the color of their skin, so if we just tell everyone to not judge people by the color of their skin, it will all work out. No need for any more in depth or uncomfortable conversations about the many ways MLK's dream isn't being realized in society."

It's obvious now that approach didn't work.

I will strongly credit my parents for raising me with good values, even if those values weren't race-conscious. I learned to recognize the fact that my family was very fortunate, that there were a lot of people in the world who didn't have nearly the same good fortune, and that people who are very fortunate have a responsibility to help people who are less fortunate. I didn't learn that rampant racism in society is one of the reasons some people are much less fortunate, but once I became educated as an adult on these issues, my passion about them naturally grew from the values I'd been instilled with as a child.

We have to recognize now that part of instilling our children with a complete set of good values is teaching them about racial justice. And how to be anti-racist instead of just not racist.

We have to reject widely held beliefs that help perpetuate structural racism even in the absence of active racist intent, such as the commonly held beliefs about schooling that have resulted in segregation getting worse, not better, in certain parts of this country over the last few decades.

And we have to do so many other things. This is nowhere close to being a comprehensive list. My heart hurts at what is happening in this country. Writing this is my little attempt at making a difference. I hope it can make a small difference. I vow to do more in the months and years ahead to try to continue to make those small differences. If we all do something every day to make just a little tiny difference, that can add up to enormous change.

But only if we don't settle for doing the easy things.

Any of us who has been settling for doing just the easy things, we have to recognize that time is over.

We have to do the hard things too if we're going to save our country.