Best and worst states in controlling COVID-19

After peaking at more than 36,000 people on April 24, new cases of COVID-19 had been on a downward trend in the United States. But, on June 8, the number of new cases began a sharp increase. As of July 2, the number of new US cases hit an all-time high of more than 50,000 per day. This new surge in COVID-19 cases has coincided with a number of states reopening businesses and loosening restrictions. 

At a Senate hearing on June 30, Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, noted that as bad as these numbers are now, they may certainly get worse. 

“It is going to be very disturbing, I will guarantee you that, because when you have an outbreak in one part of the country, even though in other parts of the country they’re doing well, they are vulnerable,” Dr. Fauci said. “We are now having 40-plus thousand new cases a day. I would not be surprised if we go up to 100,000 a day if this does not turn around.”

But, how do we turn things around? Rather than scolding state governors, businesses, and individuals for getting lax, it might be more instructive to look to the states that have been doing things right—and keeping COVID-19 cases under control—to see what we can learn. To that end, WalletHub released a new report that identified states in which residents showed the greatest improvements in health in the past few weeks. 

For this report, WalletHub considered 13 pertinent metrics for each of the 50 states and the District of Columbia. These metrics included the COVID-19 death rate, hospitalization rate, virus transmission rate, and the rate at which people tested positive. WalletHub then determined a weighted average from all the metrics to calculate an overall score for each state, which was used to rank states.

States with the greatest health improvements

Hawaii. Hawaii ranked highest, with the greatest improvement in health among all states and districts. 

“Hawaii is ranked as having the biggest health improvement in recent weeks because the state’s COVID-19 death rate for the latest week [ending June 28] was zero, and there was only a very slight increase [in recent weeks] in the number of people who tested positive for the virus,” said Jill Gonzalez, WalletHub analyst. “People with COVID-19 in Hawaii have the lowest expected rates of transmission compared to other people [in the US], too.”

Since the start of the pandemic, Hawaii’s cumulative incidence rate of COVID-19 cases is 65 per 100,000 people, according to data from Johns Hopkins University. Thanks to early social distancing measures instituted by the state, Hawaii had flattened the curve of new cases as early as mid-April. Hawaii continues to impose a 14-day quarantine on people traveling into the state. Like other states, however, Hawaii has seen an uptick in new cases since early June. 

West Virginia. West Virginia ranked second on WalletHub’s list due to low rates of death, hospitalizations, and people testing positive in recent weeks. 

The state’s overall incidence of COVID-19 is 166 cases per 100,000 people. West Virginia has been successful in keeping cases low because it instituted early stay-at-home orders and school closings, and lately a slow rollout of reopening businesses. 

Alaska. Coming in third, Alaska was in a three-way tie (with Hawaii and West Virginia) for states with the lowest death rate. Alaska also had low rates of transmission, people testing positive, and hospitalizations. 

With a low incidence of 133 cases per 100,000 residents, Alaska has kept the virus in check with early school closures and stay-at-home mandates, as well as by closing down businesses earlier than most other states. 

Maine. Maine was in the fourth spot, scoring well for a low death rate, hospitalization rate, and positive testing rate. 

Maine’s incidence of COVID-19 cases is 245 per 100,000. Hospitals and citizens prepared as early as December, but Maine also had the benefit of a delay in the virus reaching up to the top corner of the country. For instance, Washington and New York were already beginning to be overwhelmed while Maine experienced its first few cases. 

Vermont. Vermont ranked fifth based on metrics such as low positive testing, transmission, hospitalization, and death rates. 

The incidence of cases in Vermont is 194 per 100,000. Despite being bordered by heavily-infected states like New York, Vermont saw fewer cases than most states. Early preparedness and a populace that was willing to stick with social distancing and other safety requirements were what likely kept cases low. In fact, COVID-19 cases peaked in Vermont as early as April 4 and have been going down overall since. 

States with the poorest health improvements

Arizona. Among all states and districts, Arizona ranked last (51st) with the least improvement in its residents’ health. 

Gonzalez explained: “Arizona has seen the smallest health improvement in recent weeks because people with COVID-19 in the state have the fourth highest expected rate of transmitting the disease to others, which has led to some of the largest increases in the country of people testing positive for COVID-19 and dying from the disease.”

COVID-19 incidence is 1,155 cases per 100,000 Arizonans, but cases have skyrocketed in recent weeks. On July 1, Arizona reported a record number of new cases in a single day in the state: 4,878. The number of deaths, 88, was also a single-day record. Earlier in the week, Arizona’s governor reversed the state’s reopening plans by closing up bars, gyms, movie theaters, and water parks. 

Georgia. With high rates of positive testing and deaths, Georgia came in second-to-last place. 

While the overall incidence in Georgia is 793 cases per 100,000 people, the state reported more than 2,200 new cases on June 28 alone—its highest-ever single-day number. The following day, the governor extended Georgia’s state of emergency order and also signed another order that maintains public health requirements, such as social distancing and banning large gatherings.

Arkansas. Ranked the next lowest, in 49th place, was Arkansas. It had high numbers in such metrics as death rate, transmission, and positive testing. 

Arkansas’ incidence of COVID-19 cases is 702 per 100,000 residents. Although schools were closed in mid-March, the governor of Arkansas never issued a stay-at-home order. In mid-June, the state moved into the second phase of its reopening, despite the fact that COVID-19 cases were not on the decline. 

Louisiana. Louisiana ranked 48th primarily for its high death rate, but secondarily for its high hospitalization rate. 

The overall incidence rate in the state is 1,294 cases for every 100,000 residents, but that doesn’t quite characterize the problems Louisiana has faced. In late March, COVID-19 cases were increasing faster in Louisiana than anywhere else in the world at that time. One month earlier, the governor had allowed Mardi Gras celebrations to continue unimpeded, which critics have said led to the further spread of the virus.

Alabama. The 47th state with the least improvement was Alabama. Among all states, Alabama had some of the highest rates of positive testing and transmission.

Incidence of COVID-19 in Alabama is 795 cases per 100,000 people. Its high incidence could be due in part to the delayed response the state took in first preparing to handle the pandemic. Then in May, even while cases were spiking to record numbers, the state allowed businesses—like movie theaters, casinos, and other venues—to reopen. Experts say Alabama continues to be at risk of a second wave, although some say the first wave hasn’t even ended yet. 

What have we learned? 

“States should increase restrictions if they start to see spikes in COVID-19 deaths and hospitalizations, but they should not respond with more lockdowns,” said Gonzalez. “In response to spikes, states should enforce measures like mandatory mask wearing, temperature checks before entering crowded indoor places like grocery stores, COVID-19 tests before entering airports, and stricter occupancy limits indoors.” 

She added: “While people may find increased safety measures to be inconvenient during the reopening process, we will not be able to make any significant progress without them.”

WalletHub has the full list of state rankings in its online report.