Geographic Differences in COVID-19 Cases, Deaths, and Incidence - United States, February 12-April 7, 2020

Abstract

Community transmission of coronavirus disease 2019 (COVID-19) was first detected in the United States in February 2020. By mid-March, all 50 states, the District of Columbia (DC), New York City (NYC), and four U.S. territories had reported cases of COVID-19. This report describes the geographic distribution of laboratory-confirmed COVID-19 cases and related deaths reported by each U.S. state, each territory and freely associated state,* DC, and NYC during February 12-April 7, 2020, and estimates cumulative incidence for each jurisdiction. In addition, it projects the jurisdiction-level trajectory of this pandemic by estimating case doubling times on April 7 and changes in cumulative incidence during the most recent 7-day period (March 31-April 7). As of April 7, 2020, a total of 395,926 cases of COVID-19, including 12,757 related deaths, were reported in the United States. Cumulative COVID-19 incidence varied substantially by jurisdiction, ranging from 20.6 cases per 100,000 in Minnesota to 915.3 in NYC. On April 7, national case doubling time was approximately 6.5 days, although this ranged from 5.5 to 8.0 days in the 10 jurisdictions reporting the most cases. Absolute change in cumulative incidence during March 31-April 7 also varied widely, ranging from an increase of 8.3 cases per 100,000 in Minnesota to 418.0 in NYC. Geographic differences in numbers of COVID-19 cases and deaths, cumulative incidence, and changes in incidence likely reflect a combination of jurisdiction-specific epidemiologic and population-level factors, including 1) the timing of COVID-19 introductions; 2) population density; 3) age distribution and prevalence of underlying medical conditions among COVID-19 patients (1-3); 4) the timing and extent of community mitigation measures; 5) diagnostic testing capacity; and 6) public health reporting practices. Monitoring jurisdiction-level numbers of COVID-19 cases, deaths, and changes in incidence is critical for understanding community risk and making decisions about community mitigation, including social distancing, and strategic health care resource allocation.

Figures

FIGURE 1

Cumulative number of reported COVID-19 cases, by jurisdiction — selected U.S. jurisdictions,,† April 7, 2020 Abbreviation: COVID-19 = coronavirus disease 2019 * Restricted to U.S. reporting jurisdictions with ≥5,000 COVID-19 cases reported as of April 7, 2020. † Data from New York are exclusive of New York City.

FIGURE 2

Cumulative incidence of COVID-19, by report date — selected U.S. jurisdictions,, March 10–April 7, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Cases per 100,000 population. † Restricted to the 11 jurisdictions reporting the largest absolute increase in COVID-19 cumulative incidence during the most recent 7-day reporting period, March 31–April 7, 2020. § Data from New York are exclusive of New York City.

FIGURE 3

Number of reported COVID-19–related deaths, by jurisdiction — selected U.S. jurisdictions,,† April 7, 2020 Abbreviation: COVID-19 = coronavirus disease 2019. * Restricted to U.S. reporting jurisdictions with ≥5,000 COVID-19 cases reported as of April 7, 2020. † Data from New York are exclusive of New York City.