April 10 (UPI) -- Thus far, New York and New Jersey have borne the brunt of the COVID-19 pandemic, and researchers say the way state and local governments have prepared will determine where it strikes next.
An analysis of data published Friday by the U.S. Centers for Disease Control and Prevention suggests there could be two types of problem area in the United States going forward -- densely packed downtown areas, like New York City, and less populated areas in the midwest, for example.
By Tuesday, there were nearly 400,000 confirmed cases of COVID-19, the disease caused by the new coronavirus, across the country, with all 50 states reporting at least one case, according to the new CDC figures.
However, prevalence of the virus varied widely between states, with places like New York City reporting roughly 915 cases per 100,000 people in the general population, while Minnesota had fewer than 21 cases per 100,000 people in the general population.
While places like New York City have seen their health systems challenged by the pandemic, their "infrastructure that can handle the surge," said Leonard Marcus, founding co-director of the National Preparedness Leadership Initiative at the Harvard T.H. Chan School of Public Health and the Harvard Kennedy School of Government.
"As we are hearing about emerging hotspots in rural areas, these are particularly concerning because of hospital closures and budget cuts in many of these areas, their healthcare systems don't have the same capacities as those in urban areas," Marcus added, during a conference call with reporters on Friday. "Time will tell what the impact of the outbreak will be in these areas."
Inconsistent messages from state governments and delays to implementing social distancing and stay-at-home policies in some parts of the country could make matters worse, he said, mentioning Georgia, Iowa, North Dakota and South Dakota specifically.
Marcus pointed to the four states because they saw their total number of COVID-19 cases roughly double from March 31 to April 7. Three of them -- Iowa and North and South Dakota -- play significant roles in the United States' food-supply chain, he said. In Iowa, cases have been reported among workers in food-processing facilities.
"These states will now be playing catch-up," he said, adding that how effectively they do so could "impact the nation's food supply."
While Friday's CDC report does not project the regions of the country will be hit next by the outbreak, it shows some disturbing trends. For example, Louisiana saw its total number of confirmed cases of the virus more than triple from March 31 to April 7, while total cases doubled in nearby Mississippi and Alabama, to more than 2,000 and nearly 2,200, respectively.
Illinois saw its total number of people diagnosed with COVID-19 jump from just under 6,000 to nearly 14,000 over the same period. Most of these cases are in Chicago, which, like New York City, has a robust healthcare system. But the state was also one of several -- New York, New Jersey, Michigan, Louisiana, Washington, California Massachusetts and Georgia -- to report more than 300 deaths caused by the virus.
The states with the highest case-fatality rates to date include Kentucky, at 5.7 percent; Oklahoma, at 4.6 percent; and Michigan, at 4.5 percent. New York City's case-fatality rate through April 7 was 5.3 percent, according to the CDC report.
California, on the other hand, has been a relative success story, Marcus said. The state implemented social distancing measures early, and prepared its health system for a surge in cases -- and it has kept its case-fatality rate fairly low, at 2.4 percent as a result.
"States are reaching peaks at different times, so if the country is nimble in its response, we should be able to meet the needs of these states," he noted. "In retrospect, though, it would have been better if we had an overall national strategy on outbreak response, where everyone would be doing the same thing at the same time, in part because people travel from state to state. A uniform approach would have stood us better as a country."