Today’s entry: Hi Brian: I try to listen to or read your updates every day and thank you for providing them. I am confused about the following statement from your Q&A. Are we Americans, more likely to test positive because of our day-to-day lives in an open society and paying less attention to distancing and other guidelines? I would like to read your response and basis for this higher positive test expectation. Thank you and hope you and your family stay healthy.

Bottom Line: This note was on back of my recent story sharing how Americans are far more likely to test positive than people from most countries. We’ve seen a positive rate of around 4% worldwide. In the United States, it’s been around 15% with about a 10% rate in Florida. We know that tested Americans are far more likely to test positive than people from most other countries. This despite our country having tested more than any others. What we don’t know is the rest of the picture. For example, are some countries testing people who don’t really need the test as a precaution rather than those showing symptoms? We don’t know. We just know how many people have been tested in each country and how many have tested positive. Regardless, that we have tested far more extensively than other countries and the positive test rates are substantially higher than the rest of the world, illustrates the severity of the issue here. We will likely know in time with certainty but it's still a bit early here while the cases are still rapidly building. It could also be less about "Americans" purse and maybe more about the habits, behaviors, and lifestyles of certain groups of Americans.

Just as Florida’s positive test rate which while still high, is 33% lower than the country as a whole, is the US crisis really more of a New York crisis? In other words, with over a third of our cases coming from a single-state that only has around 5% of our population, is the US crisis more of a specific New Yorker story?

You ask a great question and hopefully, I'll have a more concrete answer for you in the near future but based on the information we’ve discussed we know that Americans are most likely to test positive for the virus in the world when tested. Also, there are dramatic differences in a spread based on geography including countries, states, and regions within states. Lastly, the population density alone doesn’t account for the spread.

This all points back to personal responsibility. California’s population is greater than double New York’s, and if you recall, the outbreak was first diagnosed on the west coast, yet they have only 11% of the cases of New York. Recently I brought you a story about the level of seriousness with which Americans were exercising during this crisis. Only 38% of Americans are extremely cautious and willing to take precautions above and beyond the minimums called for by public officials. Meanwhile 9% aren’t cautious at all, not adhering to any of the precautions given the opportunity. With the rate of spread twice that of the traditional flu, any geography with a disproportioned percentage of people who engage in reckless behavior are most likely to have the greatest concentration of cases. This likely is a key contributor to the New York crisis and it’s a reminder to everyone in South Florida to remain smart and safe.

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