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Connecticut has been on a better COVID-19 path than most states. Here's why that might be.

More than half of the states are marked as bruised red or red, for "uncontrolled spread" or "trending poorly," on covidexitstrategy.org's map tracking progress from COVID-19 toward a new normal. East of that sea of red and some yellow, for "making progress," Connecticut was one of only four states on Saturday — along with New York, New Jersey and Maine — shaded green, for "trending better."

The 14-day trend of cases in Connecticut was marked as increasing, though it had been flat two days prior. But only 50% of intensive care units were occupied, a level considered normal rather than elevated or constrained. New cases totaled 23 per million, the fifth lowest in the country. Only 1% of tests were coming back positive, tied for third lowest in the country.

"Connecticut is in such a good place, and now it's going to be a fight to keep that place," said Marta Wosinska, deputy director of policy at the Duke-Margolis Center for Health Policy at Duke University.

She's one of the collaborators on covidexitstrategy.org, along with people from U.S. Digital Response, United States of Care, and Resolve to Save Lives. The site gets its data from the Centers for Disease Control and Prevention, and from the COVID Tracking Project.

Two weeks ago, Connecticut was one of only two states — along with Rhode Island — where cases were decreasing. Connecticut also has the nation's second-lowest estimated reproduction rate, the average number of people who get infected from one infectious person, at 0.89.

So, what has generally put Connecticut on a better trajectory than most other states when it comes to the coronavirus?

In interviews this past week with Wosinska, three local public health workers, a hospital director of quality and safety, an infectious disease ecologist, a health administration and policy chair and Gov. Ned Lamont, a few potential reasons came up.

Connecticut was slower to reopen, bars were never reopened, the state has both a relatively high testing rate and a robust contact tracing program, and residents may be more diligent with mask-wearing and social distancing because the state was hit hard early on.

It's unclear what the trajectory would be now for early-impact states if interventions weren't in place, but it's not the case that the spread slowed in Connecticut because the coronavirus already ripped its way through the population: A CDC study indicated that not even 5% of the state's residents had antibodies at the beginning of May.

In Lamont's briefing Thursday, a Fox 61 reporter asked if other state leaders have reached out to learn from what Connecticut is doing right.

The governor replied that nobody's asking, "What's so great about Connecticut?" but governors do compare notes. He said Arizona Gov. Doug Ducey pointed out that perhaps people in Arizona knew somebody who lost their job from COVID-19 but not somebody who lost their life. Lamont said that because Connecticut was hit pretty hard, "I think it makes us a little more careful."

While Connecticut has been on a better trajectory than most states for weeks now, it's important to note that the state so far still has worse case and death totals than most other states.

Connecticut has the seventh-highest cases per 100,000, after New Jersey, Rhode Island, New York, Massachusetts, Arizona and Louisiana, according to the CDC. Connecticut has the second-highest deaths per 100,000, after only New Jersey. New Jersey, Rhode Island, Massachusetts and Connecticut are the four most densely populated states.

New daily cases peaked April 4 in New York, April 16 in New Jersey, April 22 in Connecticut, and April 24 in Massachusetts and Rhode Island, according to data the New York Times has compiled.

States that either haven't reached their peak daily cases yet or just reached it this month include Alabama, Arizona, California, Florida, Georgia, Idaho, Kansas, Missouri, North Carolina, Oklahoma, South Carolina, Tennessee and Texas.

Connecticut was slower to reopen than states now seeing spikes

Steve Mansfield, director of health for Ledge Light Health District, attributed Connecticut's positive trajectory to looking at the data and what is going on in other states. After seeing spikes elsewhere, Lamont decided to push back phase three of reopening, which would have allowed bars to operate and larger gatherings.

Mansfield has been critical of the state when it comes to communicating with local health districts, but when it comes to strategy, he thinks "the governor's office is being prudent and not rushing forward with reopening."

"We kept everything shut down for a long period of time, well beyond when we passed our peak, so I think that helped," said Dr. William Horgan, regional director of quality and safety for Hartford HealthCare. He also thinks the long closure of the casinos helped.

In its latest map and case count, the New York Times reports that Connecticut is one of 10 states where new cases are mostly the same, whereas cases are increasing in 37 states and decreasing only in New Hampshire, Maine and Vermont.

The New York Times also has been updating an interactive page showing how all 50 states are reopening (and re-closing), with a few sentences summarizing each state's timeline followed by a list of what is and isn't open.

Connecticut's description begins, "Connecticut was one of the last states to begin reopening, as Gov. Ned Lamont, a Democrat, allowed the state's stay-at-home order to expire on May 20."

That was the day the state allowed restaurants, zoos and museums to open outdoor spaces, as well as retail businesses and offices to reopen. Hair salons, barbershops and casinos reopened June 1, followed by indoor spaces at restaurants, gyms, movie theaters, libraries, hotels and amusement parks on June 17.

Despite Connecticut being slower to open up, the personal finance website WalletHub reported this past week that Connecticut saw the seventh-fastest recovery from unemployment claims, and the week before, the second-fastest, behind New Jersey.

Of the 37 states where cases are increasing, nearly every state started its reopening before Connecticut. For instance, with Connecticut in virtual lockdown, Georgia and Oklahoma allowed some businesses to reopen in April and Colorado lifted its stay-at-home order.

Lamont pointed out Thursday that more than 80 kids and staff recently became infected at a sleepaway camp in Missouri, while Connecticut never allowed overnight camps to open.

Florida allowed bars to reopen in early June but closed them June 26 after a spike in cases. Arkansas has allowed restaurants and bars to reopen at two-thirds capacity, while Connecticut is still at half-capacity for restaurants and bars remain closed.

"It all has to do with how many infections there are in the population when the lockdown is lifted, for it to be able to propagate forward," Micaela Martinez, an infectious disease ecologist and professor at Columbia University, said of how the virus spreads. "So, we can think about this in terms of: Did some places open up too early, relative to how much infection they have? That's likely the case."

Some states on positive path are ones that were hit hard early

Martinez is most familiar with the data in New York, where Gov. Andrew Cuomo's mask mandate went into effect April 17.

"It's a social norm for everyone to be in masks, and I think that comes out of the respect for others that comes as a result of having such a devastating outbreak here," she said. In places that weren't hit as hard, she said the coronavirus "might seem like a more distant threat."

Similarly, Hartford HealthCare's Horgan said being close to the epicenter of New York and seeing what happened there reinforced mask-wearing and social distancing for Connecticut residents.

Wosinska, of the Duke-Margolis Center, thinks that residents of states with early outbreaks have a level of experience that those in other states don't, and that reopenings basically restarted the clock.

She said that since case levels are now relatively low in Connecticut, contact tracing can work.

"I think when you end up in a situation like Arizona or Florida or Texas, this is when contact tracing can become really challenging, because there's just too many people to follow up," Wosinska said.

Patrick McCormack, director of health for Uncas Health District, thinks the work local health districts have done in contact tracing "has been instrumental towards getting the numbers where they are." In Connecticut, contact tracing involves public health staff and volunteers reaching out to those who may have been exposed to someone who tested positive for COVID-19.

Public health nurse Sue Dubb has been doing the contact tracing for Uncas Health District, and she has "been pleasantly surprised at the willingness of people to comply with the request for voluntary isolation or a voluntary quarantine."

An analysis that NPR published June 18 found that Connecticut was one of only 13 states with either enough contact tracers per capita or enough reserve staff to meet the need.

Along with contact tracing, increased testing can help slow the spread of the coronavirus. According to the Johns Hopkins Coronavirus Resource Center, Connecticut has the eighth-highest rate of tests per 100,000 people among the 50 states.

"We still have some excess capacity in our testing, and that is what we're trying to relay," Lamont said. "You don't see that in other states, those hot spot states, Arizona, Texas, Florida."

Karl Minges, chair of the Health Administration and Policy Department at the University of New Haven, pointed out that these states are now seeing weather with temperatures in the 90s and 100s, meaning that to escape the heat people may be more likely to congregate indoors, where the virus spreads easier.

"Also, there's a geopolitical ramification, that we live in a pretty blue state, and mask-wearing was heavily politicized by our president," Minges said. He added, "We're trusting our governor and our state leadership perhaps over the national, federal leadership."

Minges also noted that Connecticut has a more highly educated population than most states. A poll that Pew Research Center conducted June 4-10 found that 76% of college graduates reported wearing a mask all or most of the time, compared to 60% of those without a college degree.

Along the political spectrum, the figures were 83% for liberal Democrats, 71% for moderate Democrats, 60% for moderate Republicans and 49% for conservative Republicans.

The poll also found that Americans in counties with higher death rates from the coronavirus were more likely to wear masks.

e.moser@theday.com

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