Covid-19 hit the US at a time of partisan divide so marked that it spilled into the domain of medicine and science. Even early on in the pandemic it was possible match political affiliation to individual behavior with respect to the virus. In favor of masking, social distancing, and vaccination? Democrat. Prefer a quick return to normal, and oppose mask and vaccine mandates? Republican.
This dynamic showed up in policy and in health outcomes, as well. Comparing covid-19 death rates and spread can be tricky, because factors including population density, socioeconomic status, proximity to correctional facilities, and ethnic composition can influence the outcomes. Yet looking at how states fared in relation to one another gives some indication of the impact of policy on public health. In the case of covid-19, two years into the pandemic, red states have registered higher excess mortality than blue ones.
An article published earlier this month in the Journal of the American Medical Association by Steven Woolf, a professor at the Virginia Commonwealth University’s Center for Society and Health, looks at the excess mortality registered in 2021 in US states and attributable to the pandemic through the lens of covid-19 policy. (Excess mortality is the number of deaths that exceed what would be expected in a specific place in a given time.) Deaths were concentrated in states like Florida and Georgia, both with a covid-19 mortality rate above 200 per 100,000 citizens in 2021, where mitigation measures such as masks and distancing were scarce, and vaccination rates lower.
According to the article, states like New Jersey and New York, where the first wave in 2020 hit especially hard, had lower levels of excess covid-19 deaths in 2021, about 112 per 100,000, due to stronger protective policies.
This holds even expanding the analysis to include 2020, when not much was known about ways to contain the virus, and the first two months of 2022, though the Centers of Disease Control and Protection’s data for those months is still incomplete.
The overall average rate of excess deaths attributable to covid-19 in states run by Republican versus Democratic governors shows that red states had a rate of 268 deaths per 100,000, while in blue states the rate was 240 per 100,000. The disparity was more pronounced when it was linked to actual policy: States that didn’t enforce any kind of mask mandates, or pushed back against federal requirements, such as Oklahoma and Tennessee, experienced an average death rate of about 300 deaths per 100,000. They all had Republican governors.
Covid-19 excess death rates have been even higher in states where less than 60% of the population is fully vaccinated, reaching an average 316 per 100,000 since the beginning of the pandemic. With the exception of Kentucky and Louisiana, all of those states have Republican governors. So do the five states that experienced the highest excess mortality rates.
This is also consistent with the overall excess mortality ratio from all causes (not just covid-19), which was just as marked between red states, which tend to have less progressive healthcare policies, compared to blue ones. In the latter, excess mortality rate from all causes was 308 per 100,000 people; in the former, it was 354 per 100,000.