How Bad Was COVID in Your State? Governor’s Party Affiliation Was Key

How Bad Was COVID in Your State? Governor’s Party Affiliation Was Key

Whether your governor is a Democrat or a Republican has influenced how many coronavirus cases and deaths your state has seen during the pandemic?

Yes, claim researchers who discovered a strong link between the two — by late last summer, the odds of dying from COVID-19 was nearly twice as high in states whose governors were Republicans versus states with Democratic governors.

“Governors’ party affiliation may have contributed to a range of policy decisions that, together, influenced the spread of the virus,” said study senior author Sara Benjamin-Neelon. She is a professor in health, behavior, and society at Johns Hopkins University School of Public Health in Baltimore.

“These findings underscore the need for state policy actions that are guided by public health considerations rather than by partisan politics,” Benjamin-Neelon said in a Hopkins news release.

For the study, her team analyzed data collected between March 15 and Dec. 15, 2020, on positive COVID-19 tests, COVID-19 diagnoses, and COVID-19 deaths in all 50 states and the District of Columbia.

After adjusting for factors such as state population density, the researchers found that per-capita rates of new COVID-19 cases and COVID-19 deaths in the first few months of the pandemic were higher in the 25 states Democrat governors (including Washington, D.C.). Still, those rates became much higher in the 26 states with Republican governors by mid-summer.

The shift for positive tests occurred on May 30, for COVID-19 diagnoses on June 3, and for COVID-19 deaths on July 4, with the differences between the two groups of states peaking from late June to early August. For example, on Aug. 5, the risk of dying of COVID-19 was 1.8 times higher in GOP-led states, the findings showed.

Both groups of states had similar testing rates until late September, when they began to fall in Republican-led states. The researchers acknowledged that many other factors, including the pandemic’s natural progression from early waves in urban areas to later waves in rural areas, might have contributed to differences in case counts and death rates. Still, they said they attempted to correct for these confounding factors in their analysis.

The findings were published online March 9 in the American Journal of Preventive Medicine.

Previous research had found that Republican governors tended to be less strict than Democrat governors when it came to mask-wearing, social distancing, and other pandemic-related prevention measures.

Those findings and the new study suggest that the pandemic response’s political polarization has contributed to less effective prevention policies in some states, the researchers noted.

“Despite a more coordinated federal response this year, governors still play a key role in the pandemic response,” Benjamin-Neelon said. “

As we’re seeing, several states have lifted mask requirements even though we have yet to make substantial progress in controlling the spread of the virus.”

More information

The U.S. Centers for Disease Control and Prevention explains how to protect yourself and others from COVID-19.

Associations Between Governor Political Affiliation and COVID-19 Cases, Deaths, and Testing in the U.S.

Introduction: The response to the coronavirus disease 2019 (COVID-19) pandemic became increasingly politicized in the U.S., and the political affiliation of state leaders may contribute to policies affecting the spread of the disease. This study examines differences in COVID-19 infection, death, and testing by governor party affiliation across 50 U.S. states and Columbia. Methods: A longitudinal analysis was conducted in December 2020, examining COVID-19 incidence, death, testing, and test positivity rates from March 15 through December 15, 2020.

A Bayesian negative binomial model was fit to estimate daily RRs and posterior intervals (PIs), comparing rates by gubernatorial party affiliation. The analyses adjusted for state population density, rurality, Census region, age, race, ethnicity, poverty, number of physicians, obesity, cardiovascular disease, asthma, smoking, and presidential voting in 2020.Results: From March to early June, Republican-led states had lower COVID-19 incidence rates than Democratic-led states. On June 3, the association reversed, and Republican-led states had a higher incidence (RR=1.10, 95% PI=1.01, 1.18). This trend persisted through early December.

For death rates, Republican-led states had lower rates early in the pandemic but higher rates from July 4 (RR=1.18, 95% PI=1.02, 1.31) through mid-December. Republican-led states had higher test positivity rates starting on May 30 (RR=1.70, 95% PI=1.66, 1.73) and lower testing rates by September 30 (RR=0.95, 95% PI=0.90, 0.98). Conclusion: Gubernatorial party affiliation may drive policy decisions that impact COVID-19 infections and deaths across the U.S. Future policy decisions should be guided by public health considerations rather than political ideology.

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has resulted in a global public health crisis. As of December 15, 2020, there have been >16 million confirmed COVID-19 cases and 300,000 deaths in the US. In response to the pandemic, the governors of all 50 states declared states of emergency. Shortly thereafter, states began enacting policies to help stop the spread of the virus. However, these policies vary and are guided, in part, by decisions from state governors. Through state constitutions and laws, governors have the authority to take action in public health emergencies. In early 2020, nearly all state governors issued stay-at-home executive orders that advised or required residents to shelter in place.

However, recent studies found that Republican governors were slower to adopt stay-at-home orders if they did so at all. Moreover, another study found that Democratic governors had longer durations of stay-at-home orders.5 Further, researchers identified governor Democratic political party affiliation as the most important predictor of state mandates to wear face masks. Although recent studies have examined individual state policies, such as mandates to socially distance, wear masks, and close schools and parks, multiple policies may act together to impact the spread of COVID-19. Additionally, the pandemic response has become increasingly politicized. As such, state leaders’ political affiliation, specifical governors, might best capture state policies’ omnibus impact. Therefore, the purpose of this study is to quantify differences in incidence, death, testing, and test positivity rates over time, stratified by governors’ political affiliation among the 50 states and the District of Columbia.

METHODS

 Study Sample

A longitudinal analysis examined COVID-19 incident cases, death rates, polymerase chain reaction testing, and test positivity from March 15 (March 24 for testing and test positivity) through December 15, 2020, for the 50 states and the District of Columbia. Based on prior studies, it was hypothesized that states with Democratic governors would have higher incidence, death, and test positivity rates early in the pandemic due to points of entry for the virus, but that the trends would reverse in later months, reflecting policy differences that break along party lines. The IRBs at the Medical University of South Carolina and Johns Hopkins Bloomberg School of Public Health deemed this research exempt.

 Measures

Governor party affiliation was documented for each U.S. state; for the District of Columbia, mayoral affiliation was used. Daily incident cases and deaths were obtained from the COVID Tracking Project. Polymerase chain reaction testing and test positivity data came from the HHS. Potential confounders included state population density, Census region, state percentage of residents aged ≥65 years, percentage of Black residents, percentage of Hispanic residents, percentage below the federal poverty line, the percentage living in rural areas, the percentage with obesity, the percentage with cardiovascular disease, the percentage with asthma, percentage smoking, number of physicians per 100,000 residents, and percentage voting Democratic (versus Republican) in the 2020 presidential election.19

 Statistical Analysis

Bayesian negative binomial models were used to examine the incident case, death, testing, and test positivity rates. The models included penalized cubic B-splines for the fixed and random temporal effects—models adjusted for the above covariates. Ridging priors were assigned to the fixed and random spline coefficients.20 Posterior computation was implemented using Gibbs sampling.18,21 Model details, including prior specification, computational diagnostics, and sensitivity analyses, appear in the Appendix. Governors’ affiliation stratified models and posterior mean daily rates were graphed with their 95% posterior intervals (PIs). Adjusted RRs and 95% PIs were calculated to compare states, with RRs >1.00 indicating higher rates among Republican-led states. Analyses were conducted using R, version 3.6.

RESULTS

The sample comprised 26 Republican-led and 25 Democratic-led states. Figure 1A–B presents incidence trends (cases per 100,000) and adjusted RRs by gubernatorial affiliation. Republican-led states had fewer cases from March to early June 2020. However, on June 3, the association reversed (RR=1.10, 95% PI=1.01, 1.18), indicating that Republican-led states had on average 1.10 times more cases per 100,000 than Democratic-led states. The RRs increased steadily thereafter, achieving a maximum of 1.77 (95% PI=1.62, 1.90) on June 28 and remaining positive for the remainder of the study, although the PIs overlapped 1.00 starting on December 3. A similar pattern emerged for deaths shown in Figure 2A–B. Republican-led states had lower death rates early in the pandemic, but the trend reversed on July 4 (RR=1.18, 95% PI=1.02, 1.31). The RRs increased through August 5 (RR=1.80, 95% PI=1.57, 1.98) and the PIs remained >1.00 until December 13 (RR=1.20, 95% PI=0.96, 1.39). Testing rates (Figure 3 A–B) tracked similarly for Republican and Democratic states until September 30 (RR=0.95, 95% PI=0.90, 0.98). By November 27, the Republican-led states’ testing rate was substantially lower than Democratic states (RR=0.77, 95% PI=0.72, 0.80). The test positivity rate (Figure 4A–B) was higher for Republican-led states starting on May 30 and was 1.70 (95% PI=1.65, 1.74) times higher on June 23.

Figure 1
Figure 1(A) COVID-19 incidence rates per 100,000 individuals by governor affiliation; (B) adjusted RRs and 95% posterior intervals (PIs). RRs >1 indicate higher rates for Republican governors.Show full captionView Large Image Figure ViewerDownload Hi-res image Download (PPT)
Figure 2
Figure 2(A) COVID-19 death rates per 1 million individuals by governor affiliation; (B) adjusted RRs and posterior intervals (PIs). RRs >1 indicate higher rates for Republican governors.Show full captionView Large Image Figure ViewerDownload Hi-res image Download (PPT)
Figure 3
Figure 3(A) PCR testing rates per 1,000 individuals by governor affiliation; (B) adjusted RRs and posterior intervals (PIs). RRs >1 indicate higher rates for Republican governors.Show full captionView Large Image Figure ViewerDownload Hi-res image Download (PPT)
Figure 4
Figure 4(A) PCR test positivity rates per 100 tests by governor affiliation; (B) adjusted RRs and posterior intervals (PIs). RRs >1 indicate higher rates for Republican governors.Show full captionView Large Image Figure ViewerDownload Hi-res image Download (PPT)

DISCUSSION

In this longitudinal analysis, Republican-led states had fewer per capita COVID-19 cases, deaths, and positive tests early in the pandemic, but these trends reversed in early May (positive tests), June (cases), and July (deaths). Testing rates were similar until September, when Republican states fell behind Democratic states. High COVID-19 cases and deaths could explain the early trends among Democratic-led states home to initial ports of entry for the virus in early 2020. However, the subsequent reversal in trends, particularly concerning testing, may reflect policy differences that could have facilitated the virus’s spread. Adolph et al.

Found that Republican governors were slower to adopt both stay-at-home orders and mandates to wear face masks. Other studies have shown that Democratic governors were more likely to issue stay-at-home orders with longer durations. Moreover, decisions by Republican governors in spring 2020 to retract policies, such as the lifting of stay-at-home orders on April 28 in Georgia, may have contributed to increased cases and deaths. Democratic states also had lower test positivity rates from May 30 through December 15, suggesting more rigorous containment strategies in response to the pandemic. Thus, governors’ political affiliation might function as an upstream progenitor of multifaceted policies that, in unison, impact the spread of the virus. Although there were exceptions in states such as Maryland and Massachusetts, Republican governors were generally less likely to enact policies aligned with public health social distancing recommendations.3

 Limitations

This is the first study to quantify differences over time-based on governor party affiliation. There are, however, limitations. This was a population-level rather than individual-level analysis. Although analyses were adjusted for potential confounders (e.g., rurality), the findings could reflect the virus’s spread from urban to rural areas. Additionally, as with any observational study, causality cannot be inferred. Finally, governors are not the only authoritative actor in a state; Republican-controlled legislatures may have limited governors in states like Wisconsin. Future research could explore associations between party affiliation of state or local legislatures, particularly when these differ from governors.

CONCLUSIONS

These findings suggest that governor political party affiliation may differentially impact COVID-19 incidence and death rates. Attitudes toward the pandemic were highly polarized in 2020. Future state policy actions should be guided by public health considerations rather than political expedience26 and should be supported by a coordinated federal response within the new presidential administration.

ACKNOWLEDGMENTS

Dr. Neelon is a part-time employee of the Department of Veterans Affairs. This article’s content does not represent the Department of Veterans Affairs’s views or the U.S. government. The article represents the authors’ views and not those of the Department of Veterans Affairs or Health Services Research and Development. Dr. Mueller was supported by the National Heart, Lung, and Blood Institute of NIH under Award Number K01HL141589 (Principal Investigator: Mueller).

The funder did not influence the study design, implementation, or findings. Author contributions are as follows: BN had full access to all data in the study and takes responsibility for the data integrity and data analysis accuracy. BN, NTM, JLP, and SEB-N contributed to the concept and design of the study. BN and FM contributed to the acquisition, analysis, and interpretation of the data. BN and SEB-N drafted the manuscript, and all NTM, JLP, and FM provided critical revisions. A preprint of this manuscript is posted on MedRχiv at www.medrxiv.org/content/10.1101/2020.10.08.20209619v1. No financial disclosures were reported by the authors of this manuscript.No financial disclosures were reported by the authors of this paper.

Covid-19 Death Rates Higher in States With GOP Governors: Study

“These findings underscore the need for state policy actions that are guided by public health considerations rather than by partisan politics.”

A new study shows that while states led by Democratic governors were overwhelmed by the coronavirus pandemic in the early months of the crisis, per-capita rates of Covid-19 cases and deaths eventually became most severe in states with Republican governors—a finding the researchers attribute to diverging approaches to public health policies that affected the spread of the virus.

“Governors’ party affiliation may have contributed to a range of policy decisions that, together, influenced the spread of the virus.”
—Sara Benjamin-Neelon, Johns Hopkins

“From March to early June, Republican-led states had lower Covid-19 incidence rates compared with Democratic-led states. On June 3, the association reversed, and Republican-led states had higher incidence,”

 Reads the study, conducted by researchers at the Johns Hopkins Bloomberg School of Public Health and the Medical University of South Carolina.

“For death rates,” the authors added, “

Republican-led states had lower rates early in the pandemic, but higher rates from July 4 through mid-December.”

According to the researchers, “The early trends could be explained by high Covid-19 cases and deaths among Democratic-led states that are home to initial ports of entry for the virus in early 2020″—such as Seattle and New York City.

“However,” they continued, “the subsequent reversal in trends, particularly concerning testing, may reflect policy differences that could have facilitated the spread of the virus.”

The study, published this week in the peer-reviewed American Journal of Preventive Medicine, examined Covid-19 “incidence, death, testing, and test positivity rates from March 15 through December 15, 2020,” when there were more than 16 million confirmed cases and 300,000 deaths in the U.S.

Making statistical adjustments to account for population density, the analysis focused on per-capita infection and death rates in the 26 GOP-led states and 25 Democratic-led jurisdictions, including Washington, D.C.

As the researchers noted, the response to the pandemic “became increasingly politicized in the U.S.,” and according to the study, the “political affiliation of state leaders may contribute to policies affecting the spread of the disease.”

The new paper cited other recent studies, which found that “Republican governors… were slower to adopt stay-at-home orders, if they did so at all,” while “Democratic governors had longer durations of stay-at-home orders.” Also, the researchers pointed out that having a Democratic governor was “the most important predictor of state mandates to wear face masks.”

In a March 23, 2020 appearance on “Tucker Carlson Tonight,” Texas Lt. Gov. Dan Patrick (R) claimed that reopening the economy was more important than adhering to public health guidelines, even though abandoning social distancing requirements and other disease mitigation measures meant exacerbating the deadly Covid-19 pandemic.

After consulting a group of Wall Street titans last March, then-President Donald Trump ignored epidemiologists’ advice and followed through with his call for a premature end to coronavirus-related restrictions. The U.S. will “soon be open for business,” Trump said at the time, aiming for an Easter reopening date.

The study suggested that

“decisions by Republican governors in spring 2020 to retract policies, such as the lifting of stay-at-home orders on April 28 in Georgia, may have contributed to increased cases and deaths.”

In a statement, Sara Benjamin-Neelon, a professor at Johns Hopkins and co-author of the paper, said that “governors’ party affiliation may have contributed to a range of policy decisions that, together, influenced the spread of the virus.”

As NBC News reported:

Bruce Y. Lee, a health policy and management professor at the City University of New York School of Public Health, who was not involved in the review, called it “a very enlightening and well-done study.” While the study doesn’t necessarily show “cause and effect,” it does suggest “there were associations” between a governor’s political party and the spread of the virus, he said.

“The actual spread of the virus is more complex than general correlations, but those can show us more gross general insight,” Lee said, adding that the report bolsters the evidence that measures like masks and social distancing can help stop the spread of the virus.

“One of the most concerning things last year is the politicization of public health restrictions,” Lee said. “They’re not opinions, and they’re based on evidence.”

The Covid-19 death toll in the U.S. surpassed 530,000 on Thursday, the first anniversary of the World Health Organization’s declaration of a pandemic. The global death toll is now over 2,634,000.

Earlier this month, Texas Republican Gov. Greg Abbott tried to defend his widely condemned decision to scrap the Lone Star State’s mask mandate with only 7% of residents fully vaccinated, a move that critics characterized as reckless.

As Common Dreams reported last week, several experts are once again warning against lifting statewide mask mandates and other coronavirus-related precautions, given that a premature rollback of public health measures threatens to derail progress in curbing the pandemic just as the potential of widespread vaccination grows.

“Despite a more coordinated federal response this year, governors still play a key role in the pandemic response,” said Benjamin-Neelon. “As we’re seeing, several states have lifted mask requirements even though we have yet to make substantial progress in controlling the spread of the virus.”

“These findings underscore the need for state policy actions that are guided by public health considerations rather than by partisan politics,” Benjamin-Neelon said of the paper.

REFERENCES

Brian Neelon, PhD Fedelis Mutiso, MS Noel T. Mueller, PhD, MPH John L. Pearce, PhD Noel T. Mueller, PhD, MPH John L. Pearce, PhD Sara E. Benjamin-Neelon, PhD, JD, MPH Johns Hopkins University School of Public Health

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