The High Price of Politicizing COVID

Republicans have died at a far higher rate than Democrats.

LOS ANGELES, CALIFORNIA – APRIL 22: Demonstrators participate in a vehicle caravan with a sign reading ‘Trust in God not vaccines’ outside City Hall, calling on California officials to re-open the economy amidst the coronavirus pandemic, on April 22, 2020 in Los Angeles, California. A protest movement has sprung up in states across the country calling for an end to shelter-at-home orders. Mario Tama/Getty Images/AFP

NBC News (“Covid death rates are higher among Republicans than Democrats, mounting evidence shows“):

Covid deaths are unevenly distributed among Republicans and Democrats.

Average excess death rates in Florida and Ohio were 76% higher among Republicans than Democrats between March 2020 and December 2021, according to a working paper released last month by the National Bureau of Economic Research. Excess deaths refers to deaths above what would be anticipated based on historical trends.

study in June published in Health Affairs similarly found that counties with a Republican majority had a greater share of Covid deaths through October 2021, relative to majority-Democratic counties.

But experts are still puzzling over why these differences exist. Are lower vaccination rates among Republicans responsible? Or did mask use and social distancing guidelines prevent more deaths in counties run by Democrats?

The Yale researchers behind the new working paper say vaccine hesitancy among Republicans may be the biggest culprit. “In counties where a large share of the population is getting vaccinated, we see a much smaller gap between Republicans and Democrats,” said Jacob Wallace, an author of that study and an assistant professor of health policy at the Yale School of Public Health. Indeed, his paper found that the partisan gap in the deaths widened between April and December 2021, after all adults became eligible for Covid vaccines. Excess death rates in Florida and Ohio were 153% higher among Republicans than Democrats during that time, the paper showed. “We really don’t see a big divide until after vaccines became widely available in our two states,” Wallace said.

But the June study suggested that Covid vaccine uptake explained just 10% of the partisan gap in the deaths. Those researchers suggested that compliance with other public health measures such as mask use and social distancing was a significant factor. “Vaccination does play a role in the difference that we’ve observed in excess mortality between red and blue places, but it is not the whole story,” said Neil Jay Sehgal, an author of that study and an assistant professor of health policy and management at the University of Maryland School of Public Health. “When you have less transmission, you have fewer cases and you have less mortality. And you have less transmission in general by instituting protective policies like mask requirements when we had them, or capacity limits in businesses,” he added.

The September NBER study by Wallace et al is available in full open source whereas Sehgal et al’s study from June is paywalled. The statistics in the former are beyond my training, which is quite rusty, but a cursory review confirms that they made the obvious controls for age. I simply don’t have enough to go on as to why the two studies come to different conclusions but would speculate that it’s simply a function of different methodologies. In particular, Wallace and company looked only at Florida and Ohio whereas Seghal and company appear to have looked at national-level data. Additionally, the former used “excess deaths” whereas the latter appears to have looked a county-level mortality data.

Indeed:

Both papers come with limitations. The study from Sehgal’s team looked at counties, not individuals, which makes it difficult to determine whether other demographic factors — such as education level, proximity to health care services or the share of older residents — played a role in the trend.

The new Yale paper, by contrast, linked political affiliation to excess Covid deaths at the individual level, but it still used county-level vaccination rates. The research was also limited to two states.

“It may very well be that in Ohio and Florida, because of the nature of Ohioans and Floridians, vaccine uptake may have played a greater role than [in] the country at large,” Sehgal said.

Wallace, however, said it’s common knowledge that attitudes toward vaccines “are not Ohio- and Florida-specific issues.”

Joe Gerald, an associate professor of public health policy and management at the University of Arizona, who was not involved in either study, agreed that Ohio and Florida are good places to study this issue, because “you have lots and lots of people that are otherwise very similar — they live in the same place, they’re roughly the same age distribution — but they differ by party ID.” He said he thinks vaccine uptake rates partly explain the gap in deaths, but it’s still not clear how much they’re to blame.

My instinct when I saw the headline was that—while there are obvious differences in political attitudes that would reasonably have made Republicans more likely to die from COVID—the most obvious culprit is age. Republicans skew old and old folks are much, much more likely to die from COVID. That Wallace and company controlled for that and Sehgal and company didn’t makes me take the former more seriously.

Former President Trump politicized the virus from the outset and the right-wing infotainment complex and Republican governors and mayors followed suit, dismissing the pandemic as no worse than the seasonal flu, condemning shutdowns, lampooning masking and social distancing, and spreading conspiracies about the vaccines. In hindsight, some Democratic leaders over-reacted based on early evidence. And there was a counter-politicization from the left that continued failed policies long after the evidence was in because they had become signs of virtue, demonstrations that they’re not MAGA idiots.

The difference, alas, is that refusing to mask and get vaccinated literally killed people. Probably hundreds of thousands of them.

UPDATE: Keith Humphrey, a renowned public health expert at Stanford, comments via Twitter, “I don’t think the county data are very useful because individuals die, not counties, so in high R county the deaths could still be primarily Ds. The individual-level data is much more informative.”

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. KM says:

    And there was a counter-politicization from the left that continued failed policies long after the evidence was in because they had become signs of virtue, demonstrations that they’re not MAGA idiots.

    This comes across kinda bitter. I mean, “failed policies” @James? The policies that failed specifically because of said MAGA idiots who deliberately sabotaged them and spread the disease in such a way that containment or even mitigation was impossible? Masks and vax policies work. They worked everywhere else in the world and continue to work in places not here specifically because they didn’t have a government actively sabotaging them even though their public might have been resistant. It became “virtue signaling” when half the country decided to embrace a death cult mentality and harass those who tried to follow rules or protect themselves. in other words, people screamed to let folks decided to wear a mask or not then promptly attacked everyone who still did with “you know you don’t need to wear that, right?” at every turn. Instead of accepting a good portion of the country didn’t want to get sick, it’s became “oh, you’re just doing it to make me look bad!!!” as now we could tell who was choosing to do the right thing and who had been forced.

    History isn’t going to be kind to COVID deniers or those who were wishy-washy in condemning them. As we start to see the true scope of the damage over the next decade or two, the conservative framing is going to fall away just like it did with smoking, abortion and every other “alarmist” trend. Republicans died in droves because they wanted to virtue signal to their Orange Lord and then turned around and accused Dems of it for not wanting the same fate. Sometimes a mask is just a mask and hey, we went 2+ without a cold/flu season so why go back to that?

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  2. Sleeping Dog says:

    The just rewards for R elites will be for the party to lose elections because they killed off too many supporters.

    That snark out of the way, it is reasonable to conclude that vax and masking/social distancing has been a key differentiation between groups when looking at death rates. To be more granular than that will require more focused data analysis. Which, it should be noted, maybe impossible as many states never collected the data to begin with.

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  3. Kathy says:

    @KM:

    I would like to know what failed policies James means.

    I can think of some, like spraying disinfectant on every surface on Earth. Related ones like quarantining one’s mail and parcels for three days. Relying only on hand sanitizer to prevent spread. Cloth masks.

    All these do help a bit, but not enough by themselves. Using N95/KN95 or KF94 masks, distancing, avoiding crowds, etc. work much better. Layered on top of hygiene and ventilation, they work even better. Topping it all with a vaccine and boosters works best.

    Another thing, I’m sure many of those on the trumpian wing of the Benito party who got ill, were hospitalized, died, or recovered and are going through long COVID, still think it’s a blue state problem.

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  4. steve says:

    The stats look pretty good to me. Will ask our statistician what she thinks. I think Ohio and Florida will likely underestimate national differences. Florida has always performed a bit better than I thought they would. Maybe a lack of really cold weather? Anyway, I think James has it about right. It was incredible politicized on the right. As a result they had many more deaths. On the other side they may have had slightly better economic performance. On the left I think there were places that maintained some form of lockdown beyond much utility and some places probably hung onto masks as policy longer than merited.

    Now that the variants are so contagious masks are much less effective unless you are using an N 95 pretty religiously. People should be able to make that choice for themselves. Still, it has been the uptake of vaccines which has been most surprising to me. There have always been anti-vaxxer groups in the US. They have always been present on both sides of the political spectrum, maybe a bit more often on the right. But, I didnt expect the massive resistance to vaccines and the passive approach from GOP leaders/politicians in not addressing this. Trump was the one leading the anti-covid effort but he also was one of the ones pushing for the vaccine, one of the few good things he did. I thought that might lead to more acceptance but I was wrong. Or maybe it would have been worse, I dont know. Whatever, it was truly bizarre.

    Now every right wing crank in the world is in expert on vaccines and viruses, ventilators and drugs all because they watched a couple of YouTubes. Or Joe Rogan said something. Or some nurse or doctor I never heard of said they saw something. Or they cite some meta-analysis they never read and dont have the background in statistics to understand anyway.

    Steve

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  5. James Joyner says:

    @KM: I’m decidedly not making a false equivalency, simply addressing the obvious counter that politicization went both ways—although mostly as a natural reaction to Republican politicization. In addition to ones @Kathy notes, I would point to keeping schools closed far longer than it made sense to do, encouraging the wearing of cloth masks long after it became clear that surgical masks were far superior, encouraging the wearing of masks in wide open spaces, etc.

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  6. JohnMc says:

    A variable not mentioned — likely/unlikely to have been in crowds, especially indoors.
    Thinking who would have been first back into stores, churches, etc after lockdown.

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  7. Jen says:

    I too would like to hear of the failed policies.

    I think I remember James posting about how masking was no longer needed after vaccines, and doing so was performative rather than functional. We now know that isn’t entirely accurate–unmasking led to continued spread but with less serious effects for those who were vaccinated. This ongoing spread contributed to the emergence of strains capable of vaccine escape, which in turn led to a need for increased masking.

    The problem with “bothsidesing” this is that Trump’s politicization literally led to deaths. If there were any “failed policies” pushed by “the left,” they were rooted in the verity that science changes and we must exercise caution when applying what was previously known to novel viruses.

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  8. Modulo Myself says:

    @James Joyner:

    All of these measures were a reaction to Covid, not to Republicans. In my experience, wearing masks outside the first few months was like washing groceries–a better safe than sorry gesture in a city that was devastated by Covid. Nobody was doing it because of the Republicans and Trump.

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  9. Jen says:

    @Jen: Scratch that, never mind…I see @James Joyner‘s response.

    Cloth masks were meant to be an interim measure to free up surgical masks for healthcare workers who were dying at an alarming rate. It drives me a bit crazy to see people continue to use them.

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  10. gVOR08 says:

    @steve: @steve:

    But, I didnt expect the massive resistance to vaccines and the passive approach from GOP leaders/politicians in not addressing this.

    Conservatism has always relied on myth, for which see Plato’s noble lie. But in the age of FOX “News” and social media, myth making has accelerated and we can watch the process in real time. It took the GOPs and holy rollers years to build abortion into a major wedge issue. Now, as with anti-vax and CRT, we can watch it happen in months.

    And as @James Joyner: illustrates, it’s bothsides. They scream, “You’re teaching CRT to our kids!” and we go, “Whu? No we’re not, you idiot!” We’re both extremists politicizing the issue. And even though it’s true, it does no good to say, “They started it.” It also does no good to let it slide. Which is part of what makes the tactic so effective for them.

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  11. KM says:

    @James Joyner:
    Gonna have to push back some of these:

    keeping schools closed far longer than it made sense to do

    This goes directly back to mask and vax non-compliance, as well as the reluctance to authorize the vax for kids until “proven safe”. Like it or not, schools are hot beds of disease and not babysitting services for teachers to sacrifice their lives in. I’m damn sure it “made sense” for a parent who wanted their kid out of the way to force the schools to open ASAP but that’s not how it shook out. Add in insane parents getting up in teacher’s faces and this one isn’t a failed policy so much as a live demonstration of MAGA interference in the process to speed things up to their preferred timetable.

    encouraging the wearing of cloth masks long after it became clear that surgical masks were far superior

    And not everyone could get them regularly. Supplies were still an issue far longer then they should have been and honestly, some protection is better then none. Telling people to wear a cloth mask if they don’t have a surgical mask perfect sense. Wearing a T-shirt in a blizzard is better then going out there naked; yes, the parka is ideal but if you don’t have one, wear the damn T-shirt! The perfect is the enemy of the good on this one; not failed, just not ideal.

    encouraging the wearing of masks in wide open spaces, etc.

    And in this wide open space, how close are the other people? Just because there ain’t any walls doesn’t mean there weren’t close-pressed crowds. This is more a physics thing running into a “common sense” thing. The breeze can still blow a sneeze right into your face, you know. You’re better protected but not safe; the false illusion of I’m-outside can cause people to ignore other safety concerns, mitigating or even negating the benefit of open space.

    As someone who went to Disney as soon as it reopened, those wide-open spaces you walk around in were full of people who got very close. Add up all the nose-maskers and people pulling down their masks to sneeze and outside wasn’t as uncontaminated as you’d think. Outside masking makes sense if idiots are nearby and god, they were there aplenty.

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  12. gVOR08 says:

    You used to occasionally see the argument that W was worse than Trump because W caused the deaths of hundreds of thousands of Iraqis. Not an argument anyone seems to still want to make.

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  13. Kathy says:

    So, my propensity to distance, avoid crowded places, refusal to go to restaurants, bars, theaters, parties, etc., four shots of COVID vaccine, and constant mask wearing has virue-signaled me free of COVID for 30 months?

    I must be doing something wrong.

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  14. steve says:

    “I would like to know what failed policies James means.”

    James can speak for himself but look at how we handled going outdoors. When DeSantis said he was going to let people go out on the beaches we already knew with pretty good evidence that the risk of getting covid outdoors was very low, yet there was a lot of criticism for doing this. When it came time for the BLM protests, which were outdoors, the risk was really low and that has been borne out by lack of spread during those protests. However, it certainly looked like it was politically driven and in some cases probably was. To be fair, there were a lot of people who opposed both and IIRC the official CDC position opposed both and that was probably out of erring on the side of caution.

    Steve

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  15. gVOR08 says:

    I’ve worn a mask in open spaces and in the car. But because it was only a mile between stores where I’d wear it and it wasn’t worth taking off only to put it back on again. But I do see people walking down an empty sidewalk or driving alone on the Interstate with masks. The fact is that most of us here have at least some rudimentary idea of how virus transmission works and what words like aerosol mean, but many people don’t. Some have chosen to take advice from experts without really understanding it beyond, “Mask protects me.” So they wear a mask even in inappropriate places because they have no basis for deciding what’s appropriate. Others chose to take the advice of charlatans.

    What makes me crazy is someone wearing a mask voluntarily, where no one has told them to, but wearing it below the nose. I assume it’s a function of wanting the protection but having no real idea how it works.

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  16. Kurtz says:

    @gVOR08:

    You used to occasionally see the argument that W was worse than Trump because W caused the deaths of hundreds of thousands of Iraqis. Not an argument anyone seems to still want to make.

    I don’t think it’s a very good argument.

  17. Modulo Myself says:

    When DeSantis said he was going to let people go out on the beaches we already knew with pretty good evidence that the risk of getting covid outdoors was very low, yet there was a lot of criticism for doing this.

    The GOP vibe was so odd and confrontational about a global pandemic and there was a reaction to that, because it was not normal. There was no need for confrontation, no need to push back. It was manufactured irresponsibility, and for what? Florida ended up having more deaths than New York, and New York’s came almost all in the beginning.

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  18. grumpy realist says:

    Sorry, James–but stupidity should hurt. It’s the only way that humans learn. The brighter ones are able to look at their neighbours doing stupid things and dying/getting sick and say to themselves “huh, let’s not do that”.

    So if you decide you’re not going to believe in vaccines, catch something malignant for which a vaccine is available and FREE, bring it home to your similarly-non-vaccinated family and you all die/come down with long COVID, it’s like feeling sorry for a dog who ran out to chase a car and got run over. Yeah, it’s sad–but it’s also due to the stupidity of the dog.

    And if you mix up your health care with your politics–I have absolutely no sympathy for you whatsoever.

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  19. Gustopher says:

    @steve:

    When it came time for the BLM protests, which were outdoors, the risk was really low and that has been borne out by lack of spread during those protests.

    A lot of experts were very nervous that the protests were going to cause another wave, because you have people fairly close together, yelling slogans. We were still learning.

    This was also not that long after the Sturgis Superspreader Motorcycle Jamboree.

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  20. Tony W says:

    We have 4% of the world’s population and 17% of the world’s COVID deaths.

    It’s not that we did too much, it’s that we didn’t do enough, early enough. South Korea got their first case the same day we did. They have had a vastly different outcome.

    Elections matter.

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  21. steve says:

    Yes, but the Sturgis event had lot of indoor activities, ie they all went to bars and drank. And I would agree that if you were outdoors with no mask and the people around you had no masks and people yelled continually the risk would elevate, though probably not as high as being indoors. In fact, looking at red pictures most people did wear masks and a lot of people distanced and they didnt yell all the time. My take is that we had enough info at that time to know it was not a big risk. Other people may have wanted to wait until some more papers came out.

    Steve

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  22. Gustopher says:

    @James Joyner:

    I would point to keeping schools closed far longer than it made sense to do,

    I don’t think we have good data on excess deaths caused by reopening schools, because it is mixed in with all the other political factors. It’s really hard to get a control group there. (Young kids tend to get less severe covid, but they are good at spreading disease to others, and teenagers get severe covid at roughly the same rate as folks in their twenties)

    We don’t even have good data on academic performance — blue states didn’t see more of a drop in learning than red states, so you would need to start considering other issues like stress from loved ones dying, their own less severe covid infections, etc.

    At some point, we just had to decide to experiment with sending kids back and hoping for the best. There was no clear “right time” when it made sense to do so.

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  23. MarkedMan says:

    @gVOR08:

    Conservatism has always relied on myth, for which see Plato’s noble lie.

    FWIW I don’t think anti-health precautions is in any way conservative (small c variety), although it is distressingly common among people who happen to self identify as Conservative.

  24. MarkedMan says:

    There is the public health perspective on how we did during the pandemic and then there is the common man perspective. To public health officials the fact that people are resistant to self protection is built in, and is just one of many things to deal with. They evaluate success by looking at the whole population. I understand this intellectually but my common sense tells me that those of us who took this seriously did about as well as we could have, and the trumpers got what they got.

  25. Michael Reynolds says:

    It’s a bit like making tea. One teabag in one cup = tea. One teabag in a swimming pool = swimming pool. If you’re in an enclosed space with lots of people you’re at more risk than if you’re in a small room with few people, and if you’re in a small room all alone there’s no risk at all. Walking down a windy beach alone? No threat. Walking down a windless beach with a bunch of people, somewhat higher risk.

    It’s all about saturation and time. Viruses per square meter of air multiplied by hours exposed. It was never going to be as simple as 1+1=2.

    People – especially conservative people, and even more so poorly-educated conservative people, AKA MAGAs – are not capable of processing ambiguous data. These are people who erect defenses against doubt, largely because they’ve been taught from birth to accept a giant pile of bullshit as fact and must never question the bullshit for fear of discovering that it’s nothing but bullshit. Just to remove any ambiguity, bullshit = religion.

    I’m sorry for all the believers who leap to condemn my line of reasoning connecting religion and Covid denial, but I’m right and they’re wrong. Some day we’ll get data, and that data will show a strong correlation between Evangelical Christianity and unnecessary Covid deaths. If you teach people to deny reality guess what? They deny reality. Sometimes with fatal consequences.

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  26. gVOR08 says:

    @MarkedMan: Another example of my personal obsession that Websters’ “conservative” has little to do with modern American “Conservative”. And Corey Robin made a good case that it’s never been otherwise.

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  27. gVOR08 says:

    @Michael Reynolds: Well if the holy rollers disproportionally died early, they should be grateful to Trump as they went to the bosom of God or some such. But IIRC, you have often pointed out the fact that they somehow seem to fear death no less than the test of us.

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  28. Just nutha ignint cracker says:

    @Gustopher:

    There was no clear “right time” when it made sense to do so.

    Sure there was. It was when keeping kids at home became inconvenient. Duh!

  29. Kathy says:

    @James Joyner:

    How long to keep schools closed was not immediately apparent, nor was it easy to make the determination. It also varied form place to place.

    Cloth masks, as I recall, were understood to be a stopgap measure due to lack of a supply of better masks. At that, surgical masks with ear loops are not much better than cloth masks at preventing infection, though they are ok at reducing spread.

    Masking in the open is harmless at worst and useful at best. I seriously don’t get the extreme aversion to masks. See what @KM said about crowded open spaces.

    Yes, the odds are lower outdoors, even if it’s crowded, but the odds are for each occurrence. That is, if you have one chance in a thousand of catching COVID unmasked outdoors in normal, non-crowded circumstances, you’re about 50% likely to get it outdoors after 500 times out in the open.

    I’ve been out on the street more than 500 times, way, way more, since March 2020.

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  30. OzarkHillbilly says:

    UPDATE: Keith Humphrey, a renowned public health expert at Stanford, comments via Twitter, “I don’t think the county data are very useful because individuals die, not counties, so in high R county the deaths could still be primarily Ds. The individual-level data is much more informative.”

    Oh horseshit. On the strictest level he is correct, but if you corrected for all the DEMs who died in Washington county, the vast majority would still be GOPers. I know this because there are only 2* of us.

    * s// but not by much

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  31. Jax says:

    @OzarkHillbilly: Same. With no sarcasm. Not one of our 29 deaths in our county were Dems, they were all rabid trumpies.

  32. Jax says:

    Interestingly enough, our county data shows there was a spike after every big summer event (but not as big a spike as last year), and now that school’s started, there appears to be a lag after every home football or volleyball game….7-10 days later, more positive tests are reported.

  33. Barry says:

    @James Joyner: “I’m decidedly not making a false equivalency, simply addressing the obvious counter that politicization went both ways—although mostly as a natural reaction to Republican politicization.”

    I believe that you *are* making a false equivalency there.

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