>So much for follow the science.
>He should be tried for treason.
>

They should have left the decision making up to Republican politicians,
that way the trumper deaths would have been in the millions, not just
hundreds of thousands. All patriots say that a good trumper is a dead
one.

Health Policy Open. 2023 Dec 15; 5: 100107.
Published online 2023 Nov 11. doi: 10.1016/j.hpopen.2023.100107
PMCID: PMC10684792
PMID: 38034472
The politics of COVID-19: Differences between U.S. red and blue states in
COVID-19 regulations and deaths
C. Dominik G�ss,a,? Lauren Boyd,a Kelly Perniciaro,b Danielle C. Free,b
J.R. Free,c and Ma. Teresa Tuasonb
Author information Article notes Copyright and License information PMC
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Highlights

�
Political party-affiliation has shaped response efforts to the COVID-19
pandemic.
�
Red states had higher COVID-19 infection rates and deaths in 2021
compared to blue states.
�
Red states implemented fewer political decisions to mitigate COVID-19
than blue states.
�
Biological factors such as age and obesity predicted deaths only in red
states.
�
Vaccination rates predicted fewer deaths in blue states.

Keywords: COVID-19, Policies, COVID deaths
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Abstract

The study investigated infection variables and control strategies in 2020
and 2021 and their influence on COVID-19 deaths in the United States, with
a particular focus on comparing red (Republican) and blue (Democratic)
states. The analysis reviewed cumulative COVID-19 deaths per 100,000 by
year, state political affiliation, and a priori latent factor groupings of
mitigation strategies (lockdown days in 2020, mask mandate days,
vaccination rates), social demographic variables (ethnicity, poverty rate),
and biological variables (median age, obesity). Analyses first identified
possible relationships between all assessed variables using K-means
clustering for red, blue, and purple states. Then, a series of regression
models were fit to assess the effects of mitigation strategies, social, and
biological factors specifically on COVID-19 deaths in red and blue states.
Results showed distinct differences in responding to COVID infections
between red states to blue states, particularly the red states lessor
adoption of mitigation factors leaving more sway on biological factors in
predicting deaths. Whereas in blue states, where mitigation factors were
more readily implemented, vaccinations had a more significant influence in
reducing the probability of infections ending in death. Overall, study
findings suggest politicalization of COVID-19 mitigation strategies played
a role in death rates across the United States.
Keywords: COVID-19, Policies, COVID deaths
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1. Introduction

The COVID-19 pandemic has had a profound and expansive impact on numerous
facets of human existence, resulting in millions of lives being lost and
countless others being changed forever. On the surface, the pandemic
initially presented as a significant public health crisis; however,
numerous disruptions to global operations including supply chain issues,
economic instability, workforce imbalances, and inconsistent government
response strategies amplified the difficulty of containing the disease. In
the first year of managing the disease, 2020, effort focused on limiting
exposure through social distancing, wearing masks, and mandatory lockdowns.
The second year, 2021, gave way to advancements in understanding the virus
and the development of several vaccines and antiviral options. On a global
level, COVID-19 has been handled with mixed results, but the following
study examines factors and outcomes exclusive to the United States COVID-19
landscape.
1.1. Sociopolitical and legislative influence

COVID-19 numbers in the United States surpassed all other reporting
countries for both cumulative cases and deaths, making its use of mass
behavioral mitigation measures of particular interest. While many nations
focused on a federal mandate process to manage their response to the
pandemic [1], [2], the United States adopted a jurisdictional state-based
approach. This approach created a unique Petri dish to examine a spectrum
of containment strategies across a multitude of demographic and
sociopolitical factors.

With the emergence of COVID-19 and each new viral variant, such as Delta
and Omicron, mass mitigation measures were reintroduced in varying
capacities and success rates to limit new exposures. The need for these
daily habit changes were justified based on historical precedent and modern
research related to epidemiology [3], but the efficacy of mass behavioral
changes was questioned by some scientists and sections of society [4].
While skepticism, especially among the general public, can be
conspiratorial or bizarre in nature [5], [6], there is a genuine and
appropriate concern regarding the effectiveness of mass-behavioral methods
[7]. Analyzing state policies across 2020 and 2021, with a specific focus
on success in reducing the number of pandemic deaths, can provide valuable
insight on successful mass behavioral mitigation strategies and inform
early intervention protocol for future viral outbreaks.

In the United States, COVID-19 and efforts to quell the outbreak were
largely politicized (e.g., proposed bill against requiring the wearing of
masks, 117th Congress 2021�2022, as well as media coverage [8]). Federal
actions related to behavioral mitigation measures during the pandemic were
largely suggestive and mostly consisted of recommendations and guidelines
for social interactions [9], brief travel restrictions, or were exclusive
to federal employees [10]. Federal actions focused more on resource
production and economic stimulus than behavior efforts [11], [12]. Whereas,
states were responsible for outlining specifications of mask mandates, as
well as the degree and length of enforcement [13]. This begs the question
whether there is a divide between state political affiliations in terms of
COVID-19 deaths.

In general terms, a state�s legislative efforts are influenced by the
overall political affiliation of a state and its sitting governance. As
such, the dominant political affiliation for each state can be derived from
its gubernatorial party affiliation, state senate affiliation, and state
house of representative affiliation. Whether a state is blue or red may
influence the types of legislation instated, which in turn may affect the
overall spread of COVID-19. In essence, a state�s legislative measures on
COVID-19 and consequential changes in viral patterns, provide a natural
experiment to evaluate strategy efficacy. This study seeks to investigate
if a state�s political affiliation, herein labeled as republican-affiliated
(red) or democratic-affiliated (blue), plays a significant role in the
efficacy of mitigation measures and resulting number of COVID-19 deaths.
1.2. Pre-pandemic demographics

In a similar vein to a state�s political affiliation, a state�s demographic
context prior to the pandemic is likely to play a role in overall deaths
due to COVID-19. Assessments of at-risk groups have identified the elderly
and those with underlying health issues, especially those with diabetes or
obesity, as most likely to be both infected by and die due to complications
related to COVID-19 [14], [15].

Racial disparities in infections, deaths, and healthcare equity are of
utmost concern given the diverse demographics of the United States [16].
Previous research conducted during the pandemic indicated that COVID-19
infections and deaths disproportionally affect racial and ethnic minorities
in the United States [17], [18]. The Center for Disease Control�s page on
�Health Equity Considerations and Racial and Ethnic Minority Groups�
summarizes a number of studies to determine primary factors which likely
cause the observed racial and ethnic differences in COVID-19 cases:
discrimination, healthcare access, occupational hazards, exposure, and
socioeconomic gaps [19]. In further addressing healthcare access and usage
disparities, people of color are less likely to have received at least one
dose of a COVID-19 vaccine, compared to white counterparts [20].
1.3. Existing research

The academic community responded to the need for COVID-19 research;
however, this left some notable early deficiencies in the literature [21].
Due to the breadth of pandemic factors, as well as the infeasibility of
traditional study methods while remaining socially distanced, early works
focused on opinion, single-state or single-behavior observations, sub-
grouping populations across behaviors, or the efficacy of well-being
factors [22]. This pointed approach is evidenced by the targeted
examination of single-state/single-behavioral measure studies, such as
infection rates post-vaccination in Kentucky [23]; assessment of a single-
state and efficacy of several mitigation measures, such as trends in
mitigation measures within Arizona [24]; and examination of a single-
behavioral measure, such as mask adherence, across all states [25].

However, recent studies are branching out beyond direct examination of
COVID-19 medical consequences to review the nationwide aftermath of the
pandemic within constructs of mental wellness [26], economic infrastructure
[27], and the context of collateral health concerns such as post-pandemic
weight gain [28] and alcohol use [29]. Researchers are beginning to examine
the political polarization of COVID-19 preventative measures [30] and
treatments [31] but the majority of studies appear to be on a
representative subsect of the population. Few studies have examined larger
scale public data against political affiliations, health constructs, and
infection/death rates, but there have been notable exceptions, such as a
review of the relationship between partisan affiliations, obesity, and
death rates [32]. The imparting lesson being that health is a multifaceted
concept which must be analyzed through well-aimed examination of controlled
constructs and as the sum of its parts to derive genuine understanding of
complexities [33], [34], [35]. To this point, the current study accounts
for the majority of states and a dynamic assessment of variables to create
a more comprehensive picture of COVID-19 deaths in the US.