What is Happening with the Partisan Covid Death Rate Gap?
I'd like to show you a fascinating graph. In fact, I'll show it to you a few times! It shows the number of people in the U.S. who died each day from Covid-19, since the pandemic took hold here in April 2020 until today. And it breaks them down by political party. Have a look:
I want to talk about the partisan gap in Covid-19 death rates in the U.S.. It has a wild history of flips, spikes, growth and shrinkage. At the moment I write, the gap remains significant, but is much reduced from where it was in 2021. Why is that? And will it swell again, or disappear? Is partisanship literally killing people? And could it be that a reduction in partisanship over Covid responses is, counter to expectations, leading to more deaths, not fewer?
The graph above comes from an article published in February of 2022 in the NY Times, written by David Leonhardt. I've color coded the multiple Covid waves for clarity. A quick overview shows this: during the first wave, when the world went into lockdown, in the U.S., people who died were vastly more likely to be Democrats than Republicans. They lived mostly in counties where at least 70% of voters went for Biden. But in each later wave, it has been people living in counties where 70% or more voted for Trump that have been most likely to die. The gap was substantial during the winter of 2020-21, but huge during the Delta wave in the fall of 2021. Then, during the Omicron wave that peaked in early 2022, deaths among people in "blue" counties surged to close a lot of the gap, rising a lot more for people in Democratic counties than in Republican ones--though people in "red" counties continued to die at higher rates.
What explains this? Why did Covid start out mostly killing people in Democratic-voting counties? Why the reversal of fortunes early in the pandemic, why the increase in the partisan death gap during Delta, and why the closing of the gap during Omicron?
Let's consider.
As the world went into lockdown in the Spring of 2020, uncertainty about what would happen was extreme, and there was a brief period of national and international unity. Was Covid going to come for us all? In this period of fear, Americans initially united: if doom was coming, we would all be in it together, facing our fate. But very soon it became clear that in the U.S., it wasn't everyone being hit by disease. (I myself wrote a blog post noting this emerging in Milwaukee back in March of 2020.) The early deaths were mostly of a very specific subpopulation of Americans. They were largely confined to particular groups of people living in big cities.
The result, unsurprisingly, was that Covid first began to kill Americans in substantial numbers in those places where large international airports are found in the U.S.: near major urban areas. New York City, one of the busiest international travel hubs in the U.S., had the misfortune to have Covid get a solid foothold there first. And that city saw the worst Covid death rates in the first wave.
Here's a political fact in the U.S.: urban areas are disproportionately Democratic-voting. Rural areas are disproportionately Republican. The urban/rural divide is hardly unique to the U.S., but it's grown substantially in prominence here in recent decades. So: because Covid-19 landed in urban areas and first spread there, the initial wave of Covid cases killed vastly more people in Democratic-voting places than in Republican ones. And that would shape the nation's response to the pandemic, under the Trump presidency and thereafter, in both expected and unexpected ways.
First off: it is a completely typical human response to a pandemic for those living in areas not yet struck to view those living in areas that have been hit through a victim-blaming lens. The people in the areas not yet heavily hit view those where the disease is surging as spreading the disease due to their morally-disdainful behavior. (Just look at how syphilis was named by people of various nations as it spread: each country essentially terming it "the sex disease of my corrupt national enemies.") And look who was being hit hardest in the U.S.--people in big cities, which contemporary American Republicans often view with disdain. And it was especially people of color being struck down. Covid-19 was first detected in China, so Asian Americans found themselves being blamed and shunned. It was disproportionately killing Black, Latine and Indigenous people in America, framed through those applying a racist lens as a result of their dirty living habits, poor decisionmaking, having overlarge families, or whatever other racist trope came to mind. Covid killed obese people, easily framed through fatphobia as self-murdering. And yes, it killed old people, which was deemed sad. But it is pretty easy for eugenic thinking to extend toward old folks: "They're going to die of something soon anyway, right?"
In a nation divided into Us and Them, for a lot of white people living in rural and exurban red America, Covid killed Them.
Here's another political fact: President Trump was partial to rewarding those loyal to him and punishing those whom he deemed disloyal. A common target for his ire was New York City, his former home, and a place that not only failed to vote for him, but was full of people who had mocked him and his emblem, Trump Tower. Trump is not the sort to forgive slights when a perceived enemy is down. But beyond this particular rivalry, Trump was fond of taking a pugilistic stance broadly toward the governors of states that voted for Hillary Clinton. And this had a strong impact on his administration's Covid response.
In September of 2020, when he was queried by a reporter about the high Covid death rate in the U.S., Trump said, "If you take the blue states out, we're at a level that I don't think anybody in the world would be at." It is clear he then viewed Covid through a partisan lens as a killer of Democrats. Yes, one motivation for his statement was surely his standard tactic of stoking outrage, to keep his base entertained and energized. But right-leaning media reported on this as fact at the time: Democrats had died in much higher numbers than Republicans, and also shut down more schools and businesses, and suffered more unemployment, because of their foolish choices. Republican governors were smart managers, and had kept their states open without incurring many Covid deaths.
From our current historical perspective, we can see that the do-si-do was already in progress in September 2020, and people in red counties would soon be dying at substantially higher rates than people in blue ones. We know it was just a matter of time for Covid to complete its spread across the country, and that the lesser deaths in Republican-voting areas at that moment in history were a result of the normal pattern of disease spread, not due to "smarter management." In fact, the reverse would prove to be true.
But in those first months of the pandemic, between the nature of epidemics and the partisanship of the nation, the narrative was set: Covid was deadly to people in cities, so they took it seriously, adopting whatever public health measures were suggested: shutdowns, social distancing, then masking. Republicans found themselves dying much less frequently, and congratulated themselves, blaming Covid deaths and disruption on Democratic habits and policies. Republican politicians and influencers declared themselves unafraid, and in need of no annoying public health measures like banning large gatherings or requiring masks. Trying to impose those was framed as government overreach, impinging on individual rights to liberty.
That narrative led to differences in regional behaviors, that in turn shaped the second wave of pandemic deaths. In the winter of 2020-21, Covid killed substantially more Republicans than Democrats. People in counties of every political persuasion--red, purple, and blue--died in large numbers, as there was no vaccine, and cloth masks and partial shutdowns were of only some utility in preventing deaths. But it was those who had written off taking Covid seriously who died most frequently.
For Republicans during the second wave, this disjuncture between beliefs about Covid as something that wouldn't affect them, and this staggering rise in deathrates in their communities, produced cognitive dissonance. One way to fix that would of course have been to have changed their beliefs about the seriousness of the threat Covid posed to people like themselves--and some did. But President Trump was by this time pushing the opposite line--that it was time to open up, that states with masking mandates needed to be "liberated." So, instead, many Republicans chose to hold onto their beliefs about Covid not posing a credible threat to them, framing public health measures as posing the real threat. To believe this, a majority of them dismissed reports of large numbers of Covid deaths, including in their own communities, as "fake news." And they turned to an array of quack cures to substitute for public health experts' recommendations that they mask, distance, and wait for a vaccine. Beliefs in various conspiracies surged.
From a political perspective, this was effective, as it generated a huge amount of political fervor. From a health perspective, it was a disaster for red America. Republicans went from suffering roughly a tenth of all Covid deaths, to being about a third more likely to die than Democrats.
That was a definite switcheroo. But much worse was to come. And that was because long before any vaccine was made available, more than half of Republicans believed "The coronavirus is being used to force a dangerous and unnecessary vaccine on Americans." That is, Covid was a "plandemic," a manufactured or mythic virus created to force vaccination in order to benefit some nefarious entity or group: Big Pharma, Democratic politicians, Bill Gates, whomever was most hated. These vaccines would do something terrible--sterilize Republicans, or microchip them, or change their DNA.
During the spring and summer of 2021, large numbers of Americans weary of Covid restrictions and risks joyfully flocked to be vaccinated. At the time, there was concern expressed in the media about vaccine resistance, but it tended to focus on race and ethnicity. A debate took place over whether lower vaccination rates among Black, Indigenous, and Latine Americans were due to distrust of medical authority based in a history of unethical medical experimentation on Black people, or to the perceived foolishness of these peoples, or in fact to the vaccine not being made easily accessible to people who were poor. Concerns about political resistance were also raised in media reporting, but cautiously, perhaps out of a fear of triggering the very phenomenon being conjectured upon, or the regular accusation of "lamestream media bias." There was hope among many that the fact that it was President Trump who had fast-tracked vaccine development and approval would mean that, unlike masks, Covid vaccines would be embraced across the political spectrum.
Well, that didn't happen. Initial gaps in Covid vaccination rates by race/ethnicity shrank away as work was done to get vaccines out into poorer areas. But vaccination rate gaps by political party grew. And when the Delta variant wave spread across the nation in the fall of 2021, the results were both predictable and shocking. People in counties that voted Republican now died at six times the rate of people in Democrat-voting counties. The Delta wave death pattern was the inverse of Wave 1: it was a red wave.
This is the wave that drove Americans most crazy. Because while some Republicans who had been vaccine-resistant changed their minds in the face of the evidence confronting them, the majority of those who rejected conventional medical advice and public health measures now had made this so central to their identities that they would not let it go, even if it killed them. Sick people flooded hospitals denying that what was killing them was Covid, or demanding quack cures like ivermectin, a horse de-wormer. During the first, blue wave, hospital workers were exhausted and overwhelmed, but they received applause, thank-you cards, and were celebrated in social media. During the Delta wave, hospital workers were exhausted and overwhelmed--and were screamed at, spat upon, cursed, kicked, punched, and recipients of death threats.
The swath of deaths cutting through Republican communities, while Democratic communities suffered just a fraction of this tragedy, produced what must have been huge amounts of Republican cognitive dissonance, and this proved not only destabilizing to the right, but to the American left. Vaccination earlier in the year had led to a surge of hope that we would put Covid behind us soon. The Delta wave dashed that hope. In a world where the majority of the people were still unvaccinated, living in poor nations pushed to the back of the vaccination queue, new variants would keep arising. And in a country in which a sector of the population was determined never to vaccinate, surges would continue to wash over all Americans. The population as a whole was exhausted, and many people were angry. You saw it everywhere: in rising incidences of pedestrians being killed by drivers, or road rage, or incivility toward retail workers, or violence against flight attendants.
Lest I engage in blind bothsiderism, I will note that, like the assaults on healthcare workers, these other forms of enraged assault that were surging were driven disproportionately by rage on the right, especially against service workers tasked with enforcing mask mandates. But the left was not immune. As person after person who considered themself an influencer on social media and who advocated an anti-vax position died, incredulous and aggrieved people on the left shared the dead people's rants about how they would never vaccinate, followed by their fearful posts when ill with Covid, often ending in a retraction of their anti-vax stance and plea for others to vaccinate, and finally, their obituary. There was a lot of schadenfreude involved (receiving pushback, predictably on the right, but quite often on the left itself, from people begging for the value of empathy).
Then, before the Delta wave had fully subsided, along came the fourth Omicron wave, which exploded onto the scene at the start of December 2021.
Given the lack of any hiatus in time between the Delta and Omicron waves, you might expect to see the same pattern of deaths, but that is not true at all. Instead of a large gap between many red county deaths and few blue county ones, something took place which is little discussed. Yes, death rates once again rose in undervaccinated Republican districts to a noticeable degree. But in Democratic districts, they exploded. Death rates quadrupled in blue districts.
And to me, here's the very strange thing. That extreme surge in deaths in Democratic states has barely been mentioned, in news reports or elsewhere. Something dramatic just happened in American behaviors, and beliefs, and death rates, but it's not getting attention. Reporting on Omicron has not talked about the striking shift in partisan patterns, but rather on the platitude that "Omicron is mild," and as infection rates started to fall--even if they were very high!--it was time to relinquish masking mandates and other public health measures in those states that were still enforcing them (all of them "blue states," of course).
The CDC's advice on masking had not changed. And public health experts still urged masking wherever transmission rates were high--as they still were in most of the U.S..
What can explain the fact that when many fewer people in their states were dying, during the Delta surge, blue state governors and officials enforced strong mask mandates, whereas during the Omicron surge with many more people dying, they collectively said the time was right to abandon mask requirements?
Nobody has done the research to be able to answer that question. But I can tell you what I think.
When Covid first struck, Americans had a brief period of greater national unity, as everyone shared the experiences of lockdown and fear. That made the first wave of the pandemic difficult but tolerable. But once the blue nature of the first wave was understood, in a highly polarized U.S. with a destabilizing president, Covid was recast on the right as fake news, generated to push dangerous vaccines and allow dictatorial Democratic governors to fascistically control their citizens. Thus, a terrible tension arose between waves of deaths in red communities and the beliefs held there. And ironically, that tension was made worse by vaccination and other public health measures working.
Vaccination, testing, masking, social distancing, and isolating worked as they were promised to do, in the blue sections of the country that adopted them. When the Delta wave hit, Americans in Democratic-voting areas of the nation received excellent protection from disease. Deaths were only about a tenth what they were in Republican areas of the country. In essence, vaccinated America was winning the Covid battle.
But few people actually felt safe and secure. Instead, America broke. There's been tons of research and writing about "burnout" and "pandemic fatigue," but few of us need to read it to know how bereft Americans were feeling--bereft of patience, of energy, of empathy, of good mental health. And I believe that is because universal pandemic exhaustion was heavily exacerbated by the fact that MAGA America was unable to bear the cognitive dissonance between their ideologies and their death rate. They felt red rage at all the news reports about how Delta was killing the unvaccinated, and seethed over hearing how vaccinated America was winning--and spilled out that rage in daily interactions in a way that took the very tough situation of living through a pandemic, and made it unlivable.
Conversely, though, the fear of death often spurs people to want to carpe that diem and eat, drink, and be merry for tomorrow they might die. And the spice of thumbing one's nose at blue America's moralizing pleas to stay home, socially distance, mask, etc. meant that many more Republicans than Democrats were filling bars and throwing house parties in the midst of the Delta wave. They avoided contemplating that it was not just themselves that they were putting at risk, but servers, rideshare drivers, elderly relatives, etc.
And if seeing people who shared their beliefs dying while those on Team Blue were surviving drove Red America to raging assaults and to desperate partying, those on the American left were also driven to the breaking point. Americans in Democratic districts might be winning the battle with the Covid pandemic, but they were losing the battle with the epidemic of partisan rage and cruelty.
Masking for months on end is hard. Doing so while other people refuse, and make pointed eye contact with you and sneer, or threaten, is harder. Missing out on big family celebrations or going out dancing in order to avoid spreading Covid, even though you are vaccinated, is hard. Missing out on them while people who refused to vaccinate gleefully party and travel and crowd into one another's houses is harder.
And then there was the timing. Omicron hit in December. Many people in Democrat-leaning districts had dutifully stayed home and missed visiting with family during the winter holidays in 2020. One of the things that had sustained them for months was the belief that after getting vaccinated in 2021, they could spend Christmas with their loved ones. They had purchased their plane tickets and made their plans. They couldn't bear the disappointment of cancelling those, when Republicans were just going to eyeroll and laugh at them instead of honor the sacrifice of self-interest they were making if they did.
I feel it's highly likely, too, that Americans on the left looked at who was dying during the Delta surge, saw it was almost all unvaccinated people, largely Republican. And they just said, "Eff this. I deserve my reward after being so good for so long. I'm taking a vacation. I'm going to travel to see my family, I'm going out to tourist destinations, I'm going out to have fun. If I get Omicron, it will be mild, and hey, that will boost my immunity! And if there are people who die, well, they brought that on themselves by being asinine antivaxxers. Why should I continue to suffer just to protect them?"
Predictably, the Omicron surge was massive--not just because the variant is easily transmissible, but because people did so much transmitting of it, by choosing to have "normal" holiday gatherings and "normal" winter vacations. But instead of expressing concern at the high rate of transmission, there was a collective shrug. "Wow," reported the news, "there sure are a lot of people staying home sick right now, or working sick because they can't stay home. In other news, Prime Minister Boris Johnson apologized to the Queen for partying the night before her husband Prince Philip's funeral!"
I believe politicians and the media all picked up the signal loud and clear that Americans finally seemed to have bridged over the horrible chasm separating red and blue approaches to Covid, over Christmas 2021. We were going to go with Team Red's approach: if you want to vaccinate, fine, if not, fine, everything is going to be open and masks will be optional and we won't avoid travel or limit the size of gatherings. We deserved a Real Holiday. We deserved for things to just be normal. We could be dutiful again later.
I am guessing that a feedback loop between social media and news and political talk has amplified that attitude, weeks after the holidays. Whatever steps toward masking and isolating were ongoing are now being dropped in most places, despite the fact that at the time I write this, 2300 Americans are dying every day from Omicron. You don't hear much about that death rate. The news reports state that death rates are falling, that Omicron has peaked. Omicron continues to be painted as no big deal. I suspect that politicians fear that continuing to require masks is now political suicide, given the lack of alarm they see about Covid infections.
But look again at this graph:
And look at this one from the CDC showing total daily Covid deaths in the U.S., not separated by partisanship:
I really don't think that there's been much recognition of what just happened in the U.S. Covid saga. Deaths from Omicron, so often called "mild", outstripped those of the feared Delta variant that preceded it. And unlike Delta, the Omicron surge killed almost as many people in Democratic districts as in Republican ones.
Why did deaths of Democrats surge? It's not that vaccines became ineffective. Vaccinated people suffered more from Omicron breakthrough cases than was the case with Delta, but they were just as well-protected from death. No, the reason deaths in blue districts surged is that vaccines are only one part of a set of public health measures that were in place during Delta, and those other parts were getting dropped. If people have asymptomatic cases of Omicron and don't realize it because they don't try to test, or can't access a test, they can turn into a flock of typhoid Marys. Social distancing and avoiding crowds limits spread. Not traveling limits spread. Not visiting face-to-face with people at high risk is vital to saving their lives when there is a high infection rate and breakthrough infections are common in the vaccinated.
And so very vital is masking. Remember: the main aim of masking is to protect others from our infections.
Remember too that there are people who cannot vaccinate, and people who are at high risk even if they are vaccinated, like the immunocompromised and individuals who are old. WebMD reports that, "About half of the deaths in January 2022 were among people over 75, compared to about a third in September during the Delta surge." I think that this likely reveals that a lot of the people killed in the Omicron surge were vulnerable people in blue districts who had been protected in earlier surges by their relatives careful masking and distancing or not traveling to visit, and who themselves had diligently self-isolated as much as possible. (That's probably especially true because red districts across the nation had already experienced two waves that hit them hard, producing both more natural immunity among elder survivors, and causing more of the most vulnerable to already have died. Leonhardt, the author of the article from which I took the partisan deaths graph, centers the natural immunity factor.)
I think blue America worked so hard to protect the vulnerable for a long time, but when pressed to the breaking point, did not want to hear that yet another sacrifice was required, knowing red America by and large would not make that sacrifice. And so blue America went to go visit their grandmothers for Christmas. And a lot of grandmothers died as a result. And that fact is something so horrible to think about that nobody's saying anything. Instead, we're in collective denial.
And then we extended that mistake, as blue states gave up on masking mandates while infection rates were still high. Masks should come off as the infection rate drops, certainly, but according to a rational plan--when the infection rate drops back below the "moderate" range on the Covid map of a given area, and hospitals in that area are no longer overburdened--not as soon as it is clear it has started to drop, though it is still high. What really worries me is the sense that I get that America is just deciding that public health measures are over and done with. MAGA America has declared that public health measures are no longer a source of American patriotic pride, but are fascism. And blue America seems to be giving up on fighting for public health as a concept.
Just leaving it up to individuals to protect themselves from a pandemic doesn't work. It's a large, social, networked crisis that requires a coordinated, multi-pronged, social response--especially to protect the most vulnerable among us, who can't get vaccinated, or get little protection from vaccines. When blue America tried to take a holiday from all the public health measures meant to mitigate Covid risk, except for individual vaccination, blue America's death rate from Covid surged up to nearly close with that of a red America with much lower vaccination rates.
I believe that what the Omicron graph of deaths by partisanship shows is that public health measures really work. And when you don't take all of them, due to partisanship, people die.
And I think that it is vital that people see and recognize this.
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