COVID19- Are Red States Tired of Winning Yet?

My first pandemic was one that wasn’t. A mass vaccination effort in 1976 in response to H1N1 “swine” flu at Ft. Dix New Jersey (the strain responsible for the 1918 pandemic) found me, a relatively new arrival to public health (environmental health), helping keep the lines for vaccination orderly - a public health bouncer (of mostly senior citizens). I exceled at my first pandemic response — not so much for the CDC— look it up. Most all of my epidemiological work over the following 35 years was retrospective - trying to statistically determine if it was the chicken or the ham sharing its Salmonella load with some restaurant’s patrons, or which local swimming pool was sending kids to the hospital with Cryptosporidium. Nevertheless, I was highly concerned about the epidemiology of a suspicious coronavirus disease every time I learned something new about its spreading out of China in early 2020. And as a public health guy I have followed this story fairly closely.

My first personal encounter was “informative.” In March my son, who was a health system administrator in Colorado, became symptomatic, took the PCR test, and isolated at home. The ski areas of Colorado were hit early, presumably by spread from European skiers. When my son had not received test results is a few days I thought that was odd. When he hadn’t received results in a month (already having returned to work) I thought this was crazy. The fact that he still hasn’t received his result three years later is one small part of the story of the COVID-19 disaster.

I’ll direct you to Lessons From the COVID War by “The COVID Crisis Group” (which I just finished) for a rather diplomatic review of the United States response, and to Premonition by Michael Lewis for a great story (it’s Michael Lewis) and a harsher view of the U.S. response. Both books also make serious recommendations for future preparation and strategies. I’m going to dig in a little to the political side of this fiasco (which is still ongoing), partly by reviewing some revealing “numbers.”

First, I’ll acknowledge there was no possible way to avoid a serious outbreak of COVID-19 and two words describe why — asymptomatic spread. It’s one thing to ask a sick person - have you been in close contact with someone who was sick? And who have you been in close contact with since you became sick? Then you can chase down two potential lines of transmission, isolating all those contacts to limit further spread. It’s a very different thing when the person passing COVID-19 isn’t sick. And the fact that the official testing scheme was faulty (for a long time), and officially limited to testing already sick people (for diagnostic purposes?) made contact tracing literally impossible. Uncertainties about the mode of transmission, the confusing focus on conserving masks for medical use, travel bans and all manner of other mixed messaging clouded the water early. But ultimately, we couldn’t even do the simplest things.

Every public health person knows (or should know) the story of what’s considered to be the first epidemiological study. Dr. John Snow was puzzling over an outbreak of cholera in the SoHo section of London in the year 1854, the days before microorganisms were even recognized as a source of disease (although Snow and others including Robert Koch and Louis Pasteur were hot on the trail). By mapping out cases/deaths he developed a hypothesis that the Broad Street water well, where literally all of the sick people got their water, was the source of the disease. Removing the handle from that particular well stopped the outbreak. Blunt instruments work — block contact with a potential source of disease by any means necessary. For the U.S. that may have meant limiting travelers from other countries, social distancing and masks — very early, and in a tightly organized manner. But the clearest image I have of this early period was when a poorly communicated travel ban sent traveling Americans racing to return home before the deadline only to pile up in U.S. airports’ customs lines (photo from Chicago’s O’Hare) in a near perfect demonstration of efficient viral spreading techniques.

At this point, well into our third year, it’s hard to separate the incompetence of the Trump administration from the general over-all absence of preparation for this kind of event by the government at-large. For instance, how is it no one ever noticed that importing a significant amount of our emergency supplies for a potential pandemic response (masks, etc.) was a bad idea. And even though CDC did badly fumble the COVID testing roll out (we essentially had no dependable tests), that organization had been slowly but surely neutered of emergency response capacity since the 1976 Swine Flu vaccination effort (in part by making the CDC head a political appointment). You do have to wonder what CDC head Redfield and HHS Secretary Azar were thinking as Trump was telling the press “….anyone who wants a test can get a test” on a visit to CDC in Atlanta (around the time thousands of returning travelers were stacked up at Hartsfield International). Governor Kemp in the background right seems to be thinking “I know this is total bullshit.”

At any rate, while Trump talked voluminous loads of bullshit early (“it’s completely under control”) it wasn’t until he got stuck on that “reopen the country by Easter” (April 12, 2020) thing, by my recollection, that he and his minions and his legislators and, especially, his MAGA media began sacrificing their voters. In April the hydroxychloroquine “miracle cure” thing started and the beginnings of blaming the “fake news” and liberal “elites” for exaggerating the danger (it’s like the flu). By mid-April the confirmed case count was more than 650,000 with 34,000 deaths. Then came the “maybe drink some disinfectant and shove a strong light up your butt” and communication with the public was severely curtailed. And don’t forget the mask stealing accusations, CDC exaggerating the case count, hospitals putting COVID19 on every death certificate to get a special fee, masks don’t work, states need to compete for ventilators, blah, blah, blah. And those were “official” government policies and claims. I’m not even prepared to research or to focus my memory on the crap coming from “conservative” media like Fox News. It was a tsunami.

What this run-up during 2020 toward the election and its aftermath did was to set-up Trump supporters for the more transmissible and more lethal Delta variant in the late Spring of 2021. The weekly COVID death toll in the U.S. was 305 in mid-March, 2020 and spiked to almost 16,000 in mid-April (even when vaccines were available to many). After a summer slump averaging 2,000 to 4,000 weekly deaths into August, cases spiked sharply with weekly deaths peaking at almost 19,000 per week by the end of January 2022. Almost unnoticed, COVID deaths have hovered between 1,500 and 3,500 deaths per week. Current COVID19 deaths in the U.S. is 1,164,019 from more than 100 million cases.

The U.S. ranks 15th of more than 220 countries/ territories in death rate (a high ranking is NOT good) — that is COVID deaths per 1,000,000 total population at almost 3,500 deaths/ 1M. Packed “to the gills” Hong Kong was at 1,800, Turkey was at 1,200, South Korea at 675, Japan at 595, Singapore at 291. We should have done a lot better, and I firmly believe we could have without the tribal self-sacrifices to freedom from masks and vaccination. And I think a closer look tells that story well.

Back in June of 2022 I decided to look at death rates based upon the 2016 Presidential election results, and the numbers are telling (since nobody’s really listening I couldn’t motivate myself to re-calculate with more current numbers). The mean* death rate (in deaths per 100,000 population) for “Blue” states (voting Democratic in 2016) was 236 deaths/100,000 and the median** was 239 deaths/100,000. For “Red” states (voting Republican in 2016) the mean was 325 deaths/100,000 and the median was 346 deaths/100,000. The death rate in Red states was 35%-40% higher than in Blue states! In a city like Jacksonville or Ft. Worth or Indianapolis that’s an EXTRA 900 to 1,100 deaths. For a smaller town of 100,000 population like Davenport, Iowa or Wichita Falls, Texas or Tuscaloosa, Alabama that’s an EXTRA 90-110 people, probably somebody you know.

Even more extraordinary, consider these facts:

• Red state total deaths 663,000 — Blue state total deaths 368,000 (Red states +295,000)

• Red states had the six highest death rates, topped by Mississippi at 419 deaths/100,000 (currently up to 452, but overtaken at some point by Arizona, now at 459- remember Arizona was a Trump state in 2016)

• Red states held 20 of the highest (worst) 25 state death rates

• Two prominent Republican politicians most vocal about “opening” their state early in defiance of the radical-leftist-communist-socialist public health deep state, Ron DeSantis in Florida and Brian Kemp in Georgia, currently sit in 10th place at 411 deaths/100,000 (Florida) and 14th place at 403 deaths/100,000 (Georgia) of our 50 states. Those two “heroic” Republican governors oversaw more that 165 MORE DEATHS per 100,000 population than the average of all Blue states.

• The radical- leftist- communist- socialist states of Washington, California and New York (which were all slammed very early with no established defense) are currently at # 46 (212 deaths), #41 (259 deaths) and #15 (399 deaths) respectively. Hawaii ‘s death rate is our lowest, 134 deaths/100,000.

It’s natural to want to put COVID19 behind us, except for the families of the 1,000 or so people still dying every week. But as our political discourse becomes ever more bitter and ever more unhinged from truth and reality, I think it’s important to look back at the sacrifices — many healthcare workers and others “essential” to our normalcy sacrificed it all. And as individuals we all sacrificed a portion of our lives and our personal freedoms to the blunt instrument of social distancing, whether we wanted to or not. For most of us it was truly an investment toward the responsibilities we have for our own health and for the health of others in our social contract. And there were costs — loneliness, depression, disrupted schooling, damaged businesses, interrupted careers. And some of those sacrifices were, in retrospect, too great, some perhaps not great enough.

The unforgivable sacrifices, however, are the sacrifices the right-wing political class, evangelical leaders and the “conservative” media offered up — the very lives of so many of those they influence and the innocent bystanders in every state, but especially Red states, exposed to COVID19 by their unmasked, unvaccinated, conspiracy-infused neighbors. It’s pretty easy to recognize that the Trump administration (likely with some failures to plan in administrations going way back) screwed us all in many different ways. Only four states had a death rate below 200 deaths/100,000 population — no state approached the success of highly dense South Korea (67), Japan (59) or Singapore (29).

But the fact that Red states (voting for Trump in 2016) suffered death rates so much higher than Blue states, and still show depressed levels of vaccination, illustrates to me an unspeakable regard for human life by the supposed leaders in the Republican party when it comes to potential political gains. I’m still uncertain how they perceived a potential political gain by leading more of their voters to their death, or how so many went willingly to sacrifice their lives based upon claims and fantasies any 4th grader could have disproven. But most importantly in my view, we should not miss the plain fact that there are absolutely no limits to their quest for raw power. Ethics, morals, laws, customs, truth, the Constitution of the United States of America and now the very lives of their supporters have all been sacrificed right before our eyes if we’ve been watching. The rest of us need to be prepared to act accordingly.

* “mean” is the numerical average of all the states in the political category, adding all the death rates and dividing by the number of states

** “median” is the death rate in “the” state where half of the states had a higher rate and half had a lower rate. The median number removes the influence that abnormally high or low death rates in a few states can have on the mean. For Red states the median was Indiana with 346 deaths/100,000 (Indiana is currently up to 393 deaths/100,000). For Blue states the median was Maine at 239 deaths/100,000 (Maine is currently down to 227 deaths/100,000).