Governor's Party, Policies, and COVID-19 Outcomes: Further Evidence of an Effect

Shvetsova, Olga; Zhirnov, Andrei; Giannelli, Frank; Catalano, Michael; Catalano, Olivia

Introduction This study connects the aggregate strength of public health policies taken in response to the coronavirus disease 2019 (COVID-19) pandemic in the U.S. states to the governors’ party affiliations and to state-level outcomes. Understanding the relationship between politics and public health measures can better prepare American communities for what to expect from their governments in a future crisis and encourage advocacy for delegating public health decisions to medical professionals. Methods The Public Health Protective Policy Index (PPI) captures the strength of policy response to COVID-19 at the state level. The authors estimated a Bayesian model that links the rate of disease spread to PPI. The model also accounted for the possible state-specific undercounting of cases and controls for state population density, poverty, number of physicians, cardiovascular disease, asthma, smoking, obesity, age, racial composition, and urbanization. A Bayesian linear model with natural splines of time was employed to link the dynamics of PPI to governors’ party affiliations. Results A 10–percentage point decrease in PPI was associated with an 8% increase in the expected number of new cases. Between late March and November 2020 and at the state-specific peaks of the pandemic, the PPI in the states with Democratic governors was about 10 percentage points higher than in the states with Republican governors. Conclusions Public health measures were stricter in the Democrat-led states, and stricter public health measures were associated with a slower growth of COVID-19 cases. The apparent politicization of public health measures suggests that public health decision making by health professionals rather than political incumbents could be beneficial.