The Influence of Contextual Factors on the Initial Phases of the COVID-19 Outbreak across U.S. Counties

Messner, W.; Payson, S. E.

Objectives: The COVID-19 pandemic in early 2020 poses an unprecedented threat to the health and economic prosperity of the world's population. Given incomplete reporting of contextual disaggregation in cumulative case data reported by health departments in the U.S., this research links county- and state-level characteristics to the COVID-19 outbreak. Methods: A statistical exponential growth model is estimated to describe the outbreak rate using publicly available county-level outbreak data. County- and state-level effects are simultaneously tested with a multilevel linear model using full maximum likelihood. Results: Mirroring findings from international cultural research, collectivism as a value is positively associated with the outbreak rate. The racial and ethnic composition of counties contributes to differences in the outbreak, with Black/African and Asian Americans being more affected. As expected, counties with a higher median age have a stronger outbreak, and so do counties with more people below the age of 18. Higher income, education, and personal health are generally associated with a lower outbreak. Contrariwise, obesity is negatively and significantly related to the outbreak, in agreement with the value expectancy concepts of the health belief model. Smoking is negatively related, but only directionally informative. Air pollution is another significant contributor to the outbreak, but population density does not give statistical significance. Conclusions: The results show that contextual factors influence the initial outbreak of COVID-19. Because of a high intrastate and intercounty variation in these factors, policy makers need to look at pandemics from the smallest subdivision possible, so that countermeasures can be implemented effectively.