California officials boast that the state’s extended pandemic lockdowns and health mandates saved tens of thousands of lives from COVID-19, compared to states like Florida that reopened early.
But a major study of all U.S. states’ pandemic performance found that while masks and social distancing drove down infection rates, they didn’t influence death rates, which were driven more by population age, health, poverty, race, education, health care access, vaccination and public trust.
The study argues that while Florida’s death rate per 100,000 was higher than California’s, it would actually be lower than the Golden State’s if all states had the same age and health characteristics of the country as a whole.
“California was dealt an easier hand when it comes to COVID,” said lead author Joseph L. Dieleman, associate professor at the University of Washington’s Institute for Health Metrics and Evaluation. “Its population is younger and healthier.”
The Lancet, a British medical journal, called the March 23 study the largest U.S. state-by-state analysis of COVID-19 impact. The study aimed to answer why the United States, considered the best-prepared to handle a pandemic before COVID-19, saw such disproportionate infection and death from the virus despite its advantages in wealth, education and technology. The study also analyzed why some states fared far worse than others.
Critics of Democratic Gov. Gavin Newsom’s pandemic policies, like Republican Rep. Kevin Kiley of Rocklin, argued the report’s findings showed “Newsom’s lockdowns were a tragic failure on every level.”
Although Florida’s older, unhealthier population contributed to its higher number of deaths, Dieleman said that doesn’t give Florida a pass, as the actual numbers are what count in the end.
“In Florida, there was an amazing amount of loss of life,” Dieleman said. “Those are the real lives lost — mothers and grandfathers.”
In announcing the decision to end California’s pandemic state of emergency last October, Newsom’s office called the state’s COVID-19 death rate per 100,000 people “the lowest amongst large states” and said 56,000 more Californians would have died if the state had mirrored Florida’s pandemic efforts. The announcement added that “‘lockdown’ states like California did better economically than ‘looser’ states like Florida.”
After reviewing the study, the assessment from the governor’s office was unchanged.
“In California, we followed the facts, science and medicine — in doing so we saved thousands of lives,” said Brandon Richards, Newsom’s deputy communications director. “Our students lost less ground than most other states and the national average, and our economy contracted less and rebounded faster — on our way to becoming the 4th largest economy in the world.”
A Bay Area News Group analysis as the United States marked its millionth COVID-19 death almost a year ago found the Bay Area — with its wealth, high vaccine acceptance and willingness to abide by restrictions — had one of the lowest death rates of any region in the country, helping to drive down California’s overall rate.
Newsom and Florida’s Republican Gov. Ron DeSantis have touted their pandemic policies as they compete for national attention — polls show both would be strong presidential contenders within their parties should they decide to run.
The Lancet study found that states’ use of mask and distancing mandates — a category in which California was among the country’s leaders — was linked with a meaningfully large reduction in cumulative infection rates, but not cumulative death rates. California had among the country’s lowest infection rates, even when figures were adjusted to account for differences in population density.
California also had among the country’s lowest actual death rates, 291 per 100,000. The study listed its rate 12th lowest in the country, while Florida’s rate of 416 per 100,000 was 38th.
But the study found significant differences when state figures were adjusted to account for differences in population age and health, as COVID-19 is deadlier among the aged and diseased. Census figures show Florida has one of the nation’s highest proportions of residents over age 65, 21.3%, and California one of the lowest, at 15.2%.
With an adjustment to show what it would look like if each state had the same age and health profile as the United States as a whole, Florida’s death rate jumped to 12th lowest, while California’s fell to 36th. That calculation included the proportion of each state’s residents over age 65 and under age 20, obesity and smoking rates and prevalence of diseases including asthma, cancer, heart disease and diabetes.
For some states, the adjustment made little difference. Hawaii and New Hampshire had the nation’s two lowest death rates, and Arizona, New Mexico and Mississippi were among the highest across the United States whether the figures were adjusted or not.
For others, the difference was substantial. West Virginia, which had the country’s highest actual death rate, had the 14th lowest when the figures were adjusted to account for its older and unhealthier population.
The study also found higher death rates linked to poverty, low education, larger Black and Hispanic populations, lower vaccination rates and lack of access to quality health care. Higher public health spending and more public health personnel didn’t decrease deaths.
There was no infection or death trend linked to the state governors’ political affiliation, but the study said outcomes were worse in states that voted Republican for president in 2020.
Looking at economic and educational tradeoffs for COVID mandates, the study found no link between lower infection rates and reduction in state gross domestic product, a measure of economic activity. But overall, lower infection rates were associated with higher unemployment and a decline in fourth-grade math and reading scores — two indicators of businesses and schools closing during the pandemic.
So which governor won the pandemic? Dieleman said that he’s “pretty sympathetic to the states that erred on the side of caution,” like California. But he’d “caution any governor ” against making “too bold of statements.”
“I just think there were things that went well and not well in both states,” Dieleman said.
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