The Deadly Politics of Public Health

The COVID-19 pandemic has changed innumerable aspects of how we interact with the world and with one another. Even as vaccines have begun distribution, cases continue to rise to nearly 29 million people in the United States as of March 2021. One method to limit the transmission of COVID-19 is social distancing, which reduces the amount of time spent with individuals outside one’s own household bubble. State-mandated social distancing measures that have been implemented include restrictions on large gatherings, school closures, restaurant restrictions, closures of non-essential businesses, and stay-at-home orders. Without intervention, COVID cases could double every 3 to 9 days, and even a two-day delay in social distancing measures could multiply cases by 17%-59%. 

Despite the clear efficacy of social distancing practices in combatting COVID transmission, delays in statewide implementation of these measures have occurred. These delays have been linked to a number of factors including population density, number of cases confirmed in the state, social distancing policies of neighboring states, and party politics. Of these, a recent study showed that the political affiliation of state governors was the most important predictor of the rollout of social distancing measures; Republican governors were “49.7% less likely to issue a given social distancing policy as their Democratic counterparts on any given day.” Given the impact of such delays on viral transmission, this lack of action has had severe consequences.

Under the Trump administration, states were encouraged to exercise their own authority to implement social distancing recommendations and requirements. However, given the role that partisanship has played in exacerbating the pandemic, a unified national plan is needed. 

Recent efforts by newly inaugurated President Biden mark a departure from the former administration’s hands-off approach and a shift towards a more coordinated effort in combatting COVID-19. President Biden’s requirement to wear masks in federal buildings is a good first step but will only directly affect a small subset of Americans. In order to reach all members of this country, actions must be taken at the federal level to encourage mask-wearing and social distancing behaviors among all 328 million Americans in a concerted effort to combat COVID-19.

This Health Policy Journal Club review is written by Alexandra Vallera as part of our collaboration with the Health Policy Journal Club at Baylor College of Medicine where she is a medical student.

Abstract

Context: Social distancing is an essential but economically painful measure to flatten the curve of emergent infectious diseases. As the novel coronavirus that causes COVID-19 spread throughout the United States in early 2020, the federal government left to the states the difficult and consequential decisions about when to cancel events, close schools and businesses, and issue stay-at-home orders.

Methods: We present an original, detailed dataset of state-level social distancing policy responses to the epidemic, then apply event history analysis to study the timing of implementation of five social distancing policies across all fifty states.

Results: The most important predictor of when states adopted social distancing policies is political: All else equal, states led by Republican governors were slower to implement such policies during a critical window of early COVID-19 response.

Conclusions: Continuing actions driven by partisanship, rather than public health expertise and scientific recommendations, may exact greater tolls on health and broader society.

PMID: 32955556

Adolph, C, et al. J Health Polit Policy Law. 2020 Sep 16; epub.