The Pandemic’s Toll in California and Florida Revisited
Trading off saving lives for preserving jobs
With the omicron variant receding as quickly as it arrived — and two years after COVID-19 started to disrupt our world — Americans are desperate to get out and shed their K95 masks. More Americans than ever say they are “vaxxed and done” and ready to resume their normal routines.
Actually, that’s not quite right. Many Americans hardly changed their habits during the pandemic, refusing to mask, get vaccinated, or social distance. For them — at least those that have lived to tell the tale — life continues much as it was, though streets are now more crowded and restaurant reservations are tougher to snag.
Much of the difference in attitudes breaks along familiar political lines, with Republicans generally less tolerant of public health mandates and Democrats typically more willing to “follow the science.” Republicans are also more likely to emphasize the economic and other costs of imposing health mandates, as well as the burdens on individual freedoms. These views are hardly absolute on either side, especially as many on the left increasingly resent perceived government overreach. But overall, public health mandates have been stricter in blue states, which have been quicker to impose, and slower to relax, these measures.
Has it made a difference? Last year I did a deep dive on this topic in a series of articles that demonstrated the meaningful difference in rates of COVID morbidity and especially fatalities between red and blue states. Really, it wasn’t close. Though COVID began in large blue cities like New York and Seattle, the pandemic spread to redder territory, where it exacted a much higher toll.
These superior health outcomes came at a steep price, however. Job losses generally were higher in blue states than in red, which imposed all sorts of extra costs on society and individuals, including further strains on people’s physical and mental health, in addition to the direct financial losses from unemployment.
Into this political maelstrom came a string of media stories last spring offering a glittery comparison of the pandemic’s impact on California and Florida. Officials in red-leaning Florida gloated that their state sustained comparable rates of COVID infection and mortality as in blue California, despite having much more relaxed policies and taking a much smaller hit to their economy.
What gives? As I explained in my review of that debate, it can be misleading to draw conclusions from a sample of just two states, especially when they’re not broadly representative of the group they’re supposed to epitomize. As it happens, California’s caseload at the time ranked on the high side of blue states — and only slighter better than Florida’s, which was below average for red states. We can speculate why, but we now know that last year’s figures were a temporary aberration.
Another COVID year
A lot has changed in the last year. Most importantly, vaccinations started to become available last spring for those who wanted them (and many who didn’t). We nonetheless sustained three major waves of infections — the summer surge, then the Delta variant, and finally Omicron — each larger than the preceding spike. And as we start the third year of this pandemic (!), we’re figuring out how to live with the virus. Witness the broad (though not universal) recovery in social activities. Credit card data shows that outlays on travel, entertainment, and dining all now top pre-pandemic levels. COVID spikes no longer prompt economic shutdowns as in the early days of the pandemic.
That said, there is still a wide variety in how states are dealing with the pandemic, ranging from broad mask and vaccine mandates (generally in bluer states) to more laissez-faire approaches or even mandate prohibitions by cities and counties (mainly in redder states). Along this spectrum, California and Florida still exemplify the opposite ends of government intervention.
The pandemic’s hit to California and Florida since last Spring
What a difference a year makes. When the California-Florida comparison went viral last spring — just after the winter surge had subsided — Florida (orange bar in the left graph of Figure 1) had a slightly higher case rate than California (green bar) relative to population size, and both exceeded the U.S. average (gray bar). A year later, the picture looks a lot different (right graph). The number of cases reported since last February was almost 50% higher in Florida than in California, where the infection rate was 16% lower than the national average.
The contrast in COVID-related deaths is even greater. Florida’s per-capita COVID death rate was only slightly greater than California’s as of last winter, though both states had rates lower than the U.S. average (left graph of Figure 2). However, the death rate surged in Florida over the last year while plummeting in California, whose rate is now well below the national average (right graph). Relative to population size, the number of COVID-related deaths over the last year was more than twice as high in Florida than in California. To put that in perspective, if Florida had achieved the same death rate as in California, it would have saved more than 20,000 lives. That’s about equal to every resident of Naples, FL.
There’s a critical qualification to this comparison. Florida is a retirement destination with a high number of seniors. To the extent that COVID hits the elderly disproportionately — fully three-fourths of all people who die from COVID are 65 years or older — then Florida’s death rate naturally would be higher.
But remember that Florida’s death rate in the first year of the pandemic was only slightly greater than California’s. In any case, California has a lot of seniors too. The higher share of elderly in Florida (21% compared to 15% in California) accounts for only a third of the excess deaths in Florida. Another factor is vaccination rates, but the difference is minor. Vaccination rates are lower in Florida than in California, but not by much, and they exceed the national average, except for the booster rate (Figure 3).
Other factors may also play a role, be they geographic, demographic, or otherwise. There’s also controversy about the veracity of the data, especially in Florida. But whatever the true figures, can there really be any doubt that much can be explained by Florida’s relatively lax policies and aversion to public health guidance by many of its citizens?
Expanding the sample size from two to fifty
At this point, I should reiterate the hazards of trying to draw definitive conclusions based on a sample size of just two. Except, in this case, the data not only comports with both intuition and the science of pandemic responses, but it’s also consistent with the trends observed throughout the nation. I analyzed the caseload and death rates for states that voted Republican (red) versus Democratic (blue) in the 2020 presidential election (Figure 4). The relative number of COVID cases has been higher in red states than in blue states during both years of the pandemic (left graph).
The trends are somewhat different for COVID-related deaths. The relative mortality was actually higher in blue states than in red states during the first year of the pandemic, before the medical establishment understood how to treat the disease or limit its severity with vaccines (right graph in Figure 4). But in the second year, the death rate dropped significantly in blue states while remaining almost stable in red states. So, now there is a wide and growing gap in death rates between red and blue states, consistent with the experience in Florida and California.
A deeper dive into the red/blue divide is even more revealing. Here I sort the death rates by both presidential vote (as a proxy for citizen attitudes) as well as the party of the governor (as a proxy for governmental policies for addressing the pandemic). Trump-voting states with Republican governors (“red/red”) have higher average COVID-related death rates than Trump-voting states with Democratic governors (“red/blue”). And Biden-voting states with Republican governors (“blue/red”) generally have higher COVID mortality rates than states that voted for Biden with Democratic governors (“blue/blue”). This was true in the first year of the pandemic (left graph in Figure 5), but the red/blue disparity grew wider in the second year (right graph).
In sum, states that voted for Trump have higher average death rates from COVID, no matter the party of the state leadership, and Republican-run states have higher average death rates from COVID, regardless of whether they voted for Biden or Trump. The party of both the citizens and the leadership matter.
Does public policy matter?
What should we take away from this? Many factors could help explain why individual states might have higher or lower infection or death rates from COVID. Indeed, significant geographic and demographic differences between red and blue states — in affluence, population density, quality of the health care infrastructure — might impact their susceptibility to medical conditions such as COVID.
But considering all likely factors, it’s hard to avoid the conclusion that sensible public health policies do, in fact, explain much of the variation in morbidity and death rates among states. These choices are not cost-free. Economic losses tend to be higher in states imposing stricter mandates. Jobs are still down 4% from their pre-pandemic peak in California, for example, compared to just 1% in Florida. Public health measures also often limit personal freedoms.
Reasonable people can disagree on the relative merits of these trade-offs. What cannot be disputed, however, is that taking sensible precautions makes a meaningful difference in how many people will be infected with COVID, and especially how many will die from the disease.
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