Policymakers and public health officials can learn much from the COVID-19 pandemic, including how COVID-19 pandemic policies and behaviors affected economic and educational outcomes, as reported in a study of public databases. “COVID-19 magnified the polarisation and persistent social, economic, and racial inequities that already existed across US society, but the next pandemic threat need not do the same,” the authors conclude. “US states that mitigated those structural inequalities, deployed science-based interventions such as vaccination and targeted vaccine mandates, and promoted their adoption across society were able to match the best-performing nations in minimising COVID-19 death rates. These findings could contribute to the design and targeting of clinical and policy interventions to facilitate better health outcomes in future crises.”
Data analyzed by regression included COVID-19 infection and mortality estimates from the Institute for Health Metrics and Evaluation’s (IHME) COVID-19 database; state gross domestic product (GDP) from the Bureau of Economic Analysis; employment rates as reported by the Federal Reserve; student standardized test scores from the National Center for Education Statistics; and race and ethnicity by state reported the US Census Bureau. Policy and behavioral responses associated with these factors were quantified to assess trade-offs between the outcomes and COVID-19 outcomes.
“Standardised cumulative COVID-19 death rates for the period from Jan 1, 2020, to July 31, 2022 varied across the USA (national rate 372 deaths per 100,000 population [95% uncertainty interval [UI] 364–379]), with the lowest standardised rates in Hawaii (147 deaths per 100,000 [127–196]) and New Hampshire (215 per 100,000 [183–271]) and the highest in Arizona (581 per 100,000 [509–672]) and Washington, DC (526 per 100,000 [425–631]),” the investigators found. “A lower poverty rate, higher mean number of years of education, and a greater proportion of people expressing interpersonal trust were statistically associated with lower infection and death rates, and states where larger percentages of the population identify as Black (non-Hispanic) or Hispanic were associated with higher cumulative death rates. Access to quality health care (measured by the IHME’s Healthcare Access and Quality Index) was associated with fewer total COVID-19 deaths and SARS-CoV-2 infections, but higher public health spending and more public health personnel per capita were not, at the state level. The political affiliation of the state governor was not associated with lower SARS-CoV-2 infection or COVID-19 death rates, but worse COVID-19 outcomes were associated with the proportion of a state’s voters who voted for the 2020 Republican presidential candidate. State governments’ uses of protective mandates were associated with lower infection rates, as were mask use, lower mobility, and higher vaccination rate, while vaccination rates were associated with lower death rates. State GDP and student reading test scores were not associated with state COVD-19 policy responses, infection rates, or death rates. Employment, however, had a statistically significant relationship with restaurant closures and greater infections and deaths: on average, 1574 (95% UI 884–7107) additional infections per 10,000 population were associated in states with a one percentage point increase in employment rate. Several policy mandates and protective behaviours were associated with lower fourth-grade mathematics test scores, but our study results did not find a link to state-level estimates of school closures.”