Yesterday, we highlighted differences in the experience of COVID-19 on either side of the Atlantic. As promised, today we focus on differences between US states. More specifically, viewing these differences through a political lens. Let us be in no doubt. This is an exercise in correlation, not causation. Many cohort studies have identified and quantified the importance of age, gender, prior disease, risk of exposure through occupation, population density, behavioural attitudes and genetic influences. Some like OPENSAFELY, US Veterans and ISARIC we have reported here. Today, we are focused solely on descriptive statistics that look at differences in the number of excess deaths through the perspective of political affiliation - Tracking The Tribes.
Figure 1 reminds us of the 3 wave pattern that we saw in the USA in 2020. Just over 500,000 excess deaths during the year.
Figure 1 - Excess Deaths across all US states
The pandemic hit first and hardest in the coastal cities and states of the North East. The second wave most prominent in the southern states, sweltering in summer heat. Winter brought the expected third wave, hitting everywhere but particularly those least exposed to the ravages of the virus.
Figure 2 shows the timeline of weekly excess deaths for all those states where Democrats held the ascendancy in the 2020 electoral college. The first wave dominates the landscape but the third wave is not yet run.
Figure 2 - Excess Deaths across US States declaring for the Democrats
FIgure 3 shows the same timeline for all those states where the electoral college votes were red. Here we see the toll of the second wave, where just over 50% of the excess deaths were under age 75.
FIgure 3 - Excess Deaths across US states declaring for the Republicans
Perhaps though, it is the last figure that prompts most inspection. Here in Figure 4 we look at those states that flipped compared to the 2016 Presidential Election - Arizona, Pennsylvania, Georgia, Michigan and Wisconsin.
Figure 4 - Excess Deaths from the "swing" US states
This time it is the third wave that dominates. Moreover, the slope of the line from week 42 (mid October) is higher than any of the previous larger groupings, seeing the weekly number of excess deaths quadrupling over the following 8 weeks. Other studies have explored the impact of political rallies and general mobility patterns where competition was fiercest for the winning share of the vote. These excess deaths and the underlying hospitalisations will have provided a grim backdrop as the nation approached election day on November 3.
Such analysis is always a trade-off, and should whet interest to go further. Every US state is split between Democrat and Republican voters, admittedly to different extents. Smaller areas such as counties or census tracts would provide a more homogeneous picture of voting patterns. However, as we look at smaller areas, the credibility or availability of data on excess deaths by narrow age bands becomes strained or difficult. For now, the patterns by US state are sufficient to highlight that already done and encourage yet more investigation.