Year three of the Covid-19 pandemic is now more than halfway over, believe it or not — with a fall surge likely on the way. But the emergency phase is far enough in the country’s rearview mirror that the experience of the pandemic thus far can be examined a little more clinically and a little less ideologically. Increasingly, it feels possible to take stock not just of what happened but also of the inadequacy of some of the stories we told ourselves to make sense of the mess.
Several weeks ago, I looked at the emerging data about pandemic learning loss — which, while real and significant, appeared perhaps less catastrophic than many Americans have feared. This week, I want to consider two prominent frameworks about the pandemic that are nevertheless rarely considered alongside each other: disparities in Covid mortality by race and by partisanship.
First, race. My colleagues at The Morning recently reported on a positive turn: After two years of horrifying divergence, the gap in death rates between white Americans and Black and Hispanic Americans had mercifully closed.
This is an encouraging development, though closing that gap a year or 18 months ago, with the rollout of vaccines, would have saved many more Black and brown lives. But it also highlights a failing so conspicuous it should maybe sit close to the center of any retrospective analysis of Covid-19 in this country: just how big and bad those racial and ethnic mortality gaps have been for almost the entire duration of the pandemic so far.
These racial disparities, the focus of considerable consternation in 2020, were still distressingly large as recently as last fall and winter, when many stopped paying close attention. As data from the Centers for Disease Control and Prevention shows, during the country’s brutal wave of the Delta variant of the coronavirus, the age-adjusted death rates for Black Americans were almost twice as high as those of white Americans. For Hispanic Americans, the rates were about 50 percent higher than those of whites. During the initial wave of the Omicron variant, when immune evasion somewhat leveled the playing field of infection, the differences were only slightly smaller, with Black Americans dying about 60 percent more frequently than white Americans.
These gaps are distressing on their own. But it is also illustrative to consider those racial disparities alongside another much-talked-about pandemic divide: partisanship.
The “red Covid” pattern, in which red states see higher deaths, has been clear for a while now, serving both to confirm many liberals’ suspicions about the reckless behavior of conservatives and perhaps to raise questions about what it meant that conservatives seemed comfortable with the trade-offs they’d made, even knowing the costs to life.
But an eye-opening study published by the National Bureau of Economic Research last month gave the story new clarity, by matching medical data to individual voter registration records, examining almost 600,000 deaths from all causes in Ohio and Florida over the last several years and calculating how much higher excess mortality was through December 2021 for Republicans than for Democrats.
A look at only two states during a slightly shorter pandemic period, the study is more limited than the C.D.C. data set, which uses Covid mortality. But the comparison is nevertheless illuminating: As measured by the N.B.E.R. paper, the death toll’s partisanship gap, while large, was only about as large as the racial and ethnic gap found in the C.D.C. data. Overall — from the beginning of the pandemic until the arrival of Omicron — Republican excess mortality in Ohio and Florida was 76 percent higher than Democratic excess mortality. According to overall age-adjusted mortality data compiled by the C.D.C. compared to white mortality throughout the pandemic, Black mortality was 65 percent higher and Hispanic mortality 75 percent higher.
And although the partisan gap grew with the arrival of vaccines, it never grew as large as the racial gap had been in early 2020. In 2021, Republican excess mortality in those two states was at its highest, compared to Democratic levels: 153 percent. At the peak of racial disparity in the pandemic’s first wave, Black Americans were dying more than three times as much as white Americans.
This is not to suggest that one of these stories was more important than the other, but that each has played a quite significant role. You may think that the story of exceptional American pandemic failure was the result of right-wing vaccine refusal and the cynical sabotage of good-faith public health mitigation measures by conservative media. That story is true, the crimes real. But structural factors — not only race but class and education, too — appear to loom just as large, complicating any intuitive model of what went wrong here that emphasizes the pandemic culture war above all else.
Take some of the smaller-bore observations from the partisanship paper, produced by two Yale public health scholars and a third from the Yale School of Management. First, at least in Ohio and Florida, despite what seemed at the time to be almost unbridgeable divides over things like mask wearing and school closures, social distancing and lockdowns, the excess mortality gap between Republicans and Democrats in the pre-vaccine phase of the pandemic was relatively small, with Republican excess mortality only 22 percent higher than the death rate among Democrats.
Especially in the initial phases of spread, it can be hard to disentangle the effects of policy and behavioral response from somewhat random drivers like where the virus arrived first, what sorts of places those were and what kinds of people populated them, and even what the weather was like when the virus came. But those caveats in mind, the excess mortality data collected here suggests that however self-destructive red states and Republican individuals seemed to be, in 2020, the ultimate cost of that recklessness was less dramatic. (Judging by national county-level data, in fact, heavily Democratic districts were dying at much higher rates until the late winter or early spring of 2021, though, again, that reflects some amount of first exposure bad luck, as well as factors of demographics and density.)
This dynamic changed almost on a dime with the introduction of vaccines, with an enormous gap opening up between Democrats and Republicans in 2021. In the conventional narrative, Republican vaccine skepticism was an extension of the Covid-minimizing, anti-science response of American conservatives in the pandemic’s first year. But the vaccine gap looks like a far bigger deal than the divergent behavioral paths the country took before they arrived.
In certain ways, this is the story of the American pandemic response more broadly. The country clearly stumbled in 2020. And yet before vaccines were widely available, and when we tried to slow the spread of the disease through behavioral measures, the scale of the failure was relatively small compared with what followed in the years after.
In 2020, American death rates and excess mortality fell merely at the worse end of its peer countries — above Germany and barely France but below Britain, Italy and Spain, for instance. In the vaccine era of the pandemic, American performance has been much worse, with our death rates becoming much more conspicuous and dramatic outliers — enough to make the country by far the worst performing of its peers.
Partisanship was a huge driver of that more significant second-year failure, since Republican resistance to vaccination explains a large share of cumulative American Covid mortality. And yet in taking stock of the country’s pandemic experience overall, it seems far from holistically determinative. According to polling by the Kaiser Family Foundation, only 62 percent of Republicans have completed their primary vaccinations, compared with 87 percent of Democrats. But income and education tell a similar story: Only 67 percent of Americans with household incomes below $40,000 have completed their primary vaccinations, compared with 85 percent with household incomes above $90,000. For Americans without college degrees, the number is also 67 percent, compared with 85 percent of college graduates. For uninsured adults under 65, it is just 60 percent.
What does this all mean for the next pandemic fall and winter? Well, thankfully, the racial and ethnic gaps around vaccination have almost entirely closed, which is one major reason the mortality gap has, too: According to Kaiser, 74 percent of Black and Hispanic Americans have been vaccinated, compared with 77 percent of whites. The demographic gaps for boosters are slightly larger: 50 percent of white adults have been boosted, according to Kaiser, compared with 43 percent of Black adults and 40 percent of Hispanic adults. (Only 31 percent of Republicans have been boosted.)
But the fall and winter won’t necessarily follow the steady state pattern of the past few months. All across the Northern Hemisphere at the moment are signs of distressing spikes in new cases and indeed hospitalizations as well, with admissions growing over the last few weeks in Germany, France and Britain, among others (though the rates of growth there appear to be slowing down already). Thanks to immunological protection acquired from both infection and vaccination, new cases are considerably less scary than they once were — both here and there. So while the news from Europe isn’t especially reassuring, it would probably take an Omicron-like curveball to deliver a new American peak like those we experienced each of the previous two winters, and there does not seem to be anything like that on the horizon.
And yet Americans are still dying at an annualized rate above 100,000 — a rate that may well grow as we head deeper into the fall. What are we doing about that? What could we be doing?
One set of answers is implied by the story of vaccination and mortality by race, and the way improvements on one measure changed the trajectory of the other: more first shots and more boosting. This is the central strategy offered by the Biden administration. But the vaccinated share of the country has barely grown in months, and the uptake of next generation bivalent boosters looks, in the early stages, quite abysmal.
In theory, of course, much more could be done to promote boosters and ease access to them. But according to The Times’s global vaccination tracker, Americans are doing almost exactly as poorly with boosters as we did with the first round of vaccines, not worse. The country ranks 66th globally in the share of population that has completed a primary vaccination course. For a first booster, it ranks 71st. Overall, what the pattern suggests is that there is if not a natural drop-off from primary vaccination to boosters then at least a close-to-universal one — which makes it much harder to believe in a dramatic right turn for American uptake.
But another possible set of responses suggests itself too, one that wouldn’t require a reversal of vaccination trends or a transformation of the pandemic culture war either: an approach to public health infrastructure, both literal and legal, that would reduce spread through background interventions without meaningfully burdening individual Americans at all.
These measures have been obvious at least as long as vaccines have been available, and yet in a perverse way the arrival of vaccines seemed to almost retire them from public discussion. They include better ventilation in public buildings, particularly schools, where billions of dollars have already been allocated for better filtration systems but where according to the C.D.C. very little of it has been spent effectively; higher occupational health and safety standards, to subtly change spread dynamics in workplaces; and paid sick leave, to allow those who do fall sick to stay home and avoid infecting others. (Not to mention the argument from social welfare.) These measures would not solve the problem of ongoing spread or bring the pandemic to an ultimate end. But they would help. And when hundreds of Americans are dying each day, help would be good.
Testing could help, too, of course, though culturally it seems to have been dumped into a bucket with masks, as an individual tool and individual burden, rather than one with investments in ventilation improvements, as part of an invisible Covid-mitigating infrastructure. This is somewhat typical. Over the last six months, an individual risk approach to Covid has predominated — both at the level of public health guidance and for most individuals navigating the new, quasi-endemic landscape. Much of the squabbling over policy has made use of the same individual responsibility terms, with heated debates in arcane corners of Twitter featuring one group of advocates pushing measures to protect the country’s most vulnerable, chastising those who’ve stopped worrying about spread and regarding those pushing normalization as guilty of “social murder” and even “genocide”; and another dismissing that group as worrywarts exaggerating the threat of disease, turned on by anxiety and control and pushing for an unrealistic return to mask mandates, school closures and the like.
This argument is unhelpful, not just because it is needlessly toxic but also because the terms themselves are inadequate. One of the lessons of that early phase of the pandemic, and especially its racial disparities, is that mitigation is not strictly a matter of individual risk management. Spread matters, too, as do structural factors. We have tools to help both, without returning the country psychologically to the depths of Covid panic.
The New York Times
