The evolving roles of US political partisanship and social vulnerability in the COVID-19 pandemic from February 2020-February 2021

PLOS Glob Public Health. 2022 Dec 5;2(12):e0000557. doi: 10.1371/journal.pgph.0000557. eCollection 2022.


The COVID-19 pandemic has had intense, heterogeneous impacts on different communities and geographies in the United States. We explore county-level associations between COVID-19 attributed deaths and social, demographic, vulnerability, and political variables to develop a better understanding of the evolving roles these variables have played in relation to mortality. We focus on the role of political variables, as captured by support for either the Republican or Democratic presidential candidates in the 2020 elections and the stringency of state-wide governor mandates, during three non-overlapping time periods between February 2020 and February 2021. We find that during the first three months of the pandemic, Democratic-leaning and internationally-connected urban counties were affected. During subsequent months (between May and September 2020), Republican counties with high percentages of Hispanic and Black populations were most hardly hit. In the third time period -between October 2020 and February 2021- we find that Republican-leaning counties with loose mask mandates experienced up to 3 times higher death rates than Democratic-leaning counties, even after controlling for multiple social vulnerability factors. Some of these deaths could perhaps have been avoided given that the effectiveness of non-pharmaceutical interventions in preventing uncontrolled disease transmission, such as social distancing and wearing masks indoors, had been well-established at this point in time.

Grant support

MS was partially supported by the National Institute Of General Medical Sciences of the National Institutes of Health under Award Number R01GM130668. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. This project has been funded (in part) by contract 200-2016-91779 with the Centers for Disease Control and Prevention. The findings, conclusions, and views expressed are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention (CDC).