ABSTRACT
INTRODUCTION: This study connects the aggregate strength of public health policies taken in response to the COVID-19 pandemic in the U.S. states to the governors' party affiliations and to state-level outcomes. Understanding the relationship between politics and public health measures can better prepare American communities for what to expect from their governments in a future crisis and encourage advocacy for delegating public health decisions to medical professionals. METHODS: The public health Protective Policy Index captures the strength of policy response to COVID-19 at the state level. The authors estimated a Bayesian model that links the rate of disease spread to Protective Policy Index. The model also accounted for the possible state-specific undercounting of cases and controls for state population density, poverty, number of physicians, cardiovascular disease, asthma, smoking, obesity, age, racial composition, and urbanization. A Bayesian linear model with natural splines of time was employed to link the dynamics of Protective Policy Index to governors' party affiliations. RESULTS: A 10-percentage point decrease in Protective Policy Index was associated with an 8% increase in the expected number of new cases. Between late March and November 2020 and at the state-specific peaks of the pandemic, the Protective Policy Index in the states with Democratic governors was about 10âpercentage points higher than in the states with Republican governors. CONCLUSIONS: Public health measures were stricter in the Democrat-led states, and stricter public health measures were associated with a slower growth of COVID-19 cases. The apparent politicization of public health measures suggests that public health decision making by health professionals rather than by political incumbents could be beneficial.
