On January 25 (2023) I posted a blog (How Have We Been Doing with the COVID Pandemic?) that documented the tepid performance of the United States in mortality statistics as a consequence of the pandemic compared to other wealthy countries. I also documented the statistics that compare states’ excess death rates (i.e., number of deaths above what would be expected compared to recent historic trends before the pandemic) during the pandemic, showing staggering differences. For instance, Mississippi, with the highest excess death rate, had almost 6 times the rate of Hawaii, which had the lowest rate. There is also a strong negative correlation across the country between deaths and vaccine status, i.e. the more people that are fully vaccinated, the fewer the deaths.
Stimulated by comments on that post, I decided to undertake a more granular analysis of the situation.
Approach
Because states took markedly disparate approaches to the management of the pandemic, this “experiment of nature” afforded the opportunity to compare results of differing pandemic policies. California and Florida provide a useful contrast. Based on the amount of restrictions in place in each state (lockdowns, school and business closures, mask and vaccine mandates, etc.), California ranked as the fifth most restrictive state, while Florida was the second least restrictive state. How have they done?
Economy
The per capita Gross Domestic Product (or Gross State Product) in 2021 was about $73,000 in California and $47,000 in Florida. Of course Florida has a lot of retirees, so a better gauge of the economic impact of Covid looks at recent increases in the GDPs of each state. The latest data show that, in the third quarter of 2022, the real GDP in California rose 7.8%, while Florida’s rate increased by 6.9%
Education
The handling of school closures was a hot button issue during the worst of the pandemic. The National Assessment of Educational Programs (NAEP) is a respected vehicle that assesses student achievement over time. Its national test scores (on a scale of 0 to 500) have shown a steady improvement over the last few decades, but this slammed to a halt with Covid. In 2022, 8th graders in Florida lost seven points in their math scores, and four points in reading. California 8th graders lost six points in math scores, and zero in reading.
Deaths by Party Affiliation
I was unable to find a breakdown of the rate of Covid deaths by political party in each state. There is plenty of national information though. In the years from 2018 to 2020, death rates were similar for Republicans and Democrats. Spikes in death rates from Covid were also similar before Covid vaccines became available. After vaccines became available, the death rates have diverged dramatically: according to a study from Yale, as of April 2021, excess death rates were 153% higher in registered Republicans than in registered Democrats.
Vaccination Status
To date, the percentage of the population in California that has received one vaccination, two vaccinations, or more than the two doses is, respectively, 84%, 74%, and 41%. For Florida, the figures are 81%, 68%, and 29%.
Nationally, 90% of Democrats have been vaccinated in contrast to 58% of Republicans. Independents have been vaccinated at the rate of 68%. Party affiliation has become a more prominent predictor of vaccination status than race or ethnicity.
Excess Death Rates
For a more complete explanation of the concept of “excess death” rates, please refer to the previous blog (January 25, 2023). In a nutshell, it is a statistic that documents the rate of deaths in excess of an average over the previous four to six years. During the course of the pandemic through the middle of January, 2023,
the excess death rate in California is 288.7. In Florida, it is 373.7.
Conclusion
From the data above, It may be tempting to conclude, based on excess deaths rates, that California, by reason of a more favorable excess death rate, has fared better than Florida. And despite the implementation of rather draconian social measures compared to Florida, the impact of California’s policies on the economy and education is at least as favorable as Florida’s.
In gathering all this information, I have relied on authoritative sources, but I am somewhat skeptical of some of the data. For instance, I can hardly believe that California 8th graders suffered no diminution of reading test scores over the course of the pandemic.
But what if the evidence did show that the restrictive social policies have a negative impact on the economy? No one can argue with the cold facts of an excess death rate almost 100 points per 100,000 people lower in California as compared to non-interventionist Florida. This presents a dilemma well known to medical ethicists: how to weigh the value of human life against economic well being? This is a discussion far beyond the scope of The Medical Beat.
Note: information in this essay is retrievable in the notes referenced in the January 25th blog and the internet citations below:
Thanks for another thoughtful post, Jim! To me, the bigger ethical question is what we owe to society versus what we get back in terms of personal freedom. Some of those “points” of excess death were folks who were perfectly fine with sacrificing some of their own freedom to increase the safety of all by following public health recommendations, but still paid the price of illness and death due to the insistence of others that their own freedom was more important. Vaccination is a case of this argument, as is gun safety and many other societal safety issues.
Interesting blog, Jim. As you know I live in an over 55 community and most of my close friends in and outside this community are over 75. Most are Republicans or
are generally conservative. Most are fully vaccinated, although some were not vaccinated at all. Fortunately, I never contracted the virus but some in my family did and they were all fully vaccinated. A large percentage of my friends who were fully vaccinated did contract the virus, many more than once. I don’t know what this has to do with your study, but I have become very skeptical of statistics ESPECIALLY in California. Thanks to a friend on the school board, I follow what has happened to the students in my town, As a result of being out of the classroom It has been devastating and our school district is instituting a program of special tutoring as well as counseling to both elementary and high school students. Our library is also involved in special tutoring. In addition, a friend who is in hospital administration told me that many deaths that were reported as covid deaths were in fact deaths due to other serious problems and when they were in the hospital for those problems it was discovered that they had covid but did not die of covid.
Obviously what I have written above may be somewhat biased because of my conservative views but never the less I appreciate reading your blog and hearing both sides of the story. Stay well.
Joan, thanks so much for your comments. I too am skeptical about statistics, which is why I like the “excess death” figure. In my zeal to keep my posts less than 800 words, I did not go into detail why I distrust data about deaths from Covid only, so here it is.
You friend is clearly correct about the possible overcount of Covid deaths in hospitals. Undoubtedly, many people who have a positive test for Covid die in hospitals from end stage diseases. The Covid is an innocent bystander, yet the death may be listed as a Covid test.
Undercounting occurs too. Many African Americans, due to distrust of the healthcare system, never access conventional care. How many deaths were due to Covid among this demographic? Similarly, many Hispanics avoid the healthcare system for fear of entanglement with ICE.
The concept of excess death takes into account ALL deaths from whatever cause, based on death certificates. It captures deaths like suicides, which would not be included in Covid stats, but surely the economic dislocations from the pandemic factored into a lot of so-called non-Covid deaths. No one dies in America without a death certificate and that is why the deaths beyond what is expected is such a powerful concept.
In my own social and family circles, almost all have contracted the virus, even though everyone is as vaccinated as can be Strangely, I have not gotten it, even though Carrie did. No one died, though, or even needed any kind of medical care. However, before Covid vaccines, a doctor friend of mine did die of Covid–he spent an entire month on a breathing machine before he died. Family was unable to visit, but his wife was allowed to see him a few hours before he died. The Covid vaccines are far from perfect, but they largely prevent such tragedies.
I welcome your comments and appreciate that you made them so all subscribers could read them. I would like to see more such pushback that could engender the type of dialogue we are having here. Perhaps you could give your friends the address for The Medical Beat. The more, and varied, subscribers the better!