"The COVID-19 pandemic removed any doubt that state policies can affect health outcomes. East Coast states (eg, New York, New Jersey) that responded to the first wave of the pandemic in the spring of 2020 with strict protective measures achieved relatively quick control of community spread within as much as 8 weeks,9 and they blunted subsequent surges by reinstating those policies.
In contrast, states that had spent decades opposing public health provisions were among the most resistant to COVID-19 guidelines and took active measures to resist restrictions. Some elected officials made a political issue out of challenging scientific evidence, embracing dubious theories, and labeling public health safeguards as infringements on personal freedom. Conservative governors used preemption to reverse efforts by mayors and school districts to control local transmission rates.
These policy choices may have been associated with increased COVID-19–related morbidity and mortality. States that rushed to curtail lockdowns in the spring of 2020 experienced more protracted surges in infections and disruptions to their economies.9 In 2021, excess deaths were disproportionately concentrated in states where resistance to COVID-19 vaccination was prevalent.
For example, excess death rates in Florida and Georgia (more than 200 deaths per 100 000) were much higher than in states with largely vaccinated populations such as New York (112 per 100 000), New Jersey (73 deaths per 100 000), and Massachusetts (50 per 100 000). States that resisted public health protections experienced higher numbers of excess deaths during the Delta variant surge in the fall of 2021 (Figure). Between August and December 2021, Florida experienced more than triple the number of excess deaths (29 252) as New York (8786), despite both states having similar population counts (21.7 million and 19.3 million, respectively).10"
|Figure. Weekly Excess Death Rate (per 100 000) in Selected States, 2021|