A. Introduction
Earlier posts on this blog have documented that vaccination rates against Covid-19 have been systematically lower in accordance with the share of a state’s vote for Trump in the 2020 election, and that mask-wearing to protect the individuals and those around them have also been systematically lower. The higher the share voting for Trump in a state, the lower the share vaccinated and the lower the share wearing masks.
Those choices have had consequences. As shown in the charts above, it should not then be surprising that states with a higher share of their vote for Trump have seen, on average, a higher number of cases of Covid-19 (per 10,000 of population) as well as a higher number of deaths. The relationship is statistically a very strong one. While many factors affect the likelihood of being infected with Covid-19 and of dying from it (including factors such as urban density, extent of travel, health status of the population, adequacy of the health care system, and more), political identification by itself appears to be a strong and independent factor.
In what is literally a life and death issue, one would have thought that rational self-interest would have dominated. It has not. Following a review of the data, this post will discuss some possible reasons why.
B. The Relationship Between the Incidence of Covid-19 Cases and Deaths and the Share Voting for Trump
The figures at the top of this post plot the relationship between the number of cases of Covid-19 in a state (per 10,000 of population), or the number of deaths (also per 10,000), and the share in the state who voted for Trump in 2020. The Covid data come from the CDC. It was downloaded October 26, but since case and death counts from the states may not be fully reported to the CDC for up to a week to ten days, I used October 15 as the end date for the analysis here. “Cases” are confirmed cases, and “deaths” are deaths as a consequence of Covid-19, both as defined in the CDC guidance for how these should be recorded.
For the start date I used July 1, 2020. This came at the end of the first wave of Covid-19 cases and deaths. Cases and deaths in this first wave were excluded for two reasons. One is that the first wave arrived suddenly in mid-March and with an intensity that surprised many. The nation was unprepared, with little done to prepare for the disease that was spreading around the world as Trump was claiming it was all under control, that it was “going to disappear”, and that it would soon “go away”. Also, the CDC had bungled the initial testing (where testing was more readily accessible in parts of Africa than in the US in the key initial months), so the full extent of the developing problem was not clear until it hit. The response, and the then only possible response, was to quickly institute lockdowns, and this was soon done in all 50 states. The lockdowns were effective, albeit costly, and by late April the approach had succeeded in starting to bring down the daily number of new cases. Case numbers continued to fall in May and into June.
But starting in early May, disparate decisions were taken across the different states on how fast to lift the lockdown measures. Some opened up early and with little guidance on or advocacy for the wearing of masks, while others opened up more cautiously. But with the opening up, and the refusal by a significant share of the population to wear masks and to follow social distancing recommendations, the daily number of new cases stopped falling and by around mid-June began to rise again. The daily number of deaths followed a similar pattern but with a lag of about two weeks, and so began to rise around the end of June. Thus July 1 can be taken as a turning point – the end of the first wave and the start of the second. While differences across the states had already started to develop from early May (when decisions were taken on how rapidly to open up), the consequences of the varying approaches only became clear as the second wave started to build. On average across the nation, this was around July 1.
The second reason to exclude this first wave is that the quality of the data for that initial period was poor. The Trump administration was slow in launching and then ramping up testing, with testing limited even well into April to those who showed obvious symptoms or who had been in close contact with someone with a confirmed case. Thus many cases were missed. While testing has been far from perfect throughout this pandemic, it was much worse in the earlier months than it was later. For this reason as well, excluding the estimates from the earlier months will provide a better measure of how successful or not the different states were as they responded to the pandemic in their different ways after the initial lockdowns.
Excluding the first wave leads to the exclusion of 6% of confirmed cases and 18% of deaths from the overall totals as of October 15, 2021. Most thus remained. Note also the disparity in these figures. That the official figures recorded that just 6% of the confirmed cases in the US (as of October 15) were in this initial, first wave, period, while this same period recorded 18% of deaths, strongly suggests that cases were significantly undercounted in that first wave.
The charts then show the incidence of total confirmed cases of Covid-19, or deaths from it, per 10,000 of population, over the period from July 1, 2020, to October 15, 2021, with this plotted against the share of the vote that Trump received in that state in 2020. The relationship is a strong one: The higher the share of the state vote for Trump, the higher the incidence of Covid-19 cases and of deaths. Taking averages, the average number of confirmed cases over this period per 10,000 in the states won by Trump was 1,461 (i.e. 14.6% of their population) vs. 1,113 in the states won by Biden. That is, there were on average 31% more cases in the states won by Trump. The number of deaths from Covid-19 came to 21.2 per 10,000 in the states won by Trump vs. 15.3 in the states won by Biden, or 38% more in the states won by Trump.
But averaging across all the states won by Trump or by Biden is not terribly meaningful as there will be a mix of voters in every state. Furthermore, there were a number of states where the vote was close to 50/50.
It is thus more meaningful to examine the trend across the different states, as a function of the share voting for Trump. This trend is provided in the regression line shown in each chart, where simple, linear, ordinary least squares regression was used. The statistical relationship found was very strong, and especially so for the regression for the number of cases of Covid-19. The R-squared (a measure of how much of the variation in the values is accounted for by the regression line alone) was extremely high for such a cross-state sample as here – at 0.63 for the number of Covid-19 cases and a still high 0.36 for the number of Covid-19 deaths. (R-squared values can vary between 1.0, in which case the regression line explains 100% of the variation across states, and 0.0, in which case the regression line explains none of the variation.)
The higher correlation (the higher R-squared) observed in the relationship for the number of cases than in the relationship for the number of deaths is what one would expect. To die from the disease, one must first have caught it. Hence this will depend on the number of cases in the state. But deaths from it will then depend on additional factors such as the age structure of the population, general health conditions (obesity rates, for example), as well as the availability and quality of health care services (hospitals, for example). These factors will vary by state, and hence add additional variation to that found for the number of confirmed cases.
The slope of the regression line is an estimate of how many additional cases of (or deaths from) Covid-19 to expect (per 10,000) for each 1% point higher share of the vote for Trump. For each additional 1% point in the share of the vote for Trump in a state, there were on average 23.8 more cases (per 10,000 of population) of Covid-19 during the period examined, and on average 0.36 more deaths (per 10,000). The t-statistics for these slope coefficients were both extremely high, at 9.1 for the number of cases and 5.2 for the number of deaths. A t-statistic of 2.0 or higher is generally taken to be an indicator that the relationship found is statistically significant (as it implies that in 95% of the cases, the slope is something different from zero – a slope of zero would imply no relationship). A t-statistic of 3.5 would raise that significance to 99.9%. The t-statistics here of 9.1 and 5.2 are both far above even that mark.
One can also use the regression lines to address the question of what the impact would have been on Covid-19 cases and deaths if everyone behaved as Biden voters did (or as Trump voters did). The regression lines look at how the incidence of cases or deaths change based on each additional percentage point in the vote for Trump. If one extrapolates this to the extreme case of zero votes for Trump (and hence a “pure” Biden vote), one can estimate what cases and deaths would have been if all behaved as Biden voters did.
This is a straight line, i.e. linear, extrapolation of the effects, and the limitations from this assumption will be addressed in a moment. But using linearity, the effects are easily calculated by simply inserting zeroes for the Trump share of the vote into the regression equations, so that one is left with the constants of +96.94 for the number of cases (per 10,000 of population) and -0.69 for the number of deaths. That is, there would have been a predicted 97 (per 10,000) cases of Covid-19 over this period in the US rather than the actual figure of 1,261 (per 10,000). This is 92% lower. And the number of deaths would have been essentially zero (and indeed would have reached zero with still some share voting for Trump – based on the regression equation coefficients it would have been at the 2% point share for the Trump vote).
Are these results plausible? Would cases and deaths have fallen by so much if all of the population had behaved (in terms of wearing masks, social distancing, getting vaccinated once vaccines became available, and other such behaviors) as the Biden voters did? The answer is yes. Indeed, the linear extrapolation is conservative, as infectious diseases such as Covid-19 spread exponentially.
If in some state each infected person infects, on average, two further people, the number infected will double in each time period for the disease. This is exponential growth, with a reproduction rate of two in this example – a doubling in each period. For Covid-19, the time period from when a person is infected to when that person may, on average, spread it to another, is a week and a half. A person becomes infectious (can spread it to others) about one week after they became infected with the disease, and then can infect others for about a week (with the average then at the half-way point of that week). Thus 100 cases of active infections in some region would double to 200 in that time period of a week and a half, then to 400 in the next time period, and so on. If, in contrast, responsible behavior (such as vaccinations and mask-wearing) reduces the reproduction rate to one-half rather than two, then 100 cases will lead to 50 in the next time period, to 25 in the next, and so on down to zero.
In any given state there is a mix of Biden voters and Trump voters. While there are many factors that matter, if these two identities reflect, on average, differing shares of people that do or do not choose to be vaccinated, wear masks, and so on, then the average reproduction rate will vary depending on the relative shares of such voters. That average reproduction rate will be lower in states with a higher share of Biden voters, and for a sufficiently high share of Biden voters (a sufficiently low share of Trump voters), there will be an exponential decline in new infections from Covid-19. The linear extrapolation based on the regression equations would thus be a conservative estimate of the number of cases to expect when most of the population behaves as the Biden voters have.
There are, of course, many factors that enter into whether a person is infected by someone with Covid-19, and whether they then die from the infection they got from someone. But the charts and the regression results suggest that the share of the population in a state voting for Biden or for Trump is, by itself, strongly correlated with how likely that was. Why?
C. Personal Behavior and Political Identity
The fact of, and then the consequences from, this political divide for infection by Covid should not be a surprise to anyone. As noted before, Trump voters are far less likely to be vaccinated or to wear masks to protect themselves and others from this highly infectious, and deadly, disease. This then translates into higher infection rates, and the higher infection rates then to higher deaths.
One sees this unwillingness to be vaccinated also in surveys. The most recent of the regular surveys by the Kaiser Family Foundation (published on October 28) found that 90% of Democrats had received at least the first dose of the Covid vaccine, while only 61% of Republicans had. Furthermore, 31% of Republicans declared they would “definitely not” be vaccinated, while just 2% of Democrats held that view. Gallup surveys have found similar results, with a survey from mid-September finding that 92% of Democrats had received at least the first dose of the Covid vaccine, but that only 56% of Republicans had. And 40% of Republicans in that survey said they are not planning on being vaccinated ever, while only 3% of Democrats said that.
Not surprisingly, one then sees this reflected in state politics. Republican governors (such as Abbott of Texas and DeSantis of Florida) have gone so far as to issue executive orders to block private companies from protecting their staff and their customers from this disease, and even to prohibit local school boards from taking measures to protect schoolchildren.
The direct result is that the virus that causes Covid-19 has continued to spread. An infectious disease such as Covid-19 will only persist as long as it is being spread on to others. It cannot survive on its own. The issue, then, is not just that someone refusing to wear a mask or to be vaccinated is highly likely to catch the disease, but that that person is likely to spread it to others. While Republican governors such as Abbott and DeSantis have said this is a matter of “personal freedom”, it is not that at all. No one is free to do harm to others. It is the same reason why there are laws against drunk driving. Drunk drivers are more likely to cause crashes (not all of the time, but often), and those crashes will harm others, up to and including killing others. Spreading Covid-19 is similar, up to and including that those who become infected may die from it.
For whatever causal reason, the facts themselves are clear. But why has a significant share of the population chosen to behave this way? This is now more speculative, and goes into an area that I openly acknowledge is not my area of expertise. With that proviso, some speculation.
It is clear that political identity has played a central role, where Trump from the start treated the then developing pandemic as an issue where you were either with him – and his assertion that he had it all under control – or against him. This started with Trump’s assertion in an interview on January 22, 2020 (from Davos, Switzerland) that he had no worries, that “we have it totally under control”, and that “It’s going to be just fine”. This claim continued through February (as cases were growing in the US), where on February 27 he said “It’s going to disappear. One day it’s like a miracle. It will disappear.” And in campaign rallies in February, he claimed to his cheering supporters that he had been doing a superb job in stopping the virus and that any charge to the contrary was simply a “hoax” coming from the Democrats.
Thus, from the start, Trump made the issue a political one. If you were a true supporter of Trump you could not treat the disease as something of concern – Trump had taken care of it. Any assertion that the developing pandemic was in fact serious, and needed to be addressed, was a “hoax” perpetrated by the Democrats.
Trump then continued to assert all would soon be well, saying on March 10 that “it will go away”, on April 29 that “This is going away. It’s gonna go. It’s gonna leave. It’s gonna be gone.”, on May 11 that “we have prevailed”, on June 17 that “It’s fading away.”, and on July 19 that “It’s going to disappear”. But more than 600,000 Americans have died since July 19, 2020, not far short of the 651,000 Americans who have died in battle in all of America’s wars since 1775. From the start of the pandemic, more than 750,000 Americans have now died.
Trump’s politicization of Covid-19 was then amplified when, at the April 3 press conference in which he announced the CDC recommendation that everyone should wear face masks when going out, he immediately then added that he would not himself wear a face mask. Face masks are highly effective in hindering the spread from person to person of the virus that causes Covid-19, and until vaccines became available, were the best way to hinder that spread. But wearing a face mask is also highly visible. For those who saw themselves as supporters of Trump, and believed what he said (that the virus was going away, that he had it under control, and that any concerns over this were merely a hoax promoted by the Democrats), then it was not surprising that many would follow Trump’s highly public example and not wear a mask either. Some even went so far as to shoot, and kill, store personnel when told they should wear a face mask inside some store.
It is not surprising that such views would then carry over to vaccination. Having rationalized not wearing a mask, it is easy to rationalize a refusal to be vaccinated. And rationalizations could easily be found just by watching Fox News. In the six months from April through September this year, for example, Fox News chose to air a claim undermining vaccination on all but two of those more than 180 broadcast days. Many were also exposed to claims that can only be described as truly bizarre, such as that the vaccination will be secretly inserting a microchip into your body for the government to track you, with Bill Gates behind it all; or that it will make you magnetic with this managed through 5G telecom towers; or that it will re-write your body’s DNA; and more.
One can therefore easily come up with rationalizations not to be vaccinated, of varying degrees of plausibility, if you are predisposed against it. But many of those providing such rationalizations must have realized that their rationalizations often did not make much sense. Rather, their decisions appear to have been driven more by a visceral or emotional reaction (vaccinations just “feel” wrong) than as an outcome of a rational process. That is, the decision not to be vaccinated was made first, based on emotions or feelings, with the rationalizations then arrived at later to justify a decision that had already been made. (Such a process is in accord with the “social intuitionist” model of Jonathan Haidt, where decisions are made first, in a visceral reaction based on emotion, while rationalizations then come later to justify that decision.)
In the case of Covid-19, those decisions on vaccination (and earlier on wearing masks) were made in accordance with political identity – a perceived loyalty to Trump – rather than in recognition of the very real risks that would follow if one contracted Covid-19. Wearing a mask or accepting a vaccination would simply be “wrong” and disloyal.
I have found it astonishing how strong this emotional reaction has apparently become. Covid-19 is new (it did not even exist just two years ago), it is deadly (where on average about 1.5% of those infected have died – with a much higher fatality rate than this average for those who are older or who have other health issues), and may have serious long-term ill effects even for those who do not die from it. Yet this visceral reaction appears to have been so powerful that many supporters of Trump still refuse to be vaccinated, despite the risk of genuine life and death consequences.
I should hasten to add that not all voters for Trump have refused to be vaccinated. Indeed, according to the surveys, about 60% (a majority) have as of October. There are also highly vocal partisans on the left who have refused to be vaccinated. Their reasons are likely very different from that of the typical Trump voter, but the underlying cause appears still to be intuitive – the feeling that such vaccinations are simply “wrong”. But the issue is that the relative shares of the two groups have been very different: A far higher share of those who voted for Trump have refused vaccination than is the case for those who voted for Biden. The consequences are as shown in the charts at the top of this post.
As noted before, the cause for this relationship cannot be known with certainty, and what I have presented here should be viewed as speculative on my part. There may well be other explanations. For example, a related but somewhat different explanation would be that a common third factor explains both the tendency of some to vote for Trump and also to be resistant to vaccinations. Those in this group may put faith in conspiracy theories (including, but not limited to, terrible consequences from being vaccinated), distrust authority, proudly but stubbornly insist on doing the opposite of whatever is recommended, and for such reasons not only refuse to be vaccinated but also vote for Trump.
Whatever the explanation, the results have been tragic. This has also been a lesson in how strongly some will keep to a held position, even as they have seen prominent figures, and sometimes friends or even family members, come down with this disease. When an issue becomes one of identity, it appears that even with such tragic consequences there will be many who steadfastly refuse to change.
An Economic Sense 
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