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  • How Many Republicans Died Because the GOP Turned Against Vaccines?

    How Many Republicans Died Because the GOP Turned Against Vaccines?

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    No country has a perfect COVID vaccination rate, even this far into the pandemic, but America’s record is particularly dismal. About a third of Americans—more than a hundred million people—have yet to get their initial shots. You can find anti-vaxxers in every corner of the country. But by far the single group of adults most likely to be unvaccinated is Republicans: 37 percent of Republicans are still unvaccinated or only partially vaccinated, compared with 9 percent of Democrats. Fourteen of the 15 states with the lowest vaccination rates voted for Donald Trump in 2020. (The other is Georgia.)

    We know that unvaccinated Americans are more likely to be Republican, that Republicans in positions of power led the movement against COVID vaccination, and that hundreds of thousands of unvaccinated Americans have died preventable deaths from the disease. The Republican Party is unquestionably complicit in the premature deaths of many of its own supporters, a phenomenon that may be without precedent in the history of both American democracy and virology.

    Obviously, nothing about being a Republican makes someone inherently anti-vaccine. Many Republicans—in fact, most of them—have gotten their first two shots. But the wildly disproportionate presence of Republicans among the unvaccinated reveals an ugly and counterintuitive aspect of the GOP campaign against vaccination: At every turn, top figures in the party have directly endangered their own constituents. Trump disparaged vaccines while president, even after orchestrating Operation Warp Speed. Other politicians, such as Texas Governor Greg Abbott, made all COVID-vaccine mandates illegal in their state. More recently, Florida Governor Ron DeSantis called for a grand jury to investigate the safety of COVID vaccines. The right-wing media have leaned even harder into vaccine skepticism. On his prime-time Fox News show, Tucker Carlson has regularly questioned the safety of vaccines, inviting guests who have called for the shots to be “withdrawn from the market.”

    Breaking down the cost of vaccine hesitancy would be simple if we could draw a causal relationship between Republican leaders’ anti-vaccine messaging and the adoption of those ideas by Americans, and then from those ideas to deaths due to non-vaccination. Unfortunately, we don’t have the data to do so. Individual vaccine skepticism cannot be traced back to a single source, and even if it could, we don’t know exactly who is unvaccinated and what their political affiliations are.

    What we do have is a patchwork of estimations and correlations that, taken together, paint a blurry but nevertheless grim picture of how Republican leaders spread the vaccine hesitancy that has killed so many people. We know that as of April 2022, about 318,000 people had died from COVID because they were unvaccinated, according to research from Brown University. And the close association between Republican vaccine hesitancy and higher death rates has been documented. One study estimated that by the fall of 2021, vaccine uptake accounted for 10 percent of the total difference between Republican and Democratic deaths. But that estimate has changed—and even likely grown—over time.

    Partisanship affected outcomes in the pandemic even before we had vaccines. A recent study found that from October 2020 to February 2021, the death rate in Republican-leaning counties was up to three times higher than that of Democratic-leaning counties, likely because of differences in masking and social distancing. Even when vaccines came around, these differences continued, Mauricio Santillana, an epidemiology expert at Northeastern University and a co-author of the study, told me. Follow-up research published in Lancet Regional Health Americas in October looked at deaths from April 2021 to March 2022 and found a 26 percent higher death rate in areas where voters leaned Republican. “There are subsequent and very serious [partisan] patterns with the Delta and Omicron waves, some of which can be explained by vaccination,” Bill Hanage, a co-author of the paper and an epidemiologist at Harvard, told me in an email.

    But to understand why Republicans have died at higher rates, you can’t look at vaccine status alone. Congressional districts controlled by a trifecta of Republican leaders—state governor, Senate, and House—had an 11 percent higher death rate, according to the Lancet study. A likely explanation, the authors write, could be that in the post-vaccine era, those leaders chose policies and conveyed public-health messages that made their constituents more likely to die. Although we still can’t say these decisions led to higher death rates, the association alone is jarring.

    One of the most compelling studies comes from researchers at Yale, who published their findings as a working paper in November. They link political party and excess-death rate—the percent increase in deaths above pre-COVID levels—among those registered as either Democrats or Republicans, providing a more granular view. They chose to analyze data from Florida and Ohio from before and after vaccines were available. Looking at the period before the vaccine,  researchers found a 1.6 percentage-point difference in excess death rate among Republicans and Democrats, with a higher rate among Republicans. But after vaccines became available, that gap widened dramatically to 10.4 percentage points, again with a higher Republican excess death rate. “When we compare individuals who are of the same age, who live in the same county in the same month of the pandemic, there are differences correlated with your political-party affiliation that emerge after vaccines are available,” Jacob Wallace, an assistant professor of public health at Yale who co-authored the paper, told me. “That’s a statement we can confidently make based on the study and we couldn’t before.”

    Even with this new research, it is difficult to determine just how many people died as a result of their political views. In the “excess death” study, researchers dealt only with rates of excess death, not actual death-toll numbers. Overall, excess deaths represent a small share of deaths. “On the scale of national registration for both parties,” Wallace said, “we’re talking about relatively small numbers and differences in deaths” when you look at excess death rates alone.

    The absolute number of Republican deaths is less important than the fact that they happened needlessly. Vaccines could have saved lives. And yet, the party that describes itself as pro-life campaigned against them. Democrats are not without fault, though. The Biden administration’s COVID blunders are no doubt to blame for some of the nation’s deaths. But on the whole, Democratic leaders have mostly not promoted ideas or enforced policies around COVID that actively chip away at life expectancy. It is a tragedy that the Republican push against basic lifesaving science has cut lives short and continues to do so. The partisan divide in COVID deaths, Hanage said, is just “another example of how the partisan politics of the U.S. has poisoned the well of public health.”

    What’s most concerning about all of this is that partisan disparities in death rates were also apparent before COVID. People living in Republican jurisdictions have been at a health disadvantage for more than 20 years. From 2001 to 2019, the death rate in Democratic counties decreased by 22 percent, according to a recent study; in Republican counties, it declined by only 11 percent. In the same time period, the political gap in death rates increased sixfold.

    Health outcomes have been diverging at the state level since the ’90s, Steven Woolf, an epidemiologist at Virginia Commonwealth University, told me. Woolf’s work suggests that over the decades, state policy decisions on health issues such as Medicaid, gun legislation, tobacco taxes, and, indeed, vaccines have likely had a stronger impact on state health trajectories than other factors. COVID’s high Republican death rates are not an isolated phenomenon but a continuation of this trend. As Republican-led states pushed back on lockdowns, the impact on population death rates was observed within weeks, Woolf said.

    If the issue is indeed systemic, that doesn’t bode well for the future. Other factors could explain the higher death rate in Republican-leaning places—more poverty, less education, worse socioeconomic conditions—, though Woolf said isn’t convinced that those factors aren’t related to bad state health policy too. In any case, the long-term decline of health in red states indicates that there is an ongoing problem at a high level in Republican-led places, and that something has gone awry. “If you happen to live in certain states, your chances for living a long life are going to be much higher than if you’re an American living in a different state,” Woolf said.

    Unfortunately, this trend shows no signs of breaking. The anti-science messaging that fuels such a divide is popular with Republican leaders because it plays so well with their constituents. Far-right crowds cheer for missed vaccine targets and jokes about executing scientific leaders. In an environment where partisanship trumps all—including trying to save people’s lives—such messaging is both politically effective and morally abhorrent. The data, however imperfect, demand a reckoning with the consequences of such a strategy not only during the pandemic but over the past few decades, and in the years to come. But to acknowledge how many Republicans didn’t have to die would mean giving credence to scientific and medical expertise. So long as America remains locked in a poisonous partisan battle in which science is wrongly dismissed as being associated with the left, the death toll will only rise.

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    Yasmin Tayag

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  • It’s Beginning to Look a Lot Like Another COVID Surge

    It’s Beginning to Look a Lot Like Another COVID Surge

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    When I called the epidemiologist Denis Nash this week to discuss the country’s worsening COVID numbers, he was about to take a rapid test. “I came in on the subway to work this morning, and I got a text from home,” Nash, a professor at the City University of New York, told me. “My daughter tested positive for COVID.”

    Here we go again: For the first time in several months, another wave seems to be on the horizon in the United States. In the past two weeks, reported cases have increased by 53 percent, and hospitalizations have risen by 31 percent. Virus levels in wastewater, which can provide an advance warning of spread, are following a similar trajectory. After the past two years, a winter surge “was always expected,” Nash said. Respiratory illnesses thrive in colder weather, when people tend to spend more time indoors. Thanksgiving travel and gatherings were likewise predicted to drive cases, Anne Rimoin, an epidemiologist at UCLA, told me. If people were infected then, their illnesses will probably start showing up in the data around now. “We’re going to see a surge [that is] likely going to start really increasing in velocity,” she said.

    Winter has ushered in some of the pandemic’s worst moments. Last year, Omicron’s unwanted arrival led to a level of mass infection across the country that we had not previously seen. The good news this year is that the current rise will almost certainly not be as bad as last year’s. But beyond that, experts told me, we don’t know much about what will happen next. We could be in for any type of surge—big or small, long or short, national or regional. The only certain thing is that cases and hospitalizations are rising, and that’s not good.

    The pandemic numbers are ticking upward across the country, but so far the recent increases seem especially sharp in the South and West. The daily average of reported cases in Mississippi, Georgia, Texas, South Carolina, and Alabama has doubled in the past two weeks. Hospitalizations have been slower to rise, but over the same time frame, daily hospitalizations in California have jumped 57 percent and are now higher than anywhere else in the United States. Other areas of the country, such as New York City, have also seen troubling increases.

    Whether the nationwide spike constitutes the long-predicted winter wave, and not just an intermittent rise in cases, depends on whom you ask. “I think it will continue,” Gregory Poland, a professor of medicine at the Mayo Clinic, told me. “We will pour more gas on the fire with Christmas travel.” Others hesitated to classify the uptick as such, because it has just begun. “It’s hard to know, but the case numbers are moving in the wrong direction,” Rimoin said. Case counts are unreliable as people have turned to at-home testing (or just not testing at all), though hospitalizations and wastewater readings remain reliable, albeit imperfect, metrics. “I’ve not seen a big enough change to call it a wave,” Susan Kline, an infectious-diseases expert at the University of Minnesota Medical School, told me.

    But what to call the ongoing trend matters less than the fact that it exists. For now, what happens next is anyone’s guess. The dominant variants—the Omicron offshoots BQ.1 and BQ.1.1—are worrying, but they don’t pose the same challenges as what hit us last winter. Omicron drove that wave, taking us and our immune systems by surprise. The emergence of a completely new variant is possible this year—and would change everything—but that is considered unlikely.

    The lack of data on people’s immune status makes it especially difficult to predict the outcome of the current rise. Widespread vaccination and infection mean we have a stronger wall of immunity now compared with the previous two winters, but that protection inevitably fades with time. The problem is, people fall sick asynchronously and get boosted on their own schedules, so the timing varies for everyone. “We don’t know anything about how long ago people were [vaccinated], and we don’t know anything about hybrid immunity, so it’s impossible to predict” just how bad things could get, Nash said.

    Still, a confluence of factors has created the ideal conditions for a sustained surge with serious consequences for those who get sick. Fading immunity, frustratingly low booster uptake, and the near-total abandonment of COVID precautions create ideal conditions for the virus to spread. Meanwhile, treatments for those who do get very sick are dwindling. None of the FDA-approved monoclonal antibodies, which are especially useful for the immunocompromised, works against BQ.1 and BQ.1.1., which make up about 68 percent of cases nationwide. Paxlovid is still effective, but it’s underprescribed by providers and, by one medical director’s estimate, refused by 20 to 30 percent of patients.

    The upside is that few people who get COVID now will get very sick—fewer than in previous winters. Even if cases continue to surge, most infections will not lead to severe illness because the bulk of the population has some level of immunity from vaccination, previous infection, or both. Still, long COVID can be “devastating,” Poland said, and it can develop after mild or even asymptomatic cases. But any sort of wave would in all likelihood lead to an uptick in deaths, too. So far, the death rate has remained stable, but 90 percent of people dying now are 65 and older, and only a third of them have the latest booster. Such low uptake “just drives home the fact that we have not really done a good job of targeting the right people around the country,” Nash said.

    Even if the winter COVID wave is not ultimately a big one, it will likely be bad news for hospitals, which are already filling up with adults with flu and children with respiratory syncytial virus, or RSV. Many health-care facilities are swamped; the situation will only worsen if there is a big wave. If you need help for severe COVID—or any kind of medical issue—more than likely, “you’re not going to get the same level of care that you would have without these surges,” Poland said. Critically ill kids are routinely turned away from overflowing emergency rooms, my colleague Katherine J. Wu recently reported.

    We can do little to predict how the ongoing surge might develop other than simply wait. Soon we should have a better sense of whether this is a blip in the pandemic or something more serious, and the trends of winters past can be helpful, Kline said. Last year, the Omicron-fueled surge did not begin in earnest until mid-December. “We haven’t even gotten to January yet, so I really think we’re not going to know [how bad this surge will be] for two months,” Kline said. Until then, “we just have to stay put and watch.”

    It is maddening that, this far into the pandemic, “stay put and watch” seems to be the only option when cases start to rise. It is not, of course: Plenty of tools—masking, testing, boosters—are within our power to deploy to great effect. They could flatten the wave, if enough people use them. “We have the tools,” said Nash, whose rapid test came out negative, “but the collective will is not really there to do anything about it.”

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    Yasmin Tayag

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  • What Does It Mean to Care About COVID Anymore?

    What Does It Mean to Care About COVID Anymore?

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    After nearly three years of constantly thinking about COVID, it’s alarming how easily I can stop. The truth is, as a healthy, vaxxed-to-the-brim young person who has already had COVID, the pandemic now often feels more like an abstraction than a crisis. My perception of personal risk has dropped in recent months, as has my stamina for precautions. I still care about COVID, but I also eat in crowded cafés and go mask-free at parties.

    Heading into the third pandemic winter, things have changed. Most Americans seem to have tuned out COVID. Precautions have virtually disappeared; except for in the deepest-blue cities, wearing a mask is, well, weird. Reported cases are way down since the spring and summer, but perhaps the biggest reason for America’s behavioral let-up is that much of the country sees COVID as a minor nuisance, no more bothersome than a cold or the flu.

    And to a certain degree, they’re right: Most healthy, working-age adults who are up-to-date on their vaccinations won’t get severely ill—especially now that antivirals such as Paxlovid are available. Other treatments can help if a patient does get very sick. “People who are vaccinated and relatively healthy who are getting COVID are not getting that sick,” Lisa Lee, an epidemiologist at Virginia Tech, told me. “And so people are thinking, Wow, I’ve had COVID. It wasn’t that bad. I don’t really care anymore.”

    Still, there are many reasons to continue caring about COVID. About 300 people are still dying every day; COVID is on track to be the third-leading cause of death in the U.S. for the third year running. The prospect of developing long COVID is real and terrifying, as are mounting concerns about reinfections. But admittedly, these sometimes manifest in my mind as a dull, omnipresent horror, not an urgent affront. Continuing to care about COVID while also loosening up behaviors is an uncomfortable position to be in. Most of the time, I just try to ignore the guilt gnawing at my brain. At this point, when so few people feel that the potential benefit of dodging an infection is worth the inconvenience of precautions, what does it even mean to care about COVID?

    Read: Hundreds of Americans will die from COVID today

    In an ideal epidemiological scenario, everyone would willingly deploy the full arsenal of COVID precautions, such as masking and forgoing crowded indoor activities, especially during waves. But that kind of all-out response no longer makes sense. “It’s probably not realistic to expect people to take precautions every time, perpetually, or even every winter or fall, unless there is a particularly concerning reason to do that,” Jennifer Nuzzo, an epidemiologist at Brown University, told me.

    But, now more than ever, we must remember that COVID is not just a personal threat but a community one. For older and immunocompromised people, the risks are still significant. For example, people over 50 account for 93 percent of COVID-related deaths in the U.S., even though they represent just 35.7 percent of the population. As long as the death rate remains as high as it is, caring about COVID should mean orienting precautions to protect them. This idea has been around since the pandemic began, but its prominence faded as Americans put their personal health first. “If you’re otherwise healthy, it’s so easy just to think about yourself,” Lee said. “We have to think very carefully about that other part of infectious disease, which is the part where we can potentially hurt other people.”

    Orienting behavior in this way gives low-risk people a way to care about COVID that doesn’t entail constant masking or skipping all indoor activities: They can relax when they know they aren’t going to encounter vulnerable people. Like the productivity adage “work smarter, not harder,” this perspective allows people to take precautions strategically, not always. In practice, all it takes is some foresight. If you don’t live with vulnerable people, make it second nature to ask: Will I be seeing vulnerable people anytime soon? If the answer is no, do whatever you’re comfortable with given your own risk. If you are a healthy 30-something who lives alone, going to a Friendsgiving with other people your age is different from spending Thanksgiving dinner with parents and grandparents.

    If you will be seeing someone vulnerable, the most straightforward way to avoid giving them COVID is to avoid getting infected yourself, which means wearing a good mask in public settings and minimizing your interactions with others the week before, in what some experts have called a “mini-quarantine.” Not everyone has that luxury: Parents, for example, have to send their kids to school.

    Spontaneous interactions with vulnerable people are trickier to plan for, but they follow the same principle. On a crowded bus, for example, “there’s no question that if you’re close enough to someone who could be hurt by getting COVID and you could have it, then, yeah, a mask is the way to go,” Lee said. Of course, it isn’t always possible to know when someone is high-risk; young people, too, can be medically vulnerable. There’s no clear guidance for those situations, but remaining cautious doesn’t require much effort. “Carry a mask with you,” Lee said. “It’s not a big lift.”

    Get boosted—if not for yourself, then for them. Just 11.3 percent of eligible Americans have gotten the latest, bivalent shot, which potentially reduces your chances of getting COVID and passing it along. It also means getting tested, so you know when you’re infectious, and being aware of respiratory symptoms—of any kind. Alongside COVID, the flu and RSV are putting many people in the hospital, especially the very young and the very old. No matter how low your personal risk, if you have symptoms, avoiding transmission is crucial. “A reasonable thing to prioritize is: If you have symptoms, take care to prevent it from spreading,” Caitlin Rivers, an epidemiologist at Johns Hopkins University, told me.

    Read: It’s a bad time to be a booster slacker

    As we move away from a personal approach to COVID, we have an opportunity to expand the idea of what caring looks like. Low-risk people can, and should, take an active role in bolstering the protection of vulnerable people they know. In practical terms, this means ensuring that people in your life who are over 50—especially those over 65—are boosted and have a plan to get Paxlovid if they fall sick, Nuzzo said. “I think our biggest problem right now is that not everybody has enough access to the tools, and that’s a place where people can help.” She noted that she is particularly concerned about older people who struggle to book vaccine appointments online. Caring “doesn’t mean abstaining, per se. It means facilitating. It means enabling and helping people in your community.” This holiday season, caring could mean sitting down at a computer to make Grandma’s booster appointment, or driving her to the drugstore to get it.

    If you have lost your motivation to care about COVID, you might find it in the people you love. I didn’t feel a personal need to wear a mask at the concert I attended yesterday, but I did it because I don’t want to accidentally infect my partner’s 94-year-old grandfather when I see him next week. To have this experience of the pandemic is a privilege. Many don’t have the option to stop caring, even for a moment.

    Barring another Omicron-esque event, we thankfully won’t ever return to a moment where Americans obsess over COVID en masse. But this virus isn’t going away, so we can’t escape having a population that is split between the high-risk minority and the low-risk majority. Rethinking what it means to care allows for a more nuanced and liveable idea of what responsible behavior looks like. Right now, Nuzzo told me, the language we use to describe one’s position on COVID is “black-and-white, absolutist—you either care or you don’t.” There is space between those extremes. At least for now, it’s the only way to compromise between the world we have and the world we want.

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    Yasmin Tayag

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