Perhaps no states represent the red-blue divide better than deeply Democratic California and New York and Republican-run Texas and Florida. And their approaches to fighting the COVID-19 pandemic, from mask rules to shutdowns to online schools, have been quite different, with the Golden and Empire states more aggressive with public health mandates while the Sunshine and Lone Star states have been out front on reopening.
But there is one thing they now share: COVID-19 case rates have been falling in all four of the country’s largest states, particularly over the last month, according to data from the U.S. Centers for Disease Control and Prevention. And experts say their similar fates can’t simply be explained by the success of vaccines.
“Certainly it shows that vaccinating people helps cut down on transmission, and that’s great,” said Catherine Troisi, a professor of community health and epidemiology at the University of Texas Health Science Center at Houston. “But we haven’t vaccinated everybody, we haven’t gotten to herd immunity. It’s probably not the whole answer.”
The answer to what’s driving down infection rates in states that define the country’s stark divide is more than a quest for political bragging rights. It can help identify sound strategies for the next public health crisis.
Dr. George Rutherford, an epidemiologist at UC San Francisco, said declining case rates reflect a number of things — how much virus is currently circulating; how much disease there has been in the community, allowing resistance to build as more people recover from infection; vaccination rates; and virus variants.
He noted that Florida, which has the highest case rate among the four big states, is only just recovering after a March surge that peaked in mid-April. But he remains a bit puzzled why Texas has followed a similar downward trajectory as California, though its rate of new infections is still higher than the Golden State.
“Texas for some reason has skated,” Rutherford said.
Here’s how the four big states compared:
- Infection rates: Like the rest of the country, the four big states all suffered a deadly surge in cases over the winter, but California was the hardest hit. The seven-day moving average number of cases per 100,000 people shot up in January to 114 in California, according to the CDC. It reached 95 in New York, 82 in Florida and 79 in Texas. But California also saw the sharpest drop in cases and currently boasts the lowest rate, a mere 1.3. The rate now sits at 6.5 in Texas, 9.5 in New York and 13.8 in Florida, all of which saw smaller spikes this year as case rates fell.
- Vaccinations: California also has the highest vaccination rate among the big states, according to the CDC, with 54% of its total population having received at least one shot compared with 53% in New York, 47% in Florida and 42% in Texas.
- Mask mandates: California in June 2020 required face masks for everyone down to age 2 in most settings outside the home, easing the rule earlier this month to let the fully vaccinated forgo face coverings outdoors except in crowds. The state put off until June 15 new CDC guidance that the vaccinated may go maskless except in a few indoor settings like public transit. New York replaced its 13-month mask mandate similar to California’s on Wednesday with the new CDC guidance. Texas ended its 8-month mask requirement March 10 and as of Friday will fine local agencies that attempt to impose them. Florida has never had a state mask requirement, and on May 3 suspended all local COVID restrictions and mask requirements statewide.
- Reopening: California is putting off a broad removal of business capacity limits and most other elements of the state’s color-coded tiered restrictions until June 15, when it also will loosen mask rules. New York took a similar step Wednesday. Texas lifted its business capacity restrictions March 10. Florida lifted all local COVID-19 restrictions May 3.
- Schools: Schools around the country closed as COVID-19 swept the country in the spring of 2020, but they haven’t been found to drive community infections and many resumed a partial or full return of kids to classrooms last fall. California has been among the slowest to fully reopen schools, with less than one in four districts operating fully in-person rather than partly or fully remote. About one in four New York districts are fully in person and 78 percent of Texas districts, while all Florida schools are fully open.
What to make of all that? Rutherford said widespread infection in Southern California, the epicenter of the state’s winter case surge, may have left so many immune as they began to recover from the virus that it slowed the virus’s spread. Immunity after infection could also have factored into slowing the spread in other states as well.
The sharp drop in infection rates began well before vaccines became widely available, and Troisi said current vaccination rates aren’t high enough to stop the virus from spreading, noting that children under 12 remain ineligible for vaccines.
Rutherford said that’s one reason he supports Gov. Gavin Newsom’s plan to delay a loosening of mask rules for the vaccinated until mid-June, as it will allow time for more people to get the shots. It’s unclear what percentage of the population needs to be immunized to stop the virus from spreading — so-called “herd immunity” which could require 70-80% to be vaccinated. But the more people who get the shots, the closer it gets.
“That will push us quite a ways closer to herd immunity,” Rutherford said. “These are uncharted waters.”
Experts like Troisi remain puzzled at the similar case trajectories in the large states despite vastly different rules. But she noted that people in all states don’t necessarily take their cues from the state capital. When Texas lifted its mask mandate in March, she said, “I predicted cases would go up.”
“We didn’t see that,” Troisi said. “But even when masks are not required, a certain segment of the population is going to continue wearing them.”
She said when she went to work out at the gym after the latest CDC easing of mask rules, and “it seemed to me the same number of people were wearing them.” But she added, “it’s hard to see” from the data “how much that’s stopping transmission.”
She also noted that cellphone geolocation data show people are spending more time outdoors, where transmission of the virus is rare, which may also factor into the falling case rates. She noted that experts remain puzzled why the deadly 1918 “Spanish Flu” pandemic ended abruptly a year later when there weren’t any vaccines.
“This is a new virus,” Troisi said. “This virus has surprised us. Bottom line, I’m not sure we entirely know what’s happening.”
