Which Covid-19 restrictions really worked — and which ones really didn’t?
After a partial lockdown in the spring of 2020, Florida and Texas were among the states that most aggressively reopened their economies. Most businesses were allowed to resume operations in May or June of last year. Florida never instituted a public mask mandate; Texas was the first state to revoke its mask mandate this spring. California and New York, on the other hand, have been more cautious. They didn’t let some businesses, like movie theaters and gyms, reopen until months after their more conservative counterparts had already done so. Their state mask mandates are still at least partially in effect. And yet, looking at the case and death numbers since the coronavirus pandemic began, it’s not obvious which states were cautious and which were not. New York, the original epicenter of the outbreak, has endured the second most deaths per capita behind New Jersey (271 per 100,000). Florida and Texas, despite much criticism of their laissez-faire approaches, rank right in the middle among states (26th and 24th, respectively) in the number of deaths per 100,000 people. California fared only marginally better, sitting at 30th. After a year of debates over mask mandates, lockdowns, and school closures, that mixed evidence might suggest a certain fatalism: Did none of these state policies really matter? Or was the virus going to spread no matter what states did? Was it all for nothing? Which interventions actually work is one of the most important lessons the US could learn from the Covid-19 pandemic. There will be more outbreaks in the future and, after the current response was marked by indecision and inconsistency, this is an opportunity to separate what policies and interventions are most effective from those that are a waste of time. But it’s also a maddeningly difficult question to answer. “State policies mattered,” Jen Kates, director of global health policy at the Kaiser Family Foundation, told me. “But it is hard to know and we may never know whether policies made at the state level were able to overcome all the other challenges of this pandemic.” Once the US lost control of the virus, mitigation was the only realistic path forward; fully eradicating Covid-19 was out of the question. According to the available research and interviews with experts, one policy, the requirement to wear masks indoors, appears to have successfully slowed transmission. But others, namely school closures, don’t appear to have had nearly as much of an effect on case rates. The pandemic was constantly evolving, which adds to the difficulty in figuring out which policies worked and which didn’t. And while early on, some lockdown measures — especially stay-at-home orders and closing restaurants and bars — seemed to limit Covid-19’s spread, they may have become less effective over time, in part because states abandoned them and in part because Americans’ behavior had become more politically polarized and some people stopped following those rules. For all of these reasons and more — the unpredictable nature of the virus’s spread, the structural differences between states, and the American tradition of federalism that delegated most policy decisions to state governments — the nation’s response was a policy morass. Still, the variation has one potential upside: With the benefit of hindsight, experts told me we can begin to deduce whether certain interventions were more effective than others. It’s a start. It’s hard to figure out how effective social distancing policies actually were If you look at a list of states by their number of Covid-19 deaths per capita, it’s hard to discern much of a pattern. States in the Northeast, where the virus first arrived and where states were most aggressive in restricting people’s activities, rank at the top: New Jersey, New York, Massachusetts, and Rhode Island go first, second, third, and fourth. But after that, the picture becomes more confused: Mississippi, Arizona, Alabama, and South Dakota — where the virus didn’t land until later and which were some of the most relaxed states in their policy responses — are also in the top 10. The coronavirus arrived in different places at different times. The first wave of cases in New York peaked in mid-April. California and Florida didn’t see their first peak until the back half of July. States also have immutable characteristics — climate, population density, population health, and so on — that affected their experiences during the pandemic. “A surface-level analysis of Covid-19 outcomes and state-level policies misses many other factors that differed across boundaries and over time that also had an influence,” Joshua Michaud, associate director of global health policy at the Kaiser Family Foundation, said. “It’s so hard to disentangle effects. We’re often left trying to draw firm conclusions about whether certain policies worked or not from data that can’t tell us that.” The different timelines are one of the biggest reasons it’s hard to decipher which policies were effective. Most of the country locked down in March and April 2020; 40 states issued stay-at-home orders in those first two months. But while Covid-19 was raging in New York at the time, it had hardly touched the Midwest or the South. That gave those regions a false sense of security. Many states lifted their stay-at-home orders and other business restrictions starting in April, before their own outbreaks really got going — and some of them never reestablished those policies once cases did take off.
