Preface.  This is a book review of “Pandemic Politics” about the myriad ways Trump mishandled the covid-19 pandemic. With the 2024 election coming up, it is a good time to remember how spectacularly Trump failed in managing covid-19.

In 2016 Trump said “I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn’t lose any voters, OK?”   He was far too modest, he killed hundreds of thousands of Americans and lost few supporters.

About 40% of US COVID-19 deaths “could have been averted,” a new analysis of President Donald Trump’s public-health policies found.  The report, published by the Lancet Commission, excoriated Trump’s handling of the pandemic and general approach to public health. “He expedited the spread of COVID-19 in the US,” the authors wrote. “Many of the cases and deaths were avoidable,” they said, adding that “instead of galvanizing the US populace to fight the pandemic, President Trump publicly dismissed its threat (despite privately acknowledging it), discouraged action as infection spread, and eschewed international cooperation.”

One reason I read the book was to find out how many more Republicans than Democrats died because they didn’t get vaccinated, wear masks, socially distance and so on.  I can only find one study on excess Republican deaths that has been done.

Wallace J et al (July 24, 2023) Excess Death Rates for Republican and Democratic Registered Voters in Florida and Ohio During the COVID-19 Pandemic. JAMA intern Med. doi:10.1001/jamainternmed.2023.1154

The excess death rate among Republican voters before vaccinations were available was 15% higher than for Democrats (from not masking, social distancing, etc). But after vaccines were available in May 1, 2021, their death rate was 43% higher than the excess death rate among Democratic voters.

Moriaba A (April 2023) Republicans die more from Covid-19: why we care. American Public Health Association.

If 234,000 deaths from COVID-19 could have been prevented with a primary series of vaccinations (https://bit.ly/3XrFXfz) between June 2021 and March 2022, I estimate that 140 400 of these deaths would have been among Republicans.

“Texas Data Shows Unvaccinated People 20 times More Likely to Die From COVID-19” (https://bit.ly/3H0ACog). The Republicans die at higher rates than Democrats mostly in counties with low vaccination rates.

My comment about above studies: If this is true of all Americans, not just in Florida and Ohio, then roughly 43% more Republicans died from covid-19 after April 19, 2021 when vaccinations were available to all USA residents 16 or over than Democrats.  Since April 24, 2021, 600,000 people died of covid-19. That’s a lot of Republicans dying needlessly, yet voters are still die-hards for Trump (literally…)

I was disappointed that this book compared FOX, OANN, Breitbart, and Newsmax to MSNBC, CNN and mainstream media. There is no comparison!  The news Republicans watch makes stuff up, ignores unpleasant news, riles up hatred, spreads false rumors and more. I understand why the authors bent over backwards to not appear partisan, but this lessened the credibility of the book for me.

As a science writer, I was also disappointed that a lack of scientific literacy probably played as big a role as partisanship but that was never mentioned.  According to a study in Nature Magazine, scientists donate 90% of their money to democrats (Kaurov 2022 Trends in American scientists’ political donations and implications for trust in science) because the Republican party has explicitly turned away from science, especially in public health, environmental science, climate change, covid-19, and so on.  Secondly, the Republican party attacks scientists as being politically radical blinkered denizens of a leftwing Ivory Tower to undermine findings in science they don’t like that might lead to more regulations. This article, and Chris Mooney’s book “The Republican Brain. The Science of Why They Deny Science—and Reality” finds that Republicans by definition are set in their ways and unlikely to change their views, which makes getting a degree or having a career in science difficult if not impossible. If scientists are more liberal that is no doubt due to liberals scoring higher on tolerance of ambiguity, integrating complexity, and open-minded thinking (changing one’s mind in response to new evidence), all of which are needed to get a degree in science.

And also that religion was not brought up, specifically how the majority of republicans are evangelists, fundamentalists, and pentecostals who believe in the Bible, literally. Surely that predisposes them to be gullible and easily misled.

However, the book did state that the more education the more likely a person was to get vaccinated, wear a mask, socially distance and other behavior that helped keep themselves and everyone else safer from covid-19.

What follows are some of my Kindle notes.

Alice Friedemann  www.energyskeptic.com  Author of Life After Fossil Fuels: A Reality Check on Alternative Energy; When Trucks Stop Running: Energy and the Future of Transportation”, Barriers to Making Algal Biofuels, & “Crunch! Whole Grain Artisan Chips and Crackers”.  Women in ecology  Podcasts: WGBH, Financial Sense, Jore, Planet: Critical, Crazy Town, Collapse Chronicles, Derrick Jensen, Practical Prepping, Kunstler 253 &278, Peak Prosperity,  Index of best energyskeptic posts

***

Gadarian SK et al (2022) The Deadly Toll of Partisanship in the Age of COVID

THE MANY WAYS TRUMP MISMANAGED THE CRISIS AND KILLED HUNDREDS OF THOUSANDS OF PEOPLE (ESPECIALLY REPUBLICANS)

By December 2021 when 800,000 Americans had died from COVID-19, a staggering 200,000 had been lost after vaccines were available. This magnitude of preventable death is hard to fathom.  The CDC reported that in September 2021, the risk of dying from COVID-19 was fourteen times higher for unvaccinated Americans than for fully vaccinated Americans.

We believe that a committed federal government response led by the Trump administration could have produced a different outcome. Democrats wanted to support a strong pandemic response, and Republicans wanted to support their president. Bipartisan approaches could have increased national unity by truly encouraging Americans to pull together and rally around the flag, much like what has happened in national emergencies and crises of the past.

We are arguing in this book that Trumps leadership style, based on charismatic authority and patronage, and his pursuit of political priorities that projected an image of economic and political strength rather than problem solving and good governance played a major role in the excess deaths from covid-19. President Trump was obsessed with projecting strength to ensure his own reelection, gutting bureaucracies tasked with coordinating emergency responses, refusing to take responsibility for managing the crisis, and nurturing a cult of personality that revolved around his unchallenged authority.

As an extension of this charismatic authority and as a means to consolidate and protect his power while in office, Trump cultivated a menagerie of trusted advisers based on loyalty rather than performance, expertise, or skill. He embraced patronage and favoritism to donors, family members, and business associates at a level that was unprecedented in modern American history.

From Louis DeJoy (Republican donor) as postmaster general to Ben Carson (a neurosurgeon) as secretary of housing and urban development, key executive branch appointments were held by partisan loyalists who had no substantive expertise or governing experience. Trump’s closest and most trusted advisers were his own family members. His administration conceived of public policy and federal programs in clientelist terms, to be awarded to supporters and withheld from opponents rather than to be administered using neutral and objective criteria. In practice, this meant that very senior positions—positions that would be critical in pandemic policy design and emergency response—were held by individuals who were loyal to the president but lacked critical experience or were uninterested in coordinating across bureaucracies, working with states, identifying appropriate contractors to obtain vital supplies, and the myriad other tasks a government faces in an emergency.

Alongside his disregard of expertise, Trump hollowed out the federal bureaucracy. Several important positions in the federal government were held by acting directors, reflecting Trump’s disdain for the Senate approval process as well as his belief that acting directors would be easier for him to control.

Key positions in the federal bureaucracy—those most necessary for an effective public health response—were either vacant or filled by temporary appointees.

A study by the Brookings Institute counted an astonishing number of vacant positions across key cabinet-level departments: 44 percent vacancies in Senate-confirmed positions in the Department of Education, 17% in Health and Human Services, and 65% in Homeland Security. In July 2019, the Centers for Disease Control and Prevention’s epidemiologist embedded in China’s disease control agency left the position. Instead of appointing a replacement, the Trump administration eliminated the role, leaving no American in China to monitor the public health situation when the pandemic broke out in January 2020.

How did it come to be that states were in bidding wars against one another and fighting with the federal government to obtain desperately needed health supplies? The answer is not surprising, but it is unsettling. As a former assistant secretary to the Department of Homeland Security observed, “For decades, we have worked disasters the same way. The locals execute, the states coordinate and the feds support.… The federal government under Donald Trump has decided it is going to essentially go to war, create a parallel response apparatus, and it’s winning. That’s the problem.

We know that the United States faced preexisting conditions that would make the pandemic difficult in any case. Partisan polarization, Trump’s leadership style, a crumbling health care infrastructure, and endemic economic and racial inequality would make a public health emergency such as COVID-19 challenging. But these preexisting conditions did not mean that a calamitous response was inevitable.

At the outset of the pandemic there was a window of opportunity, a moment during which effective messaging by health experts and bipartisan endorsement of an active government response could have unified the country. Americans might have united in response to the COVID-19 pandemic, as they have in many previous external crises.

On January 29, 2020, the worst-case scenario (detailed in a memo by Navarro to the president) put American deaths at half a million.

The pandemic’s earliest days were characterized by neither uniform expert-led messaging nor an effort to rally the public around a common message of shared sacrifice for the common good. Rather, the Trump administration downplayed the threat of the pandemic, adopting a divisive crisis management strategy that put polarizing figures such as the president out front. The emergency management strategy playbook was thrown out in exchange for patronage and deliberate inaction.

The administration did not just abandon its responsibility to protect the most vulnerable Americans—the sick and infirm and those living in assisted living facilities and prisons—but also abandoned all Americans while portraying the pandemic as no less than a political conspiracy against the Trump administration.

These choices led millions of Americans to understand the pandemic in partisan terms, that is, to align with what was good for their “team” rather than for the country. It was not inevitable that the COVID-19 pandemic would become a partisan issue, but the Trump administration’s choices made it so.

Behind the scenes, health officials and members of the Trump administration were receiving startling information about the unfolding pandemic and attempted to convey the seriousness of the crisis to the president. Health experts were raising the alarm on the critical need to procure surgical masks for frontline workers. The CDC began to develop a diagnostic test for COVID-19,

The intelligence community was rallying; Robert O’Brien, Trump’s fourth and final national security adviser, warned the president on January 28 that “this will be the biggest national security threat you face in your presidency.… This is going to be the roughest thing you face.

By this time, a Chinese scientist had already confirmed that the novel coronavirus could be transmitted from human to human, and the WHO had issued a global health emergency. Navarro sent a stark memo to Trump on January 29 warning of trillions in economic losses. Trump was warned about COVID-19 more than a dozen times in his President’s Daily Brief during January and February.

As a novel public health threat, it represented a blank slate about which people did not have prior convictions one way or the other. The president’s choices in this moment were critical. Multiple experts and his own advisers were urging him to act. By mid-January news organizations were covering the Wuhan lockdown and the emerging global outbreaks, but the American public heard relatively little from the president.

When we say that the pandemic was politicized, we mean specifically that a subset of American political and media elites—led by Trump—cast the COVID-19 pandemic as essentially about politics. When a president alleges that the pandemic is a conspiracy by the deep state and the establishment media to harm his reelection chances—the Democrats’ “new hoax” following the first impeachment—he is politicizing the pandemic.  It is Trump who politicized the pandemic.

To support Trump was to share his views about the pandemic. Trump turned the pandemic into a litmus test of loyalty.

As Trump was downplaying the threat in public, what was he doing in terms of policy? Trump had been briefed repeatedly by experts about the threat that COVID-19 posed but deliberately did not act on that information until January 27. On that date he assembled a coronavirus task force led by Alex Azar, secretary of housing and human services. But like many of Trump’s administrative appointments, task force members were largely appointed for loyalty, not expertise; the 12-member group included only two medical health professionals: CDC director Robert Redfield, a controversial virologist who inspired little confidence, and Dr. Anthony Fauci, a deeply respected immunologist who was little known outside of medical circles.

But February was also full of policy missteps. As health officials were begging Trump to obtain more masks and PPE, on February 7, the same day the WHO warned of a “limited stock of PPE,” Secretary of State Mike Pompeo announced that the United States was donating over seventeen tons of medical supplies to China. A day later, answering questions at the World Economic Forum, Trump stated he was aware of the first case in the United States and that he was not worried about a pandemic: “We have it totally under control.

Matt Pottinger, deputy national security adviser and former Wall Street Journal reporter in China, guided by experiences in South Korea and Japan, recommended that masks be delivered to the White House in mid-February, but senior administration officials directed staffers not to wear them.

On February 24 Trump tweeted, “The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health have been working hard and very smart. Stock Market starting to look very good to me!” This was the first time he had tweeted about the coronavirus since February 7—surprising for such a prolific tweeter.

On February 26 Trump reported that there were only 15 cases of COVID-19 in the country and that “within a couple of days [it is] going to be down to close to zero.” And Larry Kudlow, the president’s National Economic Council director, told CNBC that “we have contained this. I won’t say airtight, but it’s pretty close to airtight.

As early as February 5, Senator Chris Murphy (D-CT) tweeted, “Just left the Administration briefing on Coronavirus. Bottom line: they aren’t taking this seriously enough. Notably, no request for ANY emergency funding, which is a big mistake. Local health systems need supplies, training, screening staff etc. And they need it now.” As outbreaks emerged around the world, Trump’s silence and gaslighting conveyed a message of indifference and unseriousness.

To make matters worse, the virus was spreading without detection across the United States because there was no comprehensive program to test, trace, and isolate.

The WHO issued protocols for countries to manufacture tests for “diagnostic detection of 2019-nCOV” on January 17, building off the German model, but the United States chose to develop its own test. On February 5 the CDC began shipping its test to public health labs across the country, but within days these tests were reported to be unusable, and this would remain the case for almost a month. An investigation by Health and Human Services would later document how this catastrophic error was a product of myriad dysfunctions and system failures, including lack of leadership and coordination at the federal level.

In one instance, a CDC employee admitted that it was not “politically possible” to copy the WHO test under Trump: “Imagine the backlash we would have had if the CDC had said, ‘Hey, yeah, let’s use a German test. As state health agencies waited for the CDC to fix its faulty diagnostic tests, hospitals were not permitted to use the WHO-distributed test, and clinical and commercial labs were prohibited from developing and using their own.

By the time the Food and Drug Administration authorized the CDC test in late February and in the absence of market competitors, the limited availability of tests meant that they had to be rationed. Michael Shearer and other New York Times staff writers would refer to February as “the lost month” that made containment impossible.

An estimated 430,000 people came to the United States from China in the period after the ban was put into place. Yet, Trump repeatedly circled back to his “China travel ban” as a great achievement, boasting in a February 28 tweet that “I was busy calling early BORDER & FLIGHT closings, putting us way ahead in our battle with Coronavirus. Dems called it VERY wrong!

Rush Limbaugh stated on his radio program that “it looks like the coronavirus is being weaponized as yet another element to bring down Donald Trump. Now, I want to tell you the truth about the coronavirus.… Yeah, I’m dead right on this. The coronavirus is the common cold, folks.” A Fox News anchor claimed that the virus was another attempt to impeach Trump.

The American people were hearing from Trump and were also hearing from the media, but they were not hearing from health experts in February. This is different from other high-income countries that found that communication was a key factor in establishing early compliance and—to recall a saying of the time—to “flatten the curve.” For instance, Taiwan prioritized frequent and transparent communication with the goal of reaching as many residents as possible. To do so, Taiwan flooded information outlets with high-quality material, from YouTube and memes to broadcast media.

Trump only began to take the pandemic seriously when it was clear that it would have dire effects on the U.S. economy that would be impossible to hide.

CDC spokesperson Dr. Nancy Messonnier was the first person from within the government to make a public statement that conveyed the seriousness of COVID-19 to the American public. Her February 26 warning included recommendations for telework, closing schools, and cancellation of mass gatherings, and she concluded that “I understand this whole situation may seem overwhelming and that disruption to everyday life may be severe. But these are things that people need to start thinking about now.

Messonnier’s warning fully undercut Trump’s carefully cultivated image of strength. Her statement spooked investors, producing a 1,000-point dive in the Dow Jones Industrial Average. Messonnier was removed from her position the very next day.

Acknowledging the reality of the situation would undercut Trump’s image of confidence, contradicting his insistence that the pandemic was either a minor inconvenience or a partisan conspiracy.

Trump could have put epidemiologists on his coronavirus task force, mobilized FEMA and its procedures for disaster response, directed emergency funds to the states, and put scientists out front and supported their messages. Even an embattled president could have unified the country by endorsing the evolving science, activating existing protocols, invoking policy mechanisms to ramp up domestic production of PPE, and speaking to the American people with direct honesty. This is what a nonpoliticized response would have looked like.

And it is entirely possible for even polarizing heads of state to lead a nonpoliticized response, as illustrated by countries such as the United Kingdom, South Korea, and Taiwan that are bitterly divided over politics. in June 2020 the British public overwhelmingly agreed with the statement (89%) that “people have a civic duty to self-isolate for 14 days if they have been in contact with somebody who had been diagnosed with coronavirus.

With every day spent gaslighting Americans, telling them not to believe their own eyes and instead focus on his own successful leadership, the pandemic became worse.

Conservative media also forwarded dangerous misinformation. Fox News zealously promoted hydroxychloroquine, an unproven and potentially dangerous COVID-19 “treatment,” nearly 300 times between March 23 and April 6.  On March 21, Trump began to echo this dangerous claim on Twitter: “HYDROXYCHLOROQUINE & AZITHROMYCIN, taken together, have a real chance to be one of the biggest game changers in the history of medicine.” An OANN host even encouraged Americans to get coronavirus to build immunity.

Fox News viewers were more likely to travel, less likely to socially distance, and less likely to purchase hand sanitizer and masks. Shockingly, these same conservative media outlets were a primary “intelligence” source for Trump himself. In one example, Trump reported in an interview on Fox that he got information on ventilator needs by watching Sean Hannity. Trump even lifted footage of Hannity positively discussing Trump’s handling of the pandemic and presented it during the televised April 13 coronavirus task force briefing.

The U.S. response was not simply belated; it was also uncoordinated, chaotic, and inconsistent, a response that dangerously pitted states against the federal government—and states against each other—in bidding wars for PPE. The federal government’s own inaction explains why resources were scarce to begin with. In January and early February, the United States was still exporting PPE to China.

And as global supply chains ground to a halt, the coronavirus task force did not make the national stockpile a priority, and the president did not invoke the Defense Production Act.

Rather than using existing infrastructure to support the pandemic response, the Trump administration relied on business contacts outside of government for solutions. The administration tasked senior White House adviser and Trump son-in-law Jared Kushner to head a coronavirus supply chain task force to supply states with ventilators and PPE. Kushner’s strategy relied on private industry connections and personal relationships instead of the infrastructure at FEMA, and the task force itself was composed of inexperienced volunteers.

By all accounts—including a prominent whistleblower complaint—this federal procurement operation was a disaster. In the aftermath, Kushner sough to deflect blame. “The notion of the federal stockpile was it’s supposed to be our stockpile,” he said during one press briefing. “It’s not supposed to be states’ stockpiles that they then use.” This is quite obviously false, a display of not only shocking incompetence but also callous indifference to the welfare of hundreds of millions of Americans.

Possibly the Trump administration’s unwillingness to coordinate the states was political. The Trump administration deliberately refused to coordinate an early national response and help the states in greatest need as a way to punish Democratic-led states, states that would not help his reelection campaign (my comment: the blue states were the first to be hit by covid-19).

Trump made increasingly worrying statements that undercut pro-health messaging, including about injecting disinfectant and “hit[ting] the body with a tremendous, whether it’s ultraviolet or just very powerful light” (April 23); “that testing is, frankly, overrated” (May 14);104 and that he was taking a preventative treatment not authorized by the Food and Drug Administration (“I’m taking it—hydroxychloroquine”).

During the 2020 campaign, for example, Trump consistently ridiculed candidate Joe Biden, who exercised safety precautions in his presidential campaign including consistently wearing a mask. The Trump campaign also openly flouted prohealth measures during campaign events.

If the threat is external, such as a terrorist attack, or if a leader is successful in framing the threat as external—as Trump attempted to do by consistently bringing up China and using a series of pejorative, racialized epithets to describe the virus—incumbent leaders can sometimes deflect blame.

Republicans declined to blame Trump for mishandling the pandemic, which led them to believe that the pandemic was not as serious in the first place, further hardening their belief that Trump was not to blame in the first place.

without a common belief about what constitutes good policy making or what sorts of behaviors are deserving of sanction, bipartisan responses to policies—good or bad—are impossible. Without bipartisan consensus on at least some policies, it is hard to see how democratic policies could produce political accountability. Partisan politicians, knowing this, have little reason not to play to their base whenever possible.

Majorities gave some or a great deal of credit to state actors—governors and health departments—for their performance. And large majorities also answered that doctors, essential workers, and Dr. Fauci deserve a “great deal” of credit. (Fauci, an early hero of the U.S. pandemic response, would later become a central villain among conservative media and the political right. Tucker Carlson on Fox News would refer to him as “the guy who created Covid,” among other pejoratives. Florida governor Ron DeSantis would sell merchandise that said “Don’t Fauci My Florida.” Trump attempted to fire Fauci numerous times, retweeting a message as early as April 13 that ended with “Time to #FireFauci.” And by the winter of 2021 several Republican members of the House and Senate would call for Fauci to be jailed.)

From Minnesota to Utah and California to Michigan, Trump lambasted Democratic governors for their strong measures to control the spread of the virus

SUMMARY

Trump’s choices were puzzlingly short-sighted. The opportunity was there to frame COVID as a war, which would buoy support in an election year. As a wartime president, Trump could have led a bipartisan effort as commander in chief to mitigate the virus. Instead of developing a “plan of attack,” he pivoted to reopening the American economy. He chose the enemy to be economic malaise or political opponents, not the virus.

It is hard to imagine any other 2016 presidential candidate such as Hillary Clinton or Jeb Bush publicly contradicting infectious disease specialists the way Trump did. By publicly undercutting experts on live television, Trump left Americans uncertain about what to think, making them susceptible to misinformation and other politically self-serving influences

Republicans could have pulled on the thread of Trumpian authoritarianism to compel obedience and discipline, in which loyal party members follow a strong president’s dictates on combating COVID-19.

Republicans could have claimed vaccines as a signature Republican victory in the fight against COVID-19. Operation Warp Speed might have been portrayed as an early Trump achievement that directed billions of dollars toward supporting American innovation. Vaccines could have been touted as the Republican key to unlocking economic recovery. And that the United States received among the world’s first doses could have been touted as a savvy bit of negotiating by America’s entrepreneur in chief. Imagine if Trump had gone on television in February 2021 to urge Americans to get the “Trump Vaccine, available at no cost to you, but only while supplies last.

Even though Trump was vaccinated back in January 2021, he chose not to do it publicly.

He chose personal, petty grievances over what was best for not just Americans’ health but also his own party. Perhaps the Republican Party could have kept the Senate—maybe kept Trump in the presidency—on the backbone of public health achievements. The COVID States Project estimates that Republican governors lost an average of 22 points on their approval ratings from 2020 to 2021 due to their handling of the pandemic, whereas Democratic governors lost an average of 14 points.

The fact that the pandemic hit blue states first—states that would not be part of his reelection strategy—probably explains why Trump was so uninterested in developing a national testing plan in coordination with the federal government that could have allowed a safer reopening of the economy.

A perverse epilogue to this strategy is that Trump has never been penalized by this voter base, not even for ignoring and abandoning his fellow Republicans.

By early 2020, much of the federal bureaucracy in the United States was understaffed and underresourced. Many agencies did not have a Senate-confirmed permanent director and lacked the ability to respond effectively to the complex needs of the pandemic. Trump was actively hostile to certain federal agencies, referring to civil servants as members of a “deep state” intent on harming his presidency. Investigations from the House Select Subcommittee on the Coronavirus Crisis later revealed that not only were federal agencies unprepared for a quick response to the pandemic due to their internal issues such as staffing and morale, but there was also political interference in addition to pressure from the White House on issues of science and health.

Scientific agencies such as the CDC are supposed to function independently from the partisan branches of government. Yet interviews with agency leaders and reviews of memos, emails, and documents have shown that political appointees tried to change or affect the CDC’s guidance and weekly scientific reports about the prevalence of COVID-19 and mitigation policies. Dr. Christine Casey, editor of the CDC’s Morbidity and Mortality Weekly Report, describes an email that she received from an adviser to the Department of Health and Human Services and a Trump political appointee that she interpreted as a request to stop a scientific report because it harmed the president. She was later instructed to delete the email.

As of December 2021, the pandemic had taken more than 800,000 American lives. This is more than any other country in the world. The United States is the richest and most powerful country on Earth, with all the science and technology and best minds at our disposal. The U.S. government put billions of dollars into research and development to fast-track a vaccine, and what did we do with it? You can fund the best science in the world, but if you can’t convince a critical mass of the community to wear a mask, to take a vaccine, or to endure small sacrifices for their fellow community members, then the best science will not defeat COVID-19.

The death toll from COVID-19 has exceeded that of the average flu season 26 times over. COVID-19 has killed more Americans than, as singular events, the 1918 influenza pandemic, the American Civil War, World War I, the Japanese attack on Pearl Harbor, World War II, and the 9/11 attacks. In fact, more Americans died from COVID-19 the week before Thanksgiving 2021 than on 9/11 and Pearl Harbor combined.

People more at risk for effects of the disease are more likely to get vaccinated regardless of their partisanship: as of December 2021, 99% of people aged 65 and above had at least one dose of a COVID vaccine.

By the close of January 2022, 75% of Americans were vaccinated with at least one dose (64% fully vaccinated). But even though this was sufficient to protect many against serious infection and hospitalization, it was not enough to establish herd immunity to protect the unvaccinated. The vast majority of the deaths wrought by omicron were avoidable.

Since the delta variant wave (July 2021), President Joe Biden had been referring to the COVID-19 pandemic as the “pandemic of the unvaccinated.” With every week, the correlation between COVID-related deaths and Trump support increased.  In October 2022, the Kaiser Family Foundation found that 60% of unvaccinated people identified as Republican (compared to 17% Democrats).

The CDC shows 1,172,229 Deaths from Covid-19 in the United States so far (Worldometer 1,193,867). About 2,000 people a week are dying in 2024, at that rate 104,000 in 2024. Today in 2024, about 2000 people a week are dying of covid-19, so perhaps 104,000 will die over 2024, as many as gun and vehicle deaths combined. 2021: 49,000 gun deaths and 43,000 vehicle deaths.

TRUMP AS SUPERSPREADER

Trump’s Tulsa rally was a spectacle designed to project strength and “business as usual,” confidently flouting public health recommendations and the commonsense precautions adopted by hundreds of millions of Americans during the pandemic. Biden eventually resumed campaigning but only in socially distanced parking lot events, while Trump kept up his in-person rallies, oftentimes held indoors. Republicans even tried to hold a traditional in-person national convention in Charlotte, North Carolina, but were forced to scale back to a hybrid format when the state government refused to allow the event to proceed at full capacity and without face masks.

Tulsa and over a dozen similar campaign events held after would come to be described as “superspreader” events. Eight Trump campaign staffers tested positive for COVID after the rally, and Tulsa health officials noted the rally “likely contributed” to a surge in new COVID cases. One study estimated the collateral effect of these Trump superspreader events: nearly 30,000 confirmed COVID-19 cases, likely leading to more than 700 deaths. Trump himself even became a vector.

Trump tested positive for COVID-19 on September 26, 2020. He then kept up an active campaign schedule for almost a week, knowingly exposing more than 500 people—from fundraisers to staff to Gold Star families to Democratic candidate Biden at the presidential debate in Cleveland, Ohio—before being hospitalized at Walter Reed National Medical Center on October 2. Trump received cutting-edge experimental treatment and walked out of the hospital three days later. Upon returning to the White House, he was photographed immediately removing his mask with a still-active case of COVID-19 in the presence of White House staff. He tweeted “Don’t be afraid of Covid … Don’t let it dominate your life … I feel better than I did 20 years ago!” The same could not be said for the more than 210,000 Americans who had died by that point.

By the end of April 2020, the death toll surpassed the number of U.S. military personnel who died during the Vietnam War. By December 2020, at around 3,000 deaths per day, each day was a 9/11.

In the first week of March 2020, Trump continued to project optimism without honesty. On March 2, the eve of Super Tuesday, he held a rally in Charlotte, North Carolina. When asked about the health implications of a large gathering, Trump asserted, “I think it’s very safe.

And the very next day Trump stated that “a lot of people will have this and it’s very mild.” He also said in an interview on Fox News that he thought the death rate reported by the WHO was “really a false number.

Messaging came from the top. Trump frequently flouted mask practices and held dozens of rallies and events characterized by hundreds of maskless participants. He was first seen wearing a mask only on May 21 while touring a factory in Ypsilanti, Michigan, where ventilators, masks, and other medical supplies are made.

As Democratic presidential nominees Biden and Bernie Sanders moved their campaigns online, Trump continued to hold in-person rallies, some of which proved to be COVID-19 superspreader events. Republican opposition to canceling or adapting events reflected Trump’s eagerness, shared by the Republican Party leadership, to project confidence and get the economy going again.

TRUMP DIDN’T HAVE TO MAKE COVID-19 A PARTISAN ISSUE

Democrats and Republicans were both as likely to get a flu vaccine before the pandemic.

Deep partisan differences over health behavior and attitudes were inevitable. As we show in the following chapters, there were Democrats willing to support strong border controls (an immigration position typically held by Republicans) and Republicans willing to support strong measures for COVID economic relief (a welfare position typically held by Democrats). And there is nothing inherently partisan about protective measures; for example, one can imagine a scenario where Republicans strongly endorse mask mandates if it means getting the country back to business.

Even as Trump was posturing as a “wartime president” by finally taking the pandemic seriously, he—like the conservative media—continued to liken it to “seasonal flu.” But of course, COVID-19 was not like the seasonal flu, and evidence from other countries easily foretold what would happen next.

On the local news Americans were seeing hospitals inundated with patients. Workplaces were shuttering on the heels of governors’ orders. Preschools were closing. The everyday experience of most Americans stood in sharp contrast to the Trump administration’s messaging.

By mid-March, it was already too late to stop the partisan politics of COVID-19 in the United States. In a March survey from the Pew Research Center, 79 percent of respondents who primarily watched Fox News as their main source of political news said that the news media had “greatly” or “slightly” exaggerated the risk from coronavirus. This compares to 54% who watched CNN and 35% who watched MSNBC. Trump’s early strategy of denying the pandemic’s severity and then blaming Democrats had become the dominant political narrative. Most Republican governors followed in lockstep Trump’s tone and leadership. Eight governors—all Republican—decided against issuing statewide stay-at-home orders altogether. One explanation for this policy choice was that there was no nationwide order from the CDC, which Trump was always reluctant to issue.  Framing the pandemic as a choice between government mandates and personal freedom would become a consistent theme in subsequent months.

We know that at the outset, conservative media alleged that the COVID-19 pandemic was not as bad as the numbers made it seem to be and openly stated that information about the pandemic was being manipulated in order to harm Trump’s reelection chances. They even forwarded a narrative that the emerging pandemic was the Democrats’ fault. Breitbart, for example, pushed the line that Democrats had ignored the pandemic in their drive to impeach Trump.

COVID-19 was particularly novel as a public health emergency. Health is not an inherently polarizing issue—everyone wants to be healthy and for their families to be safe. Diseases such as Alzheimer’s, opioid addiction, and cancer do not differentiate between Americans based on their sport allegiances, musical tastes, or partisan preferences. When polio was paralyzing and killing children in the United States, Americans across the political spectrum sent three million dimes to the White House and helped fund a polio vaccine. And during a public health crisis such as a pandemic, we might expect our differences to fall away as people seek out information about what is happening and how to be safe. In the case of COVID-19, that did not happen.

The pandemic in the United States was always going to be bad. We can think of the United States as a medical patient with a set of preexisting conditions that make them susceptible to illness. One preexisting condition was a decaying health care system in which insurance company interests played an outsized role in costs and coverage. A second preexisting condition was deep social, economic, and racial divisions that, combined with unequal access to health care, perpetuated structural inequality.

When people are concerned about health crises, they usually trust medical experts more than political leaders and want to hear from them. These early days were the window of opportunity during which political leaders faced a choice: they could put experts out front and center and assemble a united, bipartisan strategy to combat the virus, or they could choose to exploit partisanship, activating political divisions to further their individual and partisan goals. The Trump administration chose partisanship.

What does it mean to “choose partisanship?” America’s national leaders chose to preserve a strong economy in an election year, chose an image of strength over the potentially worrisome look of mobilizing resources early, and chose not to encourage deference to trusted public health leaders. Instead, the president and conservative media publicly and repeatedly disagreed with public health experts about how serious the coronavirus pandemic was and what types of policies could effectively manage it.30 The active undermining of experts began with the president, seeped into agencies over which he had significant influence such as the Centers for Disease Control and Prevention, was amplified by conservative media outlets, and trickled down to state governors and mayors. And most of all, it influenced the behavior of the millions of Americans who looked to him for leadership. Americans listened to the leaders of their parties

In all, we surveyed ordinary Americans six times, from March 2020 (as states started to lock down, with schools moving to virtual formats and mass cancellation of events) to March/April 2021 (after the inauguration of President Joe Biden and alongside a mass rollout of COVID vaccines). unlike standard election polls, our surveys follow the same individuals over time.

Every country in the world faced the challenges of managing an unprecedented public health emergency, but almost no advanced democracy responded as inefficiently and ineffectively as did the United States.

Polarization shields politicians from facing the consequences of their choices. Without polarization, an erratic president buoyed by charismatic political authority would be subject to greater discipline from within his own party, and bipartisan efforts to hold him accountable for his actions would have been easier to sustain. partisan polarization at the level of party elites means that leaders are focused more on attacking their opponents and signaling their partisan loyalty than on making good policy or looking for bipartisan solutions to common problems. This extends to the wider population as well, as Americans have become increasingly polarized socially.

Trump’s vanity was both the source of his braggadocious leadership style and the tool by which he identified trustworthy advisers, who tended to be longtime friends, family members, or business associates.

In times of crisis, however defined, individuals even value “strong leadership more highly than partisan affiliation, making some politicians seem more charismatic than they otherwise would.” In his 2016 speech accepting the Republican Party nomination for president, Trump outlined an America in the midst of chaos and violence. He argued his case for presidency by saying that he was singularly fit to repair the damage, stating “I alone can fix it.” This personalization of politics presaged how he would govern during the later public health crisis—through a fixation on his own electoral prospects

Trump was never penalized by his supporters for the excesses of his leadership style or his failures of governance. Given how wealthy the United States is as a country, its health care outcomes are abysmal.

HOW OTHER COUNTRIES HANDLED COVID-19

Some countries—particularly those in Asia—had recent experience with pandemics such as SARS, Middle East respiratory syndrome (MERS), bird flu, and swine flu. For instance, South Korea authorities, having learned lessons from handling MERS,18 were prepared with a test for COVID before the first domestic case was diagnosed. Their government also performed comprehensive testing and contact tracing with a MERS protocol already in place. And they had an infrastructure for central government purchasing of PPE already in place. Their curve would peak by the end of February, before the United States had even put mass testing in place.

Germany, however, despite the sizable challenges of a federal system, entered the pandemic with its detailed National Pandemic Plan, released on January 16, involving early mobilization and coordination between local health authorities and the Robert Koch Institute (Germany’s public health agency). Hospitals shared data with a federal website to map out their supply chain needs, and extra intensive care facilities were built just in case. One of the first diagnostic tests for COVID-19 was also developed in Germany before its first case of COVID was diagnosed on January 27.  And because the German health care system is decentralized and consumer-oriented, coupled with a robust sector of private laboratories, testing could scale up quickly across the country.

The United Kingdom was considerably less prepared than Germany and, perhaps, a closer comparison to the United States at the time. The United Kingdom had its first confirmed cases by the end of January just as Brexit, its deeply polarizing exit from the European Union, was being finalized. And like the United States, the government of Boris Johnson was slow to respond

Numerous clusters emerged as a result, overwhelming contact tracing measures and necessitating a legally enforced national lockdown starting March 23. Yet this was not the most negligent case. Sweden, which chose a controversial no-lockdown model, relied on social trust and voluntary compliance to pro–social health behaviors rather than control measures.

One study found that “UK mortality would have approximately doubled had Swedish policy been adopted, while Swedish mortality would have more than halved” if Sweden had adopted British strategies.

While the European Union states largely maintain robust health care and employment retention schemes, the United States instead relied on stimulus checks and compensation. In the United States, almost forty million Americans filed for unemployment by May 2020,99 and only a third of Americans ended up back in their old job after six months.

Without a comprehensive social safety net such as robust unemployment protections, many Americans found themselves behind on bills, unable to buy food, and evicted if their work hours were cut or their place of employment shut down.

Some argue that Republicans’ rejection of mask wearing was driven by their focus on freedom and rugged individualism (as in frontier culture) or toxic masculinity. But at the same time, anti-mask behavior dotted the globe from Brazil to Germany to Indonesia

There were stark differences in mask compliance just within Europe. By the end of June, acceptance in Spain was around 92% and in Italy at 81%, and even in France, where a bus driver was murdered for enforcing a mask policy, compliance was as high as 73%. By contrast, only 52% of Britons reported wearing a face mask “frequently” or “always,” and a staggering 83% of Swedes and 85% of Finns reported never wearing a mask.

Beyond Europe, mask compliance in Hong Kong was as high as 97% and as low as 20% in Australia. Canada also exhibited high overall compliance.

Unlike European models, the Food and Drug Administration (FDA) only ever approved two companies to manufacture at-home tests, which necessarily constrained supply and drove up prices.

State level management, employment, bad Republican behavior

Some states formed alliances, such as California, Oregon and Washington’s Western States Pact, to cut down on bidding wars and improve allocation. And in several instances, notably California, the federal government would only assist in supplying the state with (in this case) cotton swabs if Governor Gavin Newsom asked Trump personally and thanked him publicly.

Republican governors as well as governors from states with more Trump supporters were either resistant to adopting or slower to adopt stay-at-home policies such as social distancing. There were some notable exceptions: DeWine, Baker, Hogan, and Vermont governor Phil Scott—all Republicans—were early adopters of social distancing guidelines in their states.

Democratic-led states not only implemented stay-at-home orders early—states such as California, Illinois, and New Jersey were among the first but also among the hardest hit—but were also among the last in lifting shutdown orders.

Trump remarked at an April 23 press briefing that he had “no problem with face masks, if the governors want to do that.” Meanwhile, most Americans were not protesting. Most Americans were at home. By the end of 2020, the American economy had lost nine million jobs, with losses concentrated in leisure and hospitality sectors as well as bars and restaurants and other low-paying industries. This is over three times as many jobs lost in the United States as in the European Union (a community of twenty-seven member states and a combined population of nearly five hundred million people).

Not only could essential workers not work from home, taking precautionary measures to protect themselves and their families, but they also couldn’t supervise at-home learning. The early days of the pandemic created a sharp difference in experiences based on income, occupation, and race. Endemic inequality meant that some Americans could withstand the shock of a job loss or a pay cut with little trouble. Those with means not only have access to better health care services but are also more likely to be able to work from home—and thus enjoy more job security—and avoid contact with others, all essential practices for containing community spread of the virus. Meanwhile, many American workers faced a difficult trade-off between caring for themselves and their families and keeping their jobs and paychecks.

to encourage mask use and overcome supply chain issues, the United States Post Office and the Department of Health and Human Services drafted plans to send 650 million reusable face masks, or 5 masks per household, to every person in the country, but this plan was canceled by the White House to avoid “concern or panic.

Without social solidarity and political trust, it is hard to demand sacrifices of a country’s citizens.

Social determinants of health such as income, age, housing, and access to insurance all made following directives easier for those with more resources. The advantage for those with more resources was compounded, since people with higher incomes also tend to have fewer underlying health conditions and work in less public-facing jobs.

An employment-based health care system meant that many people who found themselves unemployed were also suddenly uninsured and might not seek medical care even if they felt sick. People of color are more likely than white Americans to live in denser neighborhoods and in multigenerational housing, making social distancing more difficult.

Democrats would follow Democratic leadership to express more concern and be stricter in following the rules, while Republicans would take Republican cues and be less worried and less likely to report following CDC recommendations. those with the means to adapt to the pandemic would be more likely to do so than those with more limited means. And that is what we found: those who reported the highest levels of income were most likely to report nearly every behavior, with decreasing levels of compliance for people with lower household incomes.

Clearly, education matters in explaining COVID-19 behaviors: those with higher education are more likely to report adopting nearly every behavior that we asked them.

And other studies find similar gendered patterns in COVID-19 compliance, where women take COVID more seriously than men by supporting restrictive policy measures and are overall more compliant with pro–social health behavior. One study attributes this asymmetry to women being more likely to listen to medical experts and follow other countries’ experiences.18 In the same study, women also attribute their behaviors to feeling anxious and feeling responsibility for themselves and others. This evidence suggests that women feel more attuned to the implications of the pandemic for their families, and respond by exhibiting protective behaviors.

research shows that as the pandemic progressed, African American men were least likely to know how COVID spread and less likely to be familiar with symptoms and left the house more.

There were consistent political differences in Americans’ early behavioral responses to COVID-19, with a roughly 10 percentage point difference on average between Democrats and Republicans. We see a nearly 20 percentage point difference between Republicans and Democrats in seeking information about COVID-19. In short, by March 23, Americans were already living in different worlds when it comes to COVID-19. These worlds were defined by politics.

Community spread cannot be stopped if four out of ten Republicans keep meeting with people outside their households. It also would mean that more convincing and pro-health messaging would need to take place in these communities, not less.

partisanship was the best predictor of COVID-19 health behavior of all the factors that we measured.

Many Americans became less willing to adapt with the pro–social health behaviors that were necessary to manage the pandemic. Worryingly, the pandemic itself began to shift from urban to rural outbreaks, especially in counties that went for Trump in the 2016 election.

starting in wave 3 (June 6–26), the trend line diverged. About the same proportion of Democrats reported avoiding gatherings, but the proportions of Republicans and Others dropped noticeably.

Those who watch right-wing news tend to report fewer pro–social health behaviors than those who do not.

There is no better issue to illustrate the early and enduring partisan differences in pro–social health behavior than the politicization of wearing face masks. Like social distancing, it is one of the more public behaviors that signals an individual’s seriousness in the pandemic. Right out of the gate, mask wearing became the most politicized COVID prevention measure.

We find that almost eight out of ten Democrats reported wearing a mask in early April, compared to six out of ten Republicans.

by the fall of 2021, despite clear evidence that masks reduce transmission, eight Republican states enacted laws or issued executive orders that prohibited school districts from enacting mask mandates in schools: Arizona, Arkansas, Florida, Iowa, South Carolina, Oklahoma, Texas, and Utah.

What makes the United States stand out from even those countries where mask compliance was low is the partisan politics of masking in the United States. Even in a similarly polarized country such as the United Kingdom, mask opposition did not follow partisan lines. In a YouGov survey in early September 2020, a similar share of Conservatives and Labour voters reported wearing a face mask in public places.

Democrats were more likely to adopt a whole host of behaviors in response to the crisis, from washing hands to social distancing, than were Republicans. Second, these partisan differences endured over the ensuing months. We cannot explain these partisan differences away with reference to other factors such as race, income, education, or anything else that we can measure.

The Federal Aviation Administration hadn’t been systematically tracking unruly passenger behavior before 2020 when it began receiving an unprecedented number of reports of assaults on flight attendants, noncompliance with standard inflight instruction, and verbal abuse. Passengers were punching and kicking flight staff. People were angry—angry about having to wear a mask, angry at the inconvenience of travel in a pandemic, angry about the lack of responsibility of those around them. By November, the Federal Aviation Administration would record over 5,000 incidents

Another flight attendant was more colorful in her description of the problem: “I’m dealing with a lot of babysitting, which I never counted on doing.… The actual children on board behave better than the grown adults do. In some extreme cases, antimask sentiments led to physical violence against employees trying to uphold these rules, including the murder of a security guard in Michigan.

What really led Republicans to lose hope in the government’s handling of the COVID-19 pandemic was the inauguration of Biden.

The American political system may also make it difficult to apportion blame properly even when people want to. Responses to major disasters such as the coronavirus pandemic involve the coordination of multiple federal agencies, leadership from the White House, state health departments, and governors, not to mention local authorities. When things go wrong—when there aren’t enough tests, contact tracing is inadequate, schools do not have enough resources to upgrade ventilation systems, and there is not enough personal protective equipment for frontline health workers or ventilators for hospitals—it is not always clear to voters which actors, among many, are most to blame.

Republicans put the least blame on Trump of all actors they ranked, less than either Democrats or Others. Republicans are most likely to put blame on the CDC; almost 40% of Republicans in March 2020 and 43 percent in June blamed the CDC for failure to prepare. In March, equal numbers of Republicans blamed former president Obama for poor planning as blamed the CDC, which was about four times as great as the number of respondents who blamed Trump, who shared their partisan identity. Republicans and Trump voters looked for anyone other than the president to blame, whereas Democrats and nonpartisans/independents put the most responsibility on Trump and the CDC for failure to prepare.

Voters who preferred Trump said that he deserved a similar amount of credit as doctors and essential workers for helping people with the pandemic. This also revealed a degree of cognitive dissonance for Republicans; one would not think that doctors and essential workers merit the lion’s share of credit if one also believes that the pandemic is not a serious threat.

Scaling up mass testing was slow; there weren’t enough tests, and there weren’t enough appointment slots. Some surrounding counties, such as Riverside and Orange, were also ramping up tests, but others, such as San Bernadino, had yet to start. And there weren’t enough staff; the National Guard and firefighters were collecting nasal swabs alongside health care professionals. It was dire enough that California governor Gavin Newsom was asking retired health care workers to come back. And even someone who managed to get tested for coronavirus in those early days would see massive delays in getting the results.

A commercial lab in Orange County increased testing fivefold, and people in the county were waiting a week or more for test results during which time they were likely spreading the virus to others.

What kind of policies should the government enact during the pandemic? What kind of authority should the government have? One central axis of debate is individual liberty versus state authority: although many Americans cherish their freedom from government interference in most aspects of their daily lives, the COVID-19 pandemic forced them to weigh that freedom against the benefits of the kind of swift and comprehensive public health response that only a government can provide.

A secondary debate involves how a government should respond to a pandemic. Should a government mobilize the National Guard to coordinate the pandemic response? Should the federal government or the states take the lead? Should the federal government implement contact tracing in response to confirmed diagnoses, or should it implement more aggressive policies (as did countries such as Singapore) to monitor people’s movements? Amid all of this, the question of partisanship generated interesting tensions as well, because giving authority to the federal government would mean for most Democrats empowering a Republican administration whose actions they generally opposed. The conundrum for Republicans—commonly viewed as more skeptical of federal authority than Democrats—is that their party controlled the federal bureaucracy

Developing a COVID-19 test was a problem, as was distributing tests on a scale that could enable mass testing. The CDC had to get tests to the states, where mass testing sites had to be constructed de novo. With demand far outweighing supply, by early March the United States was still only testing those who had been to China, had been exposed to someone who tested positive for COVID, or were experiencing symptoms. The lack of widespread test availability, for both the symptomatic and asymptomatic, ultimately meant that the death toll was undercounted, as only confirmed cases of COVID were included in the official tally.

we see a wide and consistent partisan gap in beliefs about testing availability that persists throughout the final year of the Trump administration. The partisan gap only truly narrowed in wave 6 (April 2021). By then, with a new president in office and over twenty-one million vaccines having been allocated in the United States, Democrats’ beliefs about testing availability finally began to approach those of Republicans and nonpartisans.

older Americans were more concerned about the pandemic than younger Americans. But surprisingly, the gaps between Democrats and Republicans are larger among seniors than they are among any other age group. This tells us that just as Democratic seniors were the most concerned about test availability, Republican seniors were the most confident in test availability.

The delay in mass testing and the total failure to adopt contact tracing directly contributed to unnecessary loss of life.

White House coronavirus response coordinator Dr. Deborah Birx, once the Biden administration had taken over, stated in an interview with CNN that “I look at it this way. The first time, we have an excuse. There were about 100,000 deaths that came from that original surge. All of the rest of them, in my mind, could have been mitigated or decreased substantially if we took the lessons we had learned from that moment.

For Democrats, support for canceling everything remained consistently high throughout the pandemic, persisting even into wave 6 under the Biden administration. For Republicans, support for canceling everything dropped precipitously in April and June.

April 12 was also the date that Trump, who liked the idea of packed churches on Easter Sunday, had previously announced as his target for a return to normal.

Many Americans were genuinely hurting from the economic shutdown, and surely many Americans found the onetime Coronavirus Aid, Relief, and Economic Security (CARES) Act stimulus of $1,200 per adult to be insufficient.

Bipartisan endorsement of vaccines—where political, religious, and community leaders model good behavior by publicly getting a vaccine themselves—have been a mainstay of American public health campaigns for nearly a century. For instance, the effort to eradicate polio was thoroughly bipartisan

Big Bird got a COVID-19 vaccine in November 2021, Senator Ted Cruz referred to it as “government propaganda,” and conservative media elites went so far as to label Big Bird a communist. Prominent Republicans also adopted a habit of not reporting whether they received a vaccine, with vaccine denial becoming a point of pride among many.

During the 2009 H1N1 flu pandemic, conservative media figures such as Glenn Beck and Rush Limbaugh publicly denounced the vaccine rollout by the Obama administration, with the result that Republicans proved less amenable to vaccination than Democrats. And true to form, Fox News would sow seeds of skepticism in vaccination on air while privately over 90% of company employees were vaccinated, with strict daily testing for those who were not.

the mass rollout under the Biden administration was hamstrung by politicized vaccine hesitancy, in particular among Republicans.

the Republican Party does not formally maintain an antivaccine platform, but an individual who votes Republican may hold a “science skeptical” worldview. A Kaiser Family Foundation study asked individuals, in their own words, why they didn’t get vaccinated, and answers varied dramatically from “This event seems more and more just like the flu. Everyone is exposed and has the same chance of getting it. I never got a flu vaccine either” to “My daughter has had covid.… My thought is I am either immune or I have antibodies” and “I really don’t want to be sick from a vaccination so I kind of lost interest.” Although none of these responses actually referenced a political party, partisanship is a good indicator of whether or not an individual holds these sorts of skeptical views toward vaccination.

Florida governor Ron DeSantis sent mixed signals. While he himself was vaccinated with the single-shot Johnson & Johnson vaccine, he did not do so publicly like other governors. Moreover, his politics have buoyed antivaxxers efforts by preserving the “vaccination as personal choice” stance; he signed an executive order prohibiting vaccine passports, most notably threatening to fine cruise ships that require passengers to be vaccinated.

As the delta variant surged across undervaccinated southern U.S. states in July 2021, hosts Tucker Carlson and Laura Ingraham mused on air that vaccines could be dangerous, with Carlson going so far as to describe Biden’s vaccination push as “the greatest scandal in my lifetime, by far.

By Thanksgiving 2021, 58.9 percent of the U.S. population was vaccinated. This number varies widely by state, with Vermont (72.51%) and New York (68.07%) at the top of the chart and Idaho (44.95%) and West Virginia (41.5%) at the bottom.

That same month, three conservative talk radio personalities died from COVID-19.2 Marc Bernier, age 65, from Daytona Beach, Florida, had publicly rejected COVID-19 vaccines and compared Florida’s public health commissioner to the Nazis for urging the public to get vaccinated. Dick Farrell, from West Palm Beach, Florida, had condemned the vaccine and Anthony Fauci on his social media page and in appearances on the right-wing television channel Newsmax. Despite these public statements, after he was hospitalized Farrell privately expressed regret about his opposition to vaccination and urged his friends to get the vaccine. In Nashville, Phil Valentine had publicly criticized vaccine mandates for taking away freedom of choice and recorded a song mocking the vaccine.4 After being hospitalized for pneumonia caused by COVID-19, he put out a press release regretting that he had not been more “provaccine.

Bernier, Farrell, and Valentine had each rejected the vaccine and encouraged their listeners to do the same. All three of them died from COVID-19 at a time in which the most powerful nation in the world had made three fully safe and remarkably effective vaccines available at no cost to any adult.

Fueled by the deadlier and more transmissible delta variant and with tens of millions of Americans still unvaccinated, the summer and fall of 2021 proved to be some of the deadliest months of the pandemic. Breakthrough cases of COVID-19 in fully vaccinated individuals were increasingly common as vaccines gradually and inevitably lost their effectiveness over time, but the risk of death for the unvaccinated was far higher.

High rates of community transmission (primarily among the unvaccinated) drove high levels of hospital admissions, producing overworked emergency departments and long wait times

Much like masking was so emblematic of the partisan politics of the pandemic in the summer of 2020, vaccination became a thoroughly partisan matter in 2021. In the same way that many Republican politicians resisted mask mandates, many of these politicians—from Florida to Texas—also resisted vaccine mandates. These antimasking and antivaccine messages sustain a feedback loop that reinforces the link between Republican identity and resistance to public health measures.

And these divisions have hardened in ways that prevent even stalwart Republican Party politicians and conservative media elites from reaching out to their supporters and viewers with public health recommendations that can save lives. For example, in October 2021 Fox News anchor Neil Cavuto—a cancer survivor who also has multiple sclerosis—encouraged his audience to get vaccinated for their own safety after getting a breakthrough COVID case. In response, he received death threats.9 Crowds at a rally in Alabama in August 2021 booed Trump himself when he recommended that people get the vaccine.

A Pew Research Center poll in August found that 86 percent of Democrats had received at least one shot, compared to 60 percent of Republicans. a Kaiser Family Foundation survey found strong and enduring differences by partisanship such that “self-identifying as a Republican or leaning Republican is one of the strongest identification predictors of remaining unvaccinated.

This created a uniquely morbid outcome: a growing partisan gap in death. By October 2021, the gap in COVID-19 death tolls between red and blue Americans was growing faster than any point in the pandemic. That is, there were more COVID-19 deaths in counties that voted for Trump throughout 2021 than in counties that voted for Biden.  by 2021, death itself had become partisan.

Countries that faced early disasters, such as Italy and Brazil, learned from the past and came to excel in vaccination policies. What made American COVID so unique and so tragic was that a bad start seemed impossible to rectify. Trump’s partisan approach to managing the COVID-19 pandemic outlived his presidency. Partisan polarization continued to hamper the ability of the United States to bring the virus to an end, prolonging the suffering and killing hundreds of thousands of Americans even when effective vaccines are widely available to anyone who wants them.

Most obviously, a different president in the White House would almost certainly have handled the pandemic differently. Trump was particularly unsuited to managing a large, complex crisis due to his brand of politics, the timing of the crisis during an election year, general disdain toward the oftentimes unglamorous and unpopular work of governance, and deliberate practice of undermining the federal bureaucracy. Moreover, Trump’s practice of charismatic populism portrayed him as uniquely knowledgeable, with a particular authority that other politicians and health leaders lacked.15 Public health crises require the input and knowledge of medical and scientific experts in both setting policy and communicating with the public. But Trump’s leadership style was to not defer to other actors, and he demanded the media spotlight. It is shocking to realize just how much of the American public discourse about the COVID-19 pandemic was focused on Trump.

Trump was not only vain; he was also stubborn. Rather than learning from the pandemic as it unfolded and we gained a better understanding of its epidemiology, Trump considered new information from the perspective of image management. To him, correcting mistakes and updating expectations would signal weakness. He therefore preferred to sideline, ignore, and criticize experts when they suggested that he might be wrong.

During the infamous press briefing in which Trump suggested, without any medical evidence, that ultraviolet light or even injecting disinfectant could “knock out” coronavirus, White House coronavirus response coordinator Dr. Deborah Birx—an HIV/AIDS immunologist—sat quietly in frame, nodding along. She never corrected him in public.