COVID-19 Insights & Analytics Issue 6

Impact of State Leadership

Nov 17, 2020


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The COVID-19 Insights & Analytics newsletter is designed to provide you with a summary to quantify national trends that may help in COVID-19 response planning. The included data, analytics and dashboards are generated utilizing BD HealthSight™ Infection Advisor Analytics and are derived from electronic patient data from 338 participating U.S. hospitals initiated on March 1, 2020 through October 29, 2020 unless otherwise indicated.


In honor of our national election on November 3, we looked at the impact of political affiliation at the state level on COVID-19. States are divided into 3 cohorts; Republican Governor and legislature, Democratic Governor and Legislature, and Mixed where neither party carried both1. Please note that this summary is not intended to express any political preference or endorsement of any political party or their actions with respect to COVID, but rather to evaluate variations in COVID trends relative to mitigation strategies that may have been influenced by incumbent political leaders. Political affiliation and subsequent cohort grouping on the National Conference of State Legislature’s Partisan Composition (as of 9/8/2020)2.

Executive Summary

  • Democrat led states (which traditionally carry more urban centers and coastal lands), were impacted most severely in wave 1
  • Republican led states (which may have lifted restrictions quicker)3 experienced higher daily positive rates in wave 2
  • States with Mixed leadership were impacted in the first two waves, and are experiencing a fast increase in daily positives during the start of wave 3
  • All 3 groups have significant increase in daily positives going into wave 3, which indicates all Americans need to be vigilant to help contain the spread

Figure 1: Confirmed daily cases nationally (

Figure 2: Testing data from Republican States

Figure 3: Testing data from Democratic States

Figure 4: Testing data from Mixed States

Commentary for Figure 1, 2, 3 and 4

Observations per graph:

  • At a national level, daily positive case reporting manifests with 3 apparent waves of COVID infection since the onset of the pandemic. The first wave emerged in March and showed signs of a plateau and some attenuation in May. This was followed by a second wave of greater magnitude in the June-July time that showed signs of a more pronounced fall off in August. Unfortunately, we are now transitioning into a third wave of increased COVID infection cases as we approach the winter months.
  • The size of the 3 cohorts varies widely so we cannot directly compare daily positive totals. Republican has the largest number of samples test (1.7M), followed by Democratic (1.3M) and Mixed (0.5M) (Note: the number of samples is a reflection of the data base and not testing enablement within the states)
  • Republican states were less affected during the first wave but drove the majority of the positive test results in the second wave (2,500/day peak). So far in the third wave they are less than half of their wave 2 peak, but still lead our database with largest current daily positives of 1,100/day.
  • Democratic states experience a strong daily positive in wave one (800/day peak), lesser amount in wave two (625/day peak) and are quickly approaching their all-time highs in wave 3 (700/day).
  • Mixed states experience relatively similar daily positive peak rates in wave 1 and 2 (300/day peak). They are currently experiencing their all-time high in wave 3 (350/day).
  • Also notable is the difference in cumulative COVID % positive with Republican 9.8%, Democratic 7.0% and Mixed 6.0%.

Overall Trends observed during the pandemic:

  • Wave 1 impact was unexpected and local government policies likely had little to do with containment measures. In waves 2 and 3, mitigation strategies developed in wave 1 likely had greater impact as local government directed containment guidelines.
  • In wave 2 the Republican led states experienced the highest peak (when normalized for samples tested), Democratic had the lowest, with mixed in between.
  • Interestingly in wave 3, mixed states have the highest normalized daily positives, while both Republican and Democratic states have similar rates.
  • All 3 groups appear to be at-risk of significant wave 3 impact. All 3 groups will likely have to contend with the following factors moving forward: varying back to school and work phases, cold/flu/respiratory viral season, colder weather driving more interactions indoors and general COVID restriction fatigue.

Figure 5: Inpatient Admissions from Republican States

Figure 6: Inpatient Admissions from Democratic States

Figure 7: Inpatient Admissions from Mixed States

Commentary for Figure 5, 6 and 7

  • Inpatient admissions at Republican and Democratic states look very similar. Both cohorts recovered to 90% run rate in July and have maintained that rate through October.
  • The second wave did not drive a significant reduction in admissions, suggesting that hospital systems had improved operational ability in the midst of COVID.
  • Mixed states also recovered by July and have also returned to 100% normalized rates. This is driven by Michigan which is the largest contributor to the Mixed cohort.
  • Overall admissions continue to lag by 10% compared to a year ago and may be driven by reluctance to seek care during the pandemic. This phenomenon is present in all states.

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