Opinion: Our COVID Outcomes Were Average

By John Hood

RALEIGH — Because Gov. Roy Cooper’s former secretary of health and human services, Mandy Cohen, just got the nod from President Joe Biden to be the next director of the Centers for Disease Control, politicians and analysts are again debating how North Carolinians fared during the COVID-19 pandemic.

Defenders of Cooper and Cohen argue that their comparatively stringent regulations saved many lives when compared to states such as Florida where lockdowns were shorter and mandates less severe. Detractors argue that North Carolinians suffered greater economic pain, including lost jobs and incomes, than was necessary to combat the virus, and that the state’s decision to keep public schools closed longer than neighboring states was particularly indefensible.

I opined frequently about these issues during the pandemic, criticizing Cooper’s school closures and violations of the separation of powers. But I also urged everyone to try to keep a cool head, to recognize the unprecedented nature of the crisis and the difficult decisions our governor and other officials were compelled to make.

That being said, we have more data now than we did in 2020, 2021, or even 2022 to assess the effectiveness of policy responses to the pandemic. The clearest finding, in my view, is that closing public schools for more than a brief period in the spring of 2020 was a wrongheaded and counterproductive policy. Schoolchildren were at extremely low risk and didn’t prove to be major vectors of transmission to vulnerable populations.

What about lockdowns, business closures, mask mandates, and other non-medical interventions? Some studies suggest the stringency of such regulations exhibited little correlation with the spread of the virus. Others, such as a major paper published in the British journal The Lancet this March, found that while regulatory stringency had some relationship to infection rates, it wasn’t associated with death rates.

That latter COVID outcome measure was always the better one. Infection rates have more of a reporting bias. Places that test more will detect more infections, all other things being equal, while a death is a death, although some ambiguity about its cause may persist.

As for comparing the pandemic experience of North Carolinians to, say, Floridians, I’m afraid that far too many politicians and activists continue to hurl accusations based on the wrong statistic. They use COVID deaths per capita without adjusting for preexisting risk factors such as age. That’s silly. Many of the same people would (properly) insist on adjusting for student characteristics when assessing school performance, for example.

When adjusted for age and comorbidities, Florida’s COVID death rate from 2020 to mid-2022 was lower, not higher, than North Carolina’s. The Lancet study ranked Florida as having the 12th lowest rate in the country. North Carolina was 27th.

On the other hand, many other states in the Southeast had worse death-rate rankings than we did, including South Carolina (35th), Tennessee (38th), and Georgia (43rd).

Still, the Lancet authors found “no statistical association between the party affiliation of a state governor and cumulative death rates from COVID-19.” To the extent there was a political explanation for differences in mortality, it had less to do with lockdowns and masks than with the uptake of vaccines. Republican-leaning places tended to have lower vaccination rates — and that translated into higher mortality for vulnerable populations.

Now, here’s what I got wrong in 2020: I thought the economic damage from Cooper’s lockdowns would last longer than it did. While North Carolina did experience a worse-than-average drop in economic activity, we also bounced back faster. Big losses in employment, especially in restaurants and other service sectors, were very painful in the short run. Then loose eligibility standards for unemployment insurance induced some North Carolinians to stay out of the workforce for a while. When those standards tightened back up, most went back to work. (Many of those who didn’t appear to have severe drug addictions or mental illnesses).

In most ways, North Carolina’s experience with COVID was close to the national average. Unexciting but true.

John Hood is a John Locke Foundation board member. His latest books, Mountain Folk and Forest Folk, combine epic fantasy with early American history (FolkloreCycle.com).