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Original Graphic by E Rosalie for NOVEL SCIENCE

Peer-Reviewed Politics

The GOP-led States Had 13x Greater Odds of Ranking in the Highest Positive Testing Group — and Masks Show Rapid Benefit

What helps lower the percent-positive rates, prevent death, and avoid long-term economic downturn? We assessed percent positive testing rates, state governors’ political affiliation, and mask policies for effect and association.

Politics unmasked:

In a poll by the WSJ, 91% of economists agreed economic outlook for the US depends upon controlling the outbreak. This analysis examines the relationships that may help lower percent-positive rates, prevent death, and avoid a long-term economic downturn.

We assessed percent positive testing rates, state governors’ political affiliation, and mask policies for effect and association.

Key Findings:

— We find that a Republican governor increased a state’s odds of ending up in the highest percent positive testing group by 13 times. It also increased the risk states ranked in the high percent positive testing group by 2.6 times.

— States with mask policies in place no later than the last day of May had an average percent positive testing rate of 3.80%. If we extend that to average the states with policies in place no later than the last day in June, that number jumps to 4.74%.

— States without a mask mandate had a percentage positive testing rate of 11.14% and an average openness score of 77, per the Multistate scoring.

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— All states with Democratic governors have a mask mandate, while 35% of Republican-led have one.

— 33% of high percent positive testing states had a mandate, much lower than the 87% of the low percent positive testing rate group. The orders increased a state’s odds of appearing in the low percent positive testing group by 13 times.

— Although seven out of the nine states led by Republicans had polices enacted a month or less ago, they show a difference of nearly 3%. The odds ratio between the two groups for having a percent positive higher than 5% was 9.4 (95 CI 1.3, 67.6). The difference between Republican-led states with and without a mask policy was statistically significant.

— Governors of either political persuasion may similarly reduce the percent positive testing rate in their state using a mask policy, suggesting citizens are not the obstacle to suppressing spread.

How Do States Differ?

To understand what differs between state control over the outbreak, we analyzed percent positive testing, state governors’ political party, mask policies, and openness scores.

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Johns Hopkins University | Aug 3, 2020

The Multistate COVID-19 State Reopening Guide “provides a numerical rating of each state’s degree of ‘openness.’” The score reflects the degree to which states have reopened based on a daily grading of eleven key factors.

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A percent positive testing rate over 5% may show a state has uncontrolled spread and insufficient testing (WHO, 2020). The states with the highest percent positive testing rates averaged an openness score of 76.8.

The group had thirteen Republican and two Democratic governors. Ten of the fifteen states lack formal mask mandates. For those with policies, the average date for enacting them was July 7, 2020.

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Mask policies have the potential to slow transmission, potentially avoiding more extreme measures like shelter-in-place orders.

States with the lowest percent positive testing, potentially indicative of controlled spread and sufficient testing, have an average openness score of 63.11 and governors, both Republican (5) and Democrat (10).

Two states still lack mask mandates. The average date for enacting the policy among these states is May 5, 2020, but there were still two states that had yet to issue a mandate.

How Did a Governor’s Political Party Affect Ranking in the Highest & Lowest Percent Positive Groups?

We examined whether having a governor’s political party affected how a state rated in percent positive testing.

  • Among the highest percent positive states, a state had an 87% (13/15 = 0.87) risk for having a Republican governor and a 13% risk for having a Democratic governor.
  • For the lowest percent positive states, a state had a 33% risk for having a Republican governor and a 67% risk for having a Democratic governor.
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The odds ratio is 13 with a 95 CI (2.07, 81.48), calculated by dividing the odds of the first group by the odds in the second group. When looking at the odds of a Republican governor in the highest and lowest percentage positive, we find 0.87 ÷ (1–0.87) = 6.5 and 0.33 ÷ (1–0.33) = 0.5.

Dividing the odds of a Republican governor of ending up in the high positive percentage group by the odds for ending in the low percent positive group, 6.5 ÷ 0.5, equals 13.

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The odds of a Republican-led state ended up in the highest percent positive testing group was thirteen times higher than their odds of ranking among the lowest percent positive testing rates.

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The relative risk for Republican-led states was 0.87 ÷ 0.33 or a 2.6 times increased risk for the high percent positive testing group.

We find that a Republican governor increased a state’s odds of ending up in the highest percent positive testing group by 13 times.

It also increased the risk states ranked in the high percent positive testing group by 2.6 times.

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Did a Mask Mandate Significantly Reduce a State’s Percent Positive Testing Rate?

Five out of fifteen states had a mask mandate in the high percent positive testing group compared with thirteen out of fifteen states in the low percent positive testing group. The odds ratio was 13 (95CI 2.07, 81.48).

  • Only 33% of high-percentage positive states had a mandate, compared to 87% of low percentage-positive states.
  • Having a mask mandate increased your risk of ranking in the low-percent positive testing group by five times.

Mask mandates increased a state’s chances of landing in the lowest-percent positive testing group, suggesting mask mandates protect a state’s residents.

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We examined all Democratic- & Republican-led states to find the averages for groups overall

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Having a Democratic-governor increased the likelihood of a state mask mandate, and it increased the chances that a state tested in the lowest positive percent testing group.

As of August 3, 2020, 100% of the Democratic governors’ states have mask mandates, plus the District of Columbia. Republican states have nine out of twenty-six states with formal orders, 34%.

States with Democratic Governors averaged 5.68% positive, around half of the percent positive for Republican-led states, 10.14%.

Democratic-led states averaged an openness score of 56.5, and Republican-led states averaged 75. June 1, 2020, was the average date for Democratic governors to implement a mask policy.

The Republican states average on June 26, 2020, but that date only accounts for the 34% holding a mask mandate. The average cannot reflect the full extent of the differences between the two responses to evidence-based recommendations. Seventeen states remain without mandates, all Republican-led. This assessment does not assert that states have no valid reason for declining to enact a policy, only that they have.

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Overall, the states with masks had nearly half the rate of percent positive testing as states without a policy. To understand if the benefit remains regardless of political affiliation, given the relatively lower number of Republican-led states with policies, we examined the states with mask policies. We divided them by the governor’s political affiliation.

Averages for States with a Mask Policy

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With Policies

Averages for States with a Policy Divided by Party

The most critical find in this examination pertains to stratifying by the political party among the policy-holding states. Democratic-led states all had policies, so we could not make a comparison in that group.

Comparing percent positive testing rates in the Republican party grouping, based on the presence of a mask policy, shows a benefit, something striking given the short duration of most policies.

Of the nine states with Republican leadership and mask policies, seven enacted policies in July, with this writing occurring August 4, 2020.

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The Republican-led States with and without Mask Mandates

Although seven out of the nine states led by Republicans had polices enacted a month or less ago, they showed a difference of 3%. The odds ratio between the two groups for having a percent positive higher than 5% was 9.4 (95 CI 1.3, 67.6) and was statistically significant.

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This find suggests that governors choosing not to enact policy are neglecting to use one of the most powerful tools for fighting the current pandemic.

The justification for not enacting a policy must outweigh the likely increased mortality within the state, higher burden of disease, and greater economic decline. The evidence suggests that masks are not only effective but quickly and significantly.

Adolf et al. (2020) found that a governor’s political party had a greater effect on the speed with which states adopted social distancing practices. Comparing all states with a mask policy regardless of political affiliation shows that a policy alone may significantly reduce percent positive testing rates independent of governor affiliation.

The finding also agrees with political science research that found the public’s view follows that of political elites in times of crisis (Berinsky, 2007; Green et al., 2020). Here we see states led by Republicans benefitting despite a party-wide reluctance to accept a recommendation. PEW Research polls support the idea that people roughly followed the views of their political elites.

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Multiple unrelated studies have reported an association between politics and pandemic responses that reflected something other than the best evidence. (Adolf et al., 2020; Green et al., 2020; Makridis and Rothwell, 2020; Alcott et al., 2020).

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The political party of a state governor influenced the speed of implementing social distancing more than the public’s support for the current administration (R) in the most recent election.

State’s with a Republican governor delayed social distancing the most, and it associated with a longer delay than any other factor.

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(Adolf et al., 2020)

That the governor had more effect than the tendency of voters could be a function of the power held by the position.

Still, the observation that states may control outbreaks regardless of leaders’ political allegiance brings hope. It would require governor cooperation, however.

Any governor likely has the power to lower the percent-positive testing rate and prevent more deaths and a steeper economic decline.

The power shown by policies also speaks strongly in the other direction. Especially in the long-term, an economic downturn may follow a failure by decision-makers to observe the best evidence. That so much is beyond the control of the public is unfortunate, but identifying how we achieve suppression can better inform the actions we support.

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(Correia et al., 2020)

Limitations

Limitations exist related to the role of other mitigation strategies often paired with mask-wearing. For example, strict social distancing enacted in Vermont, which had a percent positive testing rate of 0.38%, was not paired with a mask mandate. While this may work in some locations where distance can be maintained, masks can mitigate when people must be in proximity.

Other policies enacted in locations at the same time likely also help reduce the spread. The masks themselves may serve as a constant reminder to keep a distance between oneself and others, but the marked effect that follows mask-policy implementation with its time-dependent effect deserves note.

Considering the US was the lone country that resisted full economic shutdown and mask-wearing, and the obvious difference found between states that have policies, regardless of political affiliation, must be seen as mere directional statements and not a concrete assessment of the magnitude of benefit.

Doubtless, there are many other factors that have influenced a state’s percent positive, but the relatively low cost, and apparently swift and marked benefit, warrants at least attempting. The most obvious benefit existed in states with the longest-running policies.

States with policies in place no later than the last day of May have an average percent positive testing rate of 3.80%. If we extend that to average the states with mask policies in place no later than the last day in June, that number jumps to 4.74%.

Policies enacted after June, average a positive percent testing rate above the WHO recommended 5%, but the evidence suggests that several months’ time will see that rate fall below the recommended rate.

Acknowledging that percent positive is a function of who receives testing, tests given, and the infected population all interacting in a variable environment, we see a general trend that strongly associates with mask mandates.

Possibly, other unseen variables associate with both mask-wearing and reduced transmission exist. So long as it does not pose harm, any means by which we can slow the spread that helps to avoid economic shutdowns and high-cost mitigation strategies seems advisable.

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Moving forward an additional month still shows a significant reduction in positive percent testing rate over the 11.14% rate shown by averaging all states without a mandate.

The authors fully recognize the limitations of this study but also believe the policies are advisable almost everywhere given the critical state of the pandemic, the relatively low cost of enacting a policy compared to what may come from inaction, and the benefits that appear in this study.

The positive impact correlates with mask policies and improves over time, all expected outcomes following implementing such a policy.

Masks, however unpleasant, uncomfortable, and unappealing they may be, could be the precise means by which we prevent another economic shutdown, keep schools open, and allow society to return to whatever normal emerges once the dust settles.

The 1918 pandemic is not the only justification for the conclusion that long-term economic decline could follow an inability to control the virus (Correia et al., 2020). In this current outbreak, the US saw an economic downturn before we placed measures, supporting the idea that the pandemic and not the means to control it worsen the economic outlook (Hansen, 2020).

We have also seen that the economy has not improved despite opening the economy to a high degree in several states. Until the public feels safe, the economy will not recover. How we respond to that reality has more flexibility, but a consensus concerning the economy has emerged.

The Wall-Street Journal commented in July:

“A strong economic recovery depends on effective and sustained containment of Covid-19, economists said in a new Wall Street Journal survey, as the US surpassed three million confirmed coronavirus cases. The latest monthly survey by The Wall Street Journal found that 91% of business and academic economists agreed “somewhat” or “strongly” that economic recovery depends on containing the virus.”

Goldman Sachs also commented to this effect in a July 2020 report:

“We find that face masks are associated with significantly better coronavirus outcomes. Since this is true across all three of our models and the results are robust to the inclusion of a number of control variables, it seems to reflect a largely causal impact of masks rather than correlation with other factors…these calculations imply that a face mask mandate could potentially substitute for lockdowns that would otherwise subtract nearly 5% from GDP.”

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by E Rosalie for NOVEL SCIENCE

This analysis highlighted how states benefitted from mask mandates regardless of leaderships’ political allegiances. The benefit existed for Republican-led states and Democratic-led states.

Although seven of the nine Republican-led states enacted policies within the last month, the odds of reducing the testing rate below 5% positive were nine times more likely in the group with mask mandates.

The findings in Politics Unmasked suggest that state governors wield the most significant power over whether a state slows the spread of the virus, avoids preventable deaths, and halts potential long-term economic decline.

We recommend that governors opting not to enact a mask mandate deliver an explanation available to Congress outlining the rationale to deter politically motivated decisions and good communication, an element critical in a crisis.

Governors who resist without sharing an evidence-based rationale will sow further mistrust in their decision making likely to worsen as their states suffer the potential consequences of tepid pandemic mitigation.

Mask policies appear to be one of the most powerful tools, aside from a complete shutdown of society. Mandates are a means to fight a virus for which we have no vaccine and no readily available effective therapeutics, yet policies remain unused in seventeen states.

Without a clear, evidence-based justification, failing to protect one’s citizens brushes uncomfortably close to negligence. To deny the best protection available to one’s citizens for reasons other than those based upon the best evidence available must be condemned in the strongest way possible.

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Public health biologist studying at Johns Hopkins | Science writer & artist | Views reflect me alone | Subscribe @ Novel-Science.com

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