Using an index that tracks policy responses to the pandemic, The Times analyzed outbreaks in each state relative to the state’s most recent containment measures.
Using an index that tracks policy responses to the pandemic, The Times analyzed outbreaks in each state relative to the state’s most recent containment measures.
Covid-19Guidance
States That Imposed Few Restrictions Now Have the Worst Outbreaks
ByLauren LeatherbyandRich HarrisNov. 18, 2020
Coronavirus cases are rising in almost every U.S. state. But the surge is worst now in places where leaders neglected to keep up forceful virus containment efforts or failed to implement basic measures like mask mandates in the first place, according to a New York Times analysis of data from the University of Oxford.
Using an index that tracks policy responses to the pandemic, these charts show the number of new virus cases and hospitalizations in each state relative to the state’s recent containment measures.
Outbreaks are comparatively smaller in states where efforts to contain the virus were stronger over the summer and fall — potential good news for leaders taking action now. States and cities arereinstating restrictionsand implementing new ones: In recent days, the governors ofIowa,North DakotaandUtahimposed mask mandates for the first time since the outbreak began.
The index comes from Oxford’s Blavatnik School of Government, where researchers track the policies — or lack thereof — governments use to contain the virus and protect residents, such as contact tracing, mask mandates and restrictions on businesses and gatherings. Researchers aggregate those indicators and assign a number from 0 to 100 to each government’s total response.
At its highest level of containment efforts, New York state scored an 80 on the index. At the beginning of November, most states were scoring in the 40s and 50s. Though many have taken fresh steps to contain the virus since then, the Times analysis compares cases and hospitalizations for a given date to a state’s index score from two weeks before, since researchers say it is reasonable to expect a lag between a policy's implementation and its outcome.
Most states imposed tight restrictions in the spring even if they did not have bad outbreaks then. After reopening early, some Sun Belt states, including Arizona and Texas, imposed restrictions again after case counts climbed. Now, Midwestern states have among the worst outbreaks. Many have also done the least to contain the virus.
Coronavirus containment index
States are ordered from weakest to strongest overall response.
Weaker containment
measures
Stronger containment
measures
20
40
60
80
No data
Restrictions reintroduced in
some states after summer peak
Spring
restrictions
Reopening
begins
March 1
Nov. 16
S.D.
Iowa
N.D.
Okla.
Idaho
Utah
Kan.
Miss.
Mo.
S.C.
Ala.
Neb.
Ark.
Wis.
Ga.
Tenn.
Ariz.
Ind.
Wyo.
Nev.
Ore.
Mich.
La.
Wash.
Minn.
Va.
Texas
Fla.
N.H.
W.Va.
N.C.
Ill.
Pa.
Colo.
Alaska
N.J.
Mont.
Md.
Ohio
Ky.
D.C.
Mass.
Vt.
Del.
Calif.
Conn.
Hawaii
Maine
R.I.
N.Y.
N.M.
Weaker containment
measures
Stronger containment
measures
20
40
60
80
No data
Restrictions reintroduced
in some states
Spring
restrictions
Reopening
begins
Nov. 16
March 1
S.D.
Iowa
N.D.
Okla.
Idaho
Utah
Kan.
Miss.
Mo.
S.C.
Ala.
Neb.
Ark.
Wis.
Ga.
Tenn.
Ariz.
Ind.
Wyo.
Nev.
Ore.
Mich.
La.
Wash.
Minn.
Va.
Texas
Fla.
N.H.
W.Va.
N.C.
Ill.
Pa.
Colo.
Alaska
N.J.
Mont.
Md.
Ohio
Ky.
D.C.
Mass.
Vt.
Del.
Calif.
Conn.
Hawaii
Maine
R.I.
N.Y.
N.M.
Weaker
containment
measures
Stronger
containment
measures
No data
20
40
60
80
Nov. 16
March 1
S.D.
Iowa
N.D.
Okla.
Idaho
Utah
Kan.
Miss.
Mo.
S.C.
Ala.
Neb.
Ark.
Wis.
Ga.
Tenn.
Ariz.
Ind.
Wyo.
Nev.
Ore.
Mich.
La.
Wash.
Minn.
Va.
Texas
Fla.
N.H.
W.Va.
N.C.
Ill.
Pa.
Colo.
Alaska
N.J.
Mont.
Md.
Ohio
Ky.
D.C.
Mass.
Vt.
Del.
Calif.
Conn.
Hawaii
Maine
R.I.
N.Y.
N.M.
Weaker
containment
measures
Stronger
containment
measures
No data
20
40
60
80
March 1
Nov. 16
S.D.
Iowa
N.D.
Okla.
Idaho
Utah
Kan.
Miss.
Mo.
S.C.
Ala.
Neb.
Ark.
Wis.
Ga.
Tenn.
Ariz.
Ind.
Wyo.
Nev.
Ore.
Mich.
La.
Wash.
Minn.
Va.
Texas
Fla.
N.H.
W.Va.
N.C.
Ill.
Pa.
Colo.
Alaska
N.J.
Mont.
Md.
Ohio
Ky.
D.C.
Mass.
Vt.
Del.
Calif.
Conn.
Hawaii
Maine
R.I.
N.Y.
N.M.
When cases first peaked in the United States in the spring, there was no clear correlation between containment strategies and case counts, because most states enacted similar lockdown policies at the same time. And in New York and some other states, “those lockdowns came too late to prevent a big outbreak, because that’s where the virus hit first,” said Thomas Hale, associate professor of global public policy at the Blavatnik School of Government, who leads the Oxford tracking effort.
A relationship between policies and the outbreak’s severity has become more clear as the pandemic has progressed.
“States that have kept more control policies in a more consistent way — New England states, for example — have avoided a summer surge and are now having a smaller fall surge, as opposed to states that rolled them back very quickly like Florida or Texas,” Mr. Hale said. “I think timing really matters for the decisions.”
The worst outbreaks in the country now are in places where policymakers did the least to prevent transmission, according to the Oxford index. States with stronger policy responses over the long run are seeing comparatively smaller outbreaks.
Average daily coronavirus cases per capita
States are categorized and ordered by their average containment index scores since March. Many of the states with the fewest controls have the highest case counts now.
Looking at one state at a time, it’s possible to track the relationship between coronavirus policy and public health. When the outbreak slammed the New York City area in March and April, leaders locked down. Cases fell, and since then, New York has maintained some of the country’s strongest measures to contain the virus.
New infections have stayed among the lowest in the country, adjusted for population — though cases now are rising in New York as they are everywhere.
New York
Texas locked down in the spring, when it had relatively few cases, then reopened quickly. When the state faced a surge of cases over the summer, the governorclosed barsand placed limits on restaurant capacity. Many local leaders went further. Cases dropped in late July, but since then Texas has eased efforts to contain the virus, and cases are rising again.
Texas
Many states in the Upper Midwest and Mountain West resisted more stringent control measures, like limits on gatherings and mask mandates. North Dakota, for example, made few efforts to contain the virus. After briefly ramping up restrictions —closing bars, restaurants, gyms, theaters and schools— in March, when most other states did, Gov. Doug Burgumreopened the state nearly fully in May.
For a while, the residents were spared. Now, nearlyone in 10 North Dakotans have tested positive— about a third of those in the past two weeks — and one in 1,000 have died of the virus.
North Dakota
One of the biggest problems in the United States so far has been the lack of a coherent, cohesive national response, said Wafaa El-Sadr, an epidemiologist at Columbia University. “It’s been piecemeal,” Dr. El-Sadr said. “It’s been largely delegated to a subnational level, to the states, for example, and municipalities to figure it out themselves.”
Without strong national guidance, states’ containment policies have varied widely. Since the spring, Maine mandated masks and had strict travel restrictions for out-of-state visitors; South Dakota, meanwhile, has never had a mask mandate and welcomed nearly half a million people to theSturgis motorcycle rally, as well as its state fair, which attractedmore than 100,000 visitors.
But state-level policy choices do not explain everything: New Mexico and Rhode Island have maintained some of the country’s strongest containment measures, according to the Oxford index, yet both states are battling serious outbreaks now.
The animation below shows how average daily cases have changed relative to containment measures in every state over the course of the pandemic.
The wave of new restrictions in the United States followsnationalandregional lockdownsin Europe, where outbreaks surgedpast their spring peaksbut cases per capita remained lower than many Upper Midwest states. A couple weeks into those lockdowns, countries with new restrictions may be seeing results: The rate of new daily cases has begun to level off or drop inFrance,Spain,GermanyandItaly, though it continues to rise in theUnited Kingdom.
Mr. Hale said the Oxford data makes it clear that acting quickly and forcefully is the best shot governments have to combat the virus. And the more swiftly they can act, the shorter any lockdown-style policies need to be.
Some countries that implemented fast, early restrictions and robust test-and-trace programs have seen the most success. New Zealand recentlylifted all restrictionsfollowing 10 days with no new cases. New Zealand’s prime minister, Jacinda Ardern, called it a validation of the country’s “go hard, go early” strategy, in which the country reacts rapidly to signs of community spread.
Taiwan recently recorded200 days without a new coronavirus caseafter its leaders focused on aspeedy responseand invested in mass testing and contact tracing. Despite an early outbreak, South Korea flattened the curve withaggressive testing and contact tracing, as well as widespread mask wearing.
“The question is — and I’m sure that’s the conversation now happening in the halls of power — what do we do next? Clearly you don’t want to wait too long because that’s the mistake we made last time, when things spun out of control. So there’s a need to make decisions and be decisive,” Dr. El-Sadr said. “Once you start thinking about acting, it probably is the time to act.”
Note: Measurements of government response come from the Oxford Covid-19 Government Response Tracker’s Containment and Health Index, which is the organization’s index focused on virus containment and protecting citizen health. The index does not evaluate the effectiveness of individual policies.