State Government Policy Responses to the COVID-19 Pandemic in the United States 2020-2022: Concordant Heterogeneity?

Objectives: We investigate governmental responses to the COVID-19 pandemic on a statewide basis between January 2020 and June 2022, together with mortality rates attributable to COVID-19 over the same period. Our aim is to demarcate the states' responses, and examine whether these differential responses are associated with COVID-19 mortality. Methods: Our study is based on individual state data from the Oxford COVID-19 Government Response Tracker, OxCGRT. We focus on the Government Response Index, the most comprehensive index tracked in the OxCGRT dataset. We use multivariate techniques to group the states into clusters relative to their similarities on the Government Response Index, and determine mortality rates attributable to COVID-19 in the individual groups. Results: We find that the Government Response Index was sustained at relatively constant levels in the states, with two major transition periods: a rapid rise in stringency during April through June of 2020, and a gradual decline in May and June of 2021. Heterogeneity in the Government Response Index dramatically increased in 2022. No consistent patterns emerge when relating government stringency measures with COVID-19 mortality rates. Conclusions: There is inconsistent evidence that increased governmental stringency is associated with lower COVID-19 mortality; judicious selection of time frames can lead to contrasting inferences. Political trends and motivations appear to have an outsized influence on governmental responses to the COVID-19 public health crisis, to the detriment of the populace.