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California Governor Gavin Newsom instituted stronger COVID-19 restrictions than his counterpart in Florida. Al Seib/Los Angeles Times via Getty Images
  • Despite different restrictions during the pandemic, California and Florida have similar per capita rates of COVID-19 cases.
  • Experts say safety rules are only part of the equation when it comes to COVID-19 case spread. There’s also housing density, income levels, and health systems.
  • Experts note that North Dakota and South Dakota are among the least restrictive states but are among the highest in per capita cases.

All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.

California and Florida have taken different approaches to managing the COVID-19 pandemic.

Both states initiated lockdowns early in the pandemic, but since then, Florida has eschewed mask mandates, lockdowns, and other public health guidelines to mitigate deaths and hospitalizations from COVID-19.

California, on the other hand, has had multiple lockdowns and a mask mandate in place since June 18, 2020.

Despite this, per capita cases, hospitalizations, and deaths from COVID-19 in these states are similar.

California has had about 8,900 cases per 100,000 people while Florida has had about 8,700 per 100,000.

That fact has been seized upon by some as evidence that mask wearing, physical distancing, and other mitigation efforts are not effective at preventing the spread of the virus.

However, experts say the real reason for this dynamic is much more complicated.

“First, I kind of reject the premise of the California versus Florida comparison,” Whitney R. Robinson, PhD, MSPH, an associate professor of epidemiology at the UNC Gillings School of Global Public Health, told Healthline. “[COVID deniers] are cherry-picking a restrictive state that’s done worse than other restrictive states and chosen a permissive state that’s fared better than other permissive states.”

“This comparison isn’t an accident. They are stacking the deck by choosing outliers that favor their argument,” she said.

The data bears this out.

North Dakota and South Dakota are both among the least restrictive states in the country with the higher per capita case rates of COVID-19 in the country.

North Dakota has had 13,036 cases per 100,000 residents while South Dakota has had 12,585 per 100,000, according to data tracking from the New York Times.

Vermont and Hawaii, on the other hand, have some of the lowest per capita case rates in the country (2,341 and 1,912 per 100,000, respectively) and among the most restrictive policies, according to data analysis from WalletHub.

This doesn’t necessarily prove that more restrictions are better than fewer, either — and that’s just the point.

“There are so many measured and unmeasured variables that are different between those states. And all of those are at play right now. You’re asking us to have a deep understanding of a virus that’s only been around for 12 to 14 months,” said Brian C. Castrucci, DrPH, president and chief executive officer of the de Beaumont Foundation and a former director of state health departments in Georgia and Texas.

Some of those variables that change state by state include differences in housing density (including how many families live together in a single apartment or apartment complex) and the number of densely populated cities where superspreader events can quickly lead to a large spike in cases, as well as income level, age, and race.

But separating out and controlling for those variables is difficult at this stage.

“I can’t explain why Florida is not worse off than it is. I don’t know why,” Castrucci told Healthline. “We discount that little word novel, right [in novel coronavirus]? We’re still learning a lot about this virus.”

But containing COVID-19 is far from an unsolvable dilemma.

Countries such as New Zealand, Vietnam, and even China have had success containing the virus.

The measures these countries have used include robust contact tracing, strict quarantines, and social supports, such as delivering regular meals to people in quarantine and paying them to stay home.

In other words, mitigation isn’t a mystery. The United States’ response has simply fallen short.

“Even the very restrictive states weren’t all that restrictive when you compare to places like Spain, Italy, Australia, New Zealand,” Robinson said. “Without good quarantines, income supports, worker rights, a lot of what was done in a state like California was nibbling around the edges — closed schools and churches but open restaurants and bars.”

Those sort of intermittent — and at times contradictory — containment measures might simply be insufficient to significantly curtail the damage that COVID-19 causes.

“Some measures are more pandemic theater than best prevention,” Robinson said. “Places like Japan have taken smarter, more targeted approaches — really clamping down on superspreader situations but being more permissive about low-risk activities.”

“The alternative — treating activities that vary greatly in riskiness as equally risky — leads to really bad decision making at the individual level (people are genuinely confused) and also lets governments off the hook for bad public policy (at some points, open indoor dining but closed parks),” she added.

The bigger problem might lie with some uniquely American structural and cultural barriers, along with a lack of public health investment.

The first is federalism, which is the autonomy each state has, and why the federal government left COVID-19 response up to each individual state at the beginning of the pandemic.

“I’ve been in states where I’ve been working in the health department and there’s been an outbreak in our state; we can handle that — it’s within the boundaries of our state,” Castrucci said. “If that outbreak then went to the state next to me and the state next to them, we do need federal support because we need someone coordinating this while we’re still debating.”

But that didn’t happen during COVID-19, despite it being an interstate phenomenon early.

“Federalism has never been applied in the way that the Trump administration applied it,” Castrucci said. “They said, ‘Hey, it’s the state’s problem,’ and then we have a buffet of provisions and now we’re all trying to compare which of those dishes on the buffet are better. Pandemic response should not be a Choose Your Own Adventure book.”

This dynamic, combined with disinvestment in public health across the country, was a recipe for disaster.

“The fact is that we have allowed our public health system to erode over the past several decades, so we were wholly unprepared for this,” Castrucci said.

“We spend $700 billion a year on defense and we’ve been preparing for the wrong war. This was not an ‘if,’ this was a ‘when,’” he said. “And we didn’t invest in our labs and our public health system and now we’ve been taught an extraordinarily hard lesson by COVID-19: The safety, security, and economic prosperity of this country going forward is predicated on a robust public health system that I don’t think we have the political will to invent.”

“I think there’s a great risk that that vulnerability will persist following COVID-19,” he added.

Robinson agreed, noting that growing anti-science sentiment among the American public has also been an issue, a problem that can only be solved through strong leadership and education.

“Our society’s attraction to absolutes, miracle cures, and black-and-white answers has made COVID-19 response harder and less sustainable,” she said.