How Some States Managed to Lower COVID-19 Cases Successfully

Slowing the spread is possible — here’s how.

By Michael Bohl, MD, MPH
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July 16, 2020 — 11:30 a.m. EST

How worried you are about the ongoing coronavirus disease 2019 (COVID-19) pandemic may have a lot to do with where you live. While some parts of the country are reopening, others are seeing a continuous increase in the rate of new infections. How have some states lowered COVID-19 infections, while others are seemingly spiraling?

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Part of this difference has to do with chance and the basics of population density. Areas that were introduced to the virus earlier and areas with a higher population density (such as cities) were the first to be hard-hit during the pandemic. On the other hand, areas that have fewer tourists and areas that are more rural have generally seen a slower spread of the virus. This may have made it look like cities — particularly New York — were “doing poorly” against the virus in the beginning. And while it is true that the area around New York City has experienced significantly more cases and deaths than most other places in the country, New York is now one of the states performing the best against the virus. In fact, there are many infographics available online that show how New York has flattened its curve while other states are still going up, or how the rest of the United States is still worsening when New York City’s progress is taken out of the equation.

So, what’s happening here? After the initial shock of getting hit with a pandemic, how have New York and certain other areas around the country been able to turn around and get a handle on COVID-19? Why are some states doing better while others are doing worse?

In one study, researchers sought to determine which states were best prepared to manage a pandemic. They found that the best-prepared states were ones in the Northeastern United States — especially Massachusetts, New York, and Pennsylvania. The study identified a few things that could make states more prepared:

1.     Having many actively practicing doctors

2.     Having many hospital beds

3.     Having a higher proportion of residents with health insurance

Unsurprisingly, some of the states considered the “most prepared” are now some of the states performing the best against COVID-19.

What Contributes to the Rise of COVID-19?

On the flipside, the least-prepared states included many states in the South and Southwest, especially Idaho, Nevada, and Texas. Things that could make states less prepared included:

1.     Prominent urban-rural divide

2.     Barriers to healthcare access (including distance and transportation)

3.     Having a lower proportion of residents with health insurance

4.     Poor health literacy

5.     Social stigma

6.     Privacy issues

7.     Workforce shortages

Again, unsurprisingly, some of the states considered the “least prepared” are now some of the states performing the worst against COVID-19.

What Helps Stop the Spread?

But there’s a lot more to the story than just each state’s infrastructure before the pandemic. In fact, much (if not most) of how some states have managed to lower their rates of new COVID-19 cases has to do with measures and policies enacted early on during the pandemic and continuing until now. Some of the most successful states in this regard include Connecticut, New York, Massachusetts, New Jersey, and Vermont. Four of the main things that seem to help keep COVID-19 in check are:

Testing

The beginning of the pandemic was plagued by a shortage of testing. Inefficiencies in developing, manufacturing, distributing, and interpreting tests allowed many people to go about their daily lives, unaware that they may be spreading the virus to others. Testing is one of the most important ways for us to quantify how many people are affected by this virus and testing gives us the necessary information to change people’s behavior. A positive test result can let somebody know they are carrying the virus and that they should stay away from others. Testing also makes it possible to perform contact tracing, warning people about potential exposures even before symptoms may show up. New York, one of the states doing the best right now, is also the state that has performed the most testing.

Taking early action to keep people home and to practice social distancing

New York was one of the first states to have a mandatory shutdown, telling people to stay home, in March. New Jersey was the first state to issue a mask mandate, in April. By following the advice of public health officials early on, certain states were able to significantly slow the spread of the virus. On the other hand, some states still do not have a mask requirement.

Quarantining visitors from areas with high case counts

Some states, like New York and New Jersey, have decided to control the number of potential cases of COVID-19 entering the state by issuing travel advisories. People coming in from certain parts of the country are required to quarantine for 14 days, to make sure they don’t spread the virus. According to New York State’s website, the quarantine “applies to any person arriving from a state with a positive test rate higher than 10 per 100,000 residents over a seven-day rolling average or a state with a 10% or higher positivity rate over a seven-day rolling average.” Travel advisories like these protect the people living inside the states that have imposed them.

Reopening later and with stricter criteria

Lastly, one of the biggest fears right now is that many parts of the country are opening up too soon. Eager to get back to regular life and to jumpstart the economy, certain states are moving forward with reopening plans despite the pleas of public health experts. As a result, over 30 states have reported increases in cases while reopening, prompting a number of them to pause or even reverse their reopening plans. On the flipside, states that are doing well (such as New York) have implemented a phased system that requires different parts of the state to meet specific criteria before being able to proceed.

The good news is, it is possible to slow the spread, and there are a few states that have proven track records that work. If you're disappointed with the way your state has handled the COVID-19 outbreak, spend some time researching your governor and think about what your options are come next election season. Governors have the power to make mandates that help the stop the spread of COVID-19, such as wearing masks, closing certain establishments, and more. 

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Article written by Michael Bohl, MD, MPH