A Story of Two Americas: How COVID Impacted Northeast, South Differently

The study concluded that more than 300,000 deaths could have been avoided, with 62% of these avoidable deaths happening in the South, if the region would have responded like the Northeast

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A new study by Georgetown University shows that the southern region of the U.S had a higher COVID-19 mortality rate than the other regions due to differences in pandemic-related behavior.

The study, conducted during the pre-omicron phases of the pandemic, took into consideration behaviors such as mask-wearing, social distancing, school attendance and vaccine hesitancy. It also focused on excess mortality, which is defined as the difference between expected deaths and actual deaths.



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The study concluded that more than 300,000 deaths could have been avoided, with 62% of these avoidable deaths happening in the South, if the region would have responded like the Northeast.

Top local doctors reacted to the study in this week's "COVID Q&A" session. The doctors were split on the study's conclusions.

Boston Medical Center's Dr. Sabrina Assoumou said the study's focus on excess mortality provided interesting information and agreed with the findings overall.

"(First,) we know that the Northeast had more use of non-pharmaceutical intervention in terms of mask wearing or physical distancing," said Assoumou. "The second thing is vaccination rates. You look at a state like Massachusetts where we've done a relatively good job in providing vaccines. The Northeast has done a better job at using a tool that we know works. If you have a higher uptick of vaccination, we expect that in the long run you would prevent more deaths."

Brigham and Women's Hospital's Chief of Infectious Disease Dr. Daniel Kuritzkes echoed his colleague's statement, saying that he was not surprised by the conclusion of the study but disagreed in part with the behavioral focus of the research.

"While I would be slow to put the finger on individuals and their behavior, there is no question that politically, government leadership in the South was working as hard as it could against all common sense measures to contain the pandemic in contrast to the Northeast. Here in Massachusetts, we were closely aligned between Gov. Baker, the state and local health department, academic centers, and our industry leaders from the private sector. Everyone was on the same page and it worked," Kuritzkes said.

The study also found that "between Jan. 3, 2020 and Sept. 26, 2021, there were 895,693 excess deaths associated with COVID-19, 26% more than reported as such."

Daily COVID-19 cases in Riverside County, Calif., where the music festival took place, have seen a 76% increase. Experts say the spike is due in part to more at-home tests.

The study's focus on excess deaths is seen as a stretch by Dr. Shira Doron, a hospital epidemiologist at Tufts Medical Center.

"(It's) a bit of a stretch to assume (the) differences in excess mortality are due to behavior because there were so many things that were not controlled in that study that also could have affected mortality," she said. "Vaccination is an obvious one, but less obvious ones are things like data acquisition and data accuracy for example."

Doron also pointed out that the study did not take into consideration underlying health status of the COVID-19 deaths.

"There has also been an underappreciation of the impact of underlying health status," she said. "Different parts of our country have different levels of obesity, have different age distribution, and we know both of those things are risk factors for COVID deaths. We have seen this in comparisons of different countries throughout the world in terms of death rates. You can see that the country that has a lower death rate from COVID-19 are also countries with lower rates of obesity and other chronic medical conditions. It is really hard to tease out the reasons for differences in death statistics. "

The study said the excess mortality rate between the South and the Northeast shows the story of how "two Americas emerged: one with high demand for the COVID-19 vaccine and the second with widespread vaccine hesitancy and opposition to masks and vaccines."

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