We crossed the grim milestone of 100,000 deaths from COVID-19 as America began to get back to business, though the road to reopening diverges depending on where you live. All 50 U.S. states have begun easing up on the restrictions imposed to flatten the COVID-19 curve. Unlike other countries that are models of nationally coordinated COVID-19 responses, the U.S. has been a disorganized patchwork of decisions. Some states imposed more stringent restrictions; some reopened faster than others; some never issued stay-at-home orders. Most states failed to even meet the White House’s criteria for reopening prior to easing shutdown orders.
To avoid another 100,000 deaths, as some models have predicted, we must ask: Where are the risks that lie ahead? How the states responded to the first call to action after the outbreak, during the critical period from mid-March to late April — their “COVID-19 reflex” — offers clues to which regions ought to be on a “watch out” list.
Indeed, an unreleased task force report reportedly indicates new infection spikes in the heartland. This would seem paradoxical since these states are far from the original hotspots — the populous coastal states that took the first hit of the pandemic with their urban clusters and ports of entry for travelers from abroad. The top three counties with the most COVID-19 cases per resident as of this writing are in Tennessee, Nebraska and Arkansas.
We saw this coming. My research team and I studied two indices of COVID-19 reflex and how they varied across the 50 states. We scored the states on their success in limiting movement of residents and cutting the contagion, i.e., the rate at which the coronavirus is transmitted from one infected person to others.
States such as New Jersey, New York, Massachusetts, California and Connecticut — among those first and hardest hit — were the most successful in their response, along both measures. At the other end of the spectrum, states such as Arkansas, Iowa, Kansas, Nebraska, South Dakota and Wisconsin were among the least successful on both COVID-19 reflex measures. Several others — Montana, North Dakota, Oklahoma, Tennessee and Wyoming — also were in this vulnerable category.
The first group, the “coastals,” have many things in their favor that aided their relative success. They registered the immediacy of the threat early on and their public health systems acted quickly. They have a lower proportion of their economies in blue-collar jobs that require workers to physically show up for work, so a higher proportion of people could work remotely. The second group, in the heartland, had fewer initial infections. These infections were traceable to specific facilities, such as meat-packing plants, prisons or nursing homes; therefore, at first, such infection clusters didn’t raise alarms, since it is easier for local authorities to attribute these to be isolated instances. Also, many of these states have small populations that are rural and are spread out, so the absolute numbers of infections do not seem high. Arkansas, Iowa, Nebraska, North Dakota, South Dakota, Oklahoma and Wyoming did not issue stay-at-home orders.
The coastals had some additional advantages in planning their reopening. They committed to interstate coalitions to coordinate best practices that adhere to “science, not politics” attitudes for reopening. The heartland states we identified as the most vulnerable are not part of any such coalitions and have not had an opportunity to codify such practices. These first-round COVID-19 responses signal stark differences in preparedness for the next round.
The heartland states ought not to be left to fend for themselves. It is not enough for us to say that the numbers of infections in rural, less densely populated states are small and therefore not a national priority. Vulnerability in the heartland affects the entire country. Nebraska, Iowa, Kansas, South Dakota and Wisconsin are among the top 10 states with the highest proportion of workers in food manufacturing. Many also are the largest centers for the meat-packing industry. The heartland feeds the country and it has concentrations of infection super-spreaders that are likely to be the source of the next wave: prisons, long-term care facilities and the meat-packing plants.
What is needed is a coordinated federal response. Applicable best practices from states with stronger COVID-19 reflexes need to be transferred to states that need the help now. This doesn’t just mean Nebraska turning to New York for ideas, which is not always practical. There are ideas that could be drawn even from other parts of the heartland with partial successes. Missouri and North Carolina, with meat-packing industries that process hogs and turkey, were successful in reducing mobility of their residents, our research found. Likewise, Idaho and West Virginia managed to reduce their contagion.
Far from letting states run with their own reopening plans, or even burying the report that warned of emerging risks to the heartland, this is precisely when the White House urgently needs to act on a national plan to fight the virus that leaves no state behind. We now know that some of the first 100,000 deaths likely were avoidable. Another such milestone is not inevitable, but if we repeat missteps that led us to the first milestone, the second one is possible.
Bhaskar Chakravorti is the dean of global business at The Fletcher School of Law and Diplomacy at Tufts University, founding executive director of Fletcher’s Institute for Business in the Global Context, and chairs the Digital Planet initiative and Imagining a Digital Economy for All (IDEA) 2030. He served on the World Economic Forum’s Global Future Council on Innovation and Entrepreneurship.