Presidential hopeful Gov. Ron DeSantis frequently pitches his response to the COVID-19 pandemic in Florida as a top reason why Republican primary voters should choose him over Donald Trump and other candidates. DeSantis fought off local mask mandates, questioned the safety of vaccines, and reopened schools, businesses and beaches before much of the country, policies he claims saved Florida’s economy while focusing prevention efforts on the elderly and vulnerable.
Or so the story goes. A national study on “excess mortality” published in the journal Science this week pours cold water on DeSantis’s claims and reveals that the number of COVID-related deaths outside of major metropolitan areas were likely much higher than initially reported. Like other rural and lower-income areas across the United States, and the Deep South in particular, counties in central Florida and the panhandle suffered tragically high death tolls during the second year of the pandemic despite a massive, nationwide effort to make COVID testing and vaccines widely available.
As of March 10 of this year, about 86,850 Floridians have died from COVID according to official tallies, with Florida ranking third in the nation for total COVID deaths behind the behemoth states of Texas and California. In the end, Florida’s response to COVID was not as effective as DeSantis and others may advertise, according to Andrew C. Stokes, a demographer and sociologist at Boston University who coauthored the study with scientists and public health experts.
“Ron DeSantis has been able to sell Florida as a success story, but that does not bear out once you dig into the county level data,” Stokes said in an interview. “Much of central and rural Florida experienced exceptionally high mortality rates in the second year, when vaccines were available and other measures were in place, like increased access to [COVID] treatments.”
By comparing the total number of recorded deaths from April 2020 to February 2022 to the number of deaths scientists would normally expect to see over the same time period, the researchers measured “excess mortality” or “excess deaths” at the state and county level across the nation. Stokes said this method provides more accurate snapshots of the pandemic’s impact than official death counts from rural areas where COVID data reporting is spotty and fewer sick people die inside health care facilities.
In many rural areas, coroners are elected officials who may not have deep medical expertise or the resources to accurately investigate the cause of death. Stokes said some coroners may also be swayed by their own partisan biases about COVID and the pandemic. Indeed, both Trump and DeSantis systematically downplayed the pandemic, dismissing data experts and misleading the public while attacking Democrats to appease far right pundits and the GOP base.
Excess deaths not assigned to COVID-19 may also reflect deaths indirectly related to the pandemic, including deaths associated with hospital avoidance due to fear of the virus or the brutal increase in fatal drug overdoses. At the same time, what COVID mitigation measures were in place likely reduced the number of deaths caused by other common diseases such as the flu.
“We suspect that most of the excess deaths that we are seeing above the official COVID tallies are COVID deaths, the vast majority of them,” Stokes said. “Many of the areas that were most deeply affected by the pandemic in the second year were also areas with the poorest surveillance data, so studies using the official death tallies tend to miss the full extent of the pandemic in the second year.”
The study found nearly 1.2 million excess deaths across the U.S. during the first two years of the pandemic, while the Centers for Disease Control and Prevention reports about 1.1 million COVID deaths as of July 1, 2023. Nearly half of the excess deaths — the lives of an estimated 544,194 people — were recorded during the second year of the pandemic, when billions of dollars in aid from Congress was flowing through the states to provide widespread access to COVID tests and vaccines. According to the study, excess mortality in Florida followed broader national trends:
Overall, excess mortality decreased in large metropolitan counties but increased in nonmetropolitan counties. Despite the initial concentration of mortality in large metropolitan Northeastern counties, nonmetropolitan Southern counties had the highest cumulative relative excess mortality by July 2021. These results highlight the need for investments in rural health as the pandemic’s rural impact grows.
“In western Europe, their second pandemic year was much better,” Stokes said. “They generally rebounded, while we continued to see sustained excess mortality in the second year despite widespread vaccine access.”
In the U.S., the pandemic has laid bare the deep inequities in health care quality and access faced by lower-income people and people of color, who disproportionately work the “essential” jobs on the pandemic’s front lines. Stokes said one of the most alarming findings was a tragic increase in excess mortality across the rural South during the 2021 Delta wave. In many of these areas, funding for well-functioning public health systems was cut out of state budgets years ago if it existed in the first place, and conservative politicians (including in Florida) have refused to expand Medicaid to provide health coverage for more lower-income patients.
“Rural Southern communities, including Black communities, were heavily affected due to failures in state policies and a failure to support rural health infrastructure — especially the failure to get ‘shots in arms’ in these areas,” Stokes said. “There also is a misconception that rural America [equals] white people. Black communities sustained excess COVID mortality in later stages of the pandemic, and that reflects lack of access.”
White people in rural Florida and across the South were also hit hard as conservative politicians exploited public backlash to pandemic restrictions and vaccines that the Trump administration spent $18 billion to roll out quickly and provide free of charge.
“The story of the second year of the pandemic is a story of white mortality rates increasing without a marked decline in Black and Hispanic mortality rates,” Stokes said. “The [racial] disparities declined in the second year, but not because rates improved noticeably for Black and Hispanic populations. It was more that white death rates got worse due to partisanship and misinformation.”
Counties in the rural Southwest and Four Corners area also saw dire increases in excess deaths during the pandemic’s second year, even as excess mortality declined in other regions and more populous areas of Southwestern states. Stokes said this reflects a dearth of quality health care facilities in rural areas and especially on Native American reservations, where people tend to live remotely and public health is chronically underfunded.
“Some counties, like Navajo County in Arizona, are disproportionately reservation and Native American populations,” Stokes said. “We unfortunately see remarkably high excess mortality there even after a period of widespread vaccination, due to a combination of social and structural factors.”
The COVID virus first swept cities in the Northeast in 2020, but by July 21, 2021, rates of excess mortality in the nonmetro West and South had eclipsed the urban Northeast. Cumulative rates of excess mortality remained higher in the nonmetropolitan South than in any other region through the end of February 2022, including in Florida, where excess deaths spiked in rural counties relative to the cities and suburbs.
Stokes compared Florida’s excess mortality data — and by extension, DeSantis’s much-touted pandemic policies — to that of Massachusetts and other New England states, where pandemic restrictions were in place longer, vaccination rates are higher and health care is generally easier to access for lower-income people.
“One way to really highlight that policy failure in Florida is to compare Florida during the Delta wave to any state in the mid-Atlantic or New England during the Delta wave,” Stokes said. “Massachusetts saw almost no excess mortality increase during Delta, while Florida saw a surge in deaths, especially in rural areas where excess deaths skyrocketed relative to the rest of the state.”
The DeSantis presidential campaign did not respond to a request for comment by the time this story was published.
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