The frustrations of comparative US cases during Covid: Michigan, Iowa, Utah

The United States has become a bit of a laughingstock internationally. Perhaps it always has been, but its collective response to the Covid-19 pandemic seems to have turned that laughter into a mixture of horror, scorn, and pity.

The US has as of this writing the most deaths in the world, the most cases in the world, and a still pretty pitiful testing rate. And yet most US states are lifting restrictions under either the assumption that the worst of the pandemic is behind them, and/or that the economic costs are simply too severe to wait any longer.

The topline numbers are gruesome and infuriating. The US is well on its way to 100,000 deaths, likely to hit that number well before the end of May. Most models have been readjusted to estimate a total much higher than previously anticipated. Those are just confirmed cases. The real number is likely higher, as suggested by a recent study that found excess fatalities are exceeding the number of official coronavirus deaths in New York.

But the topline numbers tell only part of the story. The lack of any kind of national guidance by the US federal government and Trump administration has forced state governments to take their own approach, and led to a patchwork of policies to address the pandemic in each state. As an IR scholar, I was already aware from cases like New Zealand, South Korea, and Norway that there were better ways to confront the pandemic than what was happening, and continues to happen, in the US. But that diversity of approaches is also on display within the US itself, and if anything it makes one even more enraged.

My own comparisons usually center each day on the rates and death counts for three particular states: Michigan, Utah, and Iowa. The first is where my friend of over two decades, Dr Curtis Collins, someone I published a study with on the 1918 Influenza pandemic, works. Michigan faced Covid-19 early, and with an immediate intensity. Michigan is also a hotbed of right-wing protests by armed groups, upset at their Governor, Gretchen Whitmer, who has extended the state’s restrictions she imposed early on in that state’s fight against the pandemic. I haven’t really paid much attention to the protestors and whatever their grievance politics is telling them to do that requires them to show up at statehouses and government officials’ homes, as they have not only in Michigan but throughout the US. But I am worried that these protests will make my friend Curt have to work more than he already has, and endanger him even more. Curt works in a hospital network that saw not only the first widespread cases in Michigan but in the US more broadly. Since mid-March he’s been working 70-hour weeks. He doesn’t get to see his family that much. Since the early 2000s, he was on a pandemic task force when Avian Flu was a scare. All that work on tabletop exercises advising governments on what to do in case of a pandemic.  Since February he and I have been texting about the oncoming pandemic and hoping that the US would start to get its act together. I can’t imagine how hard this is on him, how much he could see all this happening like a trainwreck.  I’m goddamn livid that there are people who are so cavalier about this and put more and more people into the hospitals for Curt and his colleagues to treat, thus necessitating longer and longer weeks of work for him, with no real end in sight.

The second state I keep an eye on is me and Curt's native state of Iowa. He and I still have lots of family and friends there. Covid arrived in Iowa late, and the state has never really taken the pandemic that seriously. Everything has been half-ass. I feel even more fortunate that the counsel I, and Curt who also knows them, gave my parents was heeded so early and quickly, and in such strong contrast to the rest of the state of Iowa. The day I’m currently writing this, the Governor, Kim Reynolds, announced a number of restrictions would be lifted in the state this weekend, with even more lessening to happen in a couple of weeks. This on a day when Iowa had 18 more deaths (near its peak), another 374 cases, and in a week when the counties of two of its major cities were named national ‘hot spots’ for the virus. The virus has been particularly brutal in long term care facilities and meat packing plants, and Iowa has a lot of both. Yet, as a result, a sad type of passive eugenics discourse has developed in Iowa where some in the state see the virus as only something that the elderly, or the workers in the packing plants (many of whom are immigrants), experience.  Governor Reynolds repeatedly claims that Covid is just something the state will have to get used to, have to (and I am not kidding), live with.

The third state I focus on is of course Utah, where I live. Utah’s cases have been growing, but not that precipitously. Utah’s numbers come out every day around 1:30pm local time. I check the twitter feeds of our local journalists like Robert Gehrke of the Salt Lake Tribune, and Ben Winslow of Fox13, who provide helpful context for the numbers. Utah and Iowa are similar in population size (~3.15 million). Utah has quite a bit more density, which one would think would lead to more cases than Iowa. And yet, Utah has half as many Covid cases (~7k v. Iowa’s ~14k), a quarter (!) the number of deaths (77 v. Iowa’s 336), and has had a consistently low positive test rate (4.2% v. Iowa’s 15%). Some of the numbers, like deaths, can be chalked up to demographics and behavior. Utah is the youngest state, and it also has the lowest number of smokers. Yet the low number of cases despite the higher testing suggests that Utah did something right, at least for a time.

It’s this comparison – between how Utah handled the pandemic, versus Iowa, between how my current state is handling the pandemic with how my native state is mishandling it - that bothers me the most every day. I tweet about it at least once or twice a week. But it’s such a clear-cut distinction in approaches. Utah had a coronavirus task force assembled early, headed by Lt Governor Spencer Cox, and its state epidemiologist, one of the best public health officials in the world, Dr Angela Dunn. Dr Dunn, like the infamous Tony Fauci, gained valuable experiences fighting Ebola in the 2010s in West Africa. She has an undergraduate degree in International Relations. She provides daily updates that are informative, clear, and unvarnished. Utah never did put in a shelter-in-place order with the force of law, but unlike many states across the US South, and unlike Iowa, Governor Gary Herbert’s ‘stay home stay safe’ directive enabled local county and city officials, like Salt Lake City Mayor Erin Mendenhall, to issue their own shelter-in-place orders that did have the force of law. Further, unlike Iowa, the state of Utah worked in tandem and with great transparency, with its universities (like the ARUP center at the University of Utah) and health care nonprofits, to make sure that testing was up and running early. Iowa’s approach to its own world class universities, Iowa and Iowa State, has either been indifferent, or shrouded in secrecy, with one recent report indicating that the U of Iowa advised Governor Reynolds against opening up and her administration simply ignored this advice. 

Utah, like Iowa, is also ‘opening back up’, but even here the distinctions are clear. Utah has a color coded system (red, orange, yellow, and green) that recall some of the ‘terror alerts’ of the George W Bush administration in the 2000s. Unlike that system, however, Utah’s provides clear guidance on how each area of the state is handling the pandemic. Some more rural areas are in yellow, others, like Salt Lake City and Park City, remain in orange. In Iowa, the pleas of local officials to maintain restrictions fall on deaf ears. Governor Reynolds’ daily briefings are 30 minutes long, with the first 15 minutes usually involving some guest speaker providing fluffy positive takes on how great things are going in the state, followed by 15 minutes where the governor either dodges the questions of reporters or simply forgets what they asked her and moves on.

The comparison is personal for me, and especially at this time. I talk to my brother and parents weekly. They’re seething with anger at what’s happening around them. They’ve played by the rules and now others aren’t, and it could affect them all. My kids’ school year is starting to wrap up, online though they may have been. Even as a department chair, I’ve been able to arrange my schedule so that I can usually take them back to Iowa to see grandparents, uncles/aunts/cousins and the like, every summer. They look forward to these trips. I do as well. I get to see my family, and my good friends, go golfing, and drink some of Iowa's sensational craft beer (no, really). In fact, I can’t think of another year since I moved to Utah from Kansas in 2013, when I’ve needed to see my friends and family back there more than this year. I have it way better than most people. Still, being a department chair has been draining and demoralizing, and that was before a pandemic hit. My hope, a couple months ago, was that aggressive containment measures, along with robust testing and contact tracing, nationwide would have made it even slightly possible for us to take our trip to Iowa. It’s obvious that’s not going to happen. My son had a near meltdown this week. I had to explain to him that we are actually safer here, in Utah, than we would be in Iowa. That we have good people in charge and responsible citizens here who are doing the right thing. He wanted to ‘surrender’ to the virus, and was going to hide in his closet until the virus accepted his surrender. I told him we can’t do that, that people going out and acting like the virus won’t hurt them are really the ones surrendering. Then I showed him a chart of cases and deaths, comparing Utah with Iowa. He was still mad, but understanding, and then he got worried that his grandparents and cousins and uncles and aunts might be in danger. I reassured him that they were doing what is right and will be safe, but even I’m not so sure. Our state is largely doing the right thing, their state is failing them.

And, finally, the comparison is inevitably becoming political. It shouldn’t have to be. Both Iowa and Utah are run by Republican Governors. Both have world-class research universities that provide a vital intellectual and scientific set of resources for fighting the pandemic. Alas, I’ve had several awkward group text conversations back in Iowa that included Covid truthers, people I know or even individuals I’ve been friends with over the years, who think this is all overblown and radical and part of an agenda to sink the economy and ruin Trump’s chances. Some no doubt come from a legitimately precarious position – they’ve been furloughed or fired and just want to get back to work. I’ve explained to a few that the only way they’ll have a chance at that, consistently, is to continue the sheltering policies so that the virus becomes manageable. They don’t care, or they don’t believe me, they think everyone’s entitled to their own ‘opinion’ as if a pandemic is a topic subject to equal perspectives, like who is the best NBA player of all time or what’s the best craft beer. I’ve had sidebar conversations with Curt about this, about how difficult it is to get our friends and family to take it seriously when they are living in a political culture like Iowa’s that has so much populist disdain for experts, and one whose government has now led the charge to say it’s time to open up, and that Covid is just something everyone will have to live with. What goes unsaid but should be understood is that the virus doesn’t give a shit about whether you want to go back to work, it doesn’t care that you want to hit up the tavern, and it doesn’t see the measures you’re taking to open back up to be ‘reasonable’ or worthy of diplomacy. It’s going to keep on killing. And it won’t stop with just the workers in the meatpacking plants, or the elderly in the long-term care facilities.

I need to keep this all in perspective. These are just three states, just a few small corners of a world that's being upended by this pandemic. So I just keep on keeping on, having my weekly FaceTime chats with my brother and parents, really driving home to my brother especially that he has to keep doing this. It’s hard for him, he’s an extrovert who likes to hold forth in front of large groups of friends, much like my daughter who hates being cooped up with us.  He also never finished college, even though he was always smarter than me, but unlike others in Iowa without a college degree, that doesn’t make him skeptical of expertise. He trusts me and Curt with our takes on the pandemic, and restrains his behavior accordingly. He looks after my parents, who are also still taking this seriously. I check in on my buddy Curt, telling him to take care of himself, issuing a bit of humor with references to our college days. And at the end of most days, I’m reminded of the parable of the starfish on the beach – just help the people you can. I suppose that’s good enough for now.