State Government Policy Responses to the COVID-19 Pandemic in the United States 2020-2022: Concordant Heterogeneity?

Main Article Content

James A. Koziol, Ph.D. Jan E. Schnitzer, M.D.


Objectives. We investigate governmental responses to the COVID-19 pandemic on a statewide basis between January 2020 and June 2022, together with mortality rates attributable to COVID-19 over the same period. Our aim is to demarcate the states’ responses, and examine whether these differential responses are associated with COVID-19 mortality.

Methods. Our study is based on individual state data from the Oxford COVID-19 Government Response Tracker, OxCGRT. We focus on the Government Response Index, the most comprehensive index tracked in the OxCGRT dataset. We use multivariate techniques to group the states into clusters relative to their similarities on the Government Response Index, and determine mortality rates attributable to COVID-19 in the individual groups.

Results. We find that the Government Response Index was sustained at relatively constant levels in the states, with two major transition periods: a rapid rise in stringency during April through June of 2020, and a gradual decline in May and June of 2021. Heterogeneity in the Government Response Index dramatically increased in 2022. No consistent patterns emerge when relating government stringency measures with COVID-19 mortality rates.

Conclusions. There is inconsistent evidence that increased governmental stringency is associated with lower COVID-19 mortality; judicious selection of time frames can lead to contrasting inferences. Political trends and motivations appear to have an outsized influence on governmental responses to the COVID-19 public health crisis, to the detriment of the populace.

Keywords: governmental intervention, public health policy, COVID-19 mortality

Article Details

How to Cite
KOZIOL, James A.; SCHNITZER, Jan E.. State Government Policy Responses to the COVID-19 Pandemic in the United States 2020-2022: Concordant Heterogeneity?. Medical Research Archives, [S.l.], v. 11, n. 4, apr. 2023. ISSN 2375-1924. Available at: <>. Date accessed: 14 apr. 2024. doi:
Research Articles


1. Hale T, Angrist N, Goldszmidt R et al. A global panel database of pandemic policies (Oxford COVID-19 Government Response Tracker). Nat Hum Behav 2021;5:529-538. doi: 10.1038/s41562-021-01079-8

2. Hale T, Anania J, Andretti de Mello B et al. Variation in government responses to COVID-19 Version 13.0. Blavatnik School of Government Working Paper, 11 March 2022.

3. OxCGRT Covid Policy Tracker, Methodology for calculating indices. Available from

4. Ward JH. Hierarchical grouping to optimize an objective function. J Amer Statist Assoc 1963;58:236-244.

5. Centers for Disease Control and Prevention. Provisional COVID-19 deaths by sex and age. Available at

6. Centers for Disease Control and Prevention, WONDER online database, Single-race population estimates. Available from

7. Herby J, Jonung L, Hanke SH. A literature review and meta-analysis of the effects of lockdowns on COVID-19 mortality. Studies in Applied Economics, No. 200, January 2022. Available online at

8. Chen S, Guo L, Alghaith T et al. Effective COVID-19 control: A comparative analysis of the stringency and timeliness of government responses in Asia. Int J Environ Res Public Health. 2021;18:8686. doi: 10.3390/ijerph18168686.

9. Ahmad N, Qahmash A. A hybrid approach toward COVID-19 pandemic modeling in Saudi Arabia using the modified susceptible-exposed-infectious-recovered model and open data sources. Cureus 2021;13:e20279. doi: 10.7759/cureus.20279. eCollection 2021 Dec. PMID: 35028196

10. Díaz-Castro L, Cabello-Rangel H, Hoffman K. The impact of health policies and sociodemographic factors on doubling time of the COVID-19 pandemic in Mexico. Int J Environ Res Public Health. 2021;18:2354. doi: 10.3390/ijerph18052354. PMID: 33670888

11. Teslya A, Pham TM, Godijk NG et al. Impact of self-imposed prevention measures and short-term government-imposed social distancing on mitigating and delaying a COVID-19 epidemic: A modelling study. PLoS Med. 2020;17:e1003166. doi: 10.1371/journal.pmed.1003166. eCollection 2020 Jul. PMID: 32692736

12. Chung HW, Apio C, Goo T et al. Effects of government policies on the spread of COVID-19 worldwide. Sci Rep. 2021;11:20495. doi: 10.1038/s41598-021-99368-9. PMID: 34650119

13. Hallas L, Hatibie A, Koch R et al. Variation in US states’ COVID-19 policy responses. BSG-WP-2020/034 Version 3.0, available online at

14. Warraich HJ, Kumar P, Nasir K et al. Political environment and mortality rates in the United States, 2001-19: population based cross sectional analysis. BMJ 2022;377:e069308.

15. Krieger N, Testa C, Chen JT et al. Relationship of political ideology of US federal and state elected officials and key COVID pandemic oputcomes following vaccine rollout to adults: April 2021 – March 2022. The Lancet Regional Health – Americas 2022;16:100384.

16. Stoto MA, Schlageter S, Kraemer JD. COVID-19 mortality in the United States: It’s been two Americas from the start. PLoS ONE 2022;17:e0265053.

17. Cross SH, Califf RM, Warraich HJ. Rural-urban disparity in mortality in the US from 1999 to 2019. JAMA 2021;325:2312-14.

18. Koziol JA, Schnitzer JE. Déjà vu all over again: racial, ethnic and age disparities in mortality from influenza 1918-19 and COVID-19 in the United States. Heliyon 2022;8:e09299.

19. Gordon SH, Huberfeld N, Jones DK. What federalism means for the US coronavirus 2019 response. JAMA Health Forum 2020;e200510.

20. Maani N, Galea S. COVID-19 and underinvestment in the public health infrastructure of the United States. Milbank Q 2020;98:250-259.

21. Woolf SH. The growing influence of state governments on population health in the United States. JAMA 2022;327:1331-1332.

22. Woolf SH. Excess deaths will continue in the United States until the root causes are addressed. Health Affairs 2022;41:1562-1564.