An expansive new study published in top medical journal “The Lancet” shows Maryland had the fifth-lowest COVID death rates per capita from 2020 through last summer.

The study looked at how key dynamics like racial inequity, politics, and public health policies affected COVID infection and death rates in each state, while controlling for biological factors including age, population density, and chronic conditions.

Researchers found that Maryland’s political and social environment, combined with its health care infrastructure, may have played a big part in keeping death rates down. Here’s how:

1. The state had a Republican governor but not many Trump supporters.

A high level of support for the former president in 2020 was one of the strongest predictors of high COVID death rates in a state, researchers determined — a finding that is supported by previous studies. In turn, Trump backing was associated with a “package of traits” found in states with higher COVID death rates: lower average years of education, higher poverty rates, limited access to quality health care and less interpersonal trust.

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In Maryland, about a third of people voted for Trump in the last election.

Conversely, there was no association between Republican governorship of a state and its COVID outcomes. In fact, half of the 10 states with lowest death rates had Republican governors — Maryland, Vermont, New Hampshire, Ohio and Nebraska.

“It really is politics, not party, that seems to have mattered in this pandemic,” said Thomas Bollyky, lead co-author of the study and director of the global health program at the Council on Foreign Relations in Washington, D.C.

2. Local programs addressed racial disparities head-on.

The highest death rates were driven by a “toxic mix of race and politics,” said Bollyky. This means that the combined effects of socioeconomic factors, such as poverty and limited access to health care, had greatest impact in states with strong racial health disparities coupled with staunch support for the former president in the last election.

Although Maryland is by no means lacking racial disparities, and in fact has striking ones in certain areas — such as life expectancy for Black compared to white men in Baltimore — at the state level, these racial differences in outcomes are “dwarfed” by those in states like Alabama and Mississippi, Bollyky said.

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In areas such as Baltimore, where racial disparities are most pronounced, local health officials took steps to counteract them through targeted, community-based efforts, and this made a difference overall, said Bollyky. The study specifically references Baltimore’s door-to-door vaccine ambassadors program as an example of such an effort to engage marginalized communities.

The study notes that only a quarter of all states incorporated strategies to reach communities of color in their initial vaccine rollout plans, “despite ample research showing that those communities have historical reasons to mistrust public health campaigns.”

3. Maryland had a high vaccination rate, and a vaccine mandate for state employees.

Perhaps unsurprisingly, the study found a strong association between vaccine coverage and state variation in death rates. Maryland is the 10th most-vaccinated state, with 80% of its population fully vaccinated.

Researchers found that precautions, such as mandatory masking and social distancing, did not by themselves reduce COVID deaths, but vaccine mandates for state employees did.

Former Gov. Hogan instituted a vaccine mandate for state employees working in congregate settings, such as those employed in jails, in September 2021. Some of the state’s more populated counties required employees to be vaccinated as well.

Sarah True was a public health reporter for the Baltimore Banner. She previously worked as a freelance journalist covering healthcare and health policy, and has been both a medical social worker and a health policy analyst in a past life. She holds dual Master’s degrees in public health and social work. 

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