As Election Day nears, COVID-19 spreads further into red America

A grocery store customer wears a protective face mask to prevent the spread of the coronavirus disease (COVID-19), in Tucson, Arizona, U.S., June 20, 2020. REUTERS/Cheney Orr

While COVID-19’s impact on the nation’s health and economy has been a continuing issue in the upcoming election, President Donald Trump’s recent bout with the virus has made it personal for many  Americans. Trump’s health is likely to make the pandemic more relevant in parts of the country that voted for him in the 2016 presidential election.

This analysis extends my earlier tracking of COVID-19’s spread into red states and counties across the country. It shows that while the overall rate of the spread has diminished somewhat from mid-summer, the disparity in cases between red and blue areas has continued, and is now widening in parts of the Midwest and in smaller communities. This may prove relevant to the presidential race, as some groups who live in these counties—such as seniors—report COVID-19 to be a top issue in the election, even eclipsing the economy.

Red states continue to be the most impacted

The trajectory of new COVID-19 case rates (defined as the number of new monthly cases per 100,000 population) continues to grow in America’s “red” states. This pattern was first observed over the June-to-August period, and has now continued through September. (See Figure 1 for COVID-19 case rates across the nation’s red and blue states.)


In March, April, and May, blue states, as a group, exhibited higher COVID-19 case rates. But in June, they were overtaken by red states, and have remained lower since. The red state surge was especially high in July, rising to 746 cases per 100,000 residents—more than double that of blue states. And while rates for both groups of states declined in August and September, the monthly rate of new COVID-19 cases in red states remains markedly higher. The September rate of 460 cases per 100,000 residents in red states is nearly twice that of blue states, and stands higher than even the peak blue state rate from April.

Individual states with the highest new COVID-19 rates have shifted as well, with many more red states dominating the list in recent months. These can be tracked in Figure 2, which displays individual red and blue states that showed monthly new COVID-19 rates exceeding 500 cases per 100,000 residents through September.


When the pandemic first hit the U.S., blue states in the Northeast exhibited the highest case rates. In April, both New York and New Jersey each registered new COVID-19 rates exceeding 1,100 cases per 100,000 population, followed by the New England states of Massachusetts, Connecticut, and Rhode Island, along with Washington, D.C. In May, Illinois and Maryland crossed the threshold of over 500 new cases per 100,000 population—as did Nebraska, the first red state to do so. No blue state reached the new case threshold in June, but one red state, Arizona, did.

July saw a surge of red states cross the new case rate threshold, with strong representation in the South—led by Florida with 1,400 cases per 100,000 residents, followed by Louisiana, Mississippi, South Carolina, and Alabama, along with western state Arizona. Each of these states exceeded 1,000 new cases per 100,000 residents. Eight additional red states—six in the South—showed rates exceeding 500 new cases per 100,000 residents.

This surge continued into August, when 16 red states—10 in the South—saw high new COVID-19 case rates, led by Mississippi, Alabama, Georgia, Tennessee, and Florida. Further down the list were the midwestern states of North Dakota, South Dakota, Iowa, and Kansas, as well as the western state of Idaho. Although red states dominated the list of places with high rates of new COVID-19 cases in July and August, the blue states of California and Nevada also joined those ranks in both months.

September was noteworthy in that only red states reached the threshold of 500 new COVID-19 cases per 100,000 population. There was greater visibility in the Midwest, with North Dakota leading the 16 states in this group with a rate of 1,300 cases per 100,000 residents, followed by South Dakota and Wisconsin. Missouri, Kansas, and Nebraska are also on September’s list, along with six southern and three western states. Although no blue states reached the new case rate threshold in September, those that come closest were the midwestern states of Illinois and Minnesota.

Red, small-town counties dominated COVID-19 spread in September

Just as new COVID-19 cases spread to red states, it is now occurring more broadly in red counties as well. This is significant because some may argue—inaccurately—that statewide surges in red states were only the result of high rates in heavily urban counties that are associated with Democratic voting patterns.


Figure 3 displays the trends in new monthly COVID-19 cases per 100,000 residents for red and blue counties (those won by either Donald Trump or Hillary Clinton in the 2016 election). Compared to the statewide analysis above, new COVID-19 rates were higher for blue counties though June. For July and August, new COVID-19 rates in red counties were only modestly higher than those in blue counties.

But in September, that difference widened. That month, red counties, as a group, registered a new COVID-19 case rate of 427 cases per 100,000 residents, compared to 315 for blue counties. Among individual states in September, it is noteworthy that this increase occurred in the swing states and near-swing states of Wisconsin, North Carolina, Ohio, Iowa, and Georgia.

Another recent shift in both red and blue states is the rise in new COVID-19 case rates in smaller metropolitan and non-metropolitan areas. As my previous report indicated, case rates in the early months of the pandemic tended to be highest in urban cores and suburbs surrounding large metropolitan areas. But over the summer, that pattern began to shift, with rising case rates in smaller-sized areas.


This was clearly the case in September. Figure 4 shows new COVID-19 cases per 100,000 persons for counties classified by a Brookings system that identifies urban cores, large suburbs, small metropolitan areas, and non-metropolitan areas. In both red and blue states, small metropolitan and non-metropolitan counties registered higher new COVID-19 case rates than urban cores or large suburban counties. This is especially the case in the electorally significant states of Pennsylvania, Michigan, Wisconsin, Iowa, and North Carolina.

This is important because in the 2016 election, the strongest Republican support came from rural or small-town residents. As the COVID-19 spreads into those areas, residents’ opinions on how the pandemic is being handled is likely to influence their vote.


In September, a total of 1,166 counties saw new COVID-19 cases exceed 500 per 100,000 residents. Fully 1,025 of them are red counties which Trump won in 2016, while only 141 favored Clinton. Those Trump counties are home to 41 million people, compared to 24 million residing in the Clinton counties.

A large portion of this group of red counties is located in the “middle” of the country, in states such as Missouri, Tennessee, Kansas, Texas, Oklahoma, Georgia, Iowa, North Dakota, South Dakota, and Wisconsin. Among all counties with high COVID-19 case rates in September, just five were located in urban core regions, with fully 1,038 (representing 38 million people) located in small metropolitan or non-metropolitan territory.

Implications for Election Day

President Trump’s contraction of COVID-19 has occurred just as the virus is spreading to new states and counties that he won in the 2016 election. The degree to which he will receive those residents’ continued support will likely depend on how they evaluate his administration’s handling of the pandemic since it first started.

One group that the pandemic has heavily impacted is the older adult population. Older adults were strong Trump supporters in 2016, and they comprise an especially significant part of the electorate in rural and small towns where COVID-19 has begun to spread. A late September Washington Post/ABC poll showed that among persons age 65 and older, 24% said that the coronavirus outbreak was the single most important issue in selecting a president. It is likely that recent polls showing increased support for Joe Biden among this group could reflect a negative assessment of the president’s handling of the pandemic that now has hit closer to where they live.

The COVID-19 pandemic has caused unimaginable damage to large segments of the population. Its continued spread to more parts of the country is a matter that needs to be reckoned with—and this Election Day, voters are poised to do exactly that.